Tag Archives: medicine

Double Header: Spring Fitness and Human Medications

Double Header : Spring Fitness and Human Medications

I normally wouldn’t do a double-topic like this, but I need to get something off my chest. It’s very very rare that I yell with my white coat on. Today, though? Yes. I’ll be blunt and quick about it:

 

DO NOT GIVE HUMAN MEDICATION OF ANY KIND TO YOUR PET WITHOUT SPEAKING TO YOUR VETERINARIAN FIRST.

Lethal consequences can and do result. Major damage, hospitalization for treatment, and significant costs are also potential outcomes. I don’t know a single veterinarian that charges for phone calls, and at the very least you can be stopped from making a blunder that kills your own pet.

Alright. Deep breaths. With that out of the way, this week’s longer topic was suggested by one of my patients. (Thanks, Ellie!) Springtime is coming in tiny increments, so Ellie is looking forward to longer walks and better weather. She does have some joint trouble, so we talked about how much exercise is the right amount. In contrast to my yelling above, this answer has a lot more variability.

The tipping point between good exercise and bad has to do with the condition a given individual starts in. Young and healthy? Old and arthritic? Heart disease? Injury or surgical recovery? Out of shape or overweight?

Serious consequences can occur from overestimating what your pet can tolerate. Even for healthy dogs, going from zero exercise to a full day of hard activity can be a huge problem. When muscles aren’t used to the level of activity being asked of them, they can easily become overworked and damaged. Damaged muscle releases chemicals that can damage the kidneys. Pets enduring high temperatures can also have this sort of muscle damage, so even light exercise in hot weather can cause muscle damage.

Thankfully, the answers to a lot of these different cases are simple. We’ll tackle them one at a time.

Young healthy pets should take up a fitness program gradually. This means that if there were no walks at all, don’t make the first one hours long, and don’t make it a full-speed run. Somewhere in the neighborhood of activity 10-30 minutes long, in comfortable temperatures should be tolerated fairly well. Just as we would gradually increase the duration or intensity of the workout, you can do so with your pet. If at any point, your pet seems to be lagging behind, or has flat-out stopped, it’s time for a rest! Sometimes, pets are so excited to be playing or walking that they will push themselves far harder than they should. You have to make an assessment of a reasonable duration and intensity of the activity. Always err on the side of caution!

Pets with orthopedic problems such as hip dysplasia, a torn ACL, arthritis, etc. should always stick with low-impact activity. Running or even walking on hard pavement can be enough to make them sore or limp. For dogs, swimming — actually swimming, not running on the beach — is a great way to exercise. Otherwise, slow walks of shorter durations are a good idea. I’d rather have an arthritis patient go for two 10-minute walks than one 20-minute walk if it’s at all possible. Keeping up muscle strength and mobility is critical for arthritis patients. We also have a duty to keep them from hurting. This may mean that some pain medication or an anti-inflammatory are part of the whole care plan. Owners with pets that have advanced arthritis or other bone/joint problems can also look into physical therapy. There are tons of options for PT for pets.

For pets that have more serious conditions such as heart disease or other organ dysfunction, each case has to be very carefully evaluated. It would be irresponsible of me to make any blanket statements or generalizations here beyond the advice that you should ask your vet about your pet specifically. A mistake here could push a heart patient into heart failure, for example. Obviously that’s not a good option.

One last caution for all of you who own pets with short muzzles — the brachycephalic breeds. Exercise can be particularly difficult for brachycephalics. It can also be dangerous. These pets have a heck of a time breathing as it is, and the massive turbulence created when they’re breathing hard can cause life-threatening complications such as welling in the larynx. I’ve seen many bulldogs that come in dying because their throats are swelling shut. It’s particularly dangerous in hot weather. Pugs, bulldogs, Persian cats, ShihTzus — go VERY gently and go in cool temperatures!

In closing, I’ll share two links to other spots on the web with information about exercising with your pets. Thanks again, Ellie! This was a great topic to cover.

ASPCA Exercise Guidelines for Dogs

Hill’s/Science Diet Exercise Tips for Dogs and Cats

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Local News – Detroit Zoo Gorillas

This week’s news article comes from the Detroit Zoo. The head veterinarian, Ann Duncan, cares for the zoo’s residents. One of the biggest jobs she has is to keep an eye on the heart health of the gorillas. Heart disease is a major concern for captive gorillas, so the zoo has worked on training the animals to have their hearts looked at via ultrasound. All of this is done without anesthesia — no darts, no drugs, just training!

Here’s a link to the article written by Robin Erb at the Freep.

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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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CPR – What can you do at home?

Keeping a cool head in the event of a life-threatening injury may be the only thing that gives your pet a chance higher than zero to survive.  The statistics are sadly pretty dismal.  About 6% of pets that undergo cardiac arrest survive to leave the hospital.  The aftercare of a successful resuscitation is incredibly important, which means that a pet MUST go to a critical care facility for intensive care after a resuscitation.

