Category Archives: medicine

Vomiting Isn’t “A Cat Thing.”

There is growing evidence to support the fact that ongoing vomiting in cats is NOT a normal thing. “Hairballs” aren’t normal if they’re being thrown up frequently. There’s a high probability that those cats have gastrointestinal disease.

Here’s a link to a good, quick explanation. If your cat fits the pattern, ask your vet what you can do to figure out what’s really happening!

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Filed under cats, feline, medicine, pathology

Chemical Castration : The Future?

I’m going to tackle the article sent in my by one of my regular readers. It’s an interesting article. In case you missed the link last Thursday, here it is again:

New Strides in Spaying and Neutering

The short version of the story here is that there is a company relaunching a product and method to “neuter” a dog by giving an injection in the testicles. It prevents reproduction but does not fully eliminate testosterone production.

There’s some history here. The original company that produced this formula (Neutersol) launched their product in 2003. There were issues with ownership and production that led to the discontinuation of the product. Another company, Ark Sciences, bought the rights and is relaunching the same product under the name Zeuterin.

Simply put, a dog is given an injection of a zinc-containing compound in the testicle. It causes inflammation that destroys the sperm-producing cells, which causes the dog to be sterile. In comparison to a regular castration, the testicles are NOT removed after injection. They do sometimes decrease in size, but it’s my understanding that that effect varies.

I have not yet been through the training that Ark Sciences is requiring to use Zeuterin. It’s my understanding that with the prior company/product, the dogs didn’t require much in the way of sedation, and they generally didn’t require full anesthesia. If I recall correctly, the post-injection care was pretty minimal. Some dogs were quite painful after the injections. That should be something fairly easy to address, however. Sometimes the testicles swell after injection, which is to be expected. This, too, causes pain; again, it shouldn’t be hard to address. As far as I know, there don’t seem to be any longterm problems with this method of sterilization.

So, why the fuss? Why is this news fit for a headline? Lots and lots of reasons. Neutering is a long-running debate with decades of vehement support on both sides. The US is a country in which neutering dogs at a young age (less than 1 year) is most commonly recommended. In other parts of the world, neutering is NOT recommended at all. There are pros and cons as well as many unfounded fears circulating on the internet. Inaccuracy and belief-over-evidence runs rampant, too.

Here’s what I know for sure about surgical castration:

  • Castration reduces the risk of perianal tumors (usually benign tumors around the anus of intact male dogs).
  • Castration eliminates the risk of testicular cancer.
  • Castration eliminates the risk of benign prostate enlargement.
  • Castration reduces roaming behavior and dog-dog aggression in most male dogs.
  • Castration addresses overpopulation of stray/feral/ dogs.
  • Castration of very young male dogs can alter their physical appearance slightly; the medical significance of this is less certain.

There are valid questions out there about the risks of castration, particularly early in life. Early neuter may well cause increased risk of some medical problems, including cancer, abnormal bone growth, and possibly an association with mental decline later in life. A higher rate of fearful behaviors has also been noticed in neutered dogs. Many of these questions require more study. It is, however, a very real possibility that neutering (and spaying) can cause some diseases to occur more frequently. What remains uncertain is whether the studies already published are as good as the results seem to imply. Interpreting historical data is much more complex and difficult than it seems.

I encounter a lot of fear on the part of clients about neutering. Many owners believe it will make their male dogs fat and lazy. They worry about the risks of anesthesia. They worry about the cost of the procedure. Sometimes, cultural beliefs make castration extremely unappealing as an option.

In many cases, these fears are easy to dispel. In my experience, neutered dogs are NOT less active or driven than their intact counterparts. Neutered animals don’t need as many calories as an intact male, so they will probably need less food. Overfeeding makes dogs fat, in my opinion, and is a much more potent factor than the presence of testosterone. (I’m not saying there’s zero influence of sex hormones on physique and body condition score. I’m saying most of my clients overfeed their pets.) Anesthesia performed properly is NOT high-risk. Yes, the procedure is costly compared to general well-health veterinary care. Discussing that will require a whole separate post, but I’m open to doing so in the future.

So what are we going to do with all of this information? I try to be practical about it. Honest, too, as there are some issues we need to confront head-on.

How many of these “benefits of neutering” can be replaced with deeply responsible pet ownership? Lots of them. Roaming behavior, inter-dog aggression, pet overpopulation… owners that were more hands-on with their dogs and willing to curb these kind of issues would take these problems off the surgical table and put them on the end of the leash. I’m not trying to be condescending or elitist. The flat truth is that if your dog is intact and you let him out in the backyard without a fence and with no supervision, you’re contributing to the problems. Pet overpopulation is a very real, very serious problem in this country. Not because roving packs of wild dogs are stealing children away, but because MILLIONS of stray dogs and cats are killed every year. Three to four million, in fact. Irresponsible ownership is a big part of that death toll.

Speaking from my personal standpoint, if an owner is responsible, I don’t see a problem with not neutering. Part of that responsibility is shared between the owner and the vet. I’m responsible for informing that owner of the risks and benefits of neutering. I’m responsible for answering honest questions with honest answers. Some of those answers may be, “We don’t know” or “Yes, there are specific diseases for which neutering raises the risk.” Together, owner and vet will have to weigh those pros and cons and select an outcome that works best for that situation.

In my experience, neutering is still the best case scenario for most male dogs and their owners. Our hospital still officially recommends neutering at 6 months of age.

This brings us neatly around to the actual topic of the original article. Can chemical castration replace surgical castration? I don’t think so. Not broadly, anyway. Chemical castration leaves some testosterone intact, and that hormone is the balance point for behavior and medical risk.

If a given owner is responsible and simply wants to eliminate the risk of unwanted puppies, then chemical castration is a very viable option. Remember that the presence of testosterone may also protect dogs from some of the diseases we mentioned above that occur more frequently in neutered dogs.

If the testosterone-driven behavior of a male dog will increase his risk of trauma, or increase risk to the family, other pets, other families, etc., then chemical castration won’t change that behavior. Surgical is the only way to go, as that’s the only way to eliminate the production of testosterone.

In summary, chemical castration isn’t a miracle cure for all of the controversy of neutering. I think it has a place in the discussion, as well as a place in the set of tools we use to keep pets healthy and safe. I would caution my clients and readers against thinking that chemical castration is “better” than surgical methods. It’s simply a different path to take as we navigate health care for our pets.

