Is My Dog (or Cat) In Pain?

I don’t get this question as often as I should. It seems like, on some level, people don’t want to know their pet is in pain, they just want to assume he’s ok. Outwardly the pet seems fine, so therefore he must be fine. Usually I get statements like “well, he’s not in pain because he’s not crying out or whimpering”, or “he’s just limping, sleeps all the time, and can’t jump into the car anymore, typical old dog stuff”.

Imagine you were rendered mute. You have a splitting headache, but you have no means to convey that your head hurts & you’ve got no way to treat it. You pretty much have two options: you can just accept that your head hurts and try to make the best of things, possibly avoiding things that make it worse, or just curl up and go to sleep and hope it’s gone when you wake up.

Nervous Chi3

 

That’s pretty much an animal’s life. In the wild, there is not much benefit to being sick or injured. Your pack might turn on you, you might get eaten by something else, you may starve to death. Animals are pretty hard wired to disguise illness and pain for as long as possible, so that they can perform their daily animal functions or they will probably die.

Domesticated dogs vary in their ability and desire to convey pain. Little foo-foo dogs may yelp like their being murdered when you pick them up the wrong way. Conversely, I have seen a goofy lab with a broken leg, bones literally sticking out of his body, just sitting there wagging his tail and giving kisses, like everything was A-OK.

Cats are even more elusive in their ability to display pain. Sometimes it’s as subtle as, the cat normally sleeps curled up in a little ball, but now it sleeps spread out flat, or just quietly lays there, like the Sphinx. They can have resorptive lesions: holes in their teeth that hurt so much that they still flinch, even under full surgical anesthesia. However, they still eat their hard food. They can’t tell you it hurts, they have to eat, so they just try to deal with the pain as best as they can.

Cat at Rest2

Clients often say “he’s just limping, but doesn’t seem to be in pain”. Limping is a way to deal with pain! If it hurts to put the foot down, the pet is modifying his behavior so that it hurts less. Dogs and cats with back or joint pain may or may not limp. Again, they just modify their behavior, they may stop jumping, sleep more, be stiff or have a hard time getting up.

Old Lab2

Sometimes we vets can’t tell what hurts either, we may do a therapeutic trial with some pain meds to see how the pet acts. Often the client calls back and says the pet is acting like it is young again! Running, jumping and playing like the good old days.

As recently as the 80’s, veterinarians didn’t have much of a grasp of pain management for their patients. Honestly, until the last 30 years or so, scientists didn’t think animals felt pain like humans do. Researchers discovered that animals do feel pain plenty fine, they just can’t tell us. We veterinarians started just assuming that if it hurts a human, it probably hurts the pet, so let’s manage their pain accordingly. The difference between an animal waking up from surgery in the 80’s with no pain meds on board, and one now, with careful administration of opioids, non-steroidal anti inflammatories, and other methods is pretty stark. Patients are happier, they heal faster, they eat sooner.

Colorado State University College of Veterinary Medicine has come up with these nifty charts to help assess the pain level of patients:  chronic canine pain , acute canine pain and feline pain.

Looking at the chart, you’ll notice that by the time the pet is whining, crying, screaming or otherwise vocalizing, it’s likely to be in excruciating pain.

How about we NOT let that be the time you decide that maybe the pet is in pain and should see the vet? There is a lot we can do before that pain becomes unbearable to help improve pets quality of life and happiness.

 

 

…And the Vets Were All Nestled All Snug in Their Beds While Visions of Flu Vaccines Danced in Their Heads.

ChristmasPuppy2

So I’m taking a break from my holiday preparatory madness to provide for you, a quick and dirty assessment of the situation regarding the flu outbreak in Austin.  I saw the story, the pretty reporter lady with her eyes wide, projecting fear and concern, urging pet parents to contact their vets right away, for this flu is deadly! The tone of the story was: super-alarmist media fear mongering, with a heavy emphasis on the vaccine.There is even an article in the New York Times about  vaccinating your dog for the flu. It’s a regular media frenzy! Our pets are in grave danger!

Here’s the thing that’s driving me crazy, two veterinary pharmaceutical companies JUST released their brand-new H3N2 vaccines LAST MONTH. I have a sneaky suspicion that these companies are issuing press releases regarding active cases and creating all this hysteria TO SELL MORE VACCINES. I’m getting frequent, gleeful emails from one of the pharma companies’ reps with sensational updates on the “outbreak in Austin”, including links to the news coverage. I swear she seems pretty excited about it all, I can imagine the dollar signs in her eyes.

I’m sure the vaccine is fine, and we will have it by Monday, and we recommend that you vaccinate dogs who are at risk (dogs who board frequently, go to the groomers, travel to areas with active cases, show dogs etc.)

Bear in mind, there are two canine flu strains,  H3N8 and  H3N2. There are vaccines for both strains. The newer vaccine is for the H3N2, Asian strain that is currently being seen in Austin. We have the H3N8 vaccine in stock but don’t use much of it because there have been no cases in our area in years.

We have a protocol in place should an actual outbreak occur to minimize the risk of it spreading within the hospital. We will step up and adjust our vaccine recommendations according to risk factors,  and number of active cases as needed: If the Austin outbreak proves to be severe and begins to spread, we would likely expand our recommendation to include all healthy patients, not just ones who board, etc.

Here is a map from Cornell University showing the areas where flu tests have been submitted as of September 2015. The grey dots are tests, the orange areas are where there have been positives for the H3N2 flu. No positives in Texas as of September (there were a few in the Houston area earlier this year). Obviously there are now cases in Austin. If you’re traveling there, maybe don’t take your dog? If you do, vaccinate it, but your dog won’t be protected for about a month.

Bear in mind, this is a brand new vaccine. We don’t know anything about side effects, or effectiveness. Word on the street is that it may not prevent your dog from coming down with the flu, but it should lessen the severity.

