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Darlington Holiday Fundathon!

Protect Your Pet's Health & Help Shelter Animals!

 

Recently, I learned about the plight of animals in Darlington, South Carolina. Overwhelmed by the numbers of dogs and cats in their care, the Darlington County Humane Society is battling food shortages for the shelter animals, inadequate space, difficulty providing proper medical care, and other critical challenges. 


Darlington Matilda 

Matilda, a Darlington resident


Barbara Tilton, a volunteer who is doing amazing work to aid the animals of Darlington, shared some heartbreaking truths with me. She explained that the shelter has no budget for pet food, relying entirely on donated food; dogs at the shelter became emaciated due to being fed only one cup of food a day no matter their size or breed. When cat food runs out, the cats are given dog food, which most reject and go hungry. She showed me photos of the dogs with heartworm and other diseases waiting patiently for treatment. Barbara and the other heroes of Darlington K-911 and the Darlington Rescue Team are working heroically to help these animals, but they need our help.

 

Mulling over what could be done, I decided to put Vet Confidential to work and the Darlington Holiday Fundathon was born. I figured, people need holiday gifts, and the Darlington animals need funding, so for every copy of Vet Confidential: An Insider's Guide to Protecting Your Pet's Health sold between November 15 and December 15, a donation in the amount of author royalties will be made (and if you click on the book title above to purchase, Amazon will make a donation to Darlington as well). A consumer’s guide to health care for pets, the book makes a great present for animal lovers and when giving it as a  gift to friends and family (or yourself!), you’ll give a gift to the animals of Darlington as well. 


A donor has also offered a bonus to make sure we really work our tails off: if we can sell 2,000 books in the first week, he'll make a $500 donation to Darlington!! So we really need to rock between November 15 and 22 - please help spread the word on your websites and Twitter!

Darlington Marco
  Marco has extensive burns that need treatment

The Darlington shelter will take in approximately 5,000 unwanted pets this year alone. The greatest need in their community is to teach about the importance of spay/neuter and to offer low cost spay/neuter. Sadly, in this disadvantaged rural area, many still believe all pets should have at least one litter and that the county shelter is an appropriate depository for these offspring. It is not uncommon for smiling, proud families to surrender whole boxloads of puppies or kittens; many times these same families have surrendered litters the year before. Education is critical but necessary funds are lacking. The shelter’s immediate needs include pet food, medication for the animals, funding to treat heartworm infected dogs (common in their Southern climate), and means to safely transport pets to out-of-state rescues. To read more about the animals of Darlington or make a donation, visit www.darlingtonk911.com .

Darlington George
George lost his eye to infection



Breast Cancer in Pets (yes, they get it too!)

Many pet owners don't realize that pets also suffer from breast cancer. In veterinary medicine, the term that is used is mammary gland tumors. These tumors are common in dogs and cats who are not spayed or who were spayed at a later age.

Cats generally have 8 mammary glands, arranged in 4 pairs. Dogs usually have 10 glands arranged in 5 pairs, though the number varies with the size of the dog. Mammary gland tumors in dogs and cats can be benign (non-spreading, and cured by surgical removal), or malignant (having the potential to metastasize to other areas of the body and cause death). Cats and dogs differ in the proportion of benign versus malignant mammary gland tumors. In cats, around 90% of mammary gland tumors are malignant. In dogs, less than 50% are malignant.

How can mammary gland tumors be prevented in dogs and cats?

The best way to prevent mammary gland cancer in dogs and cats is through spaying at a young age. To prevent breast cancer, it is important that a pet is spayed before she ever goes into heat. There is an old myth that animals should have one heat cycle (or give birth to one litter) before they are spayed. This is not true! In fact, dogs who are spayed before their first heat cycle are 2,000 times less likely to develop breast cancer! After just one heat cycle, the risk becomes 16 times higher. Cats spayed before their first heat have 91% less chance of developing breast cancer than unspayed cats. After just one heat cycle, the risk rises in cats as well.

To be sure your pet is spayed before she goes into heat, it's best to have the surgery performed before a dog or cat is 6 months old. Around 4-5 months of age is a good time to have your pet spayed, as vaccinations are generally completed by 4 months (animal shelters often spay animals even younger than this, to be sure they are spayed before adoption).

Detecting mammary gland tumors

Just like in people, performing mammary exams in dogs and cats is very important. Early detection is key. For example, cats with mammary tumors that are removed when the tumor is less than 2 centimeters in size have a median survival time of 4 1/2 years, while cats with tumors removed that are bigger than 3 centimeters in size only have a median survival time of 6 months.

Once your dog or cat is 5 years old, perform a mammary exam on her once a month. Gently feel the tissue under and around each nipple, "rolling" the tissue between your fingers. Very small mammary tumors often feel like a little BB pellet under the skin. If you feel even a tiny lump or firm area, bring your pet to the veterinarian immediately.

Mammary exam cat

Treatment of mammary gland tumors in pets

The main treatment at this time is surgical removal. Depending on the situation, your pet may have only the affected mammary gland removed, several glands in the area, or all the glands on that side of her body. The tumor that is removed will be sent to the lab for a biopsy to tell you if it is benign or malignant. If the tumor is malignant, you may want to ask your veterinarian for referral to a veterinary oncologist for further advice and treatment.



Happy Halloween Story (complete with orange and black puppy!)

So, my friend Mark the park ranger was walking his Labrador, Aedan, in the woods when Aedan started sniffing the air in an agitated fashion and tugging hard on the leash. This was very unusual for him; Aedan is normally a really laid-back dog and it was obvious he was extremely concerned about something that he wanted Mark to know about. Mark let him off the leash and Aedan raced away with Mark following. As Mark approached the spot where Aedan had stopped, he could see from a distance that Aedan had found some sort of animal that was making all sorts of noise- normally Aedan does not get excited about the usual animals in the woods near where they live, such as deer and so on, so Mark knew this was different. Worried it might be a sick or rabid animal, he instructed Aedan to stay where he was and leave the animal alone; Aedan obediently hovered about three feet from what he had found.

When Mark arrived at the spot, he saw what (or shall I say who) Aedan was so worried about:

Brindle pup 2

Aedan had found an abandoned puppy! They were at least a mile from any home, near a dirt road, so it was apparent that someone had driven down the road and dumped this little girl in the woods.

Of course, she was desperately afraid and making all kinds of terrified noise but as soon as Mark wrapped in her in his sweatshirt and picked her up she calmed right down and was obviously thrilled to have been rescued.

Off she went to a warm house, good meal, and a cozy bed...thanks to Aedan the wonder Lab!

And that is the Happy Halloween story of the small orange and black puppy saved by a big black Labrador named Aedan.

Brindle pup 1 

Here is a picture of the hero, Aedan Dog, with his Halloween pumpkin:

Aedan with pumpkin

Of course, they all lived happily ever after!



Inflammatory Bowel Disease in Cats (IBD)

As a veterinary internal medicine specialist, I have done my best to explain inflammatory bowel disease (IBD) to countless cat owners (and veterinary interns, and externs, and random people at dinner parties...). On many occasions I've said that I need write down my little spiel, so I can just let everyone read about it while I kick back and drink chai latte...just kidding about that part, but it is time to blog about this ubiquitous topic.

First of all, let me clear up one confusion: it's inflammatory bowel disease, not irritable bowel syndrome. I know you are forever hearing about people with IBS and how they should take this drug or eat that yogurt...what kitties get is entirely different and it is IBD, not IBS.

So what the heck is inflammatory bowel disease, in pets? What this term really means is that when a pathologist looks at a biopsy of that cat or dog's intestine under the microscope, the pathologist sees white blood cells that shouldn't be there. There are different types of inflammatory bowel disease, based on what kind of white blood cells are the culprits; the most common kind in cats is called (take a deep breath) "lymphocytic-plasmacytic inflammatory bowel disease". Don't panic - I can explain.

We all have lots of different kinds of white blood cells, whose main job is to fight infection. Some of the most common types are neutrophils, lymphocytes, plasmacytes, and eosinophils. So when a pathologist says that a cat has "lymphocytic-plasmacytic IBD", she means that under the microscope, she sees lymphocytes and plasmacytes lining the small intestines and/or the stomach.

Here's a really bad, very simplified drawing of a normal intestinal wall, and an intestine with lymphocytic-plasmcytic IBD:

IBD and LSA 004
IBD and LSA 005

Your next question is: why do the white blood cells come to the intestine? Good question, and the answer is that we don't really know. Probably there are different reasons in different animals. Whatever the reason, the intestinal immune system gets overexcited and sends all these soldiers (the white blood cells) to do battle and then the white blood cells lining the intestines make it hard for the GI system to function properly...so the cat loses weight (because he can't absorb nutrients effectively) or vomits, or has diarrhea, or doesn't want to eat, or any combination of the above.

Unlike most of the body, the intestinal immune system has to be like a bouncer at one of those hot clubs where everyone lines up - it has to really pick and choose about who gets in and who is rejected. In most of the body, anything foreign is bad and the immune system attacks and gets rid of the invader. For example, there should be no bacteria hanging around in the bladder, or the lungs. If there are, they get kicked out, hopefully. But if you think about it, the intestines are different. There are bacteria that normally live there, and also, if you're a cat, there are things like chicken, beef, and fish all hanging around. So the intestinal immune system has to be very selective: "OK, all you normal bacteria can stay, as long you behave and there aren't too many of you, but Mr. Giardia, you need to leave, and Ms. Salmonella, I'm not thrilled about you either...". We think what happens with inflammatory bowel disease is that the intestinal immune system gets confused, and starts seeing normal bacteria or food proteins as enemies that need to be evicted. 

I said that one of the things that might be pissing off the immune system is food proteins. That's called food intolerance or allergy. In some cases of IBD, a change to a hypoallergenic diet can help. A hypoallergenic diet is food that has very limited ingredients, of types that tend to be less allergenic, and generally composed of ingredients that the animal has never had before. So a cat who has been fed chicken and fish and beef might be switched to duck or lamb. When using a hypoallergenic diet, it's really important that it's made of a "novel protein" (a protein source that is new to the animal) and that there are no other protein sources in there. There would be no point to feed a venison diet, for example, that also had some chicken broth in it. It's also really important that the animal is not fed any treats or anything else that contain ingredients other than those in the diet. There is no point to have your cat on a hypoallergenic lamb diet but also give her a little piece of turkey once in a while, or chicken-flavored treats or medicine. 

Unfortunately, right now there is no accurate way to test for a food allergy. The only way we can really tell is to try feeding a novel protein diet and see if the animal improves. There are prescription novel protein diets, there are some being sold over the counter (read the ingredients carefully to make sure there is nothing extraneous in there!), or you can make a balanced homemade novel protein diet with the help of websites like www.petdiets.com.

OK, so we don't know exactly what causes inflammatory bowel disease in cats, but some theories include excess carbohydrates in the diet (like dry food), bacterial flora imbalances, food allergies, or infections (such as bacteria, viruses, or parasites). I hope that one day we understand the causes better, so treatment can be more specific, but right now we end up treating many cases of IBD in a somewhat similar fashion.

Before we talk about treatment, let's talk about diagnosis. This is a step that sometimes gets skipped, to the detriment of the cat. Signs of inflammatory bowel disease in cats are very nonspecific; one of the most common signs is weight loss, and other signs include vomiting, diarrhea, or poor appetite. These signs can all also be caused by plenty of other things, such as cancer, pancreatic inflammation (pancreatitis), liver disease, ulcers, parasites, etc. So it is very important to obtain a definitive diagnosis before jumping into treatment! Especially since treatment may involve strong drugs like corticosteroids, which you wouldn't want to give without a specific reason. 

One disease that can cause identical symptoms to IBD in cats is called "small cell lymphoma". This is a slow, low-grade type of intestinal cancer that is very treatable. It's essential to differentiate whether a cat has IBD or small cell lymphoma because the treatment regime is different. And cats with small cell lymphoma can live happily for years on proper treatment (my own cat lived almost five years with this disease and died at close to 18 from something else entirely). In small cell lymphoma, the intestines are infiltrated by the white blood cells called lymphocytes (similar to inflammatory bowel disease), except there are lots and lots of them and they are more invasive.