This is a broad topic. It was also a really long post. If you’ve made it this far, I thank you. If you’re hungry for more, check out this blog post: The SkeptVet

I’m happy to tackle questions, too. Comments welcome!

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Filed under medicine, practice

Pyrethroid Toxicity in a Cat

Last week we saw a cat with a toxic reaction to an over-the-counter flea/tick prevention product.  The owner had utilized the company’s cat product, at the appropriate dose, applied per the instructions.  This cat, however, developed the most obvious and common of the signs associated with a toxicity to one of the ingredients in the product.  The video below shows you what we saw when the owner brought the cat in.

 

 

Flea and tick topical products use a pretty wide range of ingredients.  There are a LOT of different products out there.  For most owners, knowing what might be problematic is almost impossible.  Given that a company is marketing a product for a particular species, age, and weight range, a consumer would generally believe that it’s safe and effective.  Sadly, we see often enough that safety and efficacy are lacking in some products.

 

In this case, the prevention contained a product that belongs to a  class of pesticides known as pyrethrins/pyrethroids (Pie – reeth – rens).  They’re modeled after a naturally occurring toxin in chrysanthemums.  These chemicals cause nerve cells to malfunction, leading to paralysis of the affected organism.

 

Most animals can break down the toxin fast enough that it doesn’t cause them any trouble.  The liver is responsible for a lot of the breakdown of the chemical.  However, cats lack a specific enzyme that the liver uses to destroy the toxin molecules.  This makes cats far more sensitive to the effects of pyrethroids.

 

Pyrethroids are used in many dog products, including some that we recommend and use.  Dogs aren’t anywhere near as sensitive to these products as cats, so we feel that the dog products are safe for use in dogs.  Owners have to be VERY careful, however, to never apply the dog products to cats, nor to let cats lick the freshly applied product off the dog.  Serious, potentially lethal toxicity WILL result from the use of dog products on cats.  No doubt about it.  I haven’t seen a cat show toxicity simply by living with a dog that has a pyrethroid-containing product on its skin.

 

There’s no direct antidote to pyrethrin toxicity.  We decontaminate the animal by washing them in dish soap.  This strips the oil and product off the skin, so no more is absorbed into the animal’s body.  If the tremors are severe, a muscle relaxant can be given to lessen the twitching and tremors.  I don’t think death from pyrethroid toxicity is very common, but it’s definitely possible.

 

I’m deliberately not mentioning the name of the product used on this cat, nor the specific names of the products we use.  I’m doing so to avoid libel/slander claims.  Contact your veterinarian for specific recommendations for your pet and your home environment.  Regional variations in which products are needed to control fleas/ticks are also something we have to acknowledge.  What we use up here in Michigan may not be effective in Florida, for example.

 

Avoiding products with pyrethroids is the easiest way to lower the risk to your cat.  We recommend products that do not contain pyrethroids for our feline patients.

 

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Filed under case report, cats, medicine, toxicology

Pharmacy Choices

Last week, we ran into a problem at the hospital. It brought right to the forefront a complicated, potentially upsetting dilemma faced by veterinarians and pet owners. I’ve carefully avoided preachy blog posts about the costs involved with pet medications. It’s a topic I can’t cover from an entirely fair position and I’ll admit that up front. I’ll do my best to stay objective.

Online pet pharmacies sell pet medications. They are usually cheaper than at the local vet hospital. Veterinary hospitals can’t purchase medications in enough quantity to be able to offer the prices that online pharmacies do. Some companies offer prices that, if we matched them, would cause the hospital to lose money on the sale. We simply can’t do this and stay in business.

Large retailers are now offering, and heavily advertising, pet medications as well. These prices are also lower than at most veterinary hospitals. Prices, again, may be due to buying in high volume, or a strategy to serve as a loss leader. We simply don’t know.

Lastly, some medications are human meds that we use in veterinary patients. Those are also sold by any human pharmacy. Sometimes those prices are lower than what we can offer. The reasons are the same as above.

At this point, it certainly seems like veterinarians and vet hospitals are crying over a loss of revenue. To some degree, that’s true. We’re having to find new ways to serve our clients fairly and well with the loss of revenue from some medications. I think that everyone understands our need to pay and educate our staff well, to have good equipment and supplies, and so on. All professions, all private businesses, all corporations, set out to make a living from their work.

So what’s the catch? There are several. I’m going to use heartworm prevention as an example. The manufacturers of heartworm prevention products generally sell their products directly to vets or through a licensed/approved distributor. The manufacturers tell us that they only sell this way, and that they don’t sell to online pharmacies or retail outlets. Somehow, the products end up at other retailers, though. There are only two plausible reasons: vets buy tons of product and sell it to other retailers, or the manufacturers are selling to retail outlets.

If the products are purchased by vets and sold to other retailers, that’s called diversion, or “gray market” sales. The manufacturer’s can’t safely say that their products were handled properly, stored in the proper conditions, or are free from tampering. As a result, the manufacturers won’t guarantee those products. You’ll have to deal with the retail outlet. And, of course, I’d hope that your veterinarian can help out. The trouble is, if your heartworm prevention doesn’t work the way it’s supposed to, your pet could be the one that suffers. Nobody wants that, not the vet, not the retail outlet, not the owner.

The situation that prompted this post occurred with one of our clients. They requested a written prescription for heartworm prevention for their cat. They took it to a local human pharmacy that was offering pet medications. The store didn’t have what we’d scripted in stock, and told the owner to see if the dog version would work just as well. Thankfully, the owner called and asked rather than just taking the medication home. It wouldn’t have harmed the cat, but the medication was different from the cat version — including an additional ingredient not in the cat product.

As far as I’m aware, human pharmacists and pharmacy staff do not often have any official training on veterinary medications. I’m hopeful that the retail chains offering pet medications will provide education and training for the staff there. If they haven’t, or they don’t, it’s far from an ideal situation. I’m not trying to say that pharmacists are bad people or that they don’t care. They’re probably just as uncomfortable with the situation as we are.

So what’s our take on the situation? We feel that the health and safety of your pet should be in the hands of properly trained professionals. Vets, vet techs, and even our reception staff have been trained to know which medications are the appropriate choices. They’re familiar with the products we carry. The manufacturers guarantee their products’ safety and effectiveness when you purchase through a vet hospital.

While I firmly believe that everyone involved in the practice of vet med and pharmacy has a desire to help keep pets healthy, the simple fact remains that your vet hospital is the best educated advocate for your pet’s well-being. I want all of our clients — and all pet owners — to make an informed choice.

