Monday, December 15, 2014

New companions for an elderly pet: An old life made younger

Gus was growing old.  His once-shiny dark gray fur had faded to the color of a tarnished nickel.  He paused before jumping onto the bed so he could decide if his arthritic legs would be able to meet the challenge.  He also spent more time curled up under his blanket.  His appetite had always been hearty, but now I had to entice him to eat by augmenting his food with goodies.  A CT scan confirmed my suspicions of a nasal tumor, and he got used to having steroid tablets popped down his throat every day. 

Gus was my first Cornish Rex, a cat breed with a short, curly coat; a lithe greyhound-like stature; and a fun-loving, energetic personality.  They’re known as the clowns of the cat world, but he never quite fit the breed’s paradigm.  Playing was never his thing; he preferred to sit at the window and watch squirrels frolicking in the trees.  He was a tolerant fellow.  I occasionally found him tightly swaddled in a blanket in a baby doll stroller, sound asleep, or in drag, wearing American Girl Doll clothing, the handiwork of my young daughter.  

I realized his days were numbered, and a feeling of melancholy gripped my heart.  The thought of eventually being without a pet saddened me. Although I loved the old-age version of Gus, I also began to yearn for a young and energetic kitty, a feeling probably intensified by the fact that my daughter had headed off to her first year of college.

Is it fair to our elderly pets if we bring a youngster into the home?  That is the same question many of my clients worry about.  What if the new pet bullies the senior pet:  steals his food, knocks him over, or just generally annoys the heck out of him?  I pondered those possibilities, then took the plunge. 

A five-month-old Cornish Rex named Hogan arrived at our house and gave Gus’s life a jolt.  Hogan was a whole lot of crazy fun, and Gus despised him.  The kitten just wanted a friend, but his attempts at play were usually met with a hiss and a swat.

Then something interesting began to happen:  Gus’s enthusiasm for life was reawakened.  He began to follow the kitten and watch him play. His appetite and activity level improved.  Occasionally he would even take a whack at an enticing cat toy.  The two cats were often found entwined in Gus’s favorite cozy sleeping spots.  Gus never really loved the new kitten, but he grudgingly shared the last year of his life with him, and his life was thus enriched. 

I’ve heard many similar stories over the years.  I’m not saying that it’s always a great idea to bring an energetic youngster into the fold when you have a senior pet at home, especially if your current pet is sick, unsteady on his feet, or otherwise frail; common sense should prevail!  But I think dog and cat owners sometimes focus too much on how many years are in their pet’s life.  Better to focus on how much life they have in their years, and adding a new pet might just be the perfect antidote for old age.

Sunday, December 7, 2014

Anal sac issues: Butt seriously, folks

When I was young, our springer spaniel bolted from our yard and was hit by a car.  The car wasn’t going fast, but the impact was enough to fling poor Nipper from the road onto our lawn. I stopped screaming when I realized that my beloved pup was more shaken up than hurt, and then I noticed it: an unidentifiable foul odor.  It wasn’t until I was in veterinary school that I found out what that stench was:  essence of anal gland.

Although cats have these glands, too, our feline friends fortunately are not afflicted with anal gland problems to the degree that dogs are.  But you may assume that everything I discuss about this topic also applies to cats.

The anal sacs are the reservoirs for the secretion of anal glands, which are located on both sides of a dog’s anus at approximately four and eight o’clock.  The sacs contain a substance that ranges in consistency from a paste to a liquid and is normally light to dark brown.  The contents of the sacs are emptied through ducts located on each side of the anus, usually during bowel movements or when a dog is nervous or frightened.  The probable function of the secretions is to mark territory and to distinguish an individual dog from others of his species. 

Many in the pet-owning population already know the facts about these sacs.  If this is new knowledge for you, consider yourself lucky: It means you haven’t had the annoyance of dealing with the problems these pesky little vestigial structures can cause in your dog. 

We see three categories of anal sac abnormalities, sometimes concurrently:  impaction, infection, and abscesses.   All of those conditions cause varying degrees of discomfort or pain.  The pet owner might notice the dog licking or biting near or under his tail, and often that area will be red and tender.  Also common is the “butt scoot,” in which the dog sits with his hind legs extended straight forward and propels himself ahead with his front legs, scraping his anus along the ground (or your carpet).  That’s just his way of trying to relieve the irritation (or pressure, if the sacs are impacted).  Some dogs will chase their tails, and some will strain to defecate. If the sacs are infected or abscessed, the owner may see blood or pus on the perianal area, on the floor or in the dog’s bedding.  And there’ll probably be a pungent odor.  Some dogs are depressed and in significant pain, and will stop eating. 

With impaction, the normally thin secretion becomes so thickened that the sacs don’t express properly.  Expressing impacted anal sacs is like squeezing dry, congealed toothpaste from a partially blocked tube — challenging!  To facilitate emptying the over-packed sac, I take a tiny tube and place it in the duct.  I then infuse an oily antibiotic preparation into the sacs and express them.  The oil thins and lubricates the secretion, allowing easier evacuation of the sludge.
Infected anal sacs get the same antibiotic flushing as impacted ones, after which more antibiotic is infused into the affected sac and allowed to remain.  We recheck and re-infuse the anal sacs weekly until they’re normal.   Although we can deal with infected ears by taking swabs, staining them, and looking at them under the microscope to help us choose the correct medicine, doing cytology and cultures for anal sac infections is a waste of time and money.  Trial and error is the rule here.   

Anal sac abscesses can be treated in the same way as infections, but sometimes they require anesthesia and surgery to deal with complications such as tissue death, severe swelling, and pain.
I wish oral antibiotics were more helpful for these infections, but it ain’t so.  We tend to use them as a last resort in cases where conventional treatments have failed, for abscesses, or when we see blood in the anal sac contents.  Steroids by injection or by mouth seem to work best, especially when used in conjunction with flushing.  Sometimes sitz baths in warm water help alleviate the discomfort.

