A Vet’s Guide To Life

Remember yesterday’s post?  Well, we did get the disc and the analyzer worked well today.  Surgeries were able to proceed normally, and we got through the day without any further technical difficulties.  But the whole thing made me think of another topic of discussion.

Many people might say “well, you’re dealing mostly with young, healthy pets.  Would it really have been that big of a deal to do the surgery without the blood tests?  Isn’t it really unnecessary?  After all, vets used to do surgeries without anything like this.”  All of these are great questions.  To answer them in short…yes, it would have been a big deal, yes it’s necessary, and yes vets used to do without it but also had a higher complication rate.

When we do an exam on a pet, we can only evaluate certain things.  One of the things we cannot evaluate is the function of the various internal organs.  We can’t just look at a pet and tell if the kidneys or liver are working properly.  These are very important when it comes to anesthesia, as the body eliminates the drugs through these two organs.  If they’re not doing their job, then the drugs may not be eliminated properly, leading to prolonged anesthesia or other complications.  To give you an idea of how misleading an exam might be, you have to loose 66% of your kidney function before you will have any abnormalities in lab tests, but have to loose 75% of the function before you act sick.  So there is a window between 2/3 and 3/4 kidney failure where you look, act, and feel perfectly fine, but there are detectable abnormalities.

Well, what about the fact that many patients are young?  Doesn’t that lower the risk?  Yes, it does.  The older a pet is, the more likely we are to see organ dysfunction.  However, there are numerous abnormalities that we are more likely to see in young pets, such as kidney cysts or a liver shunt (where blood flows around the liver rather than through it).  No, we don’t see these things often.  But I have diagnosed many young, apparently healthy pets with various diseases that we detected in a pre-anesthetic blood panel.  Older pets are even more likely to have problems detected.  If we did anesthesia without knowing for certain, we would potentially be placing the pet at risk for complications.

It all comes down to knowing or guessing.  Do you want your doctor to make a guess about whether or not your pet’s organs are normal, or do you want him/her to know for certain?  If the preanesthetic testing isn’t done, then you are doing nothing more than making a guess, and in a way gambling as surely as rolling dice in a game of craps.  Personally, I don’t like guessing when I have other alternatives.

Some days things just don’t seem to work out like you expect them to.  Today we had a busy surgery schedule, with a total of eight procedures.  For us that’s a very busy day, and doesn’t include any of the other patients we see.  I even came in about 45 minutes early this morning to make sure we got started and stayed on schedule.

With every surgery or dental cleaning we require pre-anesthetic blood testing.  This involves a simple blood chemistry panel and blood cell count, and doesn’t take very long to run.  We do this as a screening for any hidden organ dysfunction, and consider it an essential part of the procedure.  In fact, we won’t do the procedure if we can’t run the tests.  Like today….

I walk in and my head tech says that the chemistry analyzer is on the fritz.  I then take a look at it, and the LCD screen is merely a bunch of lines of pixels, and never changed.  Turning it on and off several times didn’t work, so I called the tech support number.  Apparently the disc in the machine was an older version, and that may be why the machine wasn’t working.  So basically, we were totally unable to do any lab tests at all, and had to cancel ALL of the procedures.  Thankfully the pet owners took it well, and we were able to reschedule the surgeries.

My only concern is tomorrow morning.  We have five surgeries scheduled, three of them postponed from today.  We’re supposed to get the replacement disc in the morning, and I hope it comes early enough.  I also hope that’s the actual problem and there isn’t a bigger issue that would delay us further.  That would be frustrating for us, but extremely inconvenient for the clients.

Ah, the joys of running a business!

What the heck is a Ninjate, and how does that relate to Christianity?  If you read my profile, you’ll see that I am a big geek, as well as a Christian.  Though I do touch on these subjects in this blog, I also concentrate primarily on life as a vet.  I’ve been having a growing desire to have a forum for more pointed discussions of faith and fandom, so I have started a second blog.