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Filed under ethics, medication, medicine, practice, safety, training

Sick Days

There are some sacrifices we all make to work in the veterinary field.  Working in close quarters, as well as being exposed to clients, makes the hospital something of a human Petri dish.  We do a fair bit of gentle teasing at the hospital when someone’s sick.  “Patient Zero,” “Typhoid Mary,” “Plaguebringer,” — names kicked about all in good fun.  While we agree that working while sick is a bad idea, the fact remains that when we take a sick day, we affect the ability to see patients that need care.

I’m nearly paranoid about washing my hands, using only my own office phone, getting enough sleep, etc.  It usually works.  This year?  My number was up.  I caught a nasty case of bronchitis.  In the 8 years I’ve worked at Pet Authority, I think I’ve taken less than 4 sick days.  Friday I took a half-day and hauled myself to the doctor’s office.

Whenever I visit a human medical office of any sort, I can’t help but compare my experience to what pets and clients experience at our hospital.  I was pleasantly surprised that the doctor was able to run a test for influenza right there at the office.  We have a few tests that return results in ten minutes or so as well.  I don’t have the flu, thankfully!  (Having that swab crammed way up in my nose wasn’t cool, though.  Not at all.)  Otherwise, everyone was very nice.  I was given some medications and sent home to rest.  I think I’ll be in good shape to return to work on Monday.

How we determine when we’re sick enough to go to the doctor is easy to figure out.  We each have a certain tolerance for various symptoms.  Our pets, however, can’t really distinguish between mild, moderate, and severe signs of disease.  Most pets will act as normally as they can manage no matter how bad they feel.  This has the effect of hiding the illness from owners.  That can lead to a delay in treatment, in turn affecting how successful we are in making a pet well again.

Admitting that I’m a bad example, I’d like to make some amends by sharing some signs that your pet should see the doctor “today.”  Putting off a visit could worsen problems and lead to poor outcomes.  Remember, pets don’t think about what their symptoms could be caused by.  We have to do that for them.  Each sign will also have some of the possible causes listed.

Coughing: heart failure, bronchitis, pneumonia

Squinting eye(s):  corneal ulcer, inflammation in the eye, glaucoma, pain

Vomiting:  intestinal obstruction, pancreatitis, liver disease, kidney failure, toxin ingestion, bloat

Rapid breathing:  heart failure, pain, anemia

Swollen belly:  bleeding, cancer, heart failure, bloat

Pale gums:  bleeding, severe anemia, shock

Seizures:  epilepsy, brain tumor, toxin, inflammation of the brain

Bruising: blood clotting disorder, trauma

There are certainly more signs that we should watch for, but those are some of the most serious. Our pets count on us to be watchful for evidence of a problem, and to grant them a ‘sick day’ to go see the vet.  Don’t hesitate to seek care — it’s always easier to treat small problems than catastrophes!

1323 large

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Filed under human interest, medicine

Thursday News

Treating infections is one of the most widely known aspects of medical practice. Humans and other animals are in a constant and highly variable relationship with the microscopic world inside and outside our bodies. Bacteria help us digest and use our food, but they can also cause life-threatening infections. Dealing with the bad bugs often requires an antibiotic, a chemical that kills the bacteria. Finding new antibiotics that can be brought to the market as a safe, effective treatment is a long, expensive, arduous process. As a result, we don’t see too many new antibiotics.

Scientists have discovered a small molecule in the bloodstream of the giant panda that has antibacterial properties. The pandas make this small chain of amino acids (a peptide) naturally and it circulates in their body. Interestingly, it kills bacteria very quickly — more quickly than the drugs and molecules we already know about. The hope, of course, is that we can find a way to make this available to help humans and other animals. Scientists are working on making this peptide in the lab so that wild pandas can be protected.

This is another example of why research into the natural world is far, far more important than it might at first seem. Nature has a great deal to share with us about elegant solutions.

Here’s the link to the article. (It’s pretty short.)

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Filed under human interest, immunology, infectious diseases, medication, medicine, nature, news, wildlife

Orangutan Receives Cancer Treatment

An orangutan at the Jungle Village park in Florida is being treated for non-Hodgkin’s lymphoma by a team of keepers, doctors, and veterinarians. This is a great article (with a little video) that hilights the amazing similarities of humans and primates.

The Miami Herald : Saving Peanut: Life of beloved orangutan in hands of team using human treatments

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Filed under cancer, human interest, medicine

Chronic Kidney Disease – A Case for Early Detection

Chronic kidney disease is a common diagnosis in veterinary medicine. It’s a disease for which we have no cure, only the ability to slow it down and manage the other symptoms. Ultimately, it’s fatal. The really nasty part is that we have a hard time finding it before a vast amount of irreversible damage is already done. I’ll give a little background into what’s happening with kidney disease, then talk about what we can do to treat it.

The kidney is a remarkable organ. It filters waste products out of our blood so that they can be excreted in the urine. They manage the balance of water and electrolytes (salts) in our bodies. They also make a hormone that tells the bone marrow to produce red blood cells. (Red blood cells carry oxygen throughout our bodies.) The kidneys you’re born with are the kidneys you have for the rest of your life. They don’t regrow, and “healing” is a limited ability for this important organ.

On a microscopic level, the kidney is quite complex. The illustration below shows the arrangement of blood flow and filtering in the functional unit of the kidney: the nephron (neff-ron). Tiny little arteries carry blood into a tangled ball of blood vessels called the glomerulus. Around that ball is a cup-like structure called Bowman’s Capsule. The vessels in the glomerulus are designed so that waste products and water are leaked out. Some other things the body prefers to keep are also filtered out. These wastes and other things are then collected by the Bowman’s Capsule. Bowman’s Capsule is connected to a big U-shaped tube (cut off in this illustration) that gives the kidney a chance to recollect the good things that were leaked out of the glomerulus. Those things are reabsorbed or transported back into the blood. Some new things are excreted, while others are traded out and sent into this U-shaped tube. Eventually, the U-shaped tube hooks up with a bigger tube that travels to the middle of the kidney. In the middle of the kidney, all of this waste material and whatever water the body is getting rid of is collected, then piped down to the bladder. Of course, this waste fluid is urine.
500px Physiology of Nephron svg

In chronic kidney disease, a variety of different things can go wrong, but in the end, it’s the nephrons that are destroyed. As nephrons are destroyed, the kidney begins to lose its ability to do the work it needs to do. This can be a very slow process, taking years in some cases. As with most things in the body, there’s some redundancy in the kidney to allow for a certain amount of damage without the body suffering for it. The kidneys can do their job well enough even with some loss of nephrons. Eventually, there’s a threshold after which the kidneys can’t keep up and things start to go very wrong. We can’t easily detect a problem until things start to go wrong, which is why this is such a nasty diagnosis to make.

