Ignorance is bliss

As a veterinarian we have all kinds of diagnostic tools at our disposal. When a sick pet is in front of us we use a thorough history and physical examination to best determine the likely causes of illness. Sometimes we need further diagnostics to help us out or give us more detail. At many primary care veterinarians this is blood work or X-rays. We have those at AHCC but we also have begun to increasingly use our ultrasound machine. 

Ultrasound is a fantastic diagnostic tool but it comes with a steep learning curve. I have received extra hours of ultrasound training and quite frankly really enjoy the challenge of that learning curve. However, I’ve learned the ultrasound usually draws cases which tend to have some sad news. Sure, I get a few who are normal or which show healthy puppies in the womb, but more often than not, I find some form of disease that carries with it a  guarded prognosis. I guess this is where the statement “ignorance is bliss” makes sense. 

Last week I used the ultrasound to diagnose a gall bladder mucocele in an old dog.  Surgery is almost always needed for these but even with surgery it is a very dangerous and risky process. The owners decided not to pursue the risky surgical treatments. We kept him comfortable for a few more days  before saying goodbye. The owner said something to me as we were reminiscing about her beloved…she said she was so thankful to know exactly what was ailing him so we weren’t completely in the dark as to why he was so sick. She was happy she didn’t have to take him to a specialist and that she was able to receive the answers right here at our clinic instead of another less familiar hospital.  I can’t thank her enough for sharing that with me. I’ll forever remember this as it helps me further understand the value of what I am able to offer our clients, even if it is a bit of a burden to be the bearer of bad news.

The flip side of the blissful ignorance coin is the fact that “knowledge is power”.  I too must remember the times ultrasound has saved the life of a pet by giving us the knowledge of what was occurring and time to fix it.  My most fond memory of this was when a dog had an intussuception of the intestines which was identified through ultrasound. He was on and off the surgery table within two hours of his ultrasonographic diagnosis. So yes, I love ultrasound. I’m happy to continue to provide this service and hope to save more lives with it, or at the very least, to make sense of an ailing pet and allow us to keep him comfortable with the power of knowledge. 

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Mystery Dinner

Dogs, and cats for that matter, eat all kinds of weird things.   Some eat foods, some eat toys, some eat poop (ew!)…the list goes on and on.  Being a veterinarian, we get to see some really intresting cases of weird things eaten.  In my post  Pet Poison Hotline I mentioned what happens when pets eat toxins but what about when a dog eats inanimate objects? Toys? Strings? Bones?  This condition is known as dietary indescretion.

When your pet eats an inanimate object only three things can happen:

  1. Nothing – it passes.  You may or may not see it pass as a present in the yard.  If you don’t find it eventually you begin to wonder if he ever actually ate it.  OR, you consider the possibility that it may still be inside.
  2. She makes a mess – by vomiting it back up, along with the rest of the contents of the stomach.  Then, to make matters worse, diarrhea develops too.
  3. Bad news bears – it gets stuck.  This also can cause vomiting or diarrhea or worse if not dealt with in a timely manner. 

Our physical examination and diagnostics like blood work and x-rays can help us determine if something is stuck.   Sometimes on x-ray you can see a stuck object.  Other times, you see large dilated airfilled intestines and stomach as gas backs up from the obstruction.

Check out the following x-ray for a dog presenting for vomiting and diarrhea with straining.  He has a history of getting into the trash can and did so a few days ago before all this started.  Do you see anything?

     Do you known what his diagnosis is? It’s a foreign body…in the stomach.  If you don’t see it, the following reproduction of the image with overlays points out the foreign body/bodies (green circle) in the stomach and a small amount of gas (blue arrow) in the intestine.  In this case, the gas amount is normal, it’s just the foreign body that showed up on x-rays that is abnormal.

  
 Okay, hopefully you see it now.  Now the fun part comes…what is it?  This pup had surgery and we pulled the foreign body out of his stomach.  When we went in, we were thinking we would be retrieving some rib-bones that had been in the trash can and were still stuck together.  However, this was not the case, and I should have known seeing as these two things look so identical in shape and length.   Do you know what it is yet?