The question has arisen whether inflammatory bowel disease is a precursor to small cell lymphoma, i.e. whether some cats with untreated (or treated?) IBD may go on to develop small cell lymphoma; does IBD in some cases "morph" into small cell lymphoma? We aren't sure. We do know that small cell lymphoma if unchecked can turn into a more malignant cancer called lymphoblastic lymphoma, where the cat actually develops a tumor.

Some bad illustrations are below:

IBD and LSA 001
IBD and LSA 002
IBD and LSA 003

The bottom line is that it is crucial to accurately diagnose and properly treat feline inflammatory bowel disease and small cell lymphoma. This is generally done through a combination of ultrasound and biopsies. We usually do an ultrasound first, to evaluate the stomach and intestines, see which parts of the GI tract (if  any) look abnormal, evaluate all the other organs such as the pancreas, liver, and spleen, and see if something else entirely may be causing the cat's symptoms. On ultrasound, the intestines of a cat with inflammatory bowel disease may look perfectly normal, or they may be somewhat thickened or have abnormal layering (disproportionate thickness of particular intestinal layers). Some cats with IBD or small cell lymphoma may have enlarged lymph nodes near the intestines.

It's essential that a skilled clinician performs your cat's ultrasound; some more information is here.

If the ultrasound is most consistent with the cat's symptoms being caused by IBD or small cell lymphoma (these cannot be differentiated on ultrasound), then a biopsy is performed. This can be done in one of three ways: endoscopy, surgery, or laparoscopy. Each has pros and cons, and your vet or internist can help you decide which is best for your cat. Endoscopy is least invasive and least expensive, but the biopsies are smaller and cannot be taken from as many different parts of the intestine. Surgery tends to be very accurate as long as good biopsies are taken from different sections of the intestinal tract, but obviously is more invasive and costly. Laparoscopy (minimally invasive surgery) is available at some facilities, and allows good biopsies to be taken with smaller incisions than the incision required for surgical biopsies. Being an internist, I do a lot of endoscopy, but I counsel pet owners about the pluses and minuses of each method.

It is essential to obtain biopsies before any medication is initiated, because medication, particularly corticosteroids, affect our ability to ever get a definitive diagnosis. They will mask symptoms, cause temporary improvement even with cancer, and can change the appearance of biopsy samples. It is NOT a good idea to do what is sometimes called a "steroid trial", where the cat is given steroids to see if symptoms improve. The symptoms of almost anything will temporarily improve on steroids, and once the cat has been given steroids, our ability to obtain a true diagnosis is greatly hampered. The cat can really be harmed if this causes accurate diagnosis or proper treatment to be delayed.

What is the treatment for inflammatory bowel disease? And small cell lymphoma? For inflammatory bowel disease, it depends somewhat on the severity and type. Treatment may include hypoallergenic diet, certain antibiotics such as metronidazole (Flagyl) and/or corticosteroids such as prednisolone. In cases of inflammatory bowel disease, the corticosteroid is very slowly tapered down based on the cat's progress; for example a cat might be on 10 mg a day for 2-3 months, then 5 mg a day for 2-3 months, then 2.5 mg a day, and so on. Unfortunately, most cats on corticosteroids for IBD cannot get off the drug entirely without relapsing.

For small cell lymphoma. the situation is different. Corticosteroids are also used, but the dose is never tapered, unless necessitated by side effects or other health issues. Generally cats are left on the same high dose for the rest of their life, and luckily they seem to do fine with this regime. In addition, cats with small cell lymphoma are usually treated with a drug called Leukeran (chlorambucil), also for the rest of their life. For example, a cat might receive one 2 mg tablet of Leukeran every other day. The combination of prednisolone and Leukeran works very well long-term in many cats. You can see why it is so important to obtain a definitive diagnosis if possible; if you did not know a cat had small cell lymphoma and treated presumptively for IBD, as the corticosteroid dose was tapered, the cat would relapse or potentially develop the much more devastating cancer called lymphoblastic lymphoma.

Some cats with IBD or small cell lymphoma will become deficient in certain B vitamins, particularly cobalamin (B12) and folate. This occurs because the inflamed intestines cannot properly absorb these vitamins. It is easy to test for B12 and folate deficiencies; a blood test is drawn after the cat has not eaten for about 12 hours. This test is important for several reasons: one, if either vitamin is low, it is a good clue that the cat may have intestinal disease, and two, it is essential to treat a deficiency if one exists. I often perform a test called a feline maldigestion profile, which measures these vitamins as well as checking for a deficiency of pancreatic digestive enzymes (a deficiency of digestive enzymes can cause similar symptoms to IBD or small cell lymphoma).

One of the most important things to monitor in cats with GI disease is their weight; if they are responding well to treatment they should gain back their weight and then maintain it. I encourage cat owners to purchase a good scale and monitor their cat's weight at home; my favorite scale is the Redmon Electronic Weigh-To-Grow Baby Scale.

Phew! Well, there you have it in a nutshell: IBD is a disease frequently seen in cats, which should be definitely diagnosed before treatment, and for which we don't really know the cause. Hopefully one day the veterinary profession will know more about this incredibly common problem, and in the meantime now YOU know more about it than you did 10 minutes ago!



Ultrasound for pets...what you should know

Diagnostic ultrasound for pets has been an incredible advance in veterinary medicine. The ability to use ultrasound to look inside the abdomen or chest of an animal means that we can often quickly and non-invasively investigate a host of different health conditions. But pet parents need to know some basic facts about ultrasound to protect their pets and ensure they truly benefit from this technology.

Ultrasound scans, also called sonograms, use high-frequency sound waves to form images of tissues within the body. This technology is similar to the sonar used by bats and ships at sea. The sound waves are reflected by the patient's tissues and these reflected sound waves are recorded and displayed as a visual image. This occurs in "real time", meaning that the images are immediately displayed on a screen, and events such as blood flow, heart beats, and gastrointestinal movement can be observed as they occur.

Abdominal ultrasound can be used to examine the liver, gall bladder, spleen, kidneys, bladder, prostate, uterus, ovaries, adrenal glands, stomach, and intestines. This means it can help us to pinpoint the cause of common pet health issues such as vomiting, elevated kidney or liver values on blood tests, abnormal urination, unexplained weight loss, and much more. We can also use ultrasound to look at some of the structures in the thorax (chest). We can't look inside the lungs, since ultrasound is impeded by air, but we can examine the heart and look for abnormalities such as fluid, enlarged lymph nodes, and tumors.

If your pet ever needs an ultrasound exam, it's crucial to ensure that it's done properly. An inadequate ultrasound can be worse than none at all, since it often leads to misdiagnosis, which can be very dangerous for your pet.The use of ultrasound in veterinary medicine has become very common but there are no regulations in place to ensure that your pet’s ultrasound is performed competently.

Ultrasound isn't magic; it takes training, skill, and experience for the operator to accurately locate and examine the various abdominal organs and tissues and to correctly interpret any abnormalities. Without adequate mastery, it can be very easy to misinterpret an ultrasound image—to mistake gas bubbles in the colon for bladder stones, to miss subtly enlarged abdominal lymph nodes, to overlook a localized intestinal thickening. Some organs can be very tricky to locate if the operator lacks proficiency; it is common for inexperienced individuals to miss the adrenal glands or pancreas, for example.

If your pet requires an ultrasound exam, it falls to you to ensure that the person performing the procedure has adequate training to do so effectively, since there are no standards currently in place in the veterinary profession. Anyone can buy an ultrasound machine and start using it on people’s pets, and the results of mistakes can be tragic.

The best way to protect your pet is to have the ultrasound exam done by a board-certified veterinary radiologist if possible . Radiologists undergo a lengthy residency program, during which they receive rigorous training in the performance of various types of ultrasound procedures. To become board-certified, they must pass an arduous certification exam. If there is a veterinary radiologist in your area, this is the best person to perform your pet’s ultrasound procedure. To locate a radiologist, you can go to the veterinary radiology website and search for a board-certified radiologist in your city or state.

If you can’t find a veterinary radiologist in your area, a veterinary internal medicine specialist is another good choice. Veterinary internists also receive ultrasound training during their residency programs, although their ultrasound training is not as extensive as that of a radiologist. Internists are also skilled at the interpretation of abdominal ultrasound results, since the abdominal organs are one of the areas in which they specialize. To find an internist in your area, you can check the internal medicine website .

An ultrasound exam of the heart (echocardiogram), for example for a pet with a heart murmur, should be performed by a board-certified veterinary cardiologist; you can find one in your area here.

One method to avoid for your pet is the “remote ultrasound”. In this situation, instead of having a specialist perform a full ultrasound exam, someone takes pictures using an ultrasound machine, and sends them to a radiologist for interpretation. Unfortunately many mistakes can occur with this method. If an abnormality is not recognized by the untrained person performing the exam, or the images are of poor quality, the radiologist cannot make an accurate assessment of the animal. This technique should be a last resort, for geographic areas where there is no radiologist or internist available.Owners should be given the choice of seeing a radiologist or internist and made aware that this option exists.

If you have never seen an ultrasound exam performed on a pet, here is a video of a puppy receiving an ultrasound exam to discover an object lodged in the intestines. As you can see, the procedure is not scary or uncomfortable for the puppy.

If your pet needs an ultrasound, or any other procedure, be an educated veterinary consumer. Read about the specialists that are available for pets; ask questions; get informed. Don’t ever be afraid to speak up. You and your pet both deserve the best that veterinary medicine has to offer.



Boo! Keeping your pets safe from toxic treats

As Halloween approaches, and we all stock up on candy and other treats, don’t forget that some of this tasty stuff can be highly toxic to our animal companions. 

-Chocolate isn't safe for dogs, but they love it! Most of us have a lot of chocolate around the house as Halloween and the holidays approach - if you have a dog, remember to keep your chocolate in lockdown. Don’t leave it out on the kitchen counter, coffee table, or elsewhere around your home, since an enterprising dog will go to great lengths to snatch this delicious-smelling stuff. Baking chocolate is particularly dangerous, so never leave it out when you are busy whipping up tasty desserts.

-Xylitol. This sugar substitute, found in sugar-free candy, gum, baked goods and other desserts, as well as in a powdered form for baking, is extremely dangerous to dogs. A dog who ingests xylitol is at risk of dangerously low blood sugar, seizures, liver failure, and death. Check for xylitol in the ingredients of any gum or treats in your home, and keep anything containing this substance closed away in a high cabinet. Make sure to warn the kids too, since their canine friend may try to convince them to share. 

-Grapes and raisins. Because these can cause kidney failure in dogs, never give your companion grapes, raisins, or anything that contains them. This includes breads and cakes that contain raisins as well.

If you ever think that your dog may have eaten anything on this list, or another potentially toxic substance, immediately call an animal poison control line, such as the ASPCA’s Animal Poison Control Center. And don’t forget to keep your pets safely in the house around Halloween time, when the tendency for mischief-making might put your furry friends at risk.



Pet Pain Patrol - Please Participate!

When choosing a veterinary practice for your pet, or deciding where to have a surgery or procedure performed, one of the most important parameters to evaluate is the practice's philosophy regarding pain control. In the olden days of veterinary medicine, many patients received little to no pain control after a surgery or injury. These days, many (but not all) veterinarians are vigilant about providing pain relief to the animals in their care. You need to ensure that the practice you use is up-to-date on both their pain control philosophy and the actual methods employed.

Failure to provide adequate pain control to animals is not only inhumane, it can also be severely detrimental to the animal's health and recovery. For example, pain has been shown to slow wound healing, increase rate of infection, cause shock and decreased circulation, and prolong hospital stays. 

Veterinarians must be proactive about recognizing pain in their patients. Pain is often underestimated in animals for a variety of reasons; for example, cats and older animals generally do not vocalize when in pain. It is essential to assume pain is present following a procedure or injury that would be likely to cause pain, and also to recognize more subtle signs of pain in veterinary patients. Cats are notorious for hiding significant pain. A cat in discomfort will often sit quietly in a hunched position, while a cat with proper pain control will have a more relaxed body position, move about, interact, and groom. If a dog or cat sleeps soundly with dreaming, this is a good sign of adequate pain control. Aggression is often a sign of pain in animals.