We don’t know all of the causes of anal sac problems, but there does seem to be an association with allergies (environmental as well as food), obesity, a low-fiber diet, lack of exercise, and gastrointestinal disease.  Genetics may also play a role.  Diagnosing the cause can be difficult, but for chronic recurring anal sacculitis, environmental allergy testing or a food allergy trial using a prescription hypoallergenic diet may be warranted.

Other than treating for allergies, how can these butt maladies be prevented?  Again, trial and error rules the day.  Weight loss and increased exercise may help.  Switching to a high-fiber diet or adding fiber such as pumpkin, bran cereal, or Metamucil to food has helped some of our patients.

Often, in spite everything we’ve tried, both the pet and his people are plagued by recurring anal sac disease and multiple trips to our office.  I often joke (though I doubt the pet owner is much amused) that the purpose of anal sacs is to make money for veterinarians.  If your buddy is continually scooting and you’re tired of dealing with the inconvenience, the expense, and an unhappy pet, consider the one treatment that’s a permanent cure: surgical removal of the sacs.    

Tuesday, December 2, 2014

Grape and raisin toxicity: Grape Expectations

Pressley, the cocker spaniel on our exam table, had been vomiting and lethargic for two days.  We do our best to find out if our vomiting patients have eaten something unusual, but this dog’s owner insisted that he was always walked on a leash and couldn’t possibly have eaten anything without her knowledge.  “All he gets besides his food and his treats are grapes — he loves them!” she said.

Although the danger of grape (including some currants) and raisin ingestion has been known for over a decade, not every dog owner has gotten the message.  It’s not clear at this time whether other species are affected. 

A dog can develop vomiting and diarrhea within a few hours of eating raisins or grapes.  The dog might also present with weakness, increased water drinking, not eating, or a painful abdomen.  The kidneys take a hit, and renal failure can develop within 48 hours of ingestion.  Veterinarians diagnose the toxicity by taking a careful history and administering blood tests to reveal any increases in kidney values. 

If ingestion has occurred within a couple of hours, inducing vomiting might help decrease the amount of toxin that is absorbed.  Further treatment for raisin and grape ingestion is mostly supportive:  Activated charcoal, IV fluids for 36 to 72 hours, drugs to prevent vomiting, and H2 antagonists (Pepcid is an example) are all helpful.   Such early treatment is likely to help regenerate the damaged kidneys and aid in recovery.  But the prognosis for pets that aren’t treated, or that are seen at a later stage when renal failure develops, can be grave.

When I was a child, we had a beloved English springer spaniel named Nipper.  He was a master at jumping and snatching a grape in midair with a loud clack of his teeth.  Nipper scarfed down many clusters of grapes during his 14 years on earth.  Why didn’t he develop grape toxicity and kidney failure, and die?  Because grape and raisin toxicity is puzzling!  It appears that not all dogs are susceptible to the poisoning by the fruit. 

Another curious thing about this toxicity is that nobody is quite sure what the offending substance is in grapes.  It's also not known exactly what part of the grape contains the toxin.  Wine and grape juice are not toxic, so it’s not in the juice.  It’s also not in the seeds, because both seeded and seedless varieties cause problems, and grape seed extract appears to be safe. To complicate matters, nobody really knows the toxic dose, but when you consider the many types of grapes, perhaps that isn’t surprising.  There are data on the lowest recorded amounts of the fruit that cause kidney failure.  I calculated that as few as two raisins or two grapes per pound of dog could be a toxic dose.
The calls we receive from dog owners regarding grape or raisin ingestion can present a dilemma.  Some cases are clear cut: a 10-pound Yorkie ate two snack boxes of raisins.  But Pressley the cocker didn’t have grape toxicity — turns out it was just an upset stomach.  And my Nipper lived to a ripe old age.   We still don’t know the risk factors for any given pet. 

The owner of a dog that ate the fruit and is acting normal might understandably be hesitant to spend hundreds of dollars on supportive care, but any significant exposure should be treated.  It might mean a lighter wallet, but it could also mean a live dog with normal kidney function.   

Sunday, November 23, 2014

Thanksgiving overindulgence: For pet owners, a different Black Friday

Thanksgiving stirs memories both warm and not-so, the latter often connected with our younger years, when we were forced to sit quietly and display impeccable table manners. Most of my own Thanksgiving recollections are quite pleasant, especially those of the seasonal flavors inextricably bound in my primitive brain.  

The day after Thanksgiving evokes its own set of images. So-called “Black Friday” makes us think of waiting in line at obscene hours (party!), great bargains, death-defying stampedes, and excitement.  For me, the thought of Black Friday calls up equally hectic but less enjoyable memories: of the many phone calls I’ve received from worried owners of dogs suffering from various degrees of indigestion.

It’s only natural that we’d want to share the glorious cuisine of the holiday with our furry friends!  How can we sit there in our gluttony, savoring Grandma’s special sage stuffing and creamy gravy, while Daisy’s imploring eyes stare at us?  It’s hard to ignore the saliva dripping from her flews while you’re enjoying a delectable piece of Mom’s sour cream pumpkin pie with whipped cream.

I implore you:  Please ignore it!  Ignore the whining, slavering, barking, head nudging, pacing — all of it! If you capitulate to clever canine manipulation, there could be a price to pay.

Even careful owners can be undone by a devious dog. The leftover scalloped potatoes (made with heavy cream and shredded Gruy√®re cheese on top!) languish on the kitchen table, and your dog quietly counter-surfs; or she silently salvages turkey bones from the garbage.  All the while, you’re in the living room eating the aforementioned pie. 

Sure, a little indigestion might be only slightly unpleasant for you both; your dog’s appetite temporarily decreases, or she has a bout of loose stool in the yard.  But most dogs are used to eating the same food at the same time every day, and deviation from that protocol can have more severe consequences.  Those usually involve a trip to our office, intestinal antibiotics, and anti-vomiting drugs, perhaps with Imodium and probiotics thrown into the mix for the inevitable diarrhea that follows (usually on your newly cleaned carpet).  Occasionally an abdominal x-ray, lab work, and fluids are necessary.
Not as common but of more concern is the possibility of pancreatitis.  In some dogs, even a single meal that is too high in fat can result in inflammation of that tiny but crucial organ.  The pancreas produces digestive enzymes; when it becomes inflamed, those caustic substances can leak out and literally digest the surrounding tissue.  It’s serious, painful and sometimes even fatal.