What is a ninjate?  There is a popular argument/discussion on which is cooler:  ninjas or pirates?  Sometimes it’s phrased as who would win in a fight.  Recently I gave a message on this subject, and ended up coining the term “Christian ninjate”.  I’ve Googled the phrase, and can’t find it anywhere else, so I think I’m the first to use it (”ninjate” has been around a little, but it’s not common).  A ninjate is the ultimate combination of a pirate and a ninja, having characteristics and abilities of both.  It’s sort of a geek fantasy, merging the best of each.  Yes, it seems kind of strange to relate this to Christianity, but believe me, it works!

So if you’re interested or just curious, come on over to The Christian Ninjate site, and see what it’s all about.  I doubt it will be boring, and it might just cover a unique spin on the Bible, Jesus, and God.

And don’t worry, I still plan on having some fun with veterinary medicine right here!

It seems like breeding questions are popular.  Here’s another one.

I have two yorkies, the female is almost four and the male almost two. They have had two very successful litters of puppies no health problems from parents or puppies. They have sold asap and I have had several request from people wishing to purchase a puppy from me. My question is should I allow these two dogs to bread at will or should I space the breeding apart? Thank’s for the help.

Definitely don’t breed at every opportunity.  Pregnancy and nursing take their toll on a dog’s body, and breeding too frequently can adversely affect their health.  Without proper rest, the body may not be able to handle another pregnancy and you may increase the risk to the mother and puppies.

I normally recommend breeding no more often than every other heat cycle.  That means breed on one heat cycle, rest her on the next one, and then breed on the one after that.  You can wait longer between cycles, but I wouldn’t do it sooner.  Keep in mind that your bitch is a living creature, and not simply a puppy factory.  You shouldn’t let market demand force you to breed her more frequently than is healthy.

Also keep in mind my previous discussions about whether or not you should breed in the first place.  Just because the parents are healthy doesn’t mean that they’re good breeding quality.

Zoonosis: An infectious disease in animals that can be transmitted to people. The natural reservoir for the infectious agent is a animal.

When your dog receives his or her “distemper-parvo” combination vaccine, there is usually a list of letters that you’ll see on your receipt or medical record.  If there is an “L” in the list, this stands for “leptospirosis”.  Commonly shortened to just “lepto” when talking about it, this part of the vaccine protocols is actually controversial.  There is a belief among some in the veterinary community and many breeders that the leptospirosis vaccine has a high risk of causing an allergic reaction, potentially leading to serious consequences for the dog.  Since it’s not the focus of my topic today, I won’t get into all of the specifics of this discussion, but for now I will just state that the controversy is unfounded.  Studies have shown that there is no statistical difference in reaction rates between vaccines with lepto and those without it.  Those who believe that lepto vaccines are highly reactive are using outdated information and merely passing on what was told to them.

Leptospirosis is a bacterial organism that can infect many wild animals and is passed through their urine.  If a dog (or even human) drinks water contaminated with this urine, or licks ground or grass also contaminated, they can become infected.  Transmission can also occur through broken skin or open wound, as well as through mucous membranes in the mouth, nose, genitals, and so on.  The more rain and wet ground in an area, the greater the risk of transmission as it survives in these wet conditions.  How many pet owners have been urinated on by their dogs, or had to clean up urine from the floor?  If your dog is infected, you have just been exposed to lepto.

In dogs, liver and/or kidney failure is the most common consequence.  In humans this disease may begin with flu-like symptoms and go undiagnosed until it is far advanced.  Meningitis can also be a consequence of advanced disease.  As you can imagine from this list, leptospirosis is a serious disease with the potential to be fatal.

Once diagnosed, the disease is potentially treatable with several kinds of antibiotics, but some of the damage done may be permanent.  The best option is prevention.  That means for humans to be careful when being exposed to water sources that wild animals have been around, and washing hands carefully after being in these situations.  For dogs this means being vaccinated against lepto.  Talk to your veterinarian about this vaccine, and realize that there are several opinions on it and no consensus across the profession.