One very useful parameter veterinarians can use to evaluate for pain is the heart rate. An animal in pain may be lying quietly yet with an elevated heart rate. A good veterinary practice will assess the patient's heart rate at regular intervals, using a rapid rate as a clue that additional pain relief may be needed.

There are various medications available to provide pain control for pets. Some of the most commonly used options include narcotic medications, given as an injection, pill, liquid, or skin patch, and non-steroidal anti-inflammatory medications (NSAIDs), which may be supplied as an injection, pill, or liquid.

In some situations, NSAIDs should not be used due to the likelihood of significant side effects such as kidney failure and/or gastrointestinal ulceration. NSAIDs are contraindicated in animals with liver or kidney disease, gastrointestinal symptoms such as vomiting or diarrhea, and in patients who are dehydrated or having signs of shock, such as low blood pressure or low body temperature. Screening blood work to evaluate liver and kidney function is essential prior to administration of NSAIDs.

Use of NSAIDs in cats is controversial, with Metacam being a particularly well-known example. The manufacturer's instructions for oral Metacam state that this drug should not be used in cats, and indeed multiple reports exist of significant and even fatal consequences of oral Metacam use in cats. Regarding injectable Metacam, the manufacturer's instructions state that cats should only receive one injection of Metacam, and there are reports of even one injection leading to consequences such as kidney failure. Failure to follow the manufacturer's package insert directions is a risky business not only for the patient's welfare but legally as well.

One option for pain control in cats at home is buprenorphine (Buprenex), a liquid narcotic that can be given under the cat's tongue and will absorb from the oral mucosa. Because a very small volume is needed (around 0.1 cc in most cats) and because it does not need to be swallowed, it is easy to administer and this drug is nicely effective for many types of pain in cats.

Another relatively new development for pain control in both humans and animals is skin patches that release medication over several days. Skin patches containing the narcotic fentanyl can be used in both dogs and cats; care must be taken that the patch is not ingested by the animal. Below is a dog wearing a fentanyl patch.

Pain patch on dog small.jpeg 

And here is a close-up of the patch:

Fentanyl patch close up small.jpeg

As a pet owner, please be proactive in ensuring that your pet always receives safe and adequate pain control. Animals cannot tell us when they are suffering, or ask for help, so we must be vigilant in our efforts to protect them. Don't be afraid to ask about pain control for your pet, or to investigate the safety of any drug given to your companion.



Take a look at safe anesthesia for pets!

As you can tell, my mission is to give pet owners the information they need to protect their pets' health and to wisely choose the best veterinary practice to help achieve that. I believe that knowledge is indeed power and have seen too many pets suffer because their owners did not have the tools they needed to advocate for their animal companions.

Today I suddenly realized (duh!) that just talking about ways you can protect your pet isn't enough; I need to show you. It's one thing to babble on and on about safe anesthesia and having your older pet's blood pressure checked and ensuring your pet receives safe and adequate pain control. It's another to let you see for yourself. If nothing else, picture are a lot less boring then listening to my nagging.

So, today let's talk about, and take a look at, what is required for safe anesthesia. Safe anesthesia requires monitoring equipment, so that when your pet's oxygen level or heart rate or blood pressure drops, someone knows about it and can do something to fix the problem before your pet actually stops breathing or her heart stops and...well, you know. Pets can die under anesthesia, and proper monitoring vastly reduces the chance of that.

At a minimum, your pet should be hooked up to a handy gadget called a pulse oximeter. This little gem monitors the animal's blood oxygen level and heart rate, good parameters to keep an eye on if you want to make sure someone keeps living.

Here's a picture of a kitty having his blood oxygen level and heart rate measured with a pulse oximeter. I think you'll agree he seems quite happy about it.

Pulse oximeter on cat 2 small.jpeg


You're right, he's not under anesthesia. You can also use a pulse oximeter in awake animals when you are concerned about their breathing, such as animals in heart failure or those with pneumonia. If the oxygen level is too low, the vet needs to do something about it rather quickly, such as place the animal in an oxygen cage.

Another component of safe anesthesia is called intubation. This means placing a tube in the animal's trachea (windpipe) to deliver oxygen and anesthetic gas. If an animal under anesthesia is not intubated (if the anesthesia is delivered with a mask, or just by injection), there's not much anyone can do if that animal start to crash or stops breathing. But if the animal is intubated, the vets or technicians can ventilate the animal (breathe for her).For example, if the pulse oximeter shows the animal's oxygen level is dropping, the folks doing the anesthesia can give the animal a few oxygen-rich breaths by sqeezing on the oxygen bag a few times. Or, as I mentioned above, if the animal stops breathing completely, they can use the tube to breath for the animal. Can't do that with a mask and certainly not for an animal who just got an injection. Then it's rush rush rush to try to get a tube in before the pet dies. Not good.

Here's a kitty who is under anesthesia and intubated.

Intubated cat small.jpeg


See that little black bag on the lower left? If the kitty's oxygen level drops or she stops breathing, the vets or techs can breathe for her by squeezing the bag.That way they can keep her cute little tongue nice and pink like it is in the picture.

The other thing I want you to notice about the cat above is that she has in IV catheter in her leg. This is also super important for safe anesthesia. If this little cat's heart slows down, she can be given a drug to speed it back up through the catheter. If her heart stops, she can be given epinephrine to help re-start it. If her blood pressure drops, she can be given a bolus of IV fluids or medications to correct this.

OK, gotta run to work now. Now you know all about safe anesthesia; don't let your pets receive anything less!



HyperKitty : Overview of Feline Hyperthyroidism

Feline hyperthyroidism is the most common endocrine (hormonal) disorder of cats. It occurs most frequently in middle-aged and elderly cats. Cats fed fish-flavored canned cat food (particularly salmon) or liver and giblets-flavored canned cat food are at increased risk of developing this condition. Siamese and Himalayan cats are at decreased risk of hyperthyroidism compared to other breeds of cats.

Cats have two thyroid glands located in the neck. Feline hyperthyroidism is caused by the development of a growth on one or both thyroid glands. Most commonly, the growth is of a benign type called an adenoma; more rarely, a malignant tumor of the thyroid gland can occur. Affected glands produce an excess of thyroid hormones, which cause the heart to beat more rapidly and can result in heart damage and failure. Hypertension (high blood pressure) often develops. Hyperthyroidism can adversely affect the kidneys, and may cause elevated liver enzyme levels.

            Weight loss is the most common sign of feline hyperthyroidism. Increased appetite is frequently noted, and increased thirst may also be seen. Owners may feel the cat’s heart beating more rapidly. Affected cats may become restless or irritable. Diarrhea or vomiting can occur, but should raise suspicion that the cat may have gastrointestinal disease, such as inflammatory bowel disease or intestinal lymphoma.

            Veterinarians diagnose feline hyperthyroidism through blood tests and palpation of an enlarged thyroid gland. The most reliable test is measurement of a thyroid hormone called the total T4. Cats who have additional illness may have decreased levels of thyroid hormones, and this can make the diagnosis of hyperthyroidism more difficult. In this situation, it is most important to diagnose the disease which is depressing the thyroid hormone level. In cases where feline hyperthyroidism is suspected but total T4 levels are normal, a test called a free T4 level is often performed, but this test is unreliable since falsely elevated values may occur with non-thyroidal illnesses. Intestinal diseases may cause similar symptoms to hyperthyroidism, and should be suspected in cats who are losing weight and do not have elevated total T4 thyroid hormone levels.

            If a cat has a normal or low total T4 level, even if the free T4 level is elevated, it is essential to rule out intestinal disease as the cause of the cat’s symptoms. A good initial step is an abdominal ultrasound, which may show thickened intestines or enlarged intestinal lymph nodes. However, ultrasound findings can be perfectly normal in cats with even advanced intestinal disease. If a cat is losing weight and full blood work and ultrasound do not reveal a definitive cause, intestinal biopsies, such as via endoscopy, should be considered. This is particularly true if the cat does not have other signs of hyperthyroidism, such as an elevated heart rate and/or a palpably enlarged thyroid gland.

            Feline hyperthyroidism can be treated with medication, radioactive iodine therapy, or surgery. The most commonly used medication is called methimazole (Tapazole®). Use of this drug requires close monitoring of the cat’s kidney function, blood cell counts, and liver enzymes, because serious side effects can occur. Medication does not cure the disease but will decrease the hormone levels. Because the thyroid growth will continue to enlarge, the dose of medication often needs to be periodically increased. Research has shown that methimazole is more effective with fewer side effects if the dose is divided into twice-daily dosing. For example, for a cat receiving 5 mg a day, it is safer and more effective to give 2.5 mg twice a day.

            Radioactive iodine therapy (RAI) involves an injection of a radioactive isotope. Iodine is used because it is taken up by the thyroid gland. Research has shown that hyperthyroid cats receiving this treatment after initial regulation with medication have the longest lifespans. Since treatment of hyperthyroidism may affect kidney function, it is recommended that cats are treated with medication before receiving RAI, to ensure that kidney function will remain adequate when thyroid hormone levels normalize. It is also essential to closely monitor kidney values after RAI treatment.

Laws vary a bit from state to state, but it is required that cats receiving RAI are boarded in special facilities after the injection until it is deemed safe for them to be in close contact with their owners. Generally, cats thrive in these facilities, since most are designed for maximum feline comfort.

            Surgery to remove one or both thyroid glands may be performed. As with RAI, cats should first be treated with medication if possible to ensure that kidney function will remain adequate. Additionally, normalization of thyroid hormone levels before surgery with medication will decrease the risk of anesthetic complications, since elevated thyroid hormone levels can increase the risk of heart arrhythmias. Because the parathyroid glands, which control blood calcium levels, are located in close proximity to the thyroid glands, cats who have both thyroid glands removed may experience a dangerous drop in blood calcium levels. For this reason it is not generally recommended to remove both thyroid glands simultaneously; rather only the gland which is visibly enlarged is removed.

            It is essential to measure blood pressure both before and after treatment of hyperthyroidism. Hyperthyroidism can cause hypertension; additionally, research has shown that many cats with initially normal blood pressure will develop hypertension in the months following treatment.

            In cats who have severe reactions to methimazole, but who cannot be treated with RAI or surgery, perhaps due to the owner’s financial restrictions, a drug called atenolol can be used to control heart rate and blood pressure, and to improve the cat’s mood. This drug will not slow weight loss, however.

            Cats with feline hyperthyroidism who are promptly diagnosed and treated have a good prognosis. Prognosis is best in cats who receive treatment with medication followed by radioactive iodine therapy.        



What is feline leukemia anyway? Does my cat need the vaccine?

Many cat lovers are aware of feline leukemia, but aren't exactly sure what it is. They know it's bad, but is it an infection, or cancer, or...?

Here's the story. There is a virus called the feline leukemia virus, often abbreviated FeLV. It's in the same family of viruses as the human HIV virus, and the feline FIV virus. They are all in the family called retroviruses.

It's confusing to folks because leukemia is a kind of cancer (cancer of the bone marrow), so when we say a cat has feline leukemia, it seems like the cat has cancer. Really it's more correct to say that a cat is "feline leukemia virus positive" which, like a person being HIV positive, means the cat is infected with the virus. The reason the virus is confusingly called the feline leukemia virus is because it can cause cancer in cats, particularly lymphoma. In fact, it is thought that lymphoma in even feline leukemia negative cats can be caused by prior exposure to the virus, and the virus has been found in feline tumors. So maybe they should have called it the feline lymphoma virus.

If possible, cats who are positive for feline leukemia on the kind of test called an ELISA should then be tested with another test called an IFA. ELISA tests can have false positives, or can be positive in cats who are infected but are going to fight off the infection. If the IFA test is positive, it means the cat is permanently infected.