So how do we assuage our guilt when we’re dining like royalty and our best friend is pleading for a share of the fare?  Yes, you can resist.  Or if your dog can handle table food, simply make her a doggie version of some of your dishes.  Save some of those boiled potatoes or baked sweet potatoes before you slather them with cream cheese and butter.  Soak plain croutons in hot fat-free chicken broth.  Unembellished carrots, cooked green beans and peas are all flavorful treats that some dogs enjoy.  Add small amounts of skinless, boneless turkey white meat to any of those dishes for extra palatability.   What about dessert?  The ASPCA has published a pumpkin pie cookie recipe for dogs and cats! 

Reduce the possibility of accidents by making sure leftovers and table scraps are safely put away or stored well out of reach.
And remember: Although you might enjoy pushing back from the table engorged like a replete tick, that doesn’t mean your dog does.  Filling her stomach won’t fill her heart.  Only you can do that.  


Thursday, November 13, 2014

About those lumps and bumps

If I removed every little lump I saw on my patients, I’d be wealthy!  But I don’t, and I’m not.  The reason veterinarians don’t eliminate every single blemish is that it’s usually not necessary.

You’ve probably seen an aging pet that has hairless, warty-looking bumps on his body.  Those rather unsightly lesions are most likely sebaceous adenomas, which are benign tumors of the sebaceous glands of the skin.  Because sebaceous glands secrete oil, the adenomas might be greasy and scabby.  As long as they don’t bother the pet owner or patient, and don’t get too big, they can be left alone.

But sometimes they create problems that indicate removal:   They can bleed and create a mess on rugs and furniture. They can also be itchy and an annoyance to the pet; some dogs and cats become obsessed with licking at the adenomas, which can make them red and sore.  Occasionally they are in a location that causes pain, such as between the toes.  And often our clients are just tired of looking at them!

Skin tags, which are seldom seen on cats, are another category of ugly, lumpy things.  Once in a while, their location makes them a problem.  For example, skin tags on the elbows are subject to repeated trauma whenever the dog lies down on the floor.  Sometimes skin tags are unattractive to the dog owner.   In those cases, we remove them.  Otherwise, skin tags are perfectly harmless and may be left alone.

Another benign skin mass we commonly encounter is a sebaceous cyst.  This differs from the aforementioned sebaceous adenoma in that it’s not a tumor, but a sac full of the oily secretion of the sebaceous gland.   But like sebaceous adenomas, they can bleed, itch, and aggravate the pet, and we recommend excision in those cases. 

We eliminate these small skin bumps in two ways:  Excision or tissue ablation.  When we excise a mass, we simply cut around it using a surgical scalpel or a laser beam.  The resulting skin defect may be left open or closed with sutures.  Excision of small masses might require only a local anesthetic.   Larger lumps or those in sensitive areas, such as the feet or face, will require a general anesthetic, so we usually try to remove those when the patient needs another procedure, such as a dental prophylaxis. 

A CO2 laser also can be used to ablate small lumps; the laser beam vaporizes the lump without thermal damage to surrounding tissue.   But this is painful without using local or general anesthesia, and again, we try to coordinate the removal with other procedures.

I’ve often wished we could remove some of these small skin masses right in the exam room instead of subjecting the pet to hospitalization and general anesthesia.  With the addition of a new instrument in our practice, that wish has come true.  

Cryoprobe™ is a portable and efficient cryosurgical device for the treatment of many kinds of skin lesions in small animals. The pen-shaped hand piece freezes unwanted tissue with pinpoint accuracy by using a micro-fine jet of liquefied nitrous oxide.  After the tissue freezes, it is allowed to thaw, and then it’s frozen again.  The “freeze-thaw-freeze” cycle results in destruction of the cells.  The cool thing (no pun intended) is that the treatment causes only minor discomfort and doesn’t require a local anesthetic.  

Because geriatric dogs tend to be skin-lump factories, they will benefit the most from cryosurgery, especially if they aren’t candidates for general anesthesia.  Even small mammals and birds may have lumps that can be selectively removed by freezing.   At Vernon Hills Animal Hospital, we think that this icy-cold therapy will be an asset for many of our patients!

Sunday, November 2, 2014

Pilling your cat: A hard act to swallow

When I was a new graduate, I never hesitated to prescribe pills for my feline patients.  I would demonstrate the technique of administering a capsule or tablet, and down the hatch it would go.  Occasionally my cat clients would call and tell me that they couldn’t pill their cat.  I knew that couldn’t possibly be true: There was simply no such thing as an “unpillable cat”!  After all, I had easily popped in that medication at the appointment.

So I called it the “myth of the unpillable cat” — until a few months into my first year of practice.  Because that’s when I met such a rascal, and became more humble.

It’s one thing if clients can’t pill their cat.  They don’t have our expertise, and they are afraid of hurting their little buddy, or they’re just plain afraid of her; one little struggle or hiss, and they give up.  Veterinarians, on the other hand, know every cat trick in the book.   But even the slyest and strongest among us is no match for a truly determined feline.

First, she hears the pill bottle rattle. (Here’s a hint: Take the pill out of the bottle well ahead of time.)  Just that sound is enough to send her into the crawl space for two days.  But sometimes she’ll humor you and allow you to put her into the pilling position.  You gently scruff her or place your hand over her muzzle, and that’s when the trouble starts:  If she doesn’t lacerate your forearms with her front claws, she’ll flip her hind legs over her head and push you away with her well-armed hind paws, at the same time twisting her body into impossible positions, all of which yields her desired result:  You simply have to let go.  Think you can wrap this scoundrel in a towel like a mummy and avoid the flying fur?  Hah! The unpillable cat laughs at a stinking towel!  D.H. Lawrence said that “reason is a supple nymph, and slippery as a fish by nature.”  In my opinion, reason doesn’t hold a candle to the unpillable cat.

Then there is the sly feline who allows her people to pop the pill.  But no matter how far down her throat they push it, this creature has a true gift:  She can always regurgitate it.  I see these cats from time to time, and I’m always grudgingly impressed.  

