Cold-weather couture

It was a chilly day, and Cleo the standard poodle arrived for her appointment looking chic in a plaid quilted coat.  I asked her owner if Cleo would be cold without the coat, and she admitted that she didn’t know.  “But she loves her coat, because she knows that when I put it on her we’re going somewhere,” she added.

Sweaters and coats for dogs are often objects of ridicule, but during our cold winters, some dogs benefit from being dressed for the weather.

A dog’s coat is provides insulation and helps prevent the loss of body heat into the cold air.  I’ve seen Chesapeake Bay retrievers jump into frigid water to retrieve a stick, then return to shore and beg the owner throw it again.  Labrador retrievers break through thin ice to swim after fallen game.  And one of our clients has Tibetan mastiffs that prefer sleeping outdoors, ensconced in the snow, to being in a warm house.

 

But not all dogs have a thick, warm coat that keep them from shivering in our wintry climate.  It’s not surprising that small dogs need extra insulation.  Chihuahuas, miniature pinschers, and rat terriers, for example, simply aren’t equipped to deal with our winters.  Even big dogs with short hair (especially if they are lean), such as greyhounds and Dobermans, tend to prefer being covered on their walks.

So how do you determine if your canine needs couture?  By observation.  During their dog’s first winter, most people figure out just how much cold they can abide.  A cocker spaniel that can comfortably go on a 10-minute walk when it’s 25 degrees outside might begin to shiver after 15 minutes.  The same dog in the same weather playing fetch will be uncomfortably warm with a coat or sweater on.  Acclimation plays a role, too.  The aforementioned cocker might, by the end of winter, be able to tolerate a much longer walk in the same weather with nary a garment.

   

Besides coat quality, age and health make a difference.  Puppies, sick dogs and frail old dogs need to be kept warm.  And most dogs can use a coat if it’s chilly and wet, or brutally cold and windy: Even northern breeds participating in the Iditarod have special jackets for that type of weather.

 

The same criteria apply to the need for dog booties: Observation is the key.  You’ll know your pooch needs footwear if he limps from the cold on his walks, or does a dance, hopping uncomfortably from paw to paw.  Many of our clients tell me their dogs need booties when the thermometer dips below 20 or 25 degrees.   Dogs with hairy paws can collect ice balls between their toes, which can be painful and impair mobility, a problem also solved by booties.

  

With so many pet products on the market – Americans spent $13.72 billion on them (excluding food) in 2014 – you’re sure to find Fido the perfect garment to keep him or her cozy.  Because many dogs have little or no hair on their bellies, I recommend buying a coat or sweater that covers that sensitive area, with an accommodation to allow male dogs to relieve themselves.  As for booties: Unfortunately, it’s a challenge to find ones that dogs accept, or that don’t fall off.

My client’s old dog Cleo might not have actually needed her coat, but she didn’t mind it; and because her health is somewhat fragile, it sure didn’t hurt her.  But be careful not to dress dogs that don’t need it. Being overheated, especially during aerobic activity, is uncomfortable or even dangerous.  And using unnecessary sweaters or coats as a form of self-expression isn’t a great idea.  That Roberto Cavalli puffer jacket may be a status symbol, but if your pug finds it repugnant, you’re not doing the poor guy any favors.  A simple, practical coat – or none at all – might be sufficient.  In Hamlet, Polonius says “the apparel oft proclaims the man”; but clothes don’t make the dog.

Detergent pods: A Washday Problem for Pets

When I write blog posts, I often feel that I admonish pet owners too much:  Don’t use rodent poison! Keep house plants away from pets!  Watch out for raisins and grapes!  Well, folks, that’s my job, so here’s an addition to that list of concerns:  laundry and dishwashing detergent pods.

We’re always looking for products that save us time and effort.  Hence the invention of the laundry detergent pod, which has become popular in the past couple of years.  I admit it’s a useful innovation:  Just reach into a container and plop a pre-measured packet of detergent into the dishwasher or washing machine.  No mess, no measuring. 