Six percent.  Why bother?  The blunt truth is that the reason for the arrest informs the likelihood of success.  A patient that’s very sick with cancer or organ failure or  heart disease isn’t likely to make it.  A younger animal in a trauma case or some other accident has a better chance of surviving.  I think it’s worth it if your pet is otherwise young and healthy.  Even if it’s not, it’s important for you as an owner to feel that you’ve done everything you can.  Trying CPR is one of the things that you can do wherever you are, including on your way to the hospital.

CPR (cardiopulmonary resuscitation) in pets is very similar to what is done in people.  Recently, the human CPR guidelines/instructions were changed.  Veterinarians have adopted the same recommendations for pets.  I’ll briefly go through the steps here.

First, you need to determine if your pet is breathing and has a pulse.

Breathing can be assessed by the rise and fall of the chest, or the motion of air through the nose, which you can feel with your hand on most dogs.  There is a breathing pattern called an “agonal breath” that is NOT actual breathing.  This happens when an animal has undergone arrest.  A pet may open its mouth wide and the chest may heave, but it’s not a normal breath.  I promise that if you see this, you will not mistake it for a normal breath.

The pulse is best felt on the inside of the thigh.  The videos below shows you where to feel for a pulse.  It will take a bit of pressure to feel the femoral artery.  My best tip for this is to find the thigh bone and move your fingers into the sort of groove formed by the muscles in front of and behind the bone.  The pulse may be weak and just barely there, but that still counts.  You can also put your ear against your pet’s chest, but there’s a caution with this strategy.  Hearing a heart noise does NOT necessarily mean that the heart is generating a pulse and circulating blood.

If you don’t have breathing, but you do have a pulse, you can start rescue breathing.  First, open the mouth and make sure there isn’t anything blocking the airway.  If there is, get it out before you start rescue breathing.  The next step is to close your pet’s mouth.  Seal your mouth around the nose of the pet and gently breathe out.  You only breathe out until you see your pet’s chest rise a little bit.  It is entirely possible for you to overpressurize the lungs and cause severe damage.  So, just enough breath to raise the chest a bit.  You should repeat two breaths every 4-6 seconds.   You can stop if your pet starts to breathe on its own.

If there is no breathing and no pulse, or just no pulse, you will need to start chest compressions.  This is where the guidelines have changed.  It was decided that chest compressions are more important than the breathing, so instead of airway-breathing-circulation, we have circulation-airway-breathing.

Compressions for most pets are accomplished with the pet on its side.  For dogs, you’ll want to place your hands on the chest right where the elbow would touch the ribcage if you pulled the elbow up and back.  It’s at the 4th-6th rib spaces.  Compressions should be done with you on your knees and bent over your pet.  Your elbows should be locked and you should have your hands placed one atop the other.  You’ll push the chest down about 1/3 of its total thickness.

Figure4a

Figure4c

Figure5a

(Images credited to the Journal of Veterinary Emergency and Critical Care.)

The pace of the compressions should match the beat for one of these songs:   Stayin’ Alive (Bee Gees), Another One Bites The Dust (Queen), or Cecilia (Paul Simon).  Compressions continue for a total of 30 compressions before you then breathe for your pet.  For very small dogs or cats, you can use one hand to perform compressions by slipping your fingers under the chest and “pinching” the chest between your thumb and fingers.  You will need to brace your pet’s back so that you can keep your pet in place for effective compressions.  For big round-chested dogs like bulldogs, you should position your pet on its back and compress the chest in that position, right over the breastbone, just like for people.

Compressions and breathing should continue for 2 minutes, after which you can reassess breathing and pulse.  If there is another person with you that can continue compressions after the quick check, you should trade off.  CPR is more exhausting than it seems, and it’s important that you don’t get too tired to perform effective compressions.

If, after 20 minutes, your pet has not had a heartbeat or breathing resume, it’s time to stop resuscitation.  If you become too exhausted to continue, then you’ve done all you can, and stopping is OK.

If you’re one of the lucky 6% and your pet’s heartbeat and breathing come back, get to the emergency hospital as quickly as you can.  Emergency-critical care is required because these pets need 24 hour monitoring and often fairly complex treatments.

Here are a few links to help review and show the CPR procedure.  Keep in mind that the recommendations have changed to be C-A-B instead of A-B-C.

The video below is a live dog that they’re demonstrating on, so she was absolutely incredible through the procedure. The timing of the breaths and compressions here is NOT too accurate compared to current recommendations.

The next video is a practice dummy. This is an older video as well, but there are good examples of how to locate the heart and how to breathe for your pet.

Cornell reports on the new recommendations, including timing and length of CPR.

AVMA info on CPR.