Regarding the Austin cases, one of my classmates saw about a dozen of the flu infected dogs from the affected kennel.The virus is definitely very contagious. She said the cases she saw looked like severe cases of kennel cough. No deaths or even hospitalizations.

So calm down, there is plenty of other stuff to stress about this time of year. I think this situation is under control. We promise to let you know if anything changes.

Here’s to a happy, safe, healthy and only minimally stress-laden holiday season. We at Animal Medical Center of Plano wish you all the best.

I will now resume my regularly scheduled holiday madness.

UPDATE#1: A colleague just sent me this link from a local news source claiming that there is a positive case in Plano. We have not been able to confirm this, so as soon as we find something out, we will let you know. Might not be a bad idea to avoid dog parks, and other high dog density areas until we get an idea what is going on.

UPDATE#2:Just spoke with the Arlington Humane Society (who made the claim that Plano has a flu case). The gentleman I spoke with said that he heard there are dogs in Plano who have been recently TESTED for influenza, but no positives yet. Apparently, he was on a conference call with other shelter vets who say that there is a big problem across the country with shelter outbreaks of the H3N8 flu and his concern is that it will spread beyond the shelters into the pet dog population, thus the big push to vaccinate. So, still no confirmed flu cases in the Dallas area yet. At least one of my Shelter Vet contacts has not heard of a  big flu problem in local shelters either. This still smells a little like vaccine manufacturer manufactured hysteria to me.

 

Some Thoughts on Cosmetic Surgeries on Dogs.

I am mighty and my ears are natural!

I am mighty and my ears are natural!

A client came in the other day with a super cute baby Mini Australian Shepherd. She was unhappy because someone had cropped the pup’s tail too short. She wished that they hadn’t cropped the tail at all, but she couldn’t find any pups with tails intact. The conversation reminded me of my first experience with canine cosmetic surgery.

My first job, at age 15 was at Atascazoo Animal Hospital in Humble, Texas. I had eagerly been counting down the years until I was old enough to work for my family veterinarian. I remember standing in the exam room, maybe 9 years old or so, and I asked our vet, Dr. Kiker, what I needed to do to be a veterinarian. She said, and I remember this like it was yesterday: “Make good grades and work at a veterinary clinic”.  So that’s what I did.

I was hired as a kennel assistant making a whopping $3.25 an hour (late 80’s minimum wage). On my first day I was asked to assist with an ear crop surgery on a Schnauzer. Back then, they used injectable pentothal for anesthesia. Basically they taped a syringe full of anesthetic into the dogs vein and injected some every time the dog started to wake up.

Oh and in case you didn’t know: when cut open, ears bleed.

Ears bleed a lot.

A whole lot.

My job was to hold up the ear so Dr. Kiker could cut the flappy part off, giving the dog (once healed) the characteristic pointy ears we associate with the Schnauzer breed. There was blood everywhere, and when the dog’s anesthesia got light, he started to shake his head and blood flew everywhere.

The sight (and sickly sweet, vaguely metallic smell) of copious amounts of semi-congealed blood was new to me at the time, so I proceeded to turn white as a sheet, become dizzy, and get promptly excused from my surgical duties and sent into the doctor’s office. I was calmly instructed to sit with my head between my knees to regain my equilibrium and composure. My pride took a more lasting hit. Immediately I questioned my career choice. Almost fainting on day one: maybe veterinary medicine wasn’t the field for me.

Fortunately, I stuck with the job, and never had any more queasiness at the sight of blood. (Well, animal blood, I don’t do so well with human blood).

This experience did, however, create a life long aversion to unnecessary cosmetic procedures on dogs. Particularly ear crops and tail docks.

So much so that in 10th grade Government class, when given the assignment of writing a letter to our state representative, I penned a heart felt missive to none other than future Governor, coyote sharpshooter and unsuccessful presidential candidate, Rick Perry. I implored him to please consider passing legislature to ban the cosmetic cropping of ears and docking of tails in our pets. I was convinced that my impassioned entreaty would result in sweeping changes and legions of beautiful, happy, fully-eared and tailed Dobermans, Schnauzers, Cocker Spaniels and the like. I’d be a hero to dog-kind!

Unfortunately, Mr. Perry sent me a form letter, thanking me for my request, but basically stating that he had bigger things to worry about than snips and snails and puppy dog tails (and ears).

Fast forward 25ish years, I still hate those procedures. Dr. Sharp stopped cropping ears years ago (I’ve never cropped an ear). It’s pretty hard to find any veterinarian in the area who still performs the surgery. I feel like I’m seeing more un-cropped dogs, particularly Schnauzers. Hopefully those are signs that the procedure is falling out of favor.

There is no medical reason to crop the ears on these dogs. If predisposed, they will get ear infections either way. Frankly, if there is any dog that would benefit from an ear crop, it would be a Cocker Spaniel to get some air down there into those canals, but that’s just part of their chronic ear problem picture (the other, bigger part is a strong predisposition to allergic skin disease). Same with the tail docks, have you seen a Cocker Spaniel’s natural tail? It’s a beautiful fluffy thing. Dobermans have kind of thin funny whip tails, but that’s ok. Those dogs with tails are so happy to have them, they just flap them around with reckless abandon.

These cosmetic procedures are illegal in Europe and Becoming illegal in Canada. From what I understand, the biggest hindrance to making them illegal here is the American Kennel Club. They insist on maintaining these antiquated “breed standards”.  I find this to be astonishingly inexcusable. For Pete’s sake: CHANGE THE STANDARDS! They changed them in England, where it’s illegal to show a dog WITH cropped ears!

Regarding the ears: Doberman and Pit Bull owners give me the most pushback when I discourage them from getting their dogs’ ears cropped. The owners want the dogs to look “tough”. Personally, I think that’s a weak argument. I’d be just as scared if chased by a growling, barking natural ear-ed Doberman as I would be for a cropped ear-ed one.