  

Unfortunately, detergent companies have made the pods enticing to both kids and pets.  Small children think the colorful ones are candy.  And dogs?  Well, anything left within reach is fair game to play with or feast on, and these pods are just the right size for munching.

  

Between March 2012 and April 2013 17,230 children under the age of six were accidentally poisoned by the packets (Pediatrics, December 2014).  Only 4.4% of the children were hospitalized, but of those, 56 had a “moderate or major medical outcome.”  Some victims stopped breathing and required ventilation support; one child died.

 

Dogs that eat old-fashioned laundry detergent powder react to the unpleasant taste; they drool and might also have a mild GI upset, such as vomiting and diarrhea, that will resolve itself over time.  But the reaction to biting into a detergent pod is more severe.  The product in the pod not only is highly concentrated but also explodes under pressure from the bite.  The detergent is forcefully expelled, and large amounts may be aspirated or swallowed.  Eating the pods, which are encased in plastic, may also pose a foreign body obstruction risk.

The symptoms in dogs are similar to those in children: vomiting (84%); coughing (21%); lethargy (17%); and gasping, wheezing, and other respiratory difficulties (13%).  The Pet Poison Helpline reports that 72% of pets exposed to the pods develop clinical signs.

If your furry friend gets into mischief and decides to chomp on a detergent pod, water is your friend; liberally rinse your pet’s mouth, skin, and eyes until the slippery, soapy feel is gone.  Any symptoms that persist, such as vomiting or respiratory abnormalities, warrant a trip to our office or a call to an emergency clinic.  There’s no antidote, but we can provide symptomatic and supportive care.  Don’t forget to bring the detergent container with you.

Making these products less colorful is a step in the right direction for preventing ingestion by kids but won’t help our curious canines.  Companies should explore measures that help not only children, but also pets, such as coating the pods with a foul-tasting substance.

    

I researched homemade laundry detergent as well as plant-based “natural” laundry detergents, hoping that they would be safe if ingested.  No such luck!  The safety information sheets for many of these products indicate that they can be severe irritants if inhaled or ingested.

So keep your fancy pod products (and all other cleaning products) safely out of reach of your furry companions.  Better yet, don’t buy the pods if you have small children or inquisitive pets.  It’s just not worth saving ten seconds of your time.  

Dying with love, morphine, and whiskey

A Dec. 31 blog post on The BMJ (formerly The British Medical Journal) Web site by a former editor of that journal has the medical community abuzz.  Richard Smith, M.D., concludes that “death from cancer is the best.”  He admits that his view of dying of cancer is romantic:  "You can say goodbye, reflect on your life, leave last messages, perhaps visit special places for a last time, listen to favorite pieces of music, read loved poems, and prepare, according to your beliefs, to meet your maker or enjoy eternal oblivion.

"This is ... achievable with love, morphine, and whisky," Dr. Smith writes.  Further, he warns to stay away from “overambitious oncologists” to avoid overtreatment.

He compares what he considers four main ways to die:  sudden death; the long, slow death of dementia; the “up and down death of organ failure”; and death by cancer, “where you may bang along for a long time but go down usually in weeks.”  He observes that death from organ failure -- respiratory, cardiac, or kidney -- has you in and out of hospitals and too much in the hands of doctors, and he describes the failure of one organ after another as the “most horrible medical death.”

Many physicians were aghast at his suggestions, and I can understand some of their criticisms.  Many of us have known someone with cancer who suffered greatly, sometimes for many months, despite the best efforts of hospice (including lots of morphine!).  But there’s a lot of truth in his observations about the way we humans have to die.

I thought about Dr. Smith’s article in the context of pets.  My observations of companion animals over the past 38 years lead me to conclude that there is no “best” way for them to die.   Some pets with organ failure fall asleep and never wake up, dying a peaceful death, while some are clearly uncomfortable or in severe pain.  Ditto for cancer patients.  