There are alternatives to pills, of course.  There are injections, but they don’t appeal to most cat owners or to their kitties.  Liquid oral concoctions and instant-dissolving tablets are easier to administer, but the unpillable cat will have none of that: As soon as the medication hits her tongue, she turns on a fountain of foamy saliva and violently shakes her head while racing around the house.

The most promising solution is delivery of medication via a cream, applied to the inner surface of the ear, but not many medications come in that form.  And true to her nature, the hard-core unpillable cat (maybe I should rename this critter “the unmedicatable cat,” but it doesn’t slip off the tongue) has a technique to prevent that.  Her response is immediate and violent, especially if she is equipped with front claws.  

So how do we treat these kitties?  We can’t, and we don’t.  Sometimes their life depends on the very medications they reject, but forcing a cat to do something to which he is violently opposed can destroy the bond he has with his people.  Many clients have told me that they would rather forgo treatment and take the consequences than have their cat hate them.  Still, I like to get these patients into our office to check the owner’s technique. Occasionally I find they’re just going about it the wrong way; a few tweaks and all is well.  But to the steadfastly unpillable cat, I say, “I have met the devil, and it is thee!”

Monday, October 27, 2014

Insurance is for the dogs—and cats

Your brother’s portly beagle was treated for a ruptured intervertebral disc and is finally home from the specialty clinic.   She’s okay, but her $6,000 medical bill put a significant dent in the family savings account.  You’re not worried about that; Your dog is svelte, fit and athletic.  And your neighbor’s cocker mix needed a $3,000 surgery to remove a sock he ingested.  That won’t happen to your picky poodle, so why worry about it, right?  

Wrong-ish.  I don’t want our clients to be fearful that every perceived malady might turn into a major medical expense, but I also think they need to be prepared if that day ever comes.  How to accomplish that?  By buying a pet insurance plan.

When pet insurance first came out in this country, in 1982, veterinarians were skeptical that it would be useful.  At about the same time, HMOs were expanding.  They had a negative public image due to the stipulations they imposed upon their plan members, often preventing them from getting the quality of care they needed.  That, along with the restrictions enforced by traditional human health insurance plans, left a bad taste in the mouths of veterinarians and our clients alike.  Our impression was that pet insurance was just a variation of human health insurance.

But now we know that pet insurance resembles property insurance more than it does human health insurance:  The owner submits the claim to the insurance company after the pet has received care, and then the company reimburses the owner.  That’s a good thing, because the insurance company doesn’t dictate price constraints on veterinarians, and we aren’t inundated with paperwork.  It’s also far easier for the pet owner to understand. 

A typical pet health insurance plan will reimburse you for vet bills when your dog gets sick or is injured, but you can also get coverage for wellness visits and preventive care.  A basic policy might cover only accidents, emergencies and illnesses (including cancer) for as little as $10 a month, but the maximum benefit will be lower. (Vet Pet Insurance’s limit is $7,000 annually, for example.) Higher-priced plans include additional coverage for conditions such as hereditary illnesses, chronic conditions, dental cleaning, vaccinations, laboratory tests, and drugs.  They tend to cover a higher percentage of the costs and have larger maximum benefits.

Trupanion has distinguished itself by making pet insurance less confusing. It offers separate plans for dogs and cats.  The plans are kept simple by covering only unexpected veterinary costs, such as hospital stays, diagnostic tests, medications, surgeries, oral surgery and extractions, and other things that arise when your dog or cat is ill or injured.  After the deductible, they cover 90% of the costs.  Best of all, there are no limits on the amount of reimbursement.  Like other companies, they won’t cover pre-existing conditions.

Trupanion is similar to other pet insurance companies in that it determines pricing by considering age at enrollment, breed, gender, whether your pet is neutered, and where you live.  Hereditary conditions are covered; that’s important, because some insurance companies seem to consider just about anything a hereditary condition.  A client recently told me that her insurance company rejected her claim for surgery for her Labrador’s torn cruciate ligament because the problem was “hereditary.”  I’ll bet that company wouldn’t cover glaucoma in a cocker spaniel for the same reason.  As Golum would say, that is tricksy!

Once Trupanion gives you a quote, you can customize your monthly premium by choosing a deductible, from $0 to $1,000.  That’s great,   because it allows the pet owner to set a price that fits his budget, and the deductible can be changed any time.   The premiums are adjusted periodically based on inflation and other criteria.

If you’re ever faced with making a major health-care decision about your pet, consider how much less stressful it would be if the cost was only a minor concern.   With the affordable pet insurance available today, it’s worth your time to do a little homework to protect your blood pressure, your bank account and your furry friend. 

Sunday, October 19, 2014

Continuing educations for vets: A grinding week at Peppermill

I yawned as I pulled into the garage at 1 in the morning. I had just come home from a week in Reno, Nev., where I stayed at the Peppermill Resort Spa Casino.   Besides a large casino (and the ubiquitous slot machines scattered throughout the resort), there was a spa, two swimming pools, a large fitness center, three boutiques, 11 restaurants, and over a dozen lounges. 

But don’t ask me how much money I won gambling, how I enjoyed a relaxing massage, or even how the weather in Reno was, because I don’t know!  I was there for the Wild West Veterinary Conference. And though I did get to eat a couple of sandwiches poolside, the rest of the amenities unfortunately were wasted on me.  By the time the seminars were over for the day, my neurons were fatigued, and all I wanted to do was eat dinner and go to my room to watch something completely mindless on TV.  But for those who desired it, there was plenty to keep them busy besides the aforementioned perks, including hikes in the mountains, sunrise yoga, and golf.

To maintain a professional license in Illinois, veterinarians have to accumulate 40 hours of continuing education over two years.  Sitting through seminars all day earns about six hours, which means it takes about a week of full-time learnin’ to fulfill the educational requirements.  It doesn’t seem like a lot of time, really, and most of us at Vernon Hills Animal Hospital go well over our limit.  But attending at least one of these large seminars is usually necessary to attain our 40-hour goal.  We fill in the blanks with local seminars and online webcasts. 