Perfect kidneys are at 100% function. As we talk about percent damage, keep in mind that we’re referring to the grand total sum of both kidneys. It’s possible that one kidney can be damaged more than the other, or undamaged, but we aren’t distinguishing for the purposes of this post. The end result of damage to the kidneys is that the nephrons are destroyed, leaving scar tissue where functioning kidney used to be.

Chronic renal disease en

When 2/3 of the kidneys’ functional capacity is gone, leaving only 33% working, the kidneys lose their ability to manage water balance in the body. Water is allowed to leave the bloodstream at a rate that will dehydrate the animal. This is the earliest sign of chronic kidney disease. It can be subtle. The urine will seem more dilute. Pets will begin to drink more water and pass more urine. In truth, the urine production goes up because of the inappropriate loss of water, so pets drink more to remain well-hydrated. We can detect this low urine concentration when we run a urinalysis. Sometimes, we can detect protein loss in the urine, too, which is a sign of trouble. A pet may begin losing weight.

When 3/4 of the kidneys’ functional capacity is gone, leaving only 255 working, the kidneys can no longer keep up with the removal of waste products from the blood. Byproducts of metabolism begin to build up in the bloodstream. We can detect these rising values on bloodwork, namely the serum chemistry. As these waste products rise, we begin to see effects in the animal. Appetite drops because of nausea and irritation of the stomach lining, followed by vomiting. Dehydration and weight loss occur, as well as significant loss of muscle mass. At very high levels, these wastes can directly impair brain function, too. Other effects of advancing kidney disease can include high blood pressure and anemia. Sadly, many of the pets we diagnose arrive with lots of these clinical signs.

There are lots of treatments available for renal disease, but remember that none of them are a cure. Chronic kidney disease is managed, not fixed. We lower the protein intake of a pet’s diet to decrease the waste-filtering workload of the kidney. We also keep the phosphorus low in the foods we feed to help prevent some other complex but highly damaging changes in calcium and phosphorus levels in the blood and bone. There’s an oral medicine to help with that problem as well. We can give injections of the hormone that makes red blood cells be produced. We can give fluids under the skin to help flush the wastes out through what’s left of the kidney. Some animals respond very well to these treatments. Cats tend to do better for longer periods of time than dogs. Each patient is different in terms of response to treatment and the rate the disease progresses. Some patients survive only a few months. Others can go years before we lose the fight. We manage the patient, not the numbers on the lab work, with the goal being good quality of life. The sooner we start treatment, the better most animals do!

Running lab work is the ONLY way we have to watch for the emergence of chronic kidney disease. The clinical signs that owners see are present early on, too, but they start out subtly. Most of us don’t notice a gradual change like this until it’s further along. Annual urinalysis helps us detect the changes that signal early kidney disease. Bloodwork may also show subtle signs earlier in the process, so that’s also a valuable tool.

The take home message here is this: RUN ANNUAL LABWORK ON YOUR PETS! It’s the best way we have to watch for early signs so we can begin treatment early.

Please ask questions. This is a complex disease that I could talk about for pages and pages, so I simplified the basic discussion for today. I’m happy to expand on any aspect if there’s interest!

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Filed under laboratory, medicine, preventive care, renal

The Big C

Nothing strikes fear into the heart of clients the way cancer does. Even bringing a distant, slim prospect of cancer tends to halt all other pathways of thought. When we look at the human data, it’s no wonder that we’re so afraid.

As of August 12, 2012, the us has approximately 314,145,701 people. In 2012, about 1.6 million new cancer cases are expected to be diagnosed. While the percentage doesn’t seem to be high at all, the personal experiences of those who have dealt with cancer make the case for just how insidious the disease can be.

Cancer is, at its simplest explanation, an abnormal growth of a cell. The DNA – genetic instructions – inside a cell is altered somehow, causing the cell to do things it shouldn’t do. These cells, or groups of cells, may overproduce or underproduce things they’re supposed to make. They also differ from normal cells by displaying different surface proteins.

When we’re talking about cancer, we do need to be careful about which terms we use, so I’ll try to clarify a little.

Neoplasia: “new growth” This is a general term for abnormal cell division that results in a population of abnormal cells. Neoplasia usually results in a tumor. Tumors are also called masses. Some types of neoplasia don’t form a discrete tumor. Any cell type has the potential to undergo the changes that lead to neoplasia. Tumors can happen -anywhere- in the body.

Benign: A mass that does not show aggressive/destructive behavior, and that is unlikely to spread. These tumors do not cause harm to the person or animal.

Malignant: A mass that shows aggressive/destructive behavior, that may spread, and cause great harm to the person or animal. Malignant essentially means cancerous.

So, to review. Any tumor is a neoplasm, or new growth. Some tumors are not harmful, and are called benign. Some tumors are extremely harmful, and are called malignant or cancerous.

All of this terminology matters because when we’re dealing with a tumor, how we treat it depends greatly upon whether it’s benign or malignant. Benign masses of certain types can be left alone and monitored. Cancerous/malignant masses require some kind of treatment, whether it’s surgical removal, radiation, chemotherapy, or some combination of those things.

So why is cancer such a terrible and deadly disease? First, because neoplastic cells can also trick our immune system into thinking that they are normal cells and shouldn’t be destroyed. Our own defenses fail and allow the neoplastic cells to multiply into a mass. Secondly, because this disease originates in the body, it’s very difficult to kill the neoplasm without also damaging or killing the body. Chemotherapy is a perfect example of this. Chemotherapy drugs are designed to kill neoplastic cells. However, some normal cell types are also damaged. Hair follicle cells, for example, can be harmed, which is why human chemo patients can lose their hair. Radiation treatments can kill neoplastic cells, but it also damages tissue around the target area. When treating cancer, we walk a fine line by poisoning the body just enough to kill the tumor, but not enough to kill the patient.

We know exactly what tumor cells do in the body to evade being destroyed by the immune system. We also know that certain types of cancer will release certain chemical signals into the body that we can detect. Our ability to get images of the body in unique ways (MRI, CT sacn, PET scan, Nuclear Imaging, ultrasound, etc.) has also aided us in diagnosing neoplasms early. We still struggle with this in humans and veterinary patients. There are SO MANY types of neoplasia, in so many areas, that we simply can’t screen everything continuously. Despite our best efforts, neoplasms arise.