The feline leukemia virus is more severe than FIV. It causes serious health issues more quickly and is more infectious. FeLV positive cats often develop anemia, infections, cancer, and other problems. The best living situation to keep an FeLV postive cat alive and healthy as long as possible is for the cat to be an only cat who is kept indoors. Unfortunately, it's hard to find homes for FeLV positive cats, much less homes where they are the only cat and never go outside. I had a friend who had a cat who was both FeLV and FIV positive; she kept him inside and he was her only cat, and he lived for many happy years before eventually developing lymphoma.

It's important to realize that while FeLV is more infectious than FIV (which is mainly transmitted by bites during fighting in unneutered males), FeLV is only transmitted by close contact such as grooming, licking, or sharing food or water. It won't be brought in on the owner's shoes or clothing, for example, or on the air, and it doesn't live a long time in the environment or on surfaces. By contrast, the panleukopenia virus (feline distemper) lives a very long time in the environment, up to a year or more, and can easily be transmitted through contaminated objects; there doesn't have to be contact between the cats themselves.

Because actual contact between cats is required for transmission of the feline leukemia virus, there is little point to vaccinating an indoor cat who never meets new untested cats. If you have a completely indoor cat who is negative for the feline leukemia virus, she just can't get it (unless you bring a strange cat home without testing him first). So this vaccine only needs to be given to cats who go outside or who will be exposed to untested cats. You should also be aware that the vaccine is not 100% protective - a vaccinated cat can still get the virus. The only way to really protect your cat from FeLV and FIV is to keep her inside.

The American Association of Feline Practitioners does recommend that vets vaccinate all kittens against feline leukemia; they are concerned that it is hard to predict what a kitten's lifestyle will be throughout his entire life. They're worried about a scenario where the vet doesn't vaccinate the kitten against feline leukemia because the kitten is being kept indoors, and then the owner gives him away to someone else who lets him go outside. From your perspective as a cat owner, you need to understand that indoor cats don't need the vaccine but if your cat's lifestyle changes at some point the vaccine may become necessary.

Unfortunately, the feline leukemia vaccine is one of those that has been associated with the development of tumors at the vaccine site. The new transdermal vaccine has been formulated to combat this problem. The other vaccine that is implicated in tumor development in cats is the rabies vaccine; the newer Purevax vaccine does not contain the ingredients that are thought to cause these tumors. It is also thought that long-acting steroid injections may cause tumors at the injection site in cats; another reason to avoid long-acting steroids when possible.

The most current thinking on vaccination of pets is that protocols should be tailored to the indiviual pet's situation. All pets should receive the core vaccines for diseases that are highly infectious and devastating, such as panleukopenia, and the other vaccines should be chosen based on the particular animal's risk factors. Pets should not routinely be given every vaccine on the market whether they need it or not; I am happy to see this happening less and less. Before your cat receives a feline leukemia vaccination, discuss with your vet whether it is necessary based on your cat's living situation.

Here is some information about the feline leukemia virus and FIV that you may find helpful.



Resources for Pet Parents

Hey pet people, thought today I would share 10 of my favorite pet resources with everyone - spread the word:

1. For cats with asthma, excellent information and advice: www.fritzthebrave.com

2. To order or read about the mask to give kitties with asthma inhaled medications: www.aerokat.com

3. Great litterbox to collect urine for testing in diabetic kitties: www.smartcatbox.com

4. Fun and informative website to read about parasites and infectious diseases of pets: www.wormsandgermsblog.com

5. Where to get free or low-cost spay/neuter: www.aspca.org/pet-care/spayneuter

6. Website to find a veterinary specialist in cardiology, oncology, internal medicine, or neurology in your area: www.acvim.org

7. Help with making balanced homemade diets for pets and great nutrition info for dogs and cats: www.petdiets.com

8. To get free (!) pet behavior help: www.aspcabehavior.org

9. To learn about feline nutrition: www.catinfo.org/zorans_article.pdf

10. To find an AAHA-accredited veterinary hospital near you: HealthyPet.com

Hope you all find this info helpful! Here's to a healthy week for all animals!



Pit Bull Owners: Beware of Babesia!

We need to talk about a mean little parasite called Babesia. It infects dogs' red blood cells and can cause severe anemia (decreased red blood cells) and other problems too. It has become a big problem for dogs in the US, especially American Pit Bull Terriers and American Staffordshire Terriers. Although this disease can be transmitted by ticks and other insects, it's thought that in these breeds in the US it is probably being spread when dogs bite each other, even during play or a brief disagreement. It may also be spread when dogs' tails and ears are docked.  It is likely also transmitted straight from the mom to her puppies so your dog could have Babesia even if he's never been bitten by another dog. Other dog breeds can also be infected if a dog with Babesia bites them.

It's important for Pit Bull and Staffie owners to know about Babesia because sometimes when dogs become anemic from Babesia, it is misdiagnosed as something else. Frequently it is confused with a disease called Immune Mediated Hemolytic Anemia (IMHA), which is a condition where the dog's own immune system attacks the red blood cells. If a dog with Babesia is treated with the medicines used for IMHA, which are drugs that suppress the immune system, it will make the Babesia worse. Some dogs with Babesia have vague symptoms; bottom line is that pit bulls who are anemic or mysteriously ill may need to be tested for this parasite. It's important to test for the type of Babesia that usually infects pit bulls, which is called Babesia "gibsoni" (other breeds are more commonly infected with Babesia "canis").

There are different ways to test for Babesia. Your vet can send what's called a "titer", or another test called a "PCR". The PCR is the best test, but it takes a few weeks to come back, so your vet should send both at the same time. Even if one test is negative, the other can be positive. I send my Babesia tests to to the veterinary laboratory at North Carolina State University, which I think is the best lab for this. They are very experienced with this disease, and know everything about it. There are several different kinds of Babesia and if you use a lab that doesn't do the right test for your dog, the result can be wrong. Many dogs have had "false negative" test results because they were tested for the wrong type of Babesia or with the wrong blood test instead of the PCR test. The lab at NC state tests for all the different kinds of Babesia, and they can do the PCR as long as your vet asks for it.

The best treatment for Babesia gibsoni seems to be an expensive drug called Mepron. Its other name is Atovaquone. The dogs are given Zithromax (azithromycin) at the same time. Mepron is available in the US but can be hard to find so in the meantime your vet may temporarily treat your dog with a drug called Imizol, or Imidocarb.

The bottom line: If your Pit Bull ever gets sick, make sure your vet keeps Babesia in mind!



Advice For Lumpy Bumpy Dogs

Any dog parent knows: dogs love to get little lumps and bumps on their skin, especially as they reach middle age and beyond. Some older dogs are just covered with them.

Should you worry about those annoying and sometimes unsightly lumps? Some dogs seem to get a new one every month - do you need to bother going to the vet every time?

Unfortunately, yes. Dogs get plenty of benign skin lumps, such as sebaceous cysts (those greasy ones with the yucky tan toothpaste-looking stuff inside them) and lipomas (benign fatty growths). But unfortunately, skin bumps can also be malignant, and it's important to get these examined and properly removed as soon as possible.

When you go to the vet, the doctor will examine the lump and then hopefully do a simple procedure called a "fine needle aspirate", in which a small needle is inserted into the lump to draw out a cell sample. It is very important to perform this type of aspirate in order to determine which type of lump your dog has.

Once some cells have been drawn out of the lump, which takes about 30 seconds, the sample is spread on a slide. Sometimes the vet can tell right away just by looking at the material on the slide what kind of lump it is. For example, if a chunk of that yucky brown paste squirts out onto the slide, your vet may be able to say that the lump is a benign sebaceous cyst. If the sample is just perfectly clear grease, your vet may feel comfortable stating that the lump is a lipoma.

Otherwise, your vet will want to send the slide off to the lab for a veterinary pathologist to examine. The cost for this is well worth it, and may save your dog's life.

One example of a malignant skin mass is called a "mast cell tumor"; a tumor made up of the type of cells that contain and release histamine. Mast cell tumors can be any size or shape and can look like anything. I wish I had a dollar for every mast cell tumor that looked and felt so exactly like a lipoma that I almost felt silly doing the aspirate...and then was darn glad I had!

It is super important to aspirate skin bumps and find out what they are BEFORE removing them. If a skin tumor is malignant, the surgical procedure is very different than it would be for a benign lump. For example, if the surgeon is removing a benign sebaceous adenoma because it is rupturing or getting infected, he or she just needs to remove the lump itself. However, if it's a mast cell tumor or another malignancy, it is very important to get very wide and deep margins around the tumor in order to help prevent future recurrence or metastasis. Veterinary research studies have shown exactly how many centimeters of tissue must be removed around and below a mast cell tumor in order to improve the dog's chance of survival, and the surgeon needs to know this is required. You would never make such a large, deep incision for a benign lump, so you need to know beforehand what you are dealing with.

Additionally, most general vets are comfortable removing small, benign skin lumps, but if your pet has a malignant skin mass, your vet will probably refer you to a veterinary surgical specialist for the procedure, since surgeons are trained in the most effective and safest removal of tumors. It can be very tricky to get proper margins, especially in certain areas of the body, and surgical specialists are of course skilled in the best ways to accomplish this.

Take home messages:

1. Have your dog's skin lumps examined by the vet.

2. Skin lumps should be aspirated to find out what they are, BEFORE they are removed.

3. For malignant lumps or lumps that are large or in tricky areas, referral to a surgical specialist is recommended.



Gotta cat? Getta screen!

The weather is gorgeous now, right? Unfortunately, beautiful weather means you don't need A/C or heating in your home. Wait - did she say "unfortunately"?? Yep, that's right, I did - because when folks don't need heat or A/C, they just open the windows. And in some cities that don't have a lot of bugs, many of the apartments don't have screens.

Guess what happens next. Beautiful day, open window, no screen, happy kitty sitting in the window watchin' the pigeons strutting about on the windowsill next door...kitty leans out to take a closer look...oh, if I could just get a little closer I could get that darn juicy pigeon...uh oh - sad kitty with broken legs and punctured lungs on the sidewalk 6 stories down.

It's called feline high-rise syndrome, and it happens all the time. Cats fall or jump (yes, jump- their kitty brains don't know they are 10 stories up!) and are horribly injured or killed. We have two to three cases a week at our hospital in nice weather and some even when the weather's bad. These cats have multiple fractured bones, bruised or punctured lungs, shattered jaws. Some don't make it.

Please please please. If you have a cat, get screens! You can buy adjustable screens at any hardware store for a couple of bucks.

Here I am demonstrating an adjustable screen on the news last night, with a cute kitten in my lap to boot!

No, cats do NOT have good instincts, people! Their instinct tells them to eat a piece of ribbon...that gets caught in their intestines. Their instinct tells them to cross the road chasing after that squirrel...and get killed by a car. Their instinct tells them to jump out a window 40 stories high when a bird flies by...and plummet to the sidewalk below.

Cats are gorgeous. They are excellent snugglers, and even better nappers. They are incredible athletes. But they are NOT good at protecting themselves (hello: "curiosity killed the cat")  - so we've gotta take care of that part!



I'm not a carnivore but my cats are...

I was just reading a blog where the topic of vegetarian cats was being discussed. There was some misinformation that reminded me about the importance of understanding how unique feline physiology is.

Dogs and humans are omnivores; we are very nutritionally flexible and can adjust to a variety of diets. Cats are different! Their nutritional requirements are very strict and unforgiving. If you vary from what a cat's body needs, you can get in trouble rather quickly and cause severe effects on the cat's health and well being. Most people now know about taurine, an amino acid found in meat that dogs and humans can manufacture in their bodies but cats need to eat (they can't make it). But I think an even more striking example is vitamin A. This vitamin occurs naturally only in animal tissue. Humans can either eat vitamin A, or they can eat beta-carotene in veggies and then convert it to vitamin A. Cats? Nope, you got it - they can't convert beta carotene to vitamin A; they have to eat it in animal products.

There are lots of similar examples regarding feline nutritional needs, which are summed up beautifully in this article. If you have a cat, you should read it! It also talks about the risks of feeding cats carbs (i.e. dry food) and has tons of pretty fascinating info.