Because many of the larger conferences are far away, improving one’s gray matter isn’t inexpensive.   These conventions are businesses unto themselves, and they need to have good attendance and make money.  They know that veterinarians and their staffs would rather go to Orlando or San Francisco than Chicago or Milwaukee ─ hence the trip to Reno.
My erudition for the week was heavy on dentistry and geriatric feline medicine, with some dermatology, cytology, and orthopedics thrown in the mix.   In addition to the seminars I attended, there were offerings in complementary, alternative, exotic, and equine medicines; business lectures; and a separate, comprehensive program for veterinary technicians.
Besides offering valuable learning experiences, these conferences are great way to connect with our colleagues, whether known or unfamiliar.  Due to his many speaking engagements and his involvement at the North American Veterinary Conference, Dr. Barten has a large network of friends and colleagues and is sure to always have a companionable group to socialize with at any given meeting.  Me?  Not so much, but it’s always interesting to sit next to another veterinarian or technician and hear about their experiences and opinions.  I’ve learned a lot from them over the years.
Another essential part of our ongoing education is learning about new drugs and technology, and the exhibition hall is the place to go for that.  Dozens of companies involved in veterinary medicine have exhibits where one can learn about and buy new equipment, services, gadgets, drugs, diets, software, and books.  It’s also a place to connect with the people who help you run certain aspects of your practice.  I finally got to meet Jose, a computer guru with, the company that builds and hosts our website.  I have enlisted his help over the phone many times, and it was nice to finally meet the man who belongs to the voice!  

Continuing education (CE) is important for veterinarians and our staffs because it helps us deliver the best quality of medicine we possibly can.   It’s impossible to keep up with all aspects of our profession, even with dozens of hours of CE, but we certainly do our best.  Just as important, it helps us know when we need to refer a patient in order to make sure the pet gets the best care it deserves.   But CE is not glamorous; it’s work, albeit fun work.  And exhausting.  I’m used to running around the hospital and interacting with pets and clients, not sitting still for hours at a time and absorbing new knowledge. For me, staying awake during lectures requires multiple cups of coffee, and based on the lines at the conference coffee urns, I’m not alone!   But stay awake I did, and the reward was a revitalized frame of mind and the ability to incorporate some new ideas in our practice.  

Sunday, October 5, 2014

Fitness apps for Fido

If you’ve noticed that people are opting to park their cars at the far end of parking lots much more than they used to, you might be witness to something that’s all the rage these days:  wearable activity trackers. Fitbit, Nike+ FuelBand, and Jawbone UP, among others, are worn as a wristband or clipped to clothing. They record data such as how many steps you take, the distance you’ve gone, the number of calories burned, even how long you sleep. Most of the devices use Bluetooth technology to wirelessly sync your activity data to your mobile phone.  And there are lots of cool apps that work with the trackers to enhance your fitness experience. 

Considering how much we humans love our activity trackers, it was only a matter of time before a Fitbit-like device was created for the tail-wagging community.  A number of brands have entered the market recently, and although there are subtle differences among them, their declared purpose is the same:  to help you stay connected to your best friend when you’re at work or otherwise away from him.

Introduced last summer, the Whistle Activity Monitor seems to be popular.  It attaches to your dog’s collar.   A built-in accelerometer measures his activities and rest, and sends updates wirelessly to a free app on your smartphone.   The app provides a visual summary of your dog’s activities, such as playtime, walks, and resting periods.   You can also record which medications your dog takes, write reminders for his care, and track his food intake.  As with FitBit et al., you can set a daily exercise goal and monitor the intensity of his exertion.  If you want to see how hard and how long your expensive dog walker is exercising Fido, check your smartphone.  Want the whole family to be involved?  Multiple users can access the app, ensuring that pet sitters, friends, and all family members can be plugged in to your dog’s life. 

Of course, you’ll want to share your dog’s experience on social networking sites! You can post photos there, or share them privately among your group of friends.  The app also shows you a visual comparison of activity and rest between your furry friend and other dogs of the same breed, age, and weight.  The Whistle gets a laudable eight to 10 days’ worth of battery life, includes a docking station for charging, and costs about $130, with no monthly fee.  The company assures its customers that Whistle will expand its capabilities and only become more elegant with time (including adding a soon-to-be available GPS tracker).   

Another product, FitBark ($109 if pre-ordered), is set to launch this year and is similar to Whistle.  Another product called Tagg (around $100) combines a fitness monitor and a pet tracking device.  But Voyce (around $300), which will be available this fall, was of the most interest to me.  Like Whistle and FitBark, it monitors your dog’s activity patterns.  It also measures the calories your dog burns and compares the data to prior trends.   But Voyce distinguishes itself from the rest of the trackers by using radio waves to measure your dog’s respiratory rate and resting heart rate, and it gives you a daily average.

When I first read about these doggie trackers, my initial reaction was:  Has the techie world jumped the shark?  Then I realized that despite being fairly tech-savvy, I fail miserably in the staying-connected department.  Part of the reason is my 37 years of veterinary practice, during which I’ve been required to be continually available to patients and colleagues.  For me, an occasional respite from “connectedness,” even from my own pets, is okay.  So perhaps my perspective is jaded compared with that of the general dog-owning population.    

But after further contemplation, I really do see the benefit of these activity trackers.   First, they’re fun if you love technology, although the charm might wear off after a while.  I think monitoring a pooch’s exercise (and doing something about it if it’s falling short) not only makes pet parents become more responsible but is certainly a boon to the dog’s health.  According to a 2012 study commissioned by the Association for Pet Obesity Prevention, more than 52% of dogs are overweight o r obese.   In a 14-year study by Purina, the median lifespan of the Labrador retrievers that were kept lean was increased by 1.8 years.  So that glow of pride when you receive a congratulatory text from your app because Fido met his fitness goal is a good motivator.