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More Cancer

Cancer was a prime topic for us at the hospital last week.  It’s frightening to think about all of the varieties of cancer that we see.  ANY tissue can give rise to a tumor or a cell line that is malignant: oral tissue, lymph nodes, a residual organ in the chest (the thymus), bone, liver, spleen, intestine, blood vessels, bladder, skin.  Those are some of the common types that we see.  I personally diagnosed an intestinal and oral tumor.  A specialist found the tumor in a dog’s chest that I expected to be there.  Not a good week.

On a positive note, there’s a lot that can be done for these cases.  As we’ve discussed before, “cure” in the veterinary oncology field isn’t common.  We can, however, give most animals and owners more time together.   Good time, in which the pets are feeling well enough to have good quality of life.

The other nice part about cancer is that when owners ask about it being contagious, I can say, “No, it’s not contagious.”  In all but one case, that’s a true statement.  There is one cancer type that’s contagious.  It’s a transmissible venereal tumor (CTVT), which is spread by sexual contact between dogs.  It’s a surface tumor like a nasty, bleeding wart.

The only other known contagious cancer is a tumor that affects Tasmanian Devils.  That one is spread by bites on the face.  It may well wipe out the Tasmanian Devil population to the point of extinction.

Jumping back to the dogs, an article was published this week that details some of the other interesting things that have been learned about CTVT.  It’s about 11,000 years old.  It arose from a malamute and showed that there was either inbreeding or an isolated population in which this cancer arose.  The rest of the article can be found here.

The take-home message here is this:  cancer is a nasty, wicked disease that we are still struggling to understand and cope with.  It kills 500,000 people a year in the US.  The more we can learn from other species, the better we’ll understand cancer in people, too.  The only hope we have for a cure is to continue to study and learn.

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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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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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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!

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Pet Poison Hotline

Petpoisonlogo

We recently received a great notice from one of the pet insurance companies that our clients frequently use. The company announced that they are now providing a 24/7 Poison Helpline for pets that are exposed to toxins.

The website is huge and full of great information for pet owners. There’s a Poison List, a guide to pet safety, and much more.

There is also a hotline that you can call for help if your pet has ingested or has been exposed to something potentially harmful. There is a fee for using the hotline, but it’s a very manageable $39. (This is in comparison to the ASPCA Poison Control hotline, which charges $65.) Both resources are excellent and provide vets and owners assistance if an exposure has occurred.

The Pet Poison Helpline also has an app! If you’re an iPhone/iPad user, you can see the app here. It’s reasonably priced at $1.99. The app includes a list of poisons/toxic plants with pictures.

This is worth a look, pet owners! At the hospital, we work on accidental exposures pretty regularly — at least once a month a pet eats something it shouldn’t have. Human medications are right at the top of that list. Pills get dropped, or meds get mixed up, and in some cases that could have serious side effects for pets and/or owners.

From the Pet Poison Hotline web page, here’s a list of the top 10 human medications that are poisonous to pets:

  1. 1. NSAIDs — aspirin, ibuprofen, (Advil, Aleve, Motrin)

    2. Acetaminophen — Tylenol

    3. Antidepressants (Effexor, Cymbalta, Prozac, Lexapro) *

    4. ADD/ADHD Medications (Concerta, Adderall, Ritalin)

    5. Benzodiazepines and sleep aids (Xanax, Klonopin, Ambien, Lunesta) *

    6. Birth control (estrogen, estradiol, progesterone)

    7. ACE Inhibitors (Zestril, Altace)

    8. Beta-blockers (Tenormin, Toprol, Coreg)

    9. Thyroid hormones (Synthroid, Armour desiccated thyroid)

    10. Cholesterol meds (Lipitor, Zocor, Crestor) *

* Some of these medications may be prescribed for a pet by a veterinarian. However, if your pet eats any of these, call the veterinarian or the hotline right away! The dosages may be VERY different for pets as compared to people.

Does anyone have any questions about medications or toxins? Go take a look at the website. I bet you’ll find something you’ve got around the house that could be dangerous to your pets!

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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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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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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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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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Rule #1

During veterinary school, my classmates and I came up with a list of ten veterinary-related rules. Some of these had to do with humorous events in school, but the #1 rule is as important now as it was then.

Rule #1 : Don’t Eat Poop

(No, really, it’s more complicated than you think. Many parasites are transmitted to other animals or humans through the GI tract and excretion of animals. Fecal contamination of the yard, beaches, and house doesn’t take much at all. If your dog’s feet are dirty when it comes in the house, it could be carrying in the eggs of various intestinal worms. They get on the carpet, or your bed, or play areas. It doesn’t take much to contaminate things that end up in our mouths. The potential is there, and I assure you that the risk is very real.)

The rule is phrased in such a disgusting way to make a specific impact. While stool isn’t appropriate for consumption — something I wish more dogs would realize — it can be extremely useful as a diagnostic tool. The article linked to below is a Q&A with a veterinarian about what we can learn from a stool sample. It’s worth checking out!

Veterinary Q&A: Poop as a diagnostic tool

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