So ear crops and tail docks on dogs are unnecessary, painful, and really look pretty ridiculous. I know humans put themselves through unnecessary, painful procedures, that in some cases produce ridiculous looking results as well (insert name of aged entertainer, who’s had one too many facelifts). However, the humans have a say in the matter. Not the dogs.

Guest Post from our Newest Veterinarian, Dr. Rachel Cook

Dr. Cook joined our staff this summer, after graduation from Texas A&M College of Veterinary Medicine. I have to admit, that I was less than thrilled about having to deal with a fresh, enthusiastic new veterinarian. However, Dr. Cook has been fantastic. She’s smart, articulate, dedicated, enthusiastic (but not annoyingly so), and super, duper nice.

Now I’ll let her do the talking:

Hello y’all!!! I am Dr. Cook, and I am very glad to be writing this post today as a Guest Blogger! I graduated from Texas A&M in May and have been working here at Animal Medical Center of Plano for over two months now. I absolutely love it here and am so grateful to be a part of this practice and your pets’ lives. I have met many adorable dogs and cats in this time and have enjoyed meeting their family members who bring them in to see me. It has been a great two months!

As a new veterinarian, you begin each day wondering what patient will walk through your door… Today, I want to share my “Top Ten List” of what I’ve learned and experienced thus far as a newly minted veterinarian.

10.    Though we never want our patients to be ill with a dire need to see us, there is nothing sweeter than getting to see our patients on a regular basis. I have really enjoyed getting to see my patients on multiple occasions since I started at Animal Medical Center. These visits have included recheck visits and numerous vaccination series. It is such a pleasure to see my patients’ health improve and to build a friendship with them. Of course, the little puppies and kittens are an absolute joy to watch grow up. But I also enjoy getting to see the calm, adult dog or cat who knows his or her place in the world and is just happy as can be.

9.     Some patients don’t love to come to see the veterinarian. AND THAT’S OKAY! Just a part of life. I don’t blame them or discredit that nervousness. But we want every patient’s experience to be a good one when they come here. That’s why we take the time to move slowly with our patients, offer treats, and give a lot of attention to our patients. Some dogs or cats may be aggressive and scared in the clinic, so for some patients, it is best to sedate them for a full examination for their own safety and to reduce the stress that animal may be feeling.

8.     Fleas are crazy this year. Flea allergy manifests as very itchy and uncomfortable skin infections in our dogs and cats. Flea allergic dermatitis is an easily prevented problem. Just the monthly flea prevention (which is easily combined with the monthly heartworm prevention) is all they need! PLUS by controlling fleas, you also prevent your dog or cat from getting tapeworms…. For an animal to get tapeworms, the animal must eat a FLEA which has a tapeworm…. It’s a yucky, convoluted life cycle!

Which leads me to my next nugget of wisdom:

7.     Intestinal parasites are not just an academic topic…. They are infecting our pets and are making their presence known. Intestinal parasites are a common reason for our animals to have diarrhea, most commonly affecting our puppies and kittens who inherit these gross gifts from their mothers or environment. (Thanks, Mom!).  Our younguns should be dewormed at least twice and should have a fecal test submitted to be sure they are free of parasites. A yearly fecal test gives us assurance for our adult animals, but it’s good to remember that our monthly heartworm preventatives prevent many common intestinal parasites! Anyways, although every creature has a beautiful reason for living, I cannot find a good reason for the existence of these disgusting parasites and wish they would just disappear…

6.     Since our animals cannot speak to us directly (though my Boston terrier, Major, definitively communicates with me very clearly), a veterinarian’s diagnostic tools (bloodwork, x-rays, aspirates / cytology using the microscope) are invaluable. I wish that I could just know what is going on with an animal who seems “off” and “isn’t feeling like himself or herself.” But it is often our diagnostic tools that point us in the right direction and paint a picture of what is going on for that particular patient. I have examined multiple cats and dogs for acute vomiting since I started at Animal Medical Center of Plano; these animals had no evidence of any organ dysfunction on their physical examination. However, their bloodwork may show that their kidneys are failing, or x-rays may show that the intestinal is obstructed by a squeaker toy.  Such a crucial, important diagnosis.  I am so grateful for my hospital’s tools that help us know what is truly going on with our patients.

And following that note….

5.     We will be using ultrasound technology in our clinic very soon. Ultrasound is often referred to many people as sonograms as this technology is used by human doctors to visualize babies in utero. Veterinarians are trained to use ultrasound machines to evaluate animals’ gastrointestinal tracts, kidneys and urinary bladder, reproductive tracts (including pregnancy checks), and more. This is an exciting opportunity for our clinic to be able to diagnose more clearly what is going on with our patients.

4.     When an animal has a growth / tumor / mass on its body, many of these masses have the potential to become cancerous and even scarier, to metastasize (invade other parts of the body). The best thing to do in these situations is to remove this tumor surgically. After surgery, we submit the sample to a laboratory which examines each part of the tumor to identify what type of tumor it is and if any of the tumor remains in that animal’s body. Let me just say it for the record now::: there is nothing more satisfying than having clean borders on your histopathology submission. This means that there is no detectable tumor remaining in the patient’s body. AMEN! That is our goal every time we go to remove a growth.

3.     Anal glands are just pesky little sacs of nonsense. There is no good reason for them. Maybe they are used for scent, territorial marking, and communication…. Or maybe they exist to get sprayed onto my lab coat from time to time. Animals should normally express their anal glands on their own without any trouble. But some animals (typically our smaller breed dogs or sometimes an overweight patient) don’t completely express their anal glands as they should. Problems with anal glands are diagnosed upon physical examination by your veterinarian. But at home, if your animal has an anal gland problem, you can watch for your dog or cat licking near their rear end more than usual, scooting their rear and dragging it on the floor, or even just looking more towards their rear end.

2.     The most frequent reasons for animals to come to the veterinary clinic are EARS, SKIN, AND GASTROINTESTINAL issues. These types of illnesses are very common for our pets! Just a few diagnostics to understand if any type of infection is going on with that patient, the appropriate therapy, and time makes these cases very rewarding to treat.