These trackers’ ability to show trends in your dog’s eating and activity patterns could be a valuable way to alert you to a potential health problem.  For example, an unexplained decrease in either could be a red flag and might inspire a phone call or a trip to your vet’s office.  The capability of Voyce to monitor a dog’s heart and respiratory rate has real medical potential.  It isn’t terribly important for the average healthy dog, but I can see it as a life-saving tool for those with problems such as pneumonia, laryngeal paralysis, severe heart murmurs, or congestive heart failure.   The client can send the data to a veterinarian, who can then decide whether intervention is needed. 

Think of these gadgets as giving you a new perspective on your dog’s day-to-day life.  If the tracker shows that your buddy spends the best part of his day bored and sleeping, it might inspire you to enroll him in a couple of days of doggy day care, or give him some extra time on walks or at the dog park.  That alone would make it worth the price tag.


Tuesday, September 23, 2014

New hope for canine allergies

My next patient was Scratchie the pit bull.  It was Scratchie’s sixth visit this year for itchy, infected skin.  His “seasonal” allergies now extended from spring through fall, and our various treatments hadn’t seemed to give the poor guy much relief. 

Statistics show that 10% to 15% of dogs have allergies, but sometimes it seems closer to 75% in our practice.  That’s because when pollen levels start to go up in the early spring, itchy dogs start filling up the appointment calendar until frost.  Most allergic dogs can be controlled with topical treatments and oral medications, but for some unfortunate critters, that just isn’t enough to keep them from being miserable.  Those patients usually need immunotherapy, in the form of allergy shots. 

Before beginning allergy shots, the dog must first be tested.  That requires a trip to the dermatologist for intradermal testing or a visit to our hospital for blood testing. Once the test is done, a serum is made specifically for that dog, using small amounts of allergens (the proteins that cause the dog to itch).  The patient periodically receives injections with gradually increasing amounts of allergens until a maintenance level is reached.  

Although immunotherapy has very good efficacy, this option hasn’t been popular with owners for a number of reasons. The cost of going to the dermatologist and having the skin testing done is one drawback. Then there is the issue of having to inject your dog -- not a great option if either owner or pooch is needle-shy.
Some dogs can have adverse reactions to the serum. Allergy shots can take months to start working. Finally, it can be difficult to remember to give the injections at certain time intervals.

But now there’s a better way to deliver allergens to our patients:  sub-lingual immunotherapy.  The procedure is simple.  First, we draw blood from your dog and send it to Heska Veterinary Diagnostic Laboratory.  The serum that is formulated from the allergens is then administered by drops given in the mouth instead of by injection. 

About half of dogs receiving allergy immunotherapy will have an excellent response, about 25% will have a so-so response, and about 25% will have no response at all.  When sub-lingual immunotherapy first came out, there was skepticism over whether the drops would be as effective as injections.  It turns out that not only do they work just as well, in many cases they work better!  In fact, dermatologists often find that dogs that fail to respond to injections have success with sub-lingual therapy.  Many dermatologists are using oral therapy from the get-go almost exclusively now.  

Besides its good efficacy and the no-needle thing, there are more advantages. There is much less chance of anaphylaxis (a severe and life-threatening allergic reaction) with the oral drops. Even dogs who had anaphylaxis with the injections tolerate sub-lingual immunotherapy.  The drops, which are delivered by a pump, are easy to administer by the pet owner.  With injectable therapy, mold serum must be injected in a syringe separate from the pollen serum, but with sublingual therapy the two can be combined in one vial.  And the sublingual treatment seems to work slightly faster than the injections.  Heska says it takes three to four months to see a response, but many dermatologists say they see a reduction in scratching more quickly than that.  With either method, though, it’s best to expect to see results during the next allergy season, so pet owners need to plan ahead. 

A disadvantage for some clients is the frequency of administration.  Allergy injections are usually given every one to three weeks, but sublingual immunotherapy requires twice-daily administration. However, some pet owners prefer the routine of giving medication every day and find themselves forgetting to give an injection every few weeks, so that isn’t an obstacle for them.    

If the cost of allergy testing and immunotherapy worries you, consider dogs like Scratchie.  Each time he visits, there is a professional fee plus the cost of oral and topical medications, and occasionally lab fees for cytology or culture.  Such a visit can range from $50-$275.  The cost of serum-testing a dog is around $140, and it’s a one-time expense. A vial of sublingual serum, which lasts five months, costs $105.  I realize that isn’t an inconsequential amount, but if the therapy prevents multiple visits to the animal hospital, you will have come out ahead.  Not only that, but you’ll get a better night’s sleep when your allergic dog stops licking, head-shaking, and thumping his leg against the floor while scratching all night!

Sunday, September 14, 2014

A new look at neutering

The recommendation to spay and neuter all dogs is the standard of care, but recent evidence has thrown new light on that dogma – at least for two breeds.   

Two studies from the University of California-Davis School of Veterinary Medicine have taken the veterinary world by surprise.  The research was based on 13 years of health records from UC-Davis for neutered and non-neutered male and female Labrador and golden retrievers between 6 months and 9 years of age.  The most recent study, published in July of this year, compared 1,015 goldens with 1,500 Labs.  Those two breeds were chosen because of their popularity, similar size, and comparable behavioral characteristics.

The researchers picked several cancers (lymphosarcoma, hemangiosarcoma, mammary cancer, and mast cell tumor) and three joint disorders (hip dysplasia, cranial cruciate ligament tear, and elbow dysplasia) and compared the incidence in neutered and non-neutered dogs of both breeds.  The neutered dogs were grouped into four categories, according to the age at which they had been altered.  

It turned out that non-neutered males and females of both breeds had a 5 percent rate of one or more joint disorders.  But in Labs, neutering before 6 months of age doubled that rate, to 10 percent.  More alarming, the golden retrievers that had been neutered before 6 months of age had 4 to 5 times the incidence of joint disorders compared with non-neutered goldens.  The joint disorders found to increase in male goldens were hip dysplasia and cranial cruciate ligament tears, while lab males had more cruciate tears and elbow dysplasia. 

Lead investigator Dr. Benjamin Hart at UC-Davis says,  “The effects of neutering during the first year of a dog’s life, especially in larger breeds, undoubtedly reflects the vulnerability of their joints to the delayed closure of long-bone growth plates when neutering removes the sex hormones.”  In other words, we’re messing with Mother Nature!