Look, if you love cats, you gotta love everything about them - including their inescapably carnivorous physiology. Sure, I wince every time I open a can of cat food, or cook my cat his (balanced!) homemade organic chicken diet. But if you wanna live with cats, you need to face that fact that you're living with a predator. Granted, a predator who loves to cuddle and is scared of strange noises and cries like a baby when he doesn't get enough attention...but inside that cute little body lies the metabolism of a tiger.



Save Sylvester from Steroids! Rescue Rex from Roids!

It wasn't discussed in any Congressional hearings, but it's a major problem: the overuse of steroids in veterinary medicine. You need to understand this issue so you can protect your pets.

Of course, I'm not really talking about anabolic steroids, as used by athletes. I'm talking about corticosteroids, also called glucocorticoids. These are medications related to cortisol, a hormone normally produced by the body in minute amounts. There are many kinds of corticosteroid medications, from injections to pills to topical creams; you can often recognize them by the letters -one at the end of their name (prednisone, dexamethasone, etc.) or the phrase cort somewhere in the name. 

Corticosteroids exert effects on virtually every system in the body, such as:

-Suppression of the immune system

-Resistance to the action of insulin

-Thinning of the skin and decreased ability to heal

-Increased acid in the stomach and decreased production of the cells lining the stomach and intestines

-Decreased intestinal absorption of calcium and increased absorption of fat

-Increased fat and cholesterol in the blood

-Decreased bone growth and osteoporosis

-Liver damage

-Muscular weakness

-Fluid retention

-Poor hair growth

As you can imagine, the effects of corticosteroids have the potential to be harmful to your pet if these medications are not used wisely.

There are definitely instances where corticosteroid medications are essential and can be life-saving. I don't want to scare you so much that you avoid giving your pet corticosteroids when it's truly necessary. And sometimes, it really, truly is necessary. However, it pains me to say that in veterinary medicine, corticosteroids are often used as a quick fix, catchall treatment for a variety of symptoms. Your dog's vomiting? Give him these steroid pills. Your cat is having labored breathing? I'll give her a steroid injection. Hang on, folks!

Yes, certain very specific diseases require corticosteroids as a component of therapy. But the kind of rampant, casual steroid use on pets that is currently occurring is wrong, and educated pet parents need to understand the proper use of these powerful medications so they can protect their companions.

Here are some rules that can help minimize the risk to your pet:

A diagnosis should be made prior to corticosteroid administration

Giving a pet corticosteroids without a diagnosiss will obstruct identification of the pet's health problem and may even cause it to worsen. Corticosteroids obscure correct diagnosiss by temporarily alleviating symptoms, and can even make diagnosis of some diseases difficult to impossible by affecting the results of medical tests such as blood work and biopsies.

Another concern with using corticosteroids before obtaining a diagnosis is that by suppressing the immune system, corticosteroids can endanger a pet whose symptoms are in fact caused by an infection.

Long-acting corticosteroids should be avoided if possible.

A long-acting injection is commonly used in veterinary medicine, particularly in cats, and can cause severe side effects, including diabetes. These injections have also been associated with a tumor called fibrosarcoma.  These injections should only be used as a last resort in pets who absolutely require corticosteroids and cannot be medicated in any other fashion.

Other therapies should be used first if appropriate

For some health problems, corticosteroids are the mainstay of treatment, and their use cannot be avoided. But for many conditions, other types of treatment can also be effective, and should be tried before leaping to the use of corticosteroids. For example, a dog with allergic skin disease could be treated with a hypoallergenic diet or antihistamines, or could be referred to a dermatologist for allergy testing and specialized treatment.

Often consultation with the relevant type of veterinary specialist can be helpful in developing treatment plans that minimize or eliminate the need for corticosteroids.

The animal should be monitored closely for side effects, and the corticosteroid dose adjusted if necessary

Visible side effects of corticosteroids include thinning of the hair and skin, pot belly, muscle loss, and in dogs, increased thirst and urination, hunger, and panting. If a particular pet's side effects are dramatic or severe, the dose of corticosteroids should be altered accordingly. 

The animal should first be assessed for issues that may increase the risks associated with corticosteroid use

Animals with certain health conditions are more likely to experience serious side effects of corticosteroid treatment. These health conditions include:

-Heart disease. Corticosteroids may exacerbate the risk of congestive heart failure or clot formation.

-Obesity. Corticosteroids may increase the risk of diabetes or ligament rupture.

-Pancreatitis. Corticosteroids may increase the risk of pancreatic inflammation.

-Infections. Corticosteroids suppress the immune system, so infections may worsen.

-Animals on NSAIDs (nonsteroidal anti-inflammatory medications). These drugs can cause gastrointestinal ulceration, as can corticosteroids, so they should never be used together.

-Animals having surgery. Corticosteroids inhibit healing.

Bottom line: If a vet is about to give your pet an injection, or hands you an envelope of pills, stop him or her and ask "Is this a steroid?" If so, slow down the process, ask for an explanation, and think about the rules above. If you're still uncomfortable, it's never wrong to get a second opinion or see a specialist. Never be afraid to stand up for your right to protect your pet.



Feline asthma update 8/1/09

We've talked about feline asthma (feline allergic bronchitis) before. Just wanted to give you a quick update for those with asthma kitties who are having a tough time with the cost of Flovent. Flovent comes in 3 strengths: 44 mcg, 110 mcg, and 220 mcg. There's evidence that the lower strengths of Flovent can work well for cats, and I checked around: the lower the strength of Flovent, the lower the cost. So if you are struggling to afford your kitty's meds, ask your vet about the possibility of using the 44 mcg strength.

Remember: injectable corticosteroids, particularly long-acting types such as Depo-Medrol, can cause side effects, such as diabetes, in cats. So if you have a kitty with asthma and you are not using inhaled meds (i.e. Flovent), be sure to ask your vet about this option.

If you smoke: STOP. Or at least smoke outside. If your cat already has asthma, your smoking may have caused it and is certainly making it worse. If your cat does not have asthma (yet), you are asking for trouble. And of course second-hand smoke can also cause other major health problems for your pet, such as cancer.



The Beagle Has Landed

Remember Tommy, the elderly beagle waiting for a home in the ASPCA shelter who was featured on the Today Show and Good Morning America?

Well, a wonderful woman in Michigan who had recently lost her own elderly beagle drove the whole way to New York City to adopt Tommy after seeing him on television.

Tommy's new mom, Sue, recently gave the ASPCA an update on how Tommy has settled into his new home. He lives and plays with two other rescued dogs, Charlie and Annie, he loves his stuffed duck and his bone - in short, he is one happy beagle! I am so happy for Tommy - he's a great guy, and he deserves his perfect new home.

I can't wait for the day when every shelter dog finds a home with someone as kind and generous as Tommy's new mom, Sue.



The Twelfth Day of Holiday Hazards

On the twelfth day of the holidays, my true love gave to me...PRESENTS

Ah, presents. We all love 'em, and most of us like to shower our pets with holiday gifts too. Nothing wrong with that - truth is, it's a lot easier and more fun to buy presents for our dogs and cats than other family members; they're easy to please, always grateful, and never return their gifts.

We just need to be careful that our pets' stocking stuffers are safe for them.

Most safety risks from pet toys and treats relate to what happens if the object, or part of it, gets swallowed. And let's keep in mind that if it CAN be swallowed, it WILL be swallowed.

Dogs are really good at tearing their toys apart, and then swallowing the pieces, sometimes very very large pieces. Which can then become lodged in the esophagus, stomach, or intestines. In fact, dogs are also really good at swallowing toys whole - really big toys that you could never, ever believe someone could gag down. But they do. I've seen entire fairly large balls in dogs' stomachs, more than once. Go figure.

Ask any vet how many dog toys he or she has seen removed, surgically or with the endoscope, from the gastrointestinal tract of canine patients. A whole bunch is the answer.

So- it's essential to avoid dog toys that can be successfully torn into pieces, or swallowed whole. And you need to leave a lot of latitude in these definitions because dogs can tear up or swallow things that would amaze you. You want to stick with chew toys that are basically indestructible, or chew treats that are designed to be safely digestible. Kongs are great chew toys - they have a hollow center that can be stuffed with dog food or other safe foods, which will give a dog hours of pleasure trying to dig the stuff out. And as we know, a busy dog is a happy dog. There are lots of good kong stuffing ideas on the internet - just be sure you use foods that are safe for dogs to eat - nothing fatty or greasy, or too unfamiliar to your dog's digestive tract.

As for cats, the most risky toys are those that involved string, or anything long and skinny such as ribbons, yarn, etc. When cats swallow these, which is an unfortunately common occurrence, they often become entangled in the intestines, necessitating emergency surgery, and with a potential for intestinal tearing leading to peritonitis. Cats will also swallow anything small enough to gulp down, such as buttons or other similar object, and because a cat's intestinal tract is rather narrow, these object often become lodged, with disastrous results.

So- shower your pets with presents, indeed! Just be careful what you purchase, thinking always about safety - and never assume that just because something is marketed for pets it must be safe. If only that were true, vets would have a lot fewer surgeries to perform this holiday season.



12 Days of Holiday Hazards...Day 11

On the eleventh day of the holidays, my true love gave to me...BEING LEFT BEHIND

Once again, not the gift we are all awaiting from our true loves. Yet during the holiday season, the fact is that a lot of people travel, and most can't take their pets. How can we ensure our pets are safe and sound when we're off to struggle with airport lines, highway traffic, and crowded train stations?

Well, let's start by talking about cats. I can tell you right now, if you're going away, the place your cat wants to be is in her or his own home. The vast majority of cats would waaaaaaay rather stay home alone than be boarded in a kennel or veterinarian's office. It's safer in some ways too - a boarding cat may pick up a respiratory or other infection from the other animals in the facility.

Does this mean you should just fill up a big bowl with dry food and wish your cat luck? No!! Well, first of all I'm not a fan of dry food anyway, but that's not the point. The best plan is to have a catsitter stop by once or twice a day while you're gone, for a number of reasons. One example: male cats can "block", a situation where the urinary tract becomes obstructed, which is rapidly fatal if not discovered early enough. Stress is suspected to be one of the factors that brings this on, so it's just not safe to leave your cat (who is probably missing you and a least a little stressed) home alone for more than 24 hours at a time.

Other mishaps can befall cats as well. We know cats - they think they're sneaky but usually to their own detriment. Imagine a cat stuck in the closet the whole time his family was away. One time my own cat somehow darted out the door as we left without us realizing it, and was trapped in the hallway of the apartment building. Boy was he sorry when he realized what a bad idea he had. It went from "I tricked Mommy!" to "MOMMY! " pretty fast, you can bet. Or imagine a cat who gets sick while her owners are away, or swallows something he or she shouldn't. No, it's definitely best to have someone checking up on kitty!

If you need a catsitter, it's easy: just stop by your vet''s office or another vet clinic in the neighborhood, and ask if any of the veterinary technicians catsit. Many do, and the nice thing is that they know how to recognize if a cat isn't doing well, or if there is cause for concern. If your cat has special needs, such as medication, a technician's training will come in especially handy.

Dogs - well, unless you have someone who can stay in your home, it's tough, since they need to be walked, and they get pretty lonely too. Many people do have friends or family willing to stay with Rover, but if not your friend may be off to the kennel. Be sure to check out any kennel carefully, including an inspection of the "back". Don't be shy; you have a right to see where your dog will be staying. If you are boarding your dog, remember that he or she may need a booster of the kennel cough vaccine; it's usualy required and a pretty good idea. It's one of those vaccines where the effects are not long-lasting, so don't think that a vaccine given two years ago will still be effective.

Whatever your plan, be sure to leave every phone number you can think of, including your cell and the number where you will be staying. Let your pet's caretakers know which vet you use, and write a note giving the vet permission to treat if you cannot be reached, if you are comfortable with this. Check ahead of time that any medications your pet needs are all stocked up as well.

Well folks, happy travels! Come back soon, your pets miss you!



12 Days of Holiday Hazards...Day 10

On the tenth day of the holidays, my true love gave to me...A TRIP!