  
Pacifiers!  Crazy right? Surgery went well and he recovered uneventfully.  The owners, when shown what was collected from his stomach were astounded.  Apparently, these pacifiers were missing for a full week!

It can sometimes be fun to try to guess what may be the culprit of an obstruction.  However, it is much more fun to see you smiling and not worrying over your pet as they undergo surgery to relieve an obstruction.  Be mindful of what your pet’s habits are.  Some pets will eat these things, others could care less.  Learn to know your pet and what objects or foods need to be kept away…this way, I won’t have to open up their gi tract to find out just what mystery dinner Fido had a few days ago.

Frankie

Last week I posted about the TNR group I work with. I mentioned how it’s nifty when I get to see cats they pulled off the streets and adopted out to clients who eventually come to my primary care practice, Animal Health Care Center of Hershey. Sometimes, we see them for illnesses before they are adopted out. Meet Frankie. Frankie must have been abandoned because what Flame-point Siamese is a bonafide stray? Frankie was taken in by PAWS. He was thin, under-conditioned and un-neutered. He was given lots of groceries and love. Last week, he developed vomiting and diarrhea. So much so that the pound he gained since being taken in had vanished. PAWs brought him into AHCC. One of our doctors attended to his care while he was hospitalized for a few days. He was diagnosed with inflammatory bowel disease. Medications to help reset his system were given and a dietary change was made. He went “home” to PAWS on Thursday.  I had another TNR clinic on Saturday at PAWS’ headquarters and got to see Frankie running around the great room. It is so good to see your patients feeling better and back to health. Assuming he continues to do well and gains his weight back, I’ll be neutering Frankie and cleaning up his teeth later this month. Clearly he doesn’t know these plans or I doubt he would have taken the following selfie of the both of us… ūüėČ
 

Smile!
 

Pet Poison Helpline

Have you ever had your cat eat something she shouldn’t have? What about dropping one of your birth control pills on the floor and that quick Fido swallows it? ¬†Or maybe Fluffy got into the batch of brownies you just baked?FullSizeRender¬† Chances are you ended up at the veterinary hospital after such an event. ¬†As veterinarians, we get asked all kinds of questions as to possible toxicities. It is difficult to have all the answers sometimes, especially with more obscure medication ingestion. ¬†We turn to a service called “Pet Poison Helpline”. ¬†Pet Poison Helpline (http://www.petpoisonhelpline.com/) is a wonderful service offered to any pet owner or veterinarian for a small fee of $49 per case. ¬†They have toxicologists available 24/7 to help owners and vets determine if an ingestion was toxic, what clinical signs may show up, and how to treat and monitor the patient through their toxicity.

Tonight, we utilized this service. ¬†Sneaky Sandra came into our office on emergency basis after ingesting her owners’ medications. ¬†Sandra slurped 4 different pills off of the table while her owner was grabbing a glass of water. ¬†A little while later, Sneaky Sandra had vomited and began to tremble. ¬†Her owners did the right thing in bringing her in to be seen. ¬†We examined Sandra and called Pet Poison Helpline on behalf of the owners. ¬†Sandra’s toxicity case was entered into their database. ¬†A veterinary toxicologist then led our veterinary team through determining if a poisoning had occurred, what treatments are necessary, and signs to watch for. ¬†Luckily, Sneaky Sandra ingested 4 different medications that were ALL basically benign since she only ate one of each medication. ¬†The toxicologist determined Sandra had not been poisoned more than possible having some excitement followed by sedation.

As a veterinarian, I really appreciate the help Pet Poison Helpline’s toxicologists can give us. ¬†Poisonings are so different from patient to patient that it is hard to know all the details about each one. ¬†Also, if not treated correctly from start to finish, they can be deadly. ¬†Another good thing about Pet Poison Helpline is that as an owner, if your cat eats a plant at 4am in the morning, you can call and talk with a toxicologist to determine if you need to hop in the car to the emergency veterinarian. ¬†Let’s hope as a pet owner you never have to use it, but if you do…please know Pet Poison Helpline:¬†855-764-7661 is always available for your assistance.