And Last but not least: 1. Each day, at Animal Medical Center of Plano, we strive to be better veterinarians.  This means that we are always talking about disease processes, medications, and interventions and what works best in our patients.  On a daily basis, I enjoy my discussions with Dr. Sharp, Dr. Carroll, and Dr. Brewer. You can find us reading, researching, and attending Continuing Education, because we want to do the best for our patients.  Thanks to this profession, I know that every day I have the opportunity to learn something new. Science is always advancing, and it is my intention to always stay with it.

I truly am living my dream, and I enjoy each day with my patients and their families!  I look forward to more experiences (and maybe a few more “Top Ten Lists” Letterman style) here at Animal Medical Center of Plano! Thank you for welcoming me into the practice!

Katelin’s Adventures in Hospice Care

So my 16 year old dog, Katelin has been dying on and off for about the last six months now. Shortly after my dog Scully died of kidney failure two years ago, Katelin apparently decided that looked like a pretty good way to go & proceeded to go into chronic renal failure herself. I did a little blood testing to confirm the diagnosis & rule out the slim chance that it was Leptospirosis (a treatable, bacterial cause of kidney failure), put her on Hills K/D diet (prescription kidney diet) & called it good.

I love this picture of Katelin, taken by my friend Lauren.

I love this picture of Katelin, taken by my friend Lauren.

She held her own for a good year and a half, even getting a little thick on that good fatty food, I usually keep my dogs pretty trim, but I figured I’d fatten her up in preparation for the inevitable time when the disease worsened and her appetite started to wane. Things started to change around last December, she started to decline a little. She was sleeping more, and had gotten picky about her food.

Then we began the remodel from Hell. (A 4 month process that involved ripping about half of my house apart and putting it back together). The dogs spent a lot of time either boarding or in their cages. I think for Katelin, it was about the equivalent of taking a content old person out of their house and sticking them in the nursing home. Her eating habits got more sporadic and she started to lose weight.

Oh and a week or two into the remodel, we lost her. We couldn’t find her anywhere, I thought she had slipped out via one of the workers. I had heard her barking like she was trapped in a bedroom, but couldn’t find her anywhere. After a frantic search, as a last resort I went to ground zero of construction: upstairs in the attic/former game room, which was generally behind a closed door. While looking around for her, I noticed a hole about a foot in diameter that the workers had cut into the floor. Surely she didn’t fall in there, I thought. Sure enough, one look with a flashlight, and there she was, wandering around aimlessly…inside the wall, two stories down. Miraculously, she had slid twelve feet down an AC duct to land safely on the cement floor below. The contractors had to cut a hole in the downstairs wall to get her out, unharmed.

Here's the hole in the floor where Katelin had her adventurous slide down the AC vent into the wall.

Here’s the hole in the floor where Katelin had her adventurous slide down the AC duct into the wall.

We took Katelin with us to Galveston over Spring break. Scully decided to die while I was on vacation, and I wasn’t too keen on going through that again, so she got to go see the beach for the first time (we thought it would be a good idea to kick some things off of her bucket list).

It's cold, wet and sandy. She wasn't thrilled, but was happy to hang out with us.

It’s cold, wet and sandy. She wasn’t thrilled, but was happy to hang out with us.

It was during this trip to Galveston, that Katelin decided that life’s too short to eat dog food. Specifically: her new mantra is  “human food or nothing”. Not just any human food, mind you, I actually looked up and formulated a particular home made diet formulated especially for kidney failure. The diet was a mixture of rice, hamburger meat, a little bacon grease for flavor & some vitamins and stuff. I am now a crazy person who cooks for her pet.

“Screw that”, said Katelin, “I want steak.”

Sometimes it's just nice to be at the beach and feel the wind in your ears.

Sometimes it’s just nice to be at the beach and feel the wind in your ears.

We started “watering the dog”, as my husband describes giving her Sub Q fluids (fluids under the skin to keep her hydrated). Part of me just wants to let the disease run its course, but she’s my favorite dog, so I cave to family demands to keep her going. She’s basically on life support.

At this point, Katelin is officially in hospice care. She rallied once the horrible remodel was over, she felt better, but still wouldn’t eat dog food. She mostly eats, within reason, whatever we eat for dinner. Her default meal is spaghetti and meat sauce. I do not recommend this diet to clients, she is under the care of a trained professional who understands the potential outcomes of this particular diet lifestyle (pancreatitis, gastroenteritis, etc.). However, we pretty much figure that every meal could be her last.

I do try to keep things not too spicy or fatty. We did have one accidental breach of this guideline one evening when I wasn’t present to supervise feeding time. I arrived home from my meeting and asked my son what Katelin had for dinner. He happily responded “chicken fetuccine alfredo! She loved it!”. Something in my expression of horror cued him that this may have been a bad idea. “But I thought you brought it home for her?!” He exclaimed. “No!” I responded: “It was for your brother!”

I resigned myself to the fact that I had just nursed her through a year and a half of kidney failure, only to kill her with pancreatitis. I gave her a dose of fluids, the family gave her extra hugs, went to bed, and hoped for the best. For whatever reason , she was better than ever the next day. Another bullet dodged. (NEVER feed your dog fettucini alfredo, I absolutely do not recommend this).

Summer travel has been challenging, finding a pet sitter willing to watch a dog who could die at any moment is tough. Not to mention  the addition of cooking and portioning a vat of spaghetti and meat sauce to my already lengthy list of pre travel chores. My pet care instructions are the lengthy diatribes of a crazy person.

Kathleen accompanied us on a few road trips this summer.

Kathleen accompanied us on a few road trips this summer.

Katelin had another setback this summer, when after a 4 day trip to San Antonio with friends, I was informed by my college-age pet sitter that he had forgotten to come feed the dogs. Thankfully, they had free access to water and a dog door, but Nixon and Katelin starved for 4 days.