A lot of folks will be traveling with their pets over the next few weeks. It's pretty cool, I think, how many people take their pets along when they travel these days - but this does mean we need to plan ahead to make sure everything goes smoothly, and stress (for furry and non-furry family members) is minimized.

If you're planning to fly with your pet, it's best, by far, if your pet can go with you in the cabin. This is certainly safest, and a lot less terrifying, for both of you. Of course, if your pet is too big to travel in the cabin, this won't be possible (in which case you may want to consider leaving the pet at home or in a kennel). If your pet is small enough to go with you in the airplane cabin (and I would be willing to have my pet be pretty darn cramped in a carrier to avoid putting him or her under the plane), be sure to reserve this ahead of time with the airline. There may be a fee.

 Make sure you have all the paperwork you need, which often involves a health certifcate from your vet within a certain time period before the flight. Don't wait till the last minute to schedule this! And be sure your pet is well-identified, preferably with both an ID tag on a collar and a microchip. Whether your pet is going in the cabin or under the plane, if the unthinkable happens and your pet somehow gets loose, you want to maximize the chance he or she will be returned to you.

If you are traveling by car, things are a lot easier. Consider whether your pet tends to get motion sickness (which can be evidenced not only by vomiting, but also by drooling or restlessness). If your pet has indeed shown symptoms of motion sickness in the past, consider asking your vet for something to ward this off. If you will be stopping along the way, avoid leaving your pet alone in the car, especially in an area with a lot of strangers around, such as a rest stop. If you take your pet out for a walk along the way, be extra careful - a loose pet in a strange place is a nightmare none of us need! Make sure your dog's collar and leash are on and shipshape before opening the car door.

Pet parents often ask vets about sedation during trips. Unless your pet goes ballistic during travel, it's generally safer to avoid sedation if you can. Pets are better able to regulate their body temperature and otherwise keep themselves safe when not sedated, which can not only cause a drop in body temperature but also in blood pressure, depending on the drug used. Don't automatically assume pets should be sedated for travel - most shouldn't.

Be sure to take with you any necessary medical information, and if you're driving a long way, consider locating some veterinary emergency clinics along your route. Make sure your pet's prescriptions are refilled if necessary, and it can be prudent to ask your vet for a written prescription to take with you in case medication gets lost along the way. Lots of hotels allow pets these days; it's best to check ahead for hotels that welcome pets along your route or at your destination.

p.s. If your pet is a cat, consider that unless you will be away for a prolonged period, your cat might rather stay home! With the loving care of a catsitter, of course. Tomorrow we'll talk more about pets whose owners are going away without them.



12 Days of Holiday Hazards...Day 9

On the ninth day of the holidays, my true love gave to me...CANDY

At this point, I think most people know that chocolate is toxic to dogs. The usual mistake these days isn't owners giving their dogs chocolate, but owners underestimating how much trouble dogs will go to in order to eat chocolate. Just like the rest of us, the fact that something is bad for them doesn't stop dogs from craving it, so keep chocolate and chocolate desserts under lock and key to protect your canine companion from himself.

So, we all know about chocolate, but there's a new guy in town now, who is even more dangerous to your dog. His name is xylitol, and he's hiding everywhere.

What the heck is xylitol, you ask? It's an artificial sweetener that can be found all over the place if you look hard enough. It's in that pack of gum in your purse; it's in that candy in the dish on your coffee table. It's in those low-cal cupcakes, and is even sold as a substitute for sugar to use when baking at home.

Turns out that unfortunately xylitol is extremely toxic to dogs. It causes seizures, low blood sugar, and liver failure. It can be fatal. So if you've got gum in your purse, put it away on a high shelf in the closet - with the door closed. If you have desserts containing xylitol around your home, make sure everyone in the family knows those desserts present a danger to the dog - and keep those sweets where even the most enterprising canine can't reach.

A piece of candy, a  little cupcake - they seem so innocent. But if they contain xylitol, for your dog they're poison. So check those ingredients, and read the fine print. Because taking Fido to the emergency room isn't sweet - not at all.



12 Days of Holiday Hazards...Day 8

 On the eigth day of the holidays, my true love gave to me...ANTIFREEZE

OK, so if your true love actually gave you antifreeze as a holiday gift, they probably wouldn't be your true love for much longer. But this does give me a chance to remind everyone, once again, about the danger of antifreeze. I realize that no sane pet owner is intentionally allowing their companion access to antifreeze; by now everyone knows just how incredibly toxic this stuff is to pets (and people, for that matter).

But we do need to be proactive about protecting our pets from inadvertent exposure to antifreeze, whether it occurs on our own property or elsewhere.

As temperatures drop, lots of folks are reminded that it's time to top up their car's antifreeze. The truth is that this job should really be left to professionals; even if you are the most avid do-it-yourself mechanic, there is no reason to expose your family, furry or human, to this poison. It's pretty hard to avoid spills, and you just don't want even a drop of antifreeze on your driveway or in your garage.

Keep in mind that neighbors or others may be less careful than you, and realize that any puddle on the street could contain this toxin. Pets who run loose are at particular risk, as you can't control what they may decide to lap up. Every time I see one of those telltale green puddles,  I shudder.

So- don't let your pet run loose, don't allow your pet to drink from anything other than his or her own water bowl, and if you do have antifreeze around, keep it locked up tighter than Fort Knox.

Antifreeze causes fatal kidney failure, among other life-threatening issues, so if you ever suspect your pet may have been exposed to it, get to a veterinary emergency clinic RIGHT AWAY. Time is of the absolute essence with antifreeze ingestion; there are antidotes that can be given, but the time window to do so is fairly short.

As always, if you have questions about antifreeze or any other toxin, you can call the ASPCA Poison Control Center at 888.426.4435.



12 Days of Holiday Hazards...Day 7

On the seventh day of the holidays, my true love gave to me...A CHRISTMAS TREE

How could an innocent Christmas tree be dangerous? The main risk from the tree itself is as a fire hazard. My hubby, a captain in the FDNY, says that a Christmas tree is "a giant piece of kindling". He has been to lots and lots of fires started by Christmas trees. I asked him about this and why it happens; he said that it is most often from electrical wires (such as the lights we wind all over our decorated piece of kindling, extension cords nearby, etc.), and can also be due to candles, cigarettes, or other sources.

He told me that as the tree gets dryer and dryer, the risk of fire increases. So keep your tree well watered, and don't keep it around too long - don't put it up far in advance of the holiday, and don't leave it up long afterwards. I asked him how we can avoid Christmas tree fires, and he said "Don't have one." Uh oh.  Well, his job is to prevent fires, not make us feel better about Christmas trees. The bottom line is that they are a real fire hazard.

On this FDNY website are some great tips on preventing Christmas tree fires, and other seasonal fires as well. It says here that a large percentage of home fires occur during the winter holiday season. Yikes!

 Other Christmas tree-related risks include:

-Ingestion of pine needles (some animals seem to find them weirdly delicious)

-Rambunctious or climbing pets knocking the tree over (which can lead not only to injury but to a fire). Please be sure your tree is well-stabilized

-Ingestion of the Christmas tree water, which can contain fertilizer or be just plain yucky

-Glass ornaments, which can break into sharp pieces

-Tinsel (see the Fifth Day of Holiday Hazards)

-Other "stringy" decorations which can become entangled in a pet's intestinal tract, such as popcorn strings and ribbon ornaments

OK, I admit it's a bummer to realize that Christmas trees can be dangerous, but not nearly as much of a bummer as a fire in our home would be, right?



12 Days of Holiday Hazards...Day 6

On the sixth day of the holidays, my true love gave to me...FLOWERS

During the holiday season, a lot of us will be decorating our homes, and giving and getting gifts of plants and flowers. We just need to be sure that we don't inadvertently put our own pets, or others, at risk.

So which plants and flowers do we need to worry about? Many people might answer that poinsettias carry the biggest holiday risk  to pets. Is this true?

Nope. Turns out that poinsettias don't seem to be terribly toxic to pets, perhaps causing an upset stomach, just as ingesting anything out of the ordinary might.

In terms of holiday-associated plants, holly and mistletoe are the two to worry about, and you want to keep these well away from pets. Best plan is to avoid having them in your home at all if animals or small children live there.

And although lilies aren't generally associated with the winter holidays, they are worth mentioning because they are so very toxic, and can turn up in many arrangements year round. Lilies of all kinds cause often-fatal kidney failure in cats, so it's essential to ensure that any flower arrangements you are getting or giving do not contain lilies; ask the florist if you're not sure.

For much more info on this subject, be sure to check out the ASPCA website.



12 Days of Holiday Hazards...Day 5

On the fifth day of the holidays, my true love gave to me...TINSEL

Ah, the dreaded tinsel. The dreaded, dreaded tinsel.

To the rest of the world, tinsel appears seems so shiny and festive, so sparkly and happy. But to veterinarians, the very word strikes fear into the heart.

How, you ask, could tinsel (so apparently innocent, so undeniably attractive) inspire such dread?

Well, if you ever had to perform surgery on an adorable kitty cat, usually a young, formerly very happy kitty cat, who is now violently vomiting, severely dehydrated, and in mortal danger, to pull a strand of dull, bedraggled, tangled tinsel out of the kitty cat's intestinal tract, you wouldn't be so fond of the stuff either.

Cats LOVE tinsel. They, too, find it shiny and attractive, sparkly and beguiling. So fun to bat around, and watch the light bounce off. So fun to pick up with your paws, to drag about the house, to carry in your mouth, to take a little nibble, to swallow a  tiny taste...and swallow...gulp...and swallow...uh oh. Now my belly doesn't feel so good, in fact, it feels really really bad.

PLEASE. If you have cats, NO TINSEL.

If you think that might ruin your holidays, that you can't live without tinsel, imagine how your holidays will feel when your beloved feline friend is stretched out on the surgery table, under anesthesia, fighting for his life.

Seriously. No tinsel.

 Thanks.



12 Days of Holiday Hazards...Day 4

On the fourth day of the holidays, my true love gave to me...GUESTS

Along with the tasty food, fabulous (and not-so-fabulous) presents, days off work, and other joys of the holidays come another treat: houseguests. Whether you're entertaining a few guests or many, for the evening or for a week, even the most welcome of guests can wreak havoc with our pets. While we're focusing on being great hosts, we can't forget to also be protective pet parents.  

Here are just a few examples of ways our pets can be affected by guests. By keeping these in mind, we can help ensure our pets' safety while enjoying the company of our family and friends.

-Food. Yes, food. Guests are notorious for giving the family pet pretty much...anything. Fatty food, spicy food, food with bones, foods that are toxic to animals...you name it, it's been given to a pet by someone's well-meaning guest. I kid you not, I once saw a dog who came in to me for sudden blindness, and because her eyes had turned completely white. I mean, COMPLETELY white. She looked like an eerie zombie dog.  I'm an internist, not an ophthalmologist, so of course I showed the poor doggie to the veterinary ophthalmologist in our practice right away. What the heck? She nodded wisely, and asked "Have the dog's owners had a party lately?" Yep, turned out they had. "Had the dog perhaps been given some high-fat treats, such as hot dogs or sausages?" Yep, turned out the party guests had been all too happy to share. Well, the ophthalmologist explained, this dog had ingested so much fat that the fluid in her eyes had become creamy and opaque from all the fat in her bloodstream. Luckily, the condition is reversible; as the fat is metabolized and leaves the bloodstream, the dog's eyes return to normal. But still, a scary lesson about the dangers of party guests, right?

-Trash. Along with guests, comes trash...lots and lots of smelly, delicious, overflowing-out-of-the-bin trash. And since the pet owner is completely distracted by all those very same guests, and so busy, and maybe not keeping an eye on Fido and Fluffy...they're in the kitchen having a party of their own, snacking on all sorts of tidbits from that overflowing, messy garbage can. Uh-oh. Greasy trash, moldy trash, bones in the trash, chocolate cake and cookie leftovers...it's all so yummy. And dangerous. So, when you're entertaining, be sure to bag that trash up tightly, and tuck it away where the pets can't enjoy the buffet. Or the next party you attend may be the one in your veterinarian's waiting room, with all the other pet owners whose little darlings have also been partaking.