Sick pet puzzles

It is difficult when your pet is sick. Unlike people, our pet’s cannot talk to us to let us know what is wrong, they have to let their ailments show us the clinical signs. These clinical signs are important to note when you end up taking your sick cat to the vet.  Hopefully, I’ll be able to shed some light on what goes through a vet’s mind when you bring your pet in to be seen for a sickness.

You know all those pesky questions the technicians ask you? Did she eat? Has he been coughing? Did she vomit? She did!?!, what did is look like? (Yes, we go there…not all vomit is the same. Vomiting food means something different than vomiting phlegm.) All of these questions constitute what we call a history. Knowing what your pet is doing at home starts to give us a few pieces of the puzzle.  

 More puzzle pieces fall into place once your vet has had a chance to perform a physical examination. This step helps us determine if your vomiting dog is painful in the abdomen, has a mass in the abdomen, or if the coughing dog’s lungs sound harsh. If you sit back and really pay attention to your vet performing the physical examination you should see that it is very thorough. It is easy to miss what all we do because many times we vets are asking you, the pet owner, more in-depth questions while we are performing the physical exam. The steps we take in a physical examination are usually quite methodical and almost second nature to most vets. I usually start with the lymph nodes of the chin and then go on to the ears. In fact, it is so second nature to me that when checking my own dog’s ears for wax I sometimes begin to continue on with the next step in the physical exam!

After the history and exam, some conditions are obvious and do not immediately need further diagnostics. For example, let’s take a look at Brogan. Brogan is a 4 year old lab who has been vomiting for half a day and just before his appointment he had his first bout of diarrhea.  Other than his vomiting, he has been bright, alert, and is still playing like usual. On physical examination Brogan’s temperature and vitals were normal. Palpating of his abdomen was unremarkable – no masses, thickenings, or pain noticed. He has a good appetite, but just can’t keep food down currently. My approach as a vet is to look at Brogan’s scenario and develop a list of possibilities to his illness…upset stomach, parasites, obstruction, infectious causes, and a few more.  Then I look at the likelihood of these possibilities.  If Brogan was really down and out, I usually recommend either x-rays or bloodwork.  These too, give us another, and hopefully the final piece of the puzzle. In some cases, as well Brogan, I would likely discuss with the owners that Brogan appears to be otherwise healthy and we can try to treat empirically first.  This means Brogan would receive medications for vomiting and diarrhea and if he did not improve, we then would see him back again to perform the diagnostics.

  
There are many different causes to illnesses.  As described, getting information from you, the pet’s examination, and sometimes diagnostics as well is the best way to put the pet illness puzzle together.  As veterinarians, our job is to take all of this information, figure out what is related and important to the current case, and decide the best course of action.  While these puzzles can be frustrating at times, it is one part of veterinary medicine that keeps me entertained, learning, and challenged.  There is nothing better than figuring out the correct puzzle and helping Fluffy get back to enjoying playing ball.

WORLD RABIES DAY

Yesterday, September 28th, 2013 was World Rabies Day.  Do you know the facts about rabies virus?

Core vaccination in our dogs and cats includes vaccination against the rabies virus.  Why? Rabies is widespread throughout the world (with very few exceptions) and is always fatal if proper vaccination or post-exposure vaccination is not employed.  Many people know that rabies is dangerous and that animal bites are a vehicle for virus spread; however, there’s much more to it than that…

What does rabies look like? There are two forms of rabies ‚Äď a ‚Äúfurious‚ÄĚ form and a ‚Äúparalytic or dumb‚ÄĚ form.¬† However, some animals will show no signs of rabies other than death.¬† The furious form is more easily recognized and the paralytic form can be very dangerous and hard to recognize.

Furious Form

Aggression, loss of fear, circling, excessive vocalization, attraction to humans or activity, daytime activity of species normally active at night, difficulty swallowing, drooling, biting at objects or other animals

Paralytic or ‚ÄúDumb‚ÄĚ Form

Decreased activity, uncoordinated walk/mannerisms, hind limb weakness, dull.  Cats with paralytic form suddenly become excessively friendly and may meow excessively.  Lower jaw may drop and increased drool production.