Katelin looked like hell. We thought “this is it”. Perry, my youngest had to go to a 4 day Cub Scout sleep away camp.  I wasn’t sure the dog would be alive when he got back, but he made me promise to try and keep her going. We all said a tearful goodbye when we left to drop Perry off, we weren’t even sure she’d be alive for our return. Perry took pictures of her with his iPad before he left, one of the saddest things I’ve ever seen.

I got this wild idea in my head, to make Katelin a vat of “Jewish Chicken Soup” out of some roast chicken leftovers in the fridge. I learned about the “miraculous” healing powers of this soup from binge watching Nurse Jackie with my friend Jennie earlier this year (granted, the guy in the show, who ate the soup ultimately died, but he died happy).  I didn’t have anything to lose and a spare chicken carcass, so what the heck. I’d like to mention, that I have never made chicken soup for my family, but here I am making it for the dog.

The princess gets her soup, presentation is everything. She leaves the veggies for the young dogs to eat.

The princess gets her soup, presentation is everything. She leaves the veggies for the young dogs to eat.

Once again, for whatever reason, Katelin rallied.

My friend Amy said that it Katelin was a human, she’d be an old lady who wears a red hat and reads Nitsche. I love that.

So I am currently embroiled in the old dog emotional roller coaster. The anguish of the bad days and the joy of the good ones. The selfish wish that she would just die in her sleep one night, so I don’t have to decide anything.

There is a point to all of this rambling. We, as veterinarians have a huge role in the end of our patients’ lives. We’re there at the bitter end, with our syringe of “pink juice” (AKA: euthanasia solution). We usher those beloved souls to The Rainbow Bridge & try to help our clients at that time.

However, there is a lot more to losing a pet than that final moment with the vet. There are last days, months or weeks, that are both sweet and heart rending. Your vet can help you during this time too, hospice care is a “thing”. Discuss it. The goal here isn’t to do a bunch of heroics or diagnostics, but to keep the pet as comfortable and pain free as possible.

When fortunate enough to get that “hospice time”, while it does suck, it’s also nice to just unabashedly love and spoil that old dog until the time comes to say goodbye.

The hardest part is letting go.

Update: Katelin passed away on September 12, 2015. She was a good dog & will be missed.

There's nothing like loving an old dog.

There’s nothing like loving an old dog.

Dog Flu is in Texas, Is it Time to Panic?

This is the sort of behavior that could spread the flu.

This is the sort of behavior that could spread the flu.

I wrote a few weeks ago about the Chicago area H3N2 Canine flu outbreak. According the the message boards on the Veterinary Information, new cases out there seem to be slowing down.  However, like a game of biological agent Wack-a-Mole, the virus starts to fade from Chicago, only to pop up near Houston.

Texas seems to be a great place for the appearance of scary outbreaks, as evidenced by our Ebola experience, a few months back, and even Bluebell Ice Cream’s Listeria debacle.

Frankly, what is it about Texas and media-worthy diseases?

Here are the facts as I know them:

A dog in Beach City, Texas (south east of Houston, east of Baytown) tested positive for H3N2 strain of influenza on May 8, 2015. The owners moved to Beach City from the Chicago area on April 28, 2015.

Clinical signs of influenza in dogs include:

  • high fever
  • decreased appetite
  • cough
  • nasal discharge
  • lethargy

The incubation period is 2-4 days. Clinical signs last about 4-7 days.

Cats can be infected, but so far there have been no feline cases.

Treatment is generally supportive: antibiotics, fluids, etc. Usually this disease manifests as a mild to moderate upper respiratory infection. However, in some cases, particularly the very young and very elderly (just like in humans), the symptoms can be severe, leading to pneumonia and death.

The Canine Influenza vaccine that we currently have access to DOES NOT cross protect from the H3N2 Asian strain of flu found in Chicago and now Beach City. (This is contrary to what the Houston News is reporting.The Dallas news station got it right, though) The current vaccine protects against the H3N8, or United States Influenza strain, and cross protection has not been established. This doesn’t surprise me given the issues we have with the different human strains of flu and human vaccines. Interestingly, in an interview with NPR, Dr. Edward Dubovi, virologist at Cornell University supposed that the H3N8 Strain may have come over from Asia via rescue of dogs from the meat industry.

The disease spreads through direct contact with respiratory secretions (cough, sneeze) or infected surfaces (kennel surfaces, water bowls, collars, leashes, etc.). The virus can live in the environment for 48 hours, on clothes for 24 hours, and on the hands for 12 hours. The virus is easily killed by regular disinfectants: Lysol, bleach, etc.

For more information: The AVMA has a great web page on Canine Influenza.

So what do I make of all this? So far it’s just one little ol’ case, in one little ol’ town near one of the biggest metropolitan areas in the United States. Well, I think we are going to have to wait and see. The virus is really contagious, and brand new so dogs, having no inherent immunity to it, will be very susceptible. Say that dog in Beach City sat in the full lobby of the vet clinic, coughing his lungs out. There is a good chance any dogs in that lobby will catch it. Some of those dogs will go to the dog park when they are early in the infection process and spreading the most virus particles, their owners just assume it’s allergies or something. The dog coughs and spreads the virus to all the dog park dogs, who then go home and spread it to the neighbors dogs they love to play with in the yard, who go to their vets and infect those dogs in that lobby and so on and so on.

I’m worried this will get worse before it gets better, but just like in a human flu outbreak, we have to be smart and be careful. Should this thing really start to spread, it might be prudent to avoid areas where dogs concentrate: dog parks in particular. Kennels, grooming facilities, shelters are also areas we have to be very careful with and possibly avoid. What cleaning precautions are they using? Are they isolating/sending home any coughing dogs immediately? Summer boarding season is almost here. The Chicago outbreak really got going over Easter weekend, lots of dogs in boarding kennels.