-Doors. Guests love to leave them open. Or sort of closed, but not latched. Point is, guests going in and out (and in and out) can lead to escaped pets...which can lead to lost pets, pets hit by cars, or a host of other terrifying scenarios. If you're having a party, with lots of guests coming and going, please please please lock the pets away someplace safe, such as a bedroom or study, with a big KEEP OUT sign on the door. Not only will this protect your pets from open doors, it will also  keep them safe from the food, and the trash... (see above!).

-Stress. If you think about how stressful it is for you to have houseguests, multiply that times a million, and you'll get an idea of how stressful guests can be for some pets. OK, especially cats. When guests are staying in the house, the cat is often to be found under the closest bed. And that may mean the cat isn't eating...which can lead to serious liver disease and other health problems. So please, when you have guests, make sure your pets have a place where they can find some peace, particularly if children are among those staying with you. Make sure your pets are eating normally (this may mean feeding them wherever it is that they're hiding, or staying with them while they eat so they feel safe). Try to keep to their normal schedule as much as possible, and be sure to spend a little cuddle time with them when you can grab a minute. It will calm you down too.

-Bites. OK, the guests probably won't bite your pets. Though who knows? But a scared or stressed pet may bite (or scratch) a guest. And not only will that not make you a popular host, it can cause legal trouble for you and your pet. So if you have a pet who may react badly to the 3-year-old pulling really really hard on his ears, keep that animal confined away from the guests, for his own good.

 Good luck out there folks!



12 Days of...Holiday Hazards, Day 3

On the third day of the holidays, my true love gave to me...CANDLES

For many of us, candles will play a role in our holiday celebrations. Not just for our pets, but for the safety of ourselves and our families, we need to use care with candles in our homes. Many residential fires each year are caused by candles, and some safety precautions should be followed:

-Never light a candle near anything that could potentially catch fire, such as drapes, bedding, or even the Christmas tree.

-Never, ever leave a lighted candle unattended.

-Realize that pets and children are more likely to knock things over, so don't leave them alone with lighted candles.

-Don't light candles in drafty areas.

-Keep wicks properly trimmed.

-Be sure to use appropriate candle holders, placed on a stable surface.

-If you leave the room (or go to bed), put the candle out!

 For more specific instructions regarding safe candle use, and more information about candle fires, you can read further at a number of websites on the internet,  such as this good advice from State Farm Insurance.



12 Days of...Holiday Hazards, Day 2

On the second day of the holidays, my true love gave me to...RIBBONS

Yep, ribbons...also yarn, string...all those long skinny things we use to tie up packages and make gifts look festive. They sure do look pretty...especially to cats, who love to play with ribbons and yarn (we've all seen adorable pictures of kittens playing with that cute ball of yarn). Except the problem is that ribbons, yarn, and string are TERRIBLE toys for cats, and very dangerous indeed, striking fear into the heart of veterinarians everywhere.

What could be so bad about a shiny, pretty ribbon? Or a little piece of string, or the traditional ball of yarn? Well, cats do indeed enjoy these items, and they like to take a little taste, or carry the tempting toy around in their mouths...then they end up swallowing a little bit, except of course once you've swallowed the end of a ribbon, there's nothing to do but keep swallowing, till the whole darn thing goes down the hatch.

Why would a cat do this? My theory, as disgusting as it sounds, is that all these long stringy things are a lot like little mousy intestines, something a cat would gulp down in a similar fashion. Problem is, when a cat swallows a ribbon or piece of string, it frequently gets caught in the intestines (or sometimes, especially with thread or dental floss, the end of it will even get caught around their tongue). Once the ribbon is caught in some part of the intestinal tract, the cat's digestive system will keep trying to push it along, which results in a bunching up of the intestine which is very dangerous. Given enough time, the taut piece of string, ribbon, or yarn will actually saw through the intestine, causing a perforation and peritionitis.

To vets, a ribbon lying around the house looks just like a loaded gun. Ditto for string, yarn, thread, and dental floss, even rubber bands. If you have cats, you should feel the same way. Never leave these things anywhere your cat could get a hold of them. If you have gifts with ribbon on them, put them away in a closet until it's time for gift-giving. Once a gift is opened, never leave the ribbons and such lying around - put these away promptly, someplace your cat cannot get into. 

Let me tell you, ribbons may look pretty when you're buying them, but they don't look pretty at all when you take them out of a kitty's intestinal tract at surgery. They look darn ugly then, and extremely expensive too!



12 Days of...Holiday Hazards!

So...Thanksgiving is past (except for a fridge full of leftovers), and now we're all looking forward, to a variety of holidays...all of which are really really fun but can bring along with them a whole host of health hazards for our furry friends.

 Therefore, starting today, we'll feature the Twelve Days of Holiday Hazards: a 12-day smorgasbord of seasonal safety for our canine and feline family members. Each day we'll discuss a new topic that can help to keep our four-legged friends safe as we enter the season of celebration.

The First Day of Holiday Hazards 

On the first day of the holidays, my true love gave to me...LEFTOVERS. 

Yep, our first hazard of the season is those Thanksgiving leftovers. It's tempting to share the bounty with our animal companions, but we need to do so with some care. Specifically, we need to avoid giving our canine and feline friends:

Bones, which can become lodged in an animal's throat, esophagus, stomach, or intestinal tract. This can cause vomiting, diarrhea, or even life-theatening gastrointestinal blockage. Bones can damage or even pierce a pet's esophagus or intestines. It's usually okay to give a healthy pet a little taste of plain cooked turkey (check with your own vet to make sure your dog or cat doesn't have any individual health conditions that could be affected), but be sure your pet doesn't recieve any bones, fat, or gristle, all of which could be harmful.

Greasy or spicy foods, which can cause gastrointestinal upset, or even a more serious condition called pancreatitis, in which the pancreas become dangerously inflamed. If your vet says that a little "people food" is OK for your pet, keep it bland. I usually tell my clients, "Don't give your pet anything you wouldn't give to a human toddler", i.e., avoid foods that are fatty, greasy, rich, or spicy.

Grapes or raisins, which can cause kidney failure in our canine companions. On Thanksgiving, my mother-in-law discoverd one of the small children in the family giving grapes to the grateful Labradoodle, Ishmael. Uh-oh! Make sure everyone in the family knows which treats, if any, are OK for the pets, and which could be dangerous, and be sure to get all the kids on board.

Chocolate. We've all got a houseful of delicious desserts, and there will be lots of candy around for the next few weeks; just keep in mind that chocolate is toxic to dogs, and should be kept locked away from curious canines.

Vets always see lots of pets with stomach upset, intestinal blockage, pancreatitis, or other holiday-related conditions around this time of year. Protect your pet (and keep your wallet safe from extra veterinary bills, too!) by sticking with your pet's normal diet for the next few weeks. Giving your pet holiday "treats" may not be doing him or her any favors.

 If you think a pet may have gotten a taste of something toxic, such as chocolate, grapes, raisins, holly berries, or anything else that you worry may be unsafe, you can call the ASPCA's Animal Poison Control Center for help at 888.426.4435. Don't delay.



Pet food recall, September 2008

There has been a recent recall of some dry pet foods made by Mars Petcare US, due to possible contaminination by Salmonella. The FDA notice and the list of potentially affected pet foods can be found here. The recall includes some Pedigree and Ol' Roy food, as well as others.

If you suspect your pet may have eaten contaminated food, or your pet is showing any worrisome symptoms, such as vomiting, diarrhea, or loss of appetite, please bring your pet to the veterinarian right away, and be sure to let your vet know that your pet ate a food that is on the recall list.

Salmonella also affects humans, who in this case could be sickened due to handling contaminated food, or by contact with an infected pet. If you are concerned about infection in yourself or your family, please contact your own doctor. For questions, you can call 1-877-568-4463.



Speaking of diabetic cats...

A while back, I talked about a relatively new kind of insulin that is doing wonders for diabetic cats. It's called glargine insulin (the brand name is Lantus.) I continue to be thrilled with the results we are seeing with this insulin for our diabetic felines. In studies done comparing the use of glargine insulin to other insulins for diabetic cats, the results with glargine insulin were far better - in fact, in one study, all newly diagnosed diabetic cats treated with glargine stopped needing insulin within four months!

I am seeing the same thing in my patients: all the new diabetic cats I have put on glargine have gone into remission (no longer needed insulin); some within just a few days, some after a few weeks or months.

There are some important things to be aware of. One, for the best chance of remission, the cat should be given glargine twice a day. This insulin can be administered once a day, in situations where the cat's family absolutely cannot give twice-a-day injections, but the chance of remission is reduced in tis case. Second, it is also very important what the cat is fed - it seems that carbohydrates in the diet can lead to feline diabetes (among other health problems), and diabetic cats should eat a high protein, low carbohydrate diet, unless other health issues preclude this (speak to your vet). Because dry food is generally high in carbs, it is felt that diabetic cats (and perhaps all cats) should eat moist food (such as canned, pouch, or a balanced homemade high protein/low carb diet). Third, the chance of remission from diabetes is highest in cats starting insulin for the first time. If a cat has already been diabetic for years, switching the cat to glargine may be desirable if the cat's diabetes has been difficult to regulate, but there will not be the same likelihood of remission as we see in newly diagnosed diabetic cats.

To achieve the highest chance of remission, the diabetic cat should be closely monitored and the insulin dose adjusted carefully. Most diabetic cats have the capability to produce insulin, but often are not making enough because of what is called "beta cell exhaustion".  This refers to the fact that insulin is made in the body by cells called beta cells, which are found in the pancreas. The theory is that when a cat's food contains too many carbs, these cells are forced to produce insulin at a very high rate, and basically burn out. Once the beta cells are too worn out to produce adequate insulin, the cat becomes diabetic. By placing the cat on insulin injections, we give the beta cells a chance to rest and recover. We need to make sure that we are giving the cat the correct insulin dose to ensure that the beta cells really get the rest they need; if we give an inadequate dose and the beta cells must still attempt to produce additional insulin, they may not recover. So if you have a diabetic kitty, follow your veterinarian's instructions closely and be sure the dose is adjusted as needed.

Vets have various ways of adjusting a cat's insulin dose: some vets teach the cat's owner how to take a tiny drop of blood from the ear (it's much easier than it sounds and many of my clients do this with no problem using human diabetic supplies). Other vets have the owner test the urine for sugar with dipsticks, and adjust the dose based on the results. Whatever method your veterinarian uses, the most important thing is to follow up regularly and adjust the insulin dose as needed. This is also important since with proper treatment your cat may stop needing insulin at some point, and you don't want to continue giving insulin in this case!

If your cat's diabetes is difficult to regulate, or you and your vet want some expert advice regarding your cat's diabetes, you may decide to consult a veterinary internal medicine specialist. Often an internist can help to fine-tune a cat's diabetes, and help increase the chance of remission. 



Hero Kitty

Today, one of my clients wrote to me with an amazing story. One of her cats is diabetic, and this morning he suffered a diabetic crisis—his blood sugar dropped dangerously low after his insulin injection. Another one of the cats in the house alerted my client’s son Ivan in the nick of time, thus saving the diabetic cat Ebony from seizures, coma, or worse. Hooray for this true kitty heroine!!

Dear Dr. Murray,

Yesterday, I got a frantic phone call at work from my son, Ivan.  He told me that our diabetic 16 year old kitty, Ebony, was experiencing another diabetic crisis...twitching, unable to walk, glassy eyes/unresponsive.  Ivan went into the appropriate steps of giving Karo syrup, confining Ebony to the kitchen so he couldn't hurt himself and providing him water and special food.  Even after all that, when I raced Ebony to our local vet, Ebony's blood count was still only 58. 