Regarding cancers, the data also uncovered significant differences between the breeds.  The cancer rate of both breeds when they weren’t neutered was 3 to 5 percent, except in male goldens, who have an 11 percent cancer rate. Neutering didn’t have much effect on the cancer rate of male goldens.  However, in female goldens, neutering at any point beyond 6 months increased the risk of some cancers to 3 to 4 times the level of non-neutered females.  But that was true only for goldens; neutering female labs only negligibly increased their cancer rate.  According to Dr. Hart, “The striking effect of neutering in female golden retrievers … suggests that in female goldens the sex hormones have a protective effect against cancers throughout most of the dogs’ lives.”  Mother Nature again. 

What does all this mean?   Should we stop neutering our dogs to prevent joint disease and cancer?  Before sweeping changes are made, the limitations of the studies must be discussed.  First of all, they compared Labs with goldens; no other breeds were studied.  Comparing goldens with German shepherds probably would yield vastly different results. Even within a breed, there were significant differences based on gender.  To get solid data, hundreds of studies would have to be done, not just on a breed basis, but also on a gender basis.  

When I started practicing veterinary medicine in 1977, the unwavering recommendation almost every veterinarian made was to neuter all dogs at 6 months of age.  I don’t think compliance was nearly as good then as it is today.  I remember many male dogs coming in with prostate problems, perianal tumors, and perineal hernias, all conditions associated with not being neutered.  Spaying a female of any breed before her first heat has been associated with a lowered risk of breast tumors; performing surgery on unspayed dogs to remove breast cancer and infected uteruses was a frequent occurrence back then.  I rarely see those medical problems today; it’s likely that the early neutering of pets from shelters has had a big influence on preventing them.

The two studies looked only at the risks of neutering those breeds, but not at the benefits.  Neutering a female golden, for example, elevated the risk of one or more cancers three- to fourfold.  But not spaying dogs of all breeds causes the above-mentioned breast cancer and infected uteruses, as well as messy heats and the risk of overpopulation.   You might prevent joint disease in your male Lab by leaving him intact, but in addition the problems I listed above, the compromise might be aggression, wandering, marking in the house, and, again, unwanted puppies.  

So now we veterinarians and our clients are faced with a quandary:  to fix or not to fix.    I think it’s wise to discourage neutering in goldens and Labs before 6 months of age, and 12 months is even better.  I also think a discussion is warranted with the owners of other large-breed dogs, whose joints are more vulnerable when they are altered early.  As far as never neutering, we need more data before we make a blanket recommendation across all breeds.  For the owners of Labs and goldens, we can discuss the risk-benefit ratio with you, but the decision as to whether to neuter will ultimately be yours.   

Sunday, September 7, 2014

Rodenticide toxicity: The perils of poison

A couple of years ago, I noticed a sprinkling of dried mouse droppings on the desk in my basement.  I cleaned them up and, except for setting traps in the basement, pretty much accepted the occasional debris as an unavoidable nuisance.  That changed on the day I arrived at the desk to find that fiberglass from the nearby wall had fallen on it, sodden with mouse urine and feces. Ewww!  I decided to go after the little vermin with a vengeance.

I called my pest control guy, who strategically placed bait stations around my basement.  These were plastic mazes, the payoff being a chunk of anticoagulant mouse poison at the end of the tunnel.  Even though I don’t let my cats wander into the basement, I told him I was concerned that they could be exposed to the toxin if they happened to sneak down there.  He assured me that the point of the maze was to prevent pieces of the poison from being removed from the bait station.  The mice would help themselves to the toothsome treat and leave.  And then die.

One of my cats, a rapscallion named Cam, became an expert at lying in wait for the basement door to open and then streaking down the stairs.  One day I chased after him and found him licking a substantial chunk of grainy blue mouse poison. So much for “the mice can’t remove the poison from the bait station!”  The bait stations were taken out the next day.

Rodenticides can be grouped according to how they work.  The common ones we encounter in our practice are anticoagulants, which stop normal blood clotting.  Bromadiolone, chlorophacinone, difethialone, brodifacoum, and warfarin are examples of anticoagulants. 

We receive rodent poison-related calls at least a couple of times a month.  The situations are sometimes similar to what happened at my house.  The most recent one involved a dog that escaped through the front door, ran into a neighbor’s garage and began eating a pellet of d-Con that was on the floor.  In that case, the dog was lucky: The owner knew what had happened and was able to get treatment right away. The tricky thing about anticoagulant poisoning is that the pet owner usually has no knowledge of the exposure, and the symptoms can be delayed for up to five days.  By that time, the owner has probably forgotten that Fido disappeared into the neighbor’s shed for 10 minutes last week.  The pet is presented to us with physical manifestations that aren’t specific to any one disease or syndrome:  difficulty breathing, weakness, exercise intolerance, lethargy, lameness, coughing, vomiting, and shaking.  The pet owner might not notice more specific signs, such as bruising, pale gums, tarry black stools, or blood in the urine. 

Treatment for anticoagulants is supportive care, if indicated, and administering Vitamin K1 for two to four weeks.  If the owner actually sees the pet eat the stuff, inducing vomiting (in some cases) followed by activated charcoal might help prevent absorption.  A pet with more severe clinical symptoms may be in big trouble.  Bleeding from rodent poison is typically into the body cavities.  Massive blood loss into the abdomen and chest is common and is often the cause of death.

Warfarin – the same substance often prescribed for humans as a blood-thinning medication – is what’s known as a first-generation anticoagulant poison and requires multiple feedings to deliver a lethal dose.  Second-generation anticoagulants were developed when some resistance to warfarin was discovered in rodents, and those can be lethal after just one dose.  After March 2015, consumers will no longer be able to buy anything but first-generation anticoagulants or other rodenticides, but pest control professionals will still be able to use the more potent second-generation products.

According to Audubon Magazine, there’s no safe place or delivery system for second-generation anticoagulants. Poisoning can occur from direct ingestion, but there’s also something called “relay toxicosis”: after a rodent eats the poison, it gets weak and becomes an easy, tasty meal for other animals such as raptors and mammalian predators. That includes not only dogs and cats but foxes, bears, bobcats, mountain lions, and wolves, among many others.