The conversation with clients about cancer occurs when we’ve found a mass. Most of the time, a simple examination with the naked eye is not enough to tell whether a mass is malignant or benign. Our hands and eyes are not a microscope, so we have a hard time telling whether a mass is truly dangerous. We need to send in a sample of the neoplastic cells for a pathologist to look at. In many cases, this microscopic examination allows us to state with more confidence that a mass is benign or malignant.

Clients frequently ask if there is a blood test for cancer. There are tests out there, but they currently aren’t sensitive nor specific enough for us to know whether they are helpful or not. It’s difficult to screen before a mass is found. And once it has been, it’s far more beneficial to simply send a piece or needle sample of the mass to the pathologist for examination under the microscope. A quick review of opinions from veterinary oncologists indicated that the few widely-known blood tests for cancer are not yet “ready for prime time.” The technology is good, but it’s just not refined enough for us to make or break a case on the results.

The take-home message here is that neoplasia is, in all of its forms, complex and difficult to manage. It requires a lot of investigation to diagnose. It requires extensive, sometimes dangerous, methods of treatment. Our best defense is to be proactive about having pets examined every 6-12 months, and for owners to examine their pets frequently at home for lumps, bumps, and changes. Needle or biopsy samples need to be taken and reviewed or sent to a pathologist for review. Treatment should be instituted as quickly as possible in order to have better outcomes. Just as some people survive cancer, so do some pets. Their chances are far better when we are vigilant.

Please ask questions in the comments! This is a diverse and complex topic that we could spend days and days on. Let me know what you think, or what you’re curious about. Thanks for reading!

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Filed under cancer, medicine

Symptoms and Root Causes – Itching, Ears, and Skin

If I had to pin down the most commonly seen problems in our practice, I’d choose itching/ear infections for the “Top 5” list. We could spend an eternity talking about these problems, but I’d like to try to offer a brief introduction to the deeper reasons for these things to happen. We’ll have to start by defining the things that we can see on a physical exam (the stuff you notice at home); and then the underlying reason they’re happening.

Ears
Symptoms: shaking of the head, scratching ears, foul smell, goopy waxy discharge (brown or yellow or pus) in the ears, swelling/redness of the ear, major swelling of the ear flap.
800px Ear infection in cocker spaniel

What’s happening: ear infection, called otitis externa. It’s generally caused by inflammation of the skin in the ear canal, which makes the skin susceptible to an infection by bacteria and yeast.

Feet
Symptoms : licking and/or chewing at the feet, red-brown staining of the fur on the feet, redness/swelling of the skin between the toes, swelling of the feet.

What’s happening: skin infection, called dermatitis, usually caused by bacteria and yeast infections. The skin is itchy, which is why dogs chew/lick.
Picture 240

Skin
Symptoms: hair loss, itching, flaky skin, red skin, rashes on the belly/armpits/groin, bad smell, oily/dull/dry coat, peeling skin, crusty skin, or wet/sticky ulcers on the skin surface.

What’s happening: skin infection, usually by bacteria and sometimes yeast, because of inflamed skin surface.
Malassezia dermatitis

In summary, dogs will have nasty ears, nasty skin, and ITCHING. It’s usually these things that drive an owner to call and make an appointment. It may be bad enough for an owner to lose sleep thanks to the licking or scratching going on all night long. (Dogs and cats both may also have gastrointestinal signs like vomiting and diarrhea from certain type of allergies.)

I’ll come right to the point. These signs and symptoms are NOT the underlying disease! We can treat the ears, feet, and skin with all sorts of different things. Ultimately, though, we’re just applying a bandaid that never really addresses the reason the dog is suffering these problems. We can provide temporary relief, up to a point.

The most common underlying cause of these chronic problems is an allergy. It’s not very common for dogs to have an anaphylactic response to something they’re allergic to. People who are allergic to shellfish, for example, will have swelling of the throat and go into shock if they eat shellfish. Thankfully, dogs don’t usually have such a violent response to an allergen. Pets can be allergic to things in the environment, or ingredients in their food.

With environmental allergies, we should think of the things that cause “hay fever” in people: pollen from trees/grass/weeds, dust, dust mites, molds. Dogs don’t get itchy/red eyes and runny noses as often as people do. They have all of those inflammatory reactions in their skin surface, which includes the ears and feet.

The other type of allergy that can cause trouble is a reaction to an ingredient in a dog’s food. The brand doesn’t matter, but the ingredients do! Corn, wheat, beef, poultry, and pork are very common ingredients in various types of dog food. Even a dog that has been eating the same food for several years can develop an allergy to the ingredients in the food. The brand doesn’t matter — the contents do.

Treating the allergy itself requires some testing to know exactly which allergy we’re dealing with. Some unlucky pets have both types of allergy (food and environmental). Thankfully, if we identify at least one of the allergy types, we can usually manage these pets successfully.

Testing for food allergy requires a special diet trial that lasts 8-12 weeks. Testing for environmental allergies requires either blood test or a skin test. THe skin test is much like the skin test that people get. Small injections are given in the skin, and the size of the red swollen area is measured to judge the response to the particular allergen that has been injected.

Treatment of an allergy consists of two major parts. First, we have to deal with the secondary effects of the allergy. This means treating the ear and/or skin infection aggressively. We may also need to control itching. Secondly, we need to treat the allergy itself. If we know what a pet is allergic to, we can treat that allergy directly. That’s the keystone!

Next week, I’ll start breaking down each type of allergy for a more in-depth look. In the meantime, how many of you have pets with chronic skin or ear problems?

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Quality of Life

Last week, I talked about pain in our veterinary patients. I’m going to expand on that topic today by discussing how we evaluate “Quality of Life.”

Whenever we see a patient for an appointment (for any reason, well or sick), we perform a physical examination. We also ask for an extensive history about food intake, weight gain/loss, activity level, general attitude, and any concerns the owner may have. An assessment of a pet’s level of pain is also included in the examination and history.

Once we have all of our information organized, we have a good idea about whether a pet is healthy and doing well, or not. For the pets that are doing well, there’s not much that we need to do beyond routine preventive care with vaccination, parasite prevention, bloodwork and stool checks. However, many of our patients will have a problem that needs to be addressed. We spend time talking with the owner about what’s wrong and what can be done about it. We put a plan into action to help the pet, then re-evaluate at some point in the future to reassess the situation.