Zoonosis: An infectious disease in animals that can be transmitted to people. The natural reservoir for the infectious agent is a animal.

From rabies to scabies!  You’d think I planned my alliteration.

Today I saw a pair of dogs, one with scaly patches on her ears and the other with extremely itchy skin.  One of the main things I considered in this case was scabies, also called sarcoptic mange.  The name comes from the microscopic mite that causes the disease, Sarcoptes scabiei.  This mite burrows under the skin and will usually cause a localized allergic reaction and intense itching.  As the mites grow and spread, the itching can be severe enough for the pet (or person) to cause sores because of self-trauma, as well as reddened or scaly skin due to the mites’ effects.

Skin mites such as scabies can affect many types of animals, though each species of mite is usually specific for a single or a small group of species.  Even though a host such as a human or a dog might not be its preferred environment, mites aren’t always picky and will invade whatever is close that may be used as a meal.  The mites are mostly transmitted through close contact with an infected animal or person, as they do not live long off their host.

Diagnosis is normally made by performing a superficial scraping of the skin in several locations, and then looking under the microscope to identify the mites or their eggs.  Because the mites can cause such an intense reaction, it is possible (and not uncommon) for the vet to not be able to find them even if they are present.  Sometimes we do a “therapeutic trial” in cases that are highly suspicious, giving treatment and see if it helps.

There are several accepted treatments.  One of the easiest and most common is a series of 2-3 injections of an antiparasitic medication called ivermectin.  Special medicated dips can also be used.  There are also a few topical flea and tick medications that have been used for treating this mite.  Your vet can recommend the treatment that he or she feels is best.

So the next time you bring an itchy pet to your vet and they want to scrape the skin for mites, don’t ignore the recommendation and refuse the service.  If it is scabies, it can affect not only your pet, but the whole household.

This is a topic that most pet owners are likely unaware of, and an event today reminded me of that.

My receptionist came back from lunch, and almost in passing asked me if onions are dangerous to cats.  She had taken an onion off her hamburger and laid it on the counter since she doesn’t like onions.  Her cat jumped up and quickly ate it.  She didn’t think anything about it at the time, and almost didn’t ask me.  I had her immediately go back home, get her cat, and bring him in.

As soon as she arrived back at the hospital, I placed a feeding tube down his esophagus and gave him about 48cc of hydrogen peroxide.  This is what we commonly give to induce vomiting, which he did within a few minutes.  When a toxin is ingested, if you can get to the pet within about 60 minutes, you can often get them to throw it up and prevent absorption.  You should never do this with caustic substances, but for many poisons and objects it works well.

Goober (yes, that’s his name) threw up the food he had eaten, as well as several large pieces of onions.  He was acting perfectly normal, though he was VERY unappreciative about having a rubber tube forced down his throat.  We were able to get what appeared to be all of the onion out of his stomach before it passed, and I think he will be fine.  If she hadn’t brought him in quickly, we could have been dealing with a serious or fatal situation in a few days.

Why the big worry?  Onions are very toxic to cats.  Potentially fatally toxic, in fact.  They cause abnormalities in the red blood cells leading to their destruction and severe anemia (called Heinz body anemia due to the structure created within the blood cells), and can also cause kidney failure.  This can happen relatively quickly, and with only a small amount of onion.  It has been known to happen after cats ate baby food with onion powder as an ingredient.  Garlic is in the same plant family, and can cause the same toxicity.  Cats have died from people giving them garlic tablets as a way to prevent fleas (which garlic does NOT do, and has been studied scientifically).  These plants are also potentially toxic to some dogs, but the risk is nowhere nearly as serious as with cats.

So keep all of this in mind.  NEVER give your cats anything with any onions or garlic in them.  This is a very serious toxicity, and requires intense hospitalization and even blood transfusions once symptoms begin.

Zoonosis: An infectious disease in animals that can be transmitted to people. The natural reservoir for the infectious agent is a animal.