What animals can be infected by rabies? Any mammal can be infected. We vaccinate our cats and dogs against rabies to not only protect our pets but also to protect the humans that live with them.  Incidentally, some county fairs require rabies vaccination for all livestock that are housed at the fair during fair week, again, based on their close proximity to the general public.

The CDC monitors rabies prevalence within the United States.  The most common wild-animal carriers by region in 2010 are pictured below: [photo courtesy of CDC.gov]

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How is rabies transmitted?  Exposure to rabies occurs when saliva or bodily fluids from a rabid animal comes in contact with another animals (or human) blood, mouth, or mucous membranes.

  • A direct bite or scratch from a contagious rabid mammal
  • Saliva or neural tissue from a contagious rabid animal contacting an open wound, breaking in the skin, or mucous membranes such as the eyes, nose, or mouth.
  • Virus can survive on inanimate objects for as long as it takes for the saliva to completely dry.¬† Sunlight will kill the virus, freezing and moisture may help preserve it.¬† The virus is killed by most disinfectants and there has never been a documented case of rabies transmitted to humans from an inanimate object.
  • BATS are a frequent cause of human rabies cases in the US as of 2013.¬† The CDC recommends that every bat found inside a building or home to be tested for rabies because people and animals can be bitten by a bat and have no idea it happened.
The following image shows the number of rabies positive raccoons tested in 2010 compared to the number tested. Notice how the east coast is bright yellow – meaning there were many positive rabid raccoons. [photo courtesy of CDC.gov]

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What do I do if my pet has been bitten? 

  1. First and foremost, do NOT get bitten trying to break up a fight between animals.  If you are bitten, clean the bite wound immediately and call your healthcare professional. 
  2. Check to make sure your pet’s rabies vaccine is up-to-date. 
  3. Be sure to try to ascertain the rabies vaccination status of the animal that did the biting.
  4. Call your veterinarian.
  • If all animals involved have current rabies vaccinations then rabies transmission is not likely.¬†
  • If the BITER is not vaccinated, the BITTEN pet is considered exposed.¬† Your pet must be seen by a veterinarian ASAP and the BITER should be monitored for 10 days for any signs of clinical rabies disease.¬† Once 10 days have passed and the BITER is healthy, the BITTEN is no longer considered exposed and is safe from rabies virus from the bite.
  • If the BITER is not vaccinated and the BITTEN is current on rabies vaccination, again the BITER is monitored for 10 days for signs of sickness.¬† If the BITER cannot be monitored for 10 days (such as the case with a wild-animal bite) then the BITTEN is considered exposed and should be quarantined for 90 days.¬† Rabies vaccination during the quarantine period is permitted by the Pennsylvania Department of Agriculture.
  • If the BITER and the BITTEN are both not vaccinated for rabies, again the BITER is monitored for 10 days for signs of sickness.¬† If the BITER cannot be monitored for 10 days (such as the case with a wild-animal bite) then the BITTEN is considered exposed and should be quarantined for 180 days as it can take up to 6 months for rabies to incubate in a bitten animal. Rabies vaccination during the quarantine period is permitted by the Pennsylvania Department of Agriculture.

RABIES EXPOSURE INFORMATION AND PROTOCOLS CAN BE CONFUSING.  IF YOUR PET IS POSSIBLY EXPOSED TO RABIES, PLEASE CONTACT YOUR VETERINARIAN AS SOON AS POSSIBLE FOR FURTHER DIRECTION AND CARE.

Further instructions for persons bit by a rabid animal in Pennsylvania are found here: http://www.portal.state.pa.us/portal/server.pt/gateway/PTARGS_0_2_24476_10297_0_43/AgWebsite/ProgramDetail.aspx?name=Rabies-Facts&navid=12&parentnavid=0&palid=129&

Can Rabies be prevented? YES! Vaccination against rabies is very effective.  By PA LAW, dogs and cats (including indoor only cats) must be vaccinated for rabies by 4 months of age and vaccination must be kept up-to-date.