Some conditions can’t be cured, only managed. They become an ongoing part of our evaluations and plans. As patients age, we see problems begin to arise that are simply consequences of being older. Arthritis, loss of sight, lumps bumps and tumors, dental disease, mental decline… these are just a few of the chronic issues we deal with on a daily basis with our older pets.

It rapidly becomes very important to look at the big picture. We understand that older pets or certain illnesses are going to mean that a pet isn’t “100% healthy and problem-free.” Bearing that in mind, we ned a way to evaluate whether a patient is living a good life. We need to know if the treatment we’re providing is good enough that we aren’t being unfair to our pets by asking them to suffer. These are difficult subjective questions to talk over with owners. Each pet requires an assessment based on a smaller number of very specific guidelines which help us decide if a patient is doing well enough or needs more intervention.

One of the least specific questions we ask is, “Are there more good days or bad days?” This one’s tough for the veterinary team but great for owners. You know your pets better than anyone, so you’ll know if they’re having a bad day. You’ll recognize subtle changes in personality, activity level, enjoyment of toys/treats/activities, and sleeping patterns. Many older pets do have some days that are worse than others, and we have to be lenient about that. Things aren’t going to be perfect. That being said, a pet that’s having more bad days than good ones needs help to get back to more good days than bad.

Back in 1993, the United Kingdom’s Farm Animal Welfare Council developed a way to evaluate living conditions for farm animals. They’re quite easy to adapt to companion animals, too. They utilized a concept called “The Five Freedoms.”

1. Freedom from Hunger and Thirst
2. Freedom from Discomfort
3. Freedom from Pain, Injury, and Disease
4. Freedom from Fear and Distress
5. Freedom to Express Normal Behavior

These five criteria touch on the most basic parts of a life that we could consider ‘good.’ The most basic things — eating, for example — MUST be present for that animal’s life to be considered good. Without those, we’re doing any animal a disservice by continuing without changes to improve the animal’s status.

A veterinarian named Dr. Villalobos created a Quality of Life Scale that can be used to evaluate domestic pets. Each of the following criteria is evaluated on a 0-10 scale, with 0 being worst and 10 being best. It’s useful for both the veterinary team and the owner to fill this out for patients who need evaluation. We each have unique insights that, when combined, provide the most accurate assessment of quality.

HURT – Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet’s pain successfully managed? Is oxygen necessary?

HUNGER – Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?

HYDRATION – Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.

HYGIENE – The patient should be brushed and cleaned, particularly after elmination. Avoid pressure sores and keep all wounds clean.

HAPPINESS – Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet’s bed be close to the family activities and not be isolated?

MOBILITY – Can the patient get up without assistance? Does the pet need human or mechanical help (e.g. a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)

MORE GOOD DAYS THAN BAD – When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.

A score over 35 is considered an “acceptable” quality of life. Download a nice PDF of the assessment sheet here.

This is always a touchy area with owners. I believe the most owners know in their hearts when quality of life isn’t good enough. However, acknowledging that means that we have to accept the fact that a pet is in trouble and needs help, or will need to be put to sleep. If the condition that is causing life to be poor is easily addressed, the pet gains tremendous benefit and can have quality go way up. Sometimes, though, the harsh reality is that there will be a limit to what can be done. We have to be fair, we have to be selfless, and we have to be realistic. Letting go is insanely difficult, a fact that -any- pet owner understands. From my side of the table, I have seen clients make poor decisions about quality of life that they ultimately regret. I don’t say this to be judgmental or to preach. Seeing the truth is difficult at best, not to mention emotionally painful in many ways.

The Quality of Life assessments, when started -early- and used often, can help us identify small problems before we’re trying to push a boulder up a hill. All too often, I see pets that have had declining quality of life that the owner overlooked until it’s so bad that the pet is in horrible shape. In some cases, the owners elect to euthanize. In others, they ask, “What can we do to save him?” That second question is guaranteed to bring about an extremely difficult answer. Whether it’s the high financial cost to try to get a pet with lots of problems back on its feet, or a disease we simply can’t do anything about at that point, the pet is the one who has suffered its way to that point in time.

We can do so much better than that. Every single one of the quality criteria in that list can be worked on and improved. “Pawspice” care can be a wonderful way to ease pets through their golden years, but only if we have the courage and dedication to acknowledge that it’s needed.

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Pets in Pain

“He doesn’t seem like he’s in any pain, so I’m not worried about it.”

I hear that phrase numerous times a week, usually after I broach the topic of a condition that we know is painful. Pain in pets is a concept that’s evolved considerably over the years. There was a time when veterinarians didn’t send home pain medication after surgery. The ‘rational’ justification for that was because “pets don’t feel pain” and “if they’re not in pain, they’ll move around too much after surgery.” It was an incredibly sad state of affairs that I consider a very dark time in our profession.

There are some things we’re certain of. Damage to the body is painful. We can safely assume that surgery is painful. We can safely assume that things like chronic dental disease and arthritis are painful. The human body responds in certain ways to pain. We see these same responses in dogs and cats. Even when we have a pet fully anesthetized, with pain medication on board, we see the heart rate and breathing rate increase when a painful stimulus such as a surgical incision is applied. Pets DO feel pain, there’s no doubt about that.

Identifying pain in animals isn’t always easy. The signs can be subtle. In addition, we expect that as pets age, they’ll slow down some and behave a little differently. The trouble is that those signs overlap the signs of pain in pets. Pets also have some natural instincts to mask the signs of pain (or illness) that we assume are a holdover from needing to survive in the wild. These factors make it a challenge to identify pain.

Some of the common signs of pain are:

-Less activity

-Lack of appetite

-Increased sleeping

-Aggressive behavior or other changes in social behavior

-Limping, hunched back

-Not jumping up/down off the furniture, difficulty with stairs

-Hiding behavior in cats

Some problems in pets that we assume would be painful are more difficult to assess. Dental pain is one such problem. People report severe pain from some dental conditions, but often, pets will continue to crunch up dry food even with severe dental disease being present. I don’t think it’s fair to say that they’re NOT in pain. I believe that the need to eat is such a basic life requirement that pets endure the pain. (Some owners notice that the pet isn’t chewing the food, or won’t chew treats/toys anymore.) Dental pain and arthritis pain are the two things I see most commonly.