I’m starting to realize that I’m on an “R” pattern with these diseases. Don’t worry, it won’t stay that way.

Rabies is one of the “big baddies” of zoonotic diseases. In fact, it’s such a concern that in the US and many other countries, animals are required by law to be vaccinated for it. This disease is treated so seriously because there really is no treatment once symptoms are evident, and it is almost always fatal. So let’s learn a little more about it.

Rabies is a virus transmitted through saliva. The virus replicates in the salivary glands of an animal with advanced disease, and can then become infective through either a bite or through contact with mucous membranes (mouth, nasal passages, etc.) and broken skin. Most people think of the infection through being bitten by an infected animal, but this is not the only way. There have been many stories in vet school of veterinary students and faculty examining a horse or cow with excessive salivation, even sticking their hands in its mouth, and then having to be treated for rabies exposure. If the person had a cut or other wound on their hand, the saliva could get into the body through that injury. Rabies cases have also been documented in people who have gone into caves with numerous rabid bats, inhaling the aerosolized saliva and becoming infected through the membranes in their lungs.

Once through the skin the virus will eventually migrate to the peripheral nerves. How long this can take is variable, and is not really predictable. Once it reaches the nerves, it quickly spreads to the brain where it causes encephalitis and eventually death.

Symptoms can vary, but are almost always neurological. This can include confusion, behavior changes, paralysis, uncoordinated movements, and seizures. In fact, we are taught in vet school to include rabies as a possibility in any case that shows neurological signs. Symptoms usually begin within a few weeks of exposure, but can take as many as a few years.

Prevention is a matter of vaccination and avoidance. Since any mammal can potentially become infected with rabies, mass vaccination of wild animals is impossible. There have been programs where bait is laced with an oral vaccination in hopes of reducing the cases, but these many not have wide-spread efficacy. Vaccinating pets and livestock is the best way of avoiding transmission of the disease through animals commonly in contact with humans. There is also a vaccine for humans that many of us veterinary staff receive since we are at highest risk. Other than vaccination, the average person should avoid direct contact with wild animals, especially ones showing odd behaviors.

If someone becomes exposed to the disease, receiving post-exposure injections can prevent the disease from spreading. This has to be done quickly, as the end is pretty much a foregone conclusion once the virus reaches the nerves. This speed of spread is why treatment is often started when exposure is suspected but not yet confirmed.

Here are a few other tidbits for you…
* Rabies kills around 55,000 people each year world-wide, mainly in Africa and Asia.
* There are only six known cases of people surviving rabies once symptoms began.
* Louis Pasteur and Emil Roux developed the first rabies vaccine in 1885.
* It is also sometimes called “hydrophobia” because of the victim’s inability to swallow water.
* In the Stephen King novel, Cujo is a rabid dog.
* Old Yeller (from the movie of the same name) had to be killed because he contracted rabies.
* Infected bats, monkeys, raccoons, foxes, skunks, cattle, wolves, dogs, mongoose, or cats  provide the greatest risk to humans.

Zoonosis: An infectious disease in animals that can be transmitted to people. The natural reservoir for the infectious agent is a animal.

One of the first misconceptions that I have to clear up with some of my clients is that ringworm isn’t actually a worm.  It’s a type of fungal infection of the skin and is related to other fungal diseases such as jock itch and athlete’s foot.  The name comes from the ring-like progression of the lesion once it becomes established in the superficial layers of the skin.  Many kinds of animals can get ringworm, including dogs, cats, rabbits, and guinea pigs.

The fungi that cause ringworm can be found contaminating the environment, and this is usually how humans and animals become infected.  Once infected, that animal then becomes contagious, and can transmit the disease by contact.  On animals the lesions look like scaly, hairless areas, most commonly on the head (though they can appear anywhere).  Most of the time these areas do not cause itchiness, but if it progresses far enough they can be irritating.