We veterinarians need to be vigilant now. Travel history of patients is important. If any vets read this blog: Idexx and Antech both do strain specific flu testing (Idexx added it to their Canine Comprehensive Respiratory PCR panel, Antech sends out to Cornell). We’ve got to be a lot more careful with patient isolation. Chicago area veterinary clinics took measures including: examining all respiratory cases in the owners car,  or seeing respiratory cases at the end of the day to minimize exposure to other patients. The sick dogs are treated as outpatients whenever possible, often referring the really sick ones to emergency/critical care facilities with good isolation wards.

So, bottom line: This isn’t armageddon or the zombie apocalypse. It’s the flu. Not pandemic dystopian future flu. It’s a new flu, yes. It’s a little scary, and it could get ugly, but with some preparation, knowledge, and common sense, I think we can handle it.

Is it flu or just kennel cough? My vet can figure this out.

Is it flu or just kennel cough? My vet can figure this out.

Back from the Dead

Not really back from the dead, but like Persephone in the Greek myth, I have been to Hell and back.  Well, not quite that bad. There were no pomegranates and no angry Greek Gods involved.  Since January 6th, we have been immersed in a nightmare remodel. “it will only involve the upstairs”, “you won’t even know we are here”, assured my contractor.  We just got to see the big reveal at the end.  6-8 weeks tops.  Not to bore you with the details, but we are currently 14 weeks in: we had no heat for 9 weeks, homeless for 4, the whole family, including the dogs lived in one room for about 12 weeks, it rained in the house, (oh and they discovered a new leak yesterday), and has involved every single room but the master bedroom. Like the HGTV shows (as everyone likes to remind me, or like the 80’s , movie “The Money Pit”), everything that could go wrong went wrong.

I think I hate my contractor, but I can’t share this because he’s not done yet. Pretty sure he doesn’t read this blog, though.

Anyhoo, sorry for the lack of posts.

In the meantime, I did get an iMac for Christmas, so I’m learning how to use it.  I just bought a book on how to do this.

On to veterinary topics: There is a canine flu outbreak in Chicago. I don’t live in Chicago, never been there. I hear it’s nice, except for in winter. I think the “Divergent” series takes place in post-apocalyptic Chicago. President Obama is from there.

Now they are ground zero in the latest scary outbreak.

According to this AAHA article (and I’m in a hurry to get this out before tonight’s cub scout meeting so I keep forgetting to check “open link in another window” , so sorry.)  There are about 1000 sick dogs and 5 deaths.

This article notes that this is a new strain of canine influenza that comes from Asia.

Thus, I’m not sure, in my professional opinion, that the commercially available flu vaccines will cross protect for this. I’m reading up on the latest news on VIN, but it’s time to feed the family in anticipation of Scouts.

More tomorrow (if I can squeeze it in between viola lessons, orthodontist appointments, and other joys of parenting).

Oh and just now, the wood-floor guys (repairing damage from another contractor screw-up) informed me they have no idea what color my existing floor is, so they will “try to match it as best they can”. Fantastic.

Don’t remodel.

Some Christmas-Time But Non-Christmas-y Cautionary Tales

Happy Holidays! Most wonderful time of the year, right? Not so much if you ask your friendly neighborhood veterinarian.  The months of November and December mark an inexplicable peak in the number of euthanasias we perform.  Not super sure of the cause, but for some reason, old  pets don’t fare well over the holidays.

If that isn’t cause enough for a jolly veterinary demeanor, I got a letter last week from a giant internet image provider whose name I won’t mention because they would probably threaten a law suit over that. Their name starts with “G” and ends with “Y” and rhymes with “petty”.  I had posted a picture of a flea on our clinic website. I made what I now realize is a huge mistake in judgment by just searching for an image of a flea via Google and cut/pasting it into the post.  Of the hundreds of images I could have picked, I got some super private, über copyrighted one that only this company owns (granted, there was zero indication as such on the image).  I totally understand, I made a mistake and corrected it by removing the image and offering to pay fair market value for this flea picture. However, they declined and insist we pay a hefty ransom or be sued.  According to my husband’s IT guys, this is a tactic that this company uses to boost revenue. They are “fishing” for unsuspecting shlubs like us to grab their images so they can sue us.  It seems that December is “target veterinarians” month for this company because I got a call this week from another vet suffering the same fate.

Lesson learned.  The purpose of that tale is mostly to warn you guys about the dangers of unauthorized use of copyrighted images online. (And partially to vent a little to you guys, my merry, small band of readers. I’m pretty embarrassed about the whole debacle.)

Since I’m being quite the “Debbie Downer” (Copyright “Saturday Night Live” Character??)

Here is another, more important, cautionary tale for you. This one is actually a veterinary topic:

Beware of potato chip and other snack bags.

I can personally think of several pets of clients and friends who have suffocated due to these bags.  The other day I woke up and heard this incessant crinkling sound.  I followed it to the guest bedroom, where my 1 year old terrier mix “Nixon” had her head buried in a now empty bag of salt and vinegar chips.  She was happy, happy, happy to be polishing up the unbearably tart remains.

Since I can't download any pictures off the web, this is a staged reenactment of the described events. No animals were harmed in the making of this picture.

Since I can’t download any pictures off the web, this is a staged reenactment of the described events. No animals were harmed in the making of this picture.

Problem is that the dogs are so happy that they don’t notice that they are running out of air, and they quietly pass out and die with nary a fuss.

Thank God I got there early. The bag was my husband’s (nobody else likes those chips), and he’s not a fan of Nixon’s, so after accusing him of trying to kill the dog (which he wholeheartedly denied) I educated the family about proper chip bag disposal.  The incident also reminded me that I have been wanting to post about this topic for a long time.

Here is a Facebook Link to a page on the topic with more information, plus lots of sad stories to wallow in, if you would like to be further depressed.

Just to end on a happy note, here’s a link to an old blog I wrote on the Veterinary 12 days of Christmas. It’s an oldie but a goodie.