Pictured below is  a 2010 surveilance map of the number of rabid cats and dogs by US region that were tested positive for rabies compared to the number tested overall.  Notice again how the east coast and PA tend to be covered in yellow РRabies Vaccination for all pets is recommended and required by PA State Law. [photo courtesy of cdc.gov]

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Please take time today to check your pet’s rabies vaccination status. ¬†If you do not know when they are next due for their rabies vaccination, please call your veterinarian as soon as you are able.

 If you have any further questions regarding the rabies virus or rabies vaccination protocols, please feel free to post below or call us at Animal Health Care Center of Hershey at 717-533-6745.

Parvovirus & What You Need to Know

For those of you with canine companions: There have been many recent reports of a parvovirus outbreak in Lancaster County, Pennsylvania. This virus is quite dangerous to unvaccinated dogs and puppies are especially susceptible. WGAL has had many stories on this virus, therefore, I included a link that talks more about the outbreak. My blog post here will cover what you need to know as a pet owner regarding this potentially fatal virus…

http://www.wgal.com/news/susquehanna-valley/lancaster/potentially-deadly-dog-virus-hitting-susquehanna-valley/-/9704306/21503886/-/j0y92n/-/index.html

sick pitbull

What is parvo? Parvovirus is a virus that causes excessive diarrhea and vomiting, lethargy, and inappetance. All of these together can lead to severe dehydration and shock which if not treated aggressively can be fatal.

How can my pet get parvo? The route of infection is called a fecal-oral route. This means that dogs can get infected through licking feces from an infected pet.

Are certain pets at increased risk? Dogs that are not vaccinated properly are especially susceptible. Naturally then, young puppies that are only recently vaccinated or still in the puppy vaccination series are at high risk. Adult dogs that are not up-to-date are also at risk. There have been some studies done as well that show rottweilers, dobermans, and pit bulls (think black-and-tan dogs) are at increased risk.

What do I do if my pet shows signs of parvo? If your pet becomes lethargic and anorexic, followed by vomiting and then diarrhea that can be voluminous and bloody, please call your veterinarian (if you’re in our area, call us at Animal Health Care Center of Hershey – 717-533-6745). At the visit, your pet will receive a full physical examination and if we agree that parvovirus is a possibility, we will run a test called a fecal antigen SNAP test that helps identify infection within 15 minutes.

What will you do to treat my pet? Parvovirus infection has to be “treated” aggressively. What we aim to do with therapy is to support the pet through the infection so that they are adequately hydrated and antibiotics to ward off secondary infection. Anti-vomiting medications are given and as soon as the pet is able to eat, frequent small meals are fed. Hospitalization is usually required for these cases. Prognosis varies depending on just how ill your pet was at the time of the beginning of treatment.

Can I prevent my pet from getting parvovirus? Certainly! The best protection against parvovirus is adequate vaccination. The “distemper-combo” vaccination given to your pet as a series in puppyhood and then every 1-3 years includes vaccination for parvovirus. Also, if you have a young puppy, please keep them away from dog parks where they may come in contact with dog feces of unknown pets until they are fully vaccinated. Pets recovered from parvovirus can still shed the virus for up to two weeks after initial infection.

How is the parvo virus eliminated from the environment? Parvo is susceptible to bleach. In our hospital, pets with parvo are isolated from the other hospitalized and visiting patients. Those employees that work with the parvo patients are gowned up when working with the patients and a bleach foot-bath is required after being in the isolation room.

What about my cat? my child? Humans and cats cannot get parvo from a dog. The only known cases of parvovirus are in dogs, coyotes, foxes, and more recently thought to be found in bears.

What other questions do you have? Please feel free to post below and we’ll do our best to answer your questions in a timely manner. Go check your veterinary records and make sure your pet is up-to-date on his/her distemper (DAPP or DHPP) vaccination. If you find you are behind on vaccination, please give us a call and we’ll be happy to schedule an appointment to protect your pet!

For more information – follow this link to our website and a listing of pdf informational sheets about illnesses. Scroll down the alphabetical list to parvovirus for a more in-depth article about parvo: http://animalhealthcarecenterofhershey.com/info-sheets/medical-problems/

-Dr. AH, Animal Health Care Center of Hershey-