Here are some sobering statistics:

  • In California, rodenticides showed up in 79 percent of fishers, 78 percent of mountain lions, 84 percent of San Joaquin kit foxes, and 92 percent of raptors.
  • In New York, rodenticides were found in 49 percent of 12 species of necropsied raptors. For great horned owls the figure was 81 percent.  Rodenticides are also blighting raptors in Australia, New Zealand, Ireland, and Canada.
  • In Great Britain, necropsies revealed the poisons in 92 percent of red kites, 91 percent of barn owls, and 80 percent of kestrels.     
  • Currently about 15,000 calls per year come in to the Centers for Disease Control from parents whose children have eaten rodenticides.
    Scientists and wildlife advocates recommend non-toxic pest eradication in most cases.  There are certainly situations in which rodents damage crops or homes, transmit disease, and even cause severe ecological damage (entire island ecosystems have been destroyed by rats).  But for the most part, use of second-generation anticoagulants should be severely limited, even for pest control professionals.  

    Got an infestation?  Search “non-toxic rodent control” on Google and you’ll get more than 300,000 results.  Find out about the habits of the pest, and its likes and dislikes.  Block entry points and remove any food and water sources.  This is called integrated pest management

    We are the guardians of our children, pets, and wildlife; don’t use weapons of mass destruction when a cherry bomb will do the job!

Monday, September 1, 2014

Get the most out of your pet's appointment: Can we talk?

Mrs. Ernest’s forehead was creased in concentration as I tried to extract a medical history for Chunder, the little dog she held snugly in her arms.
“How long has Chunder been vomiting?” I inquired.
“Oh, let’s see, he’s 7 years old, so I’d say about six years.” (The intake information that our technician took said he’d started vomiting three days ago and had been fine prior to that.)  
“How often during the past six years has he vomited?” I asked.  “Once a day?  Once a week?  Once a month?” 
“Just a few times a year, usually after he eats grass or goose poop,” replied Mrs. Earnest. 
“So the recent vomiting episode — it says here that it started three days ago.  Is that correct?”
“Oh, no, he started vomiting two weeks ago.  He hasn’t felt well for the past month,” she answered.

If you think conversations like that are a rarity, think again!  They are a daily occurrence at animal hospitals everywhere.  And unfortunately, they can actually affect the quality of care. A concise, orderly history of your pet’s ills is imperative in helping us diagnose and treat your little buddy.  So how can you, as your pet’s guardian, help clarify your communications to your veterinarian?

We’ve all been told to write a list of our concerns when we visit our own physicians.  Lists are a big help for veterinarians, too, but pet owners need to prioritize the list and discuss the problem that is of the most concern to them at the beginning of the appointment.  Sure, I want to take a look at the minuscule lump (which took you five minutes to find for me), but first tell me about your pet’s decreased appetite over the past two months.  The lump can wait, or can be addressed at a later date. 

Before you take your pet to his veterinary appointment, sit down and chronicle the problem on paper — at home and in a quiet place.  When did your pet’s symptoms first appear?  For acute problems, that isn’t difficult to determine; it’s pretty hard to forget the six piles of diarrhea you had to clean up before your yoga class on Monday evening!  But the onset of problems that have been going on for a long time can be much more difficult to pinpoint.  It’s often useful to ask other family members when they noticed the first occurrence of said ailment.

The next thing to record is exactly what you noticed that was unusual.  It’s not helpful to say, “He’s just not himself.”  Why is he not himself? Make a list of specific things that aren’t normal:

  • He’s always eaten his meal in less than a minute, but now it takes him two hours to finish it.
  • He stopped getting up to greet me when I get home from work.
  • He stopped eating his favorite treats.
  • He started urinating in the house, which he’s never done before.
  • Suddenly he stopped jumping on my bed at night.

When you come to the office, bring your written history with you, and choose your cohorts wisely.  Unless the appointment involves life-or-death decisions, it’s best not to bring the entire family; a few of you will suffice.  Having several people chiming in with their opinions and contradictions isn’t helpful, which is another good reason to interview your family at home.  You don’t have to leave well-behaved kids at home, though.  In fact, parents often hush up kids who try to answer my questions, but I’ve found that children of many ages can offer valuable insight into their pet’s behavior.  They might also confess to having fed that pet a pile of greasy french fries!  

Veterinarians are trained to interview clients in a way that gives us the most useful information.  You might feel impatient when we ask seemingly inane questions, but there’s a good reason for us to delve into things that you feel are inconsequential:  They are important clues to us.  But there might be times when we don’t ask you about something you think is relevant.  Make sure you speak up:  “Let me tell you what else I’m seeing that I think may be important (or is unusual, worrisome, etc.).” 

An oft-quoted statistic in the veterinary community is that clients forget 85% of what we tell them by the time they get home.  If you aren’t absolutely clear about the doctor’s diagnosis or instructions, make sure you repeat them or ask questions:  “So are you telling me that Chunder needs x-rays if he’s not better in one week?  Are you saying that I should give him this medication until he feels better, or until it’s gone?  What exactly does ‘exercise restriction’ mean for my dog?”  And we don’t mind writing down our instructions, so don’t be afraid to ask us to do so.

It’s helpful to tell your doctor your expectations.  If your dog has been limping for the past two years and you want us to stop the limping, we need to know that.  You won’t be happy with us if we palliate the limp, which is probably the best we can do, when what you expect is a cure.   We’ll need to make sure your expectations are realistic, then decide on a common goal.  That’s especially important with serious problems, where simply improving your pet’s quality of life, rather than a cure, might be our goal.

Finally, don’t be afraid to tell us your fears.  Pet owners often are secretly afraid that we will find cancer, while we might be thinking that that diagnosis isn’t very likely.  Usually we can alleviate your anxiety with diagnostics, a good plan, and some calming words. 

Being a doctor is very much like being a detective.  Without good clues, obtained by our examination and your careful observations, we can’t solve the puzzle.  As the great Sherlock Holmes said: “Data! Data! Data! I can’t make bricks without clay."