Happy Holidays/Season’s Greetings/Merry Christmas/Happy Hanukkah/Happy Kwanza/Happy Solstice, etc.!  May you get some rest, purchase all the right teacher gifts, not run out of tape or wrapping paper,  minimally argue with family, and not gain too much weight.

PS: If you subscribe to this blog and are getting a flood of updates on old posts, I’m having to go back into my archives and remove any possible unauthorized images. Sorry for the subsequent inundation.

A Vets Convoluted Thoughts on Bentley the Ebola Dog

I don't have time to find a royalty free Ebola image, so this drawing of a pink Ebola virus with a dog jumping over it will have to suffice.

I don’t have time to find a royalty free Ebola image, so this drawing of a pink Ebola virus with a dog jumping over it will have to suffice.

So today we venture into the current events vortex that is Ebola.

I live in Dallas. Well, actually I live 20 miles outside of Dallas, in the suburbs, but it might as well be ground zero given the level of hysteria that occurred when Dallas deputy Sergeant Michael Monning went to the local Care Now last week with Ebola-turned-stomach-flu.

I’m actually pretty tired of the topic and would just as soon never have to think about it again, but that’s just not how my brain is wired.  I think about Ebola almost constantly.  I suspect it’s a bit on the obsessive side, but at least I’m trying to be logical about it. Well, good luck trying to find actual facts on the topic, they are buried within media and public hysteria, conjecture and out right untruths.

I have the privilege of being directly involved in this frenzy to some degree as a veterinarian on account of  the possibility of spread of Ebola from dogs to humans and vice versa.

The CDC has some good information about this here.  Texas A&M College of Veterinary Medicine just released this fact sheet.

One of the Dallas nurses currently fighting Ebola infection,  Nina Pham, has a super cute one-year-old Cavalier King Charles Spaniel named “Bentley”.  According to this report from CBS news, he’s just been moved to a decommissioned naval base to continue his luxury quarantine.

My understanding is he will remain in quarantine for 21 days.  This is reflective of the only study that exists that demonstrates that “dogs could spread Ebola”.

Lets talk about that singular paper for a moment. Bear with me, as my volunteer editor has informed me that this part gets too “science-y”. Feel free to skim it. Hopefully you’ll get the point at the end.

The study was printed in the March of 2005 issue of the journal, Emerging Infectious Disease, by a French veterinary student, Lois Atella, and a team of scientists. They went to Gabon and “observed that several dogs were highly exposed to Ebola virus by eating [Ebola] infected dead animals”. Other dogs were seen to lick the vomit from Ebola-virus infected patients. Super gross, but we all know dogs are disgusting. We love them anyways.

The scientists took blood samples from 439 dogs in Africa and 102 French dogs (as controls). They looked for three things in the dogs:

  • antibodies to Ebola virus (Antibodies are proteins floating around in the blood that indicate the immune system has been alerted to the presence of Ebola virus)
  • viral antigen (any actual virus parts that can trigger immune response),
  • viral DNA

What they found was that in Ebola epidemic areas, roughly 25% of the dogs tested had antibodies to Ebola circulating in their blood (feel fee to go to the article to get the hard numbers).  According to the article abstract, this “suggests that dogs can be infected by Ebola virus and that the putative infection is asymptomatic”.

This statement has been translated by the media, public, and, notably the government of Spain who euthanized Excalibur, the dog belonging to an Ebola infected nurse (much to the horror of the world) to mean: DOGS CARRY EBOLA AND CAN INFECT PEOPLE!

I’m probably splitting hairs now, but here’s Important Part #1: the presence of antibodies in the system indicates that the patient or dog has been EXPOSED to the virus.  Exposed means that the virus gets into the patient, the patient’s immune system sees it and destroys it. The virus may or may not have a chance to spread, reproduce or get the patient sick, we just don’t know.  Exposure, basically means that the virus has been in the patient at some point.

Exposed is different from infected.  According to the Free Dictionary, the definition of infection is: Invasion by and multiplication of pathogenic microorganisms in a bodily part or tissue, which may produce subsequent tissue injury and progress to overt disease through a variety of cellular or toxic mechanisms.

Translation: INFECTION indicates that the virus gets into your body, sets up a little home and replicates itself, making lots of new baby viruses to go off and infect others. You may or may not have symptoms (asymptomatic vs symptomatic infection).

Important part #2:  I’m going to quote directly from the study here: “No circulating Ebola antigens or viral DNA sequences (tested by PCR) were detected in either positive or negative serum specimens, an attempts to isolate virus from these samples failed. ” The dogs tested negative for actual Ebola virus.

Said another way, the samples tested (and the study is unclear as to how many of the samples were PCR/antigen tested) did not show evidence of active Ebola infection. (The flip side of this is that animals known to actually spread Ebola, like fruit bats and monkeys test positive for the virus and are full of viral DNA.)

Bottom line is that this study DOES NOT PROVE THAT DOGS CAN SPREAD EBOLA. It doesn’t even prove that dogs shed the virus.

The study says that they “MAY excrete viral particles in urine, feces, and saliva for a short period before virus clearance as observed experimentally in other animals”.  It doesn’t prove that they do.

The study DOES show that dogs can be massively exposed to gobs and gobs of Ebola virus particles, mount an impressive immune response to said exposure and NOT GET SICK FROM IT! Get that? Dogs might be immune to Ebola. At least in Africa. 

Sounds to me like we need to be studying Ebola exposed dogs instead of killing them (Ahem, Spain?)

Back to Bentley, the nurses’ dog:  one of my classmates, Dr. Kristy O. Murray, a notable human infectious disease expert(and veterinarian), observed that what they should have done was PCR test him for viral DNA as soon as they got their hands on him, 72 hours later, and at 1,2 and 3 weeks. The human test will work.

It’s too late for the initial testing, but how about starting now?  While they are at it, they ought to go ahead and antigen/antibody test him too.