Thankfully, we now have far, far more options to help pets that are in pain. We have a very wide variety of medications that are safe, effective, and inexpensive. Some medications are fairly costly ($1-$3 a day), but I would certainly hope that owners would try to find a way to provide for their pet. Conditions like dental disease can be treated directly to decrease pain directly.

I personally deal with chronic pain. I think most everyone at least knows a family member that endures chronic pain as well, be it back pain or arthritis or other injury. Pain utterly changes who you are as an individual. It’s exhausting. The relief of this pain (even if it’s not 100% gone) completely changes the outlook. Relief from the pain restores a remarkable amount of quality to your life.

It’s no different for our pets. They don’t deserve to suffer in silence. If nothing else, if you’ve noticed any of the signs above, or your pet has a condition that you know is painful, ask what can be done to ease that pain.

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Human and Animal Health Linked

When Dr. Barbara Natterson-Horowitz was asked to treat an exotic little monkey with heart failure at the Los Angeles Zoo, she learned that monkeys can suffer heart attacks from extreme stress — just like humans. That’s when the cardiologist realized she’d never thought to look beyond her own species for insights into disease.

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Itch, Itch, Itch : Seasonal Allergies

Spring is here, more or less. We got an early preview a while back that threw off the usual calendar, but the plants and trees have inched their way through colder temps since then. Early in the warm season, trees in particular are throwing pollen into the air. Other plants do as well, and depending on the month, different types of plans will release pollen throughout the growing season. Mid-summer tends to be a mix from grasses, with trees and weeds as well. Late summer and early fall are mainly weeds. All of this pollen is a bane for anyone with hayfever or asthma. (Believe me, I know this wholeheartedly — my hayfever gradually gets worse each year.) Itchy eyes, congestion, a sore throat — all of it’s part and parcel for breathing in the pollens carried around by the wind outside. Without the help of antihistamines, steroid nasal sprays, inhalers, and allergy shots, people would be utterly miserable. Pollen.com has a nice daily map for allergen counts.
Usa map

Dogs and cats suffer from this type of allergy, too. There’s really no difference in how the immune system is behaving in response to exposure to all of this pollen. The unique part about allergies in dogs and cats is that they do a majority of the immune-related chemistry in their skin. Instead of the respiratory problems that people get, dogs and cats will get itchy, inflamed skin. When the allergy is to the things in the environment, it’s officially called “atopy.” On a quick side note, cats can get plain old asthma; and dogs can get allergic airway disease, too. I’m not going to cover those today, as they’re separate enough as topics to make up a whole other post.

When we are exposed to things that are not from our own body, the immune system has to identify these ‘foreign’ things and decide how to respond to them. This is the basic principle we discussed way, way back in the vaccine posts. (Immune Basics & Immune Responses) You’ll remember that we have to stimulate the immune system more than once in order for it to produce a good response from vaccination. The seasonal changes in pollen end up working much the same way. In this case, it’s an unfortunate turn of events. Young animals are exposed to all of these pollens during the first year of their life. This is a lot like the first vaccination. The immune system catalogs and learns the foreign material (pollens). Then, we go through winter with relatively low exposure. The next year, when the growing season begins, the immune system once again is exposed to these foreign materials. The problem is that the immune system often overreacts to this second exposure, and releases all kinds of pro-inflammatory chemicals that lead to redness and itching. The things that follow for allergy-suffering pets stem from that overreaction. Just as not all people suffer from allergies, not all dogs and cats do. We believe there is some genetic component, but the real reason for allergies developing isn’t understood.
512px Mast cells
Usually, I see a gradually increasing severity of signs and symptoms in dogs and cats. The first ‘bad’ year is just a little itching and licking here and there. Each year, the allergies get progressively worse, with more licking and itching, maybe a hot spot. Things get ugly from there: large hot spots, skin infections, hair loss, claw/toenail infections, and ear infections. It’s shocking sometimes to see how bad something as simple as a little pollen allergy can get.

Common clinical signs and history that we see include:
•Licking the feet or chewing the feet
•Redness of the feet, belly, and ears
•Licking/chewing/scratching at various areas on the skin
•Hair loss
•Flaking/peeling skin
•Hotspots – areas of moist, red, gooey skin and partial hair loss; these are painful
•Ear infections (not as common with this type of allergy but sometimes seen)

800px Chronic allergic otitis dog
When I first see a pet with mild signs, I will go over with the owner when the problems first started. Usually, owners will realize that there was a -little- itchiness in the prior summer. “This year it’s a lot worse” is something I commonly hear. We have to rule OUT a couple of other problems as we work on finding out about environmental allergies. Allergy to food ingredients and allergy to flea bites can also cause similar signs in pets. I’ll discuss those another time. Once we rule those out, or if the history suggests that the problem is very obviously seasonal, we have a preliminary diagnosis of Atopy — Environmental Allergies. One last quick note on the source of allergens: indoor allergens can cause atopy, too. Things like dust, dust mites, dander, etc. I’m focusing on the outdoor stuff because it’s seasonal.

Treatment for allergies is two-fold. First, I generally have to apply a set of band-aids in the form of treating the symptoms of the allergy. I have to help stop the itching, calm down the redness and inflammation, treat infections, and make sure that all external parasites have been ruled out or treated. These things don’t treat the underlying cause of the allergy, though. They help treat the symptoms. For some patients, this is “good enough” for that first couple of years. We give an antihistamine in almost all cases. Supplementing omega fatty acids helps. Sometimes, medicated shampoos or conditioners are useful. We have sprays for the skin, as well as antibiotics and – if things are really ugly – glucocorticoid steroids.

Ultimately, these bandaids aren’t enough. We have to treat the underlying cause of all of these secondary problems. Treating the allergy itself means we have to outsmart the immune system. The immune system produces a specific type of antibody that hooks up to a specific type of cell in the tissue. When allergens like pollen come in contact with these antibodies, the cells burst and release inflammatory chemicals. Repetitive low-level exposure to pollens makes more and more of these little grenade cells ready to respond at the next exposure. Left on its own, the immune system is hoist by its own petard.

What’s needed is a way to stop the pollen from ever contacting the explosive cells. This is done with allergy shots. Technically, this is called hyposensitization therapy. We allergy test dogs/cats with blood or by intradermal skin testing. Most people are familiar with the little tiny injections that the dermatologist gives you to see how big of a welt your skin makes. This allows us to put together a custom cocktail of allergens that are then made into a vaccine of sorts. The pets are treated with a series of injections of the things they’re allergic to, which creates a LOT of antibodies that circulate in the blood and tissue. What this does is create a massive standing army of antibodies that are ready to all pile onto pollen before it can contact those grenade cells and make them pop. We’ve used the immune system’s response to the allergy-causing pollen to create a defense against the pollen, which protects the pet from the inappropriate overreaction of the immune system. Neat, huh? Simply put, ‘allergy shot’ are a vaccine for allergies.