Our clients with sick pets are given choices for treatment, including no treatment.  Most of them are loath to put their very ill pets “in and out of hospitals and too much in the hands of doctors.”  They are relieved that when we can no longer alleviate their pet’s suffering, we have the advantage of performing euthanasia.  I don’t necessarily advocate euthanasia for humans, but I think our pets are lucky not to have to experience a “most horrible medical death,” as many humans do.  We don’t achieve this with morphine and whiskey, but with a strong sedative and pentobarbital.  And love. 

Dry winter skin: The (other) white flakes of winter

I’ve written a lot about itchiness in dogs, because it’s a prevalent problem.  If you’ve read my blog posts, you know that allergies and fleas are the most likely culprits that cause scratching.  But what about the dog with no allergies that has an uncomfortable winter itch?  For the healthy, non-allergic dog living in our arid Midwest winter environment, dry skin is the predominant cause of scratching, chewing, and rubbing.

The top layer of the epidermis (the outermost layer of skin) is composed of a compact layer of dead skin cells called keratinocytes.  The keratinocytes are continually sloughing and being replaced by cells from lower levels.  So it’s normal to see some flakes of skin, especially on dogs with dark coats, where the contrast between flakes and fur is obvious.   I can’t always judge the severity of dry skin by appearance, but the client’s history usually tells the tale. 

We’ve all experienced the itching, stinging, and general discomfort of dry skin; I always have a cheap bamboo back scratcher within easy reach in my bedroom.  But our furry friends don’t have opposable thumbs to alleviate this vexation, so it’s up to us to help them.

Humidifiers are the most effective remedy for dry skin, but many dogs are itchy in spite of them.  We then tackle the problem with oral supplements and/or topical treatments.

It’s best to avoid shampooing your dog during the dry winter months, but that’s not always practical.  If washing is a must, a hydrating shampoo (with an associated cream rinse), such as Micro Pearls Advantage Hydra-Pearls Rehydrating Shampoo, Allergroom shampoo, or Hyliderm Shampoo +PS, will preserve the fatty (lipid) skin barrier and have a soothing, emollient effect.   Topical sprays such as Micro Pearls Advantage Dermal-Soothe are great for short-haired breeds.  Look for products containing ingredients such as ceramides and phytosphingosine, which help restore the fatty skin barrier.  All of these products are available without a prescription in pet stores or on the internet.

 

The cornerstone of dry-skin therapy is fish oil.  The active elements of fish oil are polyunsaturated omega 3 fatty acids called EFA and EPA.  The fish don’t produce those fatty acids; they obtain them from their diet of algae.  If you are environmentally conscious, you can buy an omega 3 algae oil supplement, which is free of the toxins often found in fish oil and doesn’t contribute to the depletion of marine life.

Although you can use fish oil products made for people, there are advantages to using ones intended specifically for pets.  They come in convenient forms, such as pump bottles and chewable tablets, and some have enticing flavors added.  Prescription diets (Iams Response FP, Hills j/d) or over-the-counter sensitive-skin diets also can be an easy way to give dogs a daily dose of fish oil.  There are potential adverse effects of fish oil; more is not always better.  But at recommended doses (read the label!) they seem to be safe, and they do help many of our patients with dry, itchy skin.

 

When I started practicing veterinary medicine (before the crust of the Earth cooled), it was popular to add corn oil to dogs’ food to help with shedding and dry skin.  The dogs that benefited probably were on diets that were too low in fat (such as weight-loss diets).  The same might be true of flaxseed and its oil.  The fatty acid in flax is ALA, a precursor to EFA and EPA.  Barely any ALA is converted to those more-active forms, yet some of my clients swear that flaxseed makes their dog’s coat shiny and helps with dry skin.  Perhaps the extra fat or other unknown nutrients contribute to its success. 

There are hundreds of pet products for itchy, dry skin.  Choose one or two that are easy for you to administer and acceptable for your canine companion, and give ‘em a try.   Ogden Nash quips that “happiness is having a scratch for every itch.”  But maybe happiness is having no itches to scratch!

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.

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.    

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.   

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 Gruyère 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.  

   

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!

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!”