Furthermore (and if anyone can forward this to the “powers that be”, that would be great), what exactly is the end point determination for this twenty one day quarantine for Bentley? Data states he’s not likely to show signs of the disease.  Is anyone going to test him for the virus at that point or are they just going to assume he is Ebola-free because he didn’t get sick? I’m not sure we should take that chance.

The study of dogs exposed to Ebola seems to me to be a golden opportunity to get some vital information regarding not only how the virus spreads, but maybe clues to prevention or treatment  as well.  We need that information here in the US, they really need it in Africa.

 

 

 

 

 

 

 

 

 

 

 

 

When Cancer isn’t Cancer

Hey guys! Summer is over, and now I have a little time to write.  Sorry for the delay in posting. Frequent commenter “The Old Broad” requested I post more cases, so here’s one for you:

Little Ms. Izzy is a soon-to-be 7 year old red Dachshund (Her birthday is August 31, we should all wish her a happy bday!)  Her human mama brought her in to see me early in July for sneezing and a swollen nose. 

Sweet Izzy was sneezing like crazy and was affecting her owners quality of sleep with her snorting and assorted nasal shenanigans.  Her owners reported that she was definitely a “hound” and had a strong history of sticking her nose where it doesn’t belong. Particularly sniffing around the copious rabbit poop deposits in the yard. 

With Izzy  being of the Dachshund persuasion, my first thought as to the cause of her nasal distress was a bad tooth.  Dachshies have these long skinny noses and these big upper canine teeth that like to abscess and pop pus through the nasal cavity into the sinus.  The resultant sneezing and nasal discharge is usually remedied by surgical removal of the offending tooth.

Other things to consider included: plain ol’ nasal allergies, sinusitis, foreign material ( Things like: grass, sticks, etc. Dr. Sharp even had a patient with a peanut lodged in his nose once) in the nose and cancer. 

If I were to play the odds and rank the possibilities it would be teeth, allergies, sinusitis cancer and foreign body.

On physical exam, she had moderate to severe plaque, tartar and gum disease. I generally can’t evaluate for recession around the canines without anesthesia. Therefore, can’t rule in or out dental involvement yet. I couldn’t really appreciate nasal swelling, because what the owner saw was very subtle. She might have been moving slightly less air out of her right nostril, using the highly sensitive “piece of cotton stuck in front of each nostril and see how much it moves” test.  However, when I did the even more sensitive, “put the stethoscope in front of each nostril and listen” test, the air flow seemed to sound the same. 

The owner and I went over all the possibilities and decided to be conservative in light of the fact that she had only been showing symptoms for less than 24 hours.  Izzie went home with a dose of allergy medicine and a recommendation to come back for further evaluation if the sneezing didn’t resolve.   

About three weeks later, Izzie was back. Still sneezing. Dr. Brewer saw her and said the only way he could describe Izzie’s nose was that it looked like a “witches bump”.  She had developed a large nodule on her nose and a mucoid nasal discharge. and even occasionally sneezed out frank blood. 

At this point we are really concerned about “the big C”.  Nasal tumors have a nasty habit of sitting there quietly until such time as they get big enough to physically cause symptoms: sneezing, discharge, etc.  I consulted with Dr. Stephanie Cook, oncologist at Veterinary Specialists of North Texas about the sudden progression of Izzie’s symptoms. She said that once nasal tumors break through the top of the sinuses, they tend to be really aggressive and grow quickly. 

Well, that wasn’t what I wanted to hear.  I imagine Izzy’s owner wanted to hear it even less. 

Her options were for us to blindly biopsy the lesion at our place, or to refer her to the oncologists for a CT evaluation and biopsy.  My concern with us doing it was that Izzy’s problem started inside her nose and worked its way out to the skin. There was a chance that if we biopsy at the level of the skin (because we don’t have the tools to get all up inside the nose), that we would just get inflammatory cells, no cancer cells, and a big waste of money. Furthermore, we didn’t know how big and aggressive this mass was (These things can eat into the brain, eyeballs, etc. Extensive tumor spread might negate further treatment and evaluation). 

The owners elected to have a CT done to look at the mass and for any possible metastasis. Prior to her visit to the oncologists, Izzie’s owner asks if we can put her on antibioitic in the off-chance it is some kind of infection. “Sure”, I say, it won’t hurt and it might help result in a cleaner biopsy sample.

I’ll be honest though, this case walks like cancer, it talks like cancer and the odds are it’s cancer. I’m not particularly hopeful the antibiotics will do much, but there is always a chance.

Izzy’s CT and needle aspirate of the mass are all consistent with possible carcinoma (cancer). She even had a lymph node enlarged in the area.  Although the oncologist thought she saw cancer cells in the aspirate, she didn’t in the lymph node, so that was good.  Biopsy samples were taken while Izzy was under and submitted for pathology review, with results expected in about a week.

Meanwhile, a strange thing was happening while we all waited for the biopsy results: Izzy’s lump was shrinking.

In case you were wondering: antibiotics don’t cure cancer, and that’s the only medicine she was on. Cancer generally laughs at antibiotics and keeps right on growing.   

Then another strange thing happened: the biopsy report came back, no cancer. The mass contained a bunch of inflammation, bacteria and…this is the good part…a 2.5cm hunk of unidentifiable plant material.

That silly dog managed to snort some kind of plant part up into her nasal sinus which subsequently abscessed and broke out of the top of her nose! 

This, my friends, is not a common presentation of a nasal foreign body.  In our combined 80 years of practice, none of us have seen this.  We’ve seen grass out the nose, between teeth, in eyeballs, down throats and the like, but never breaking out the top of the nose.

For all intents and purposes, it should have been cancer. However, in Izzy’s particular case it wasn’t, and that for her, is a pretty darn great birthday gift.

I’m hoping to get a picture or two of little Izzy as soon as her mom sends me some, so I’ll post  when I can.

 

 

 

 

 

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