Luckily, this is not a serious disease.  In pets we most commonly make a definitive diagnosis by collecting hair from an affected or suspicious area and growing a culture to identify the organism.  There are other, quicker methods of diagnosis, such as using a blacklight, but they are not as accurate as the culture.  Once diagnosed, there are several methods of treatment, depending on how wide-spread the infection is and how long it has been going on.  Most of the time treatment will consist of topical lotions or antifungal shampoos, though severe cases may require oral medications.  Long-haired pets may also need to be shaved to reduce the numbers of spores on the skin.

If your pet has any sores that sound like this, make sure you visit your vet for a proper diagnosis.  Doing so can not only help the pet, but can help the humans in the family with quick prevention or treatment.

Zoonosis: An infectious disease in animals that can be transmitted to people. The natural reservoir for the infectious agent is a animal.
I thought that I would go back to a theme, doing an informational one this time.  Zoonotic diseases are something that we don’t talk about as much as we should, and are extremely important.  There is much misinformation out there, and human doctors are often not as knowledgeable about these topics as are veterinarians.  That’s probably because we vets are the most likely to be exposed to them!  So we’re going to make darn sure we know what we’re at risk for and how to prevent it.

So let’s begin by talking about roundworms and hookworms.  These are common intestinal parasites in dogs and cats, especially kittens and puppies.  When we do a fecal exam, one of the things we look for is the eggs of these parasites.  Both of these worms normally live in the intestines of their host, shedding eggs into the feces.  These eggs can contaminate the environment, adhering to the animal’s fur, the grass and leaves, or basically anywhere that feces have been touching.  This includes the floors of our homes, which is not uncommon as we are trying to housebreak our new puppies.  When an animal (or human) swallows anything contaminated by the eggs, the can become infected themselves.

Puppies and kittens are very commonly infected because the larvae of the worms migrate through the host’s body.  They can form cysts that are impossible to detect and are a dormant stage that are resistant to antiparasitic medications.  During pregnancy, the cysts open, and the worms migrate through the uterus or into the mammary glands, providing two sources of infection for the babies.

Humans are most commonly infected through poor hygeine.  Sandboxes can be a good place for stray cats to defecate, potentially contaminating a child’s environment.  Stray dogs and cats will sometimes eliminate in the soft ground cover of playgrounds.  A pet’s fecal materials can get into the grass in which children roll around and play.  You can likely think of similar situations in your own lives.  In any case, the people touch the area that has been contaminated, and then touch food or their mouths without washing their hands first.  Suddenly, the person (often a child) has swallowed the eggs, and will become infected.  Other sources of infection include being licked in the face by an infected pet (the eggs can be in saliva), and migration through the skin (in the case of hookworms…their larva can get into a person through bare feet).

In pets, both kinds of worms can cause diarrhea and poor body condition as the worms upset the intestinal tract and interfere with food absorption.  Hookworms drink blood from the intestines and can cause life-threatening anemia in small pets.

In humans, these worms can cause the most serious disease through “larval migrans”.  The larvae move through a person’s body, and can end up in unusual places, such as the lungs or the eyes.  This can lead to pulmonary disease and blindness.

Thankfully, these worms are easily preventable and treatable.  A veterinarian can detect these parasites in a fecal sample, and it is recommended to perform these checks twice per year.  Routine heartworm preventions in both dogs and cats also include preventions for roundworms and hookworms.  If an infection is detected, there are several very effective medications that a vet can use to eliminate the parasites.

For human risks, you can take the following simple steps.  Any time a child has handled a dog or cat, make sure they wash their hands immediately afterwards.  Pick up any feces from the yard at least weekly, if not immediately.  If a pet has defecated in the house, clean and disinfect that area as soon as you notice it.  Keep your pets on heartworm prevention to help with intestinal parasites as well.  If your vet detects parasites in your pet, try to avoid anyone being licked in the face until the infeciton is cleared.

It doesn’t take much to protect your family against potentially serious parasitic disease.