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.