We also have a medication available for treating allergies that takes the opposite approach. Instead of using the immune system and provoking a bigger response, this drug suppresses the immune system and stops the bad chemistry from happening to begin with. This drug is a specially altered version of cyclosporine that makes the drug go to the skin more readily. The only drawbacks are that this drug is quite expensive, and many animals vomit while on it. Still, for owners that don’t feel comfortable with the allergy shots, it’s a good option. The few times I’ve used it, it’s been very helpful.
Atopica dog logo
The take-home message for the day is: if it’s itchy, treat the -underlying cause- instead of just using bandaids. Thanks for reading!

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Oops! My dog’s pregnant! Now what?

I invited Valerie, one of our technicians, to submit a little essay for the post today. We had a number of cases last summer/fall in which female dogs were accidentally allowed to mate, resulting in an unexpected pregnancy and litter of pups. This can be an incredibly difficult situation for an owner, especially if they have no experience breeding dogs. Valerie has been breeding Labrador Retrievers for many years, so she’s got a lot of experience to share with us.

I think it’ll be helpful if I give some background information on the reproductive cycle of the dog. Dogs tend to cycle once or twice a year, starting at 6-12 months of age. This is commonly called a ‘heat’ cycle. During a cycle, the female’s reproductive tract ‘wakes up’ and prepares to have puppies. The resulting changes go through a series of stages that take about 3 weeks to complete. During the stage called “estrus” (heat), a female is very very interested in finding a mate. Males will show up from a long way off, and the female will be very receptive to romantic advances. Accidents can happen incredibly fast. In some cases, just one mating will be enough to produce a litter of pups. (Breeders actively trying to have a litter of pups will usually allow a series of breedings to increase the chances of a good litter of pups.)

A dog’s pregnancy lasts about 62 days. Just two short months from mating to puppies — it’s not much time for an owner to prepare for what could be a very very labor-intensive process. We spent some time a few posts back talking about the advantages of spaying a dog before her first heat, so I won’t belabor the subject again. Suffice to say that my personal opinion is firmly in the “don’t breed your dog” column as far as most owners are concerned.

I’ve added some extra notes in [ brackets ] to help out.

Here is Valerie’s contribution:

Hello! I just wanted to talk about what to prepare for when you have a dog that was bred and you have never had a dog who has had puppies before.
 
First of all, the hardest part is figuring out when she was bred and counting the days to delivery of the puppies.  Since you may not know your dog was bred, the first thing you might notice is your dog getting fat and her nipples getting a lot larger than they normally are. You may have noticed that she was in heat a few weeks prior.  This is probably a sign she is going to have puppies, so now you need to figure out when.

For example, you need to count from that night she got out and the neighbor said she was at their house all night with their male dog.  When you have figured out that day, you count about 62 days after, and that should be with 2 – 5 days of when she will have the puppies.  By time you have noticed her getting fat and her nipples getting larger she should be about 30 –  40 days along. [Note from Dr.H: Females are generally fertile in the 10-14 day portion of the 3-week cycle. So if you’re not lucky enough to know that your female snuck out for a date, you may have to just guess where the 10th-14th day of her cycle was and count from there.]

Start preparing before the puppies are due! Here are the things that you will need to do: 

•Read everything you can about whelping puppies!

•Prepare a whelping bed for her and get her acclimated to being in there. 

•Start feeding her puppy food [about day 30-40 and onward] for the extra nutrients she will need to feed her puppies. Depending on the breed of dog [and how big the litter is] she might need a extra meal during the day. [Poor nutrition can harm the puppies and cause serious, life-threatening problems for mom, too.]

•[An x-ray of the mom after day 42 will help you have an idea of how many puppies mom should be having.]

•Have plain thread and scissors handy.

•Have lots of hand towels. Try to have a little suction bulb.

When you are getting close to the 62nd day start preparing all the rest of the household (other dogs, other cats, and any children and people living in the house) to help watch her and know when she starts going into labor.  It is very important to know when she starts going into labor to ensure her safety and the health of the puppies. Usually a female will stop eating about 24 hours before having the first puppy. [There will also be a drop in her body temperature about 24 hours before labor. You should take her temperature several times a day when she is close to her due date. Signs of labor can be restlessness, panting, trembling, and then active contractions in the belly – mom’s pushing!]

Once active labor starts, be ready to help if you are needed. There should only be you and your dog in the whelping area especially if this
is her first liter. Too many people could make her nervous and she may stop pushing.  Do what ever you think you should do to keep her calm and comfortable while she is in labor, like petting and talking to her and stay right with her. A puppy should be born within 1-2 hours of the start of her contractions. If not, she needs to be taken to the veterinarian! [Generally, we say that 1 puppy per hour during active labor, or faster, is normal. Any longer than that indicates that there could be a problem.]
 
When she finally starts having the puppies, she will want to start caring for them right away. You can help mom to get the amnionic sac [a membrane that covers the puppy like a pouch] off. You can tie off the umbilical cord with some plain string about 1/2 an inch from the belly, then cut the rest off. A small suction bulb will help get mucus out of the puppies nose. Use hand towels to dry them vigorously.  [Puppies sometimes don’t want to breathe right away. Rub the heck out of them carefully to stimulate them and to get them breathing and crying. Crying means lungs full of good air!] Then get that puppy on a nipple ASAP.  The very first milk is important to help the puppy not get sick. Stay right with mom the whole time until the last puppy comes out.  It could be many hours, so get comfortable!  [Mom will pass placentas after the pups, sometimes between puppies. Just throw them out – she may try to eat them but this isn’t necessary.]

Caring for puppies after birth can be very easy if mom is taking good care of the puppies. It can be very hard if she is not or if the puppies have problems. Be prepared ahead of time so you know what to watch for and what to do. [Caring for a litter is a long enough topic that we will have to cover it another time.]
——–
That’s a brief introduction to whelping a litter! If you’re in this situation, contact your vet for information, advice, and backup. Don’t go it alone, especially if you’ve never had a dog have a litter before. You can research the whole process here:

Dog Breeding Basics

Pregnancy in Dogs

Normal Labor and Delivery

Caring for Newborn Puppies

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