But here's the amazing part of the story!  My son was sleeping soundly at the time Ebony's crisis began.  Luisa, the 8- year-old calico kitty that we named in your honor, is the one that can be credited with saving Ebony's life!  Luisa never, ever comes to Ivan when he's sleeping.  Ivan knew that something must be very wrong because she just wouldn't give up on waking him by walking up to his face and "talking"...and when she was successful in rousing him, she raced downstairs, as if to say "follow me".  I shudder to think what would have happened to Ebony without Luisa's kitty intuition and Ivan's common sense to react to her summons.

I don't know if you remember but this is actually the 2nd time she has saved the life of one of her "brothers".  Luisa was only four weeks old when I found her amongst a litter of kittens that had already passed away before I came across them.  Her loud meowing drew me over to the drainpipe and I tried to pick her up but she wiggled free and ran over to one of the other kittens...a yellow and white one my son later named "David".  She wouldn't stop nudging him with her paw and meowing.  I was shocked to see him move and realized she was telling him to "Get up!  We're rescued!"

Who could have known that your namesake would continue to save lives, just as you do!  smile

Warmest regards,

The Trembows



Why go to the beach today?

...when you can stay home and make this fun little piece of feline furniture? I have to admit, I know my cats would love it. The instructions are hilarious too.

cat chaise


Hmmm...am I a bad cat mom now if I just give my cats a plain old cardboard box? They have really raised the bar with this one. I better not let my cats see it.

The evil mad scientists have lots of cool stuff on their website-check it out. And anyone who goes to this much trouble to design cat furniture can't be too evil anyway.



Tough and Tender

Did anyone see the New York Times article the other day called Heaven's Angels ? By Caroline H. Dworin, it told the story of a group of tough, tattoed bikers who devote their time and energy to helping animals in need. It would be great if more tough guys (or wannabe tough guys) realized that true strength is not shown by hurting defenseless creatures, but by being man enough to stand up for what is right. Forcing dogs to battle does not make you a warrior; a true warrior is brave enough to fight in defense of those who need help.

Kudos to Rescue Ink ; these are the kind of tough guys I can respect.



Veterinary Ultrasound: What’s going on?

In response to my discussion of ultrasound for pets , a friend who works at a veterinary practice sent me an e-mail. She expressed concern, because the practice recently made the decision to cut down on using a specialist for their patients’ ultrasound exams; instead, they have purchased a machine that the general veterinarians will be using to perform ultrasound studies. I asked her how they planned to train the vets to do this, and she responded that the company that sold them the machine would be training them in its use. 

When a veterinary practice purchases a new ultrasound machine, an employee of the company selling the equipment will spend a day or two showing the new owners how to use it. If your pet became ill, for example with sudden vomiting, and needed an ultrasound exam which might save his life by helping to discover an intestinal blockage, gastric ulcer, tumor in the liver, or inflammation of the pancreas, would you like the study to be done by a veterinary radiologist who has completed a three-year residency program devoted to honing this skill, or someone who a company rep has spent six hours training which buttons to push on highly complex equipment? 

Did you know that during training to become a specialist,  a veterinary radiologist is required to perform at least 1,000 ultrasound studies? Think about that: someone who has done at least one thousand ultrasound exams under the supervision of board-certified radiologists before becoming a certified specialist themself, versus someone who just bought a machine last week. Bear in mind, unless you speak up and protect your pet, you may not be given the choice of who performs the ultrasound study on your companion. It's important for pet owners to be aware of the skill required to perform an effective ultrasound exam. To produce clear and accurate images, find subtle abnormalities, and especially to interpret what is seen: these require training, knowledge, and experience. 

Until the veterinary profession begins to police itself, only you can protect your pet. Any time a procedure is recommended for your pet, speak up, ask questions, and be sure to find out who will be doing it. Whether it’s an ultrasound, endoscopy, surgery, or another medical procedure, your pet deserves the best—and only you can make sure she gets the best care. 

After I read my friend’s e-mail, I wrote to her and asked her why the practice had made the decision to stop referring patients to a specialist for ultrasound exams. Her answer was simple: “Money”.



No Bones About It

Recently I used the endoscope to pull a bone out of a dog’s esophagus, something I do about once a month. As usual in these cases, the dog’s esophagus (the tube running from the mouth down to the stomach) had suffered severe damage from the pressure and abrasion of the bone that had been lodged there. I placed a stomach tube through the dog’s side for him to be fed through for the next few weeks while his esophagus healed. Because of the marked ulceration of the lining of his esophagus, the dog is at risk of “stricture”—a scar that extending across the esophagus and causing it to close off.

Of course, despite the worrisome condition of his esophagus, this dog was one of the lucky ones—not all bones can be removed with the endoscope; some must be removed surgically, and the esophagus does not always heal well. And in some cases, the bone causes a “perforation” (tear) in the esophagus, which is a grave and life-threatening situation. 

I wish that more people knew how often bones eaten by dogs get stuck in their esophagus, stomach, or intestine, necessitating endoscopy or surgery. I guess people think that it is “natural” for dogs to eat bones—well, if that’s true then we should be eating bones too, since both dogs and humans are omnivores! It’s true that the ancestors of our dogs may have been forced to eat bones—that’s all that was available to them! They didn’t have any gourmet dog food around. That doesn’t mean it’s safe to give a dog bones, any more than it would be safe for us to swallow bones or raw meat. 

If you take a look at dogs these days, you’ll see even more why giving them bones isn’t such a great idea. Even if a wolf could get away with eating a bone, that certainly doesn’t mean that a Pekinese, pug, Jack Russell, or beagle can do it! Most of our dogs have a much smaller esophagus than a wolf, and teeth that are a lot less strong as well. Without doubt I take a lot more bones out of small and medium-sized dogs than big ones—I guess in most dog breeds the saying is really true that their eyes (and mouth!) are bigger than their stomach. 

So please do your dog a favor—don’t give her bones, or let her grab bones out of the trash. If you ever suspect your dog may have swallowed a bone that is caught (your dog may gag, seem to be choking, vomit, or regurgitate), get to the vet right away for an X-ray. The longer the bone stays in there, the more serious the damage can be.



My thoughts on “Pill-Popping Pets”…

Today in the New York Times Magazine, there was a piece by James Vlahos about the use of drugs to address behavioral issues in our pets. I’ve been mulling over some of the concepts brought up in the article, and a number of thoughts come to mind.

I’d first like to mention that Dr. Nicholas Dodman, who is frequently quoted in the article, is a wonderful man who cares deeply about animals. He was one of my teachers at Tufts University School of Veterinary Medicine and I have the utmost respect for him. I know how much he cares about the well being of all animals; his motives are entirely pure and for this reason among others his work should be taken quite seriously.

Concerns were expressed, in the article and by many who read it, regarding the use of drugs as a substitute for addressing the root cause of behavioral issues. There is no doubt that it is essential, if possible, to ascertain and alleviate the underlying trigger for a pet’s unwanted behavior. This, unfortunately, can be easier said than done in today’s society. Of course dogs are lonely and bored when we are all so busy busy busy, and of course this leads to emotional and behavioral consequences—just as it would in any intelligent, social being left alone with nothing to do for hours at a time. Dogs live to have a job, and dogs with no job to perform are often unhappy—that’s no surprise. Just as of course cats (exceptionally skilled and agile predators) with nothing else to pounce on may end up pouncing on their human guardians! Dogs yearn to work; cats yearn to hunt—when one's strongest and most instinctive yearnings are denied, naturally trouble often ensues. 

Above all, though, I can’t help feeling how lucky our pets are, and I as a veterinarian am, to live in a society where all this matters so much to us. Yes, it’s distressing that there are dogs who are bored, lonely, terrified of fireworks, or fearful of strangers. It’s unfortunate that keeping cats safe means keeping them inside—not as exciting, to be sure, as a life of hunting and surviving in the great outdoors—but a more comfortable, secure, and longer life nonetheless. But none of this is nearly as heartbreaking as the plight of animals all over the world who are hungry, diseased, without shelter, or abused. In this country and even more so elsewhere, millions of dogs and cats are homeless, living short lives of danger and deprivation. Therefore, I feel blessed, and I know our pets are blessed, to live in a time and place where we’re arguing over the best way to keep animals happy and healthy, and we’re discussing it in the pages of the New York Times Magazine.

The pet food recall brought this home for me. Although the months of the recall in the spring of 2007 were among the most sad and stressful of my career, watching beloved animals suffer and die because of greedy, unethical practices perpetrated half a world away, the silver lining was the gratitude I felt to live in a country where everyone cared. The recall and its consequences were in the forefront of the media, drawing national attention and widespread outrage. As a veterinarian horrified by what was occurring, it was at least comforting to be surrounded by a nation equally appalled. 

I dream of a world in which all dogs and cats are in safe and loving homes, and in the perfectly ideal world, none of them will be bored, frightened, or lonely either—but in the meantime as we attempt to understand the emotions and behaviors of our animal companions, let’s at least be glad that so many of them have people who care.



Prescription Pet Foods: Do They Really Make a Difference?

Today a pet parent asked me: "My vet recommended a prescription diet for my dog, who has problems with her kidneys. Do prescription diets really make a difference, or is it all just marketing?"

The answer is - yes, there is a difference between prescription pet foods and those sold over the counter!

Pets who don't have any issues with their health generally don't need prescription diets, of course. But prescription diets can make a huge difference to pets with a number of different health problems.

Here are some examples:

Kidney disease: Diets formulated for animals with kidney disease (generally diets that are lower in protein and phosphorous, for example) can make a real difference in the quality of life and longevity of these pets. Several studies have shown this to be the case. There are prescription kidney diets, and there are also recipes for homemade diets for animals with kidney problems. (Be sure any homemade diet you use has been developed and balanced by a veterinary nutritionist .)

Liver disease: In some types of liver disease in which animals develop a problem called "hepatic encephalopathy", special diets can be very helpful. When animals have very poor liver function or a liver "shunt" (an extra blood vessel that allows the blood to bypass the liver), certain toxic substances are not properly filtered from the bloodstream, as they would be by a normally functioning liver. These toxic substances can cause "hepatic encephalopathy", a situation where the animal acts drunk, dizzy, weak, or blind due to the effect of the substances on the brain. By reducing the buildup of these toxic substances, diets for liver disease can help alleviate hepatic encephalopathy.

Hyperlipidemia: This long word refers to a condition where the fat levels in an animal's bloodstream are too high. On a blood test, these fats are called "triglycerides". Animals whose triglyceride levels are too high can suffer problems such as seizures and inflammation of the pancreas if the triglyceride levels are not lowered. Abnormally high triglyceride levels can be caused by certain hormonal imbalances, or by improperly functioning fat-processing systems in the body.  Certain breeds of pets, such as schnauzers, are predisposed to this condition. Prescription low fat diets are often very important in this situation, to help lower the triglyceride levels and prevent or alleviate seizures or pancreatic issues.

Allergies: Animals with food allergies, which may be exhibited by gastrointestinal signs such as diarrhea, or by itchiness of the skin, can be greatly helped by prescription hypoallergenic diets. For a diet to be hypoallergenic, it must contain a protein the animal has never eaten before, and be very pure, i.e., not containing other proteins or other allergy-causing substances.

One problem that vets are encountering is that so many of these special proteins are being used in over-the-counter pet foods. Because people noticed that vets often recommend lamb-based food, for example, they thought it must be good to feed pets lamb. Because of this demand, pet food manufacturers began putting out pet food containing lamb. But the reason vets would recommend lamb for allergic pets was because it was a protein most pets in this country had not eaten before, not because there was something intrinsically healthy about lamb. Once lamb began being used in commercial pet foods, vets had to turn to more exotic sources of protein for allergic pets, such as duck, venison, and rabbit. But once again, pet foods began to be made using these proteins as well, so it is becoming ever harder for vets to find a protein source that an allergic pet has never tried! We are turning to really crazy things like ostrich and kangaroo meat. But pretty soon, these will turn up in commercial pet foods as well. (For this reason, it's a good idea to avoid feeding your healthy pet all these different exotic proteinsl if your pet ever develops a food allergy, there will be nothing hypoallergenic left to try!) 

Urinary tract stones: For pets who have developed stones in the urinary tract (the bladder, kidneys, ureters, or urethra) at some point, prescription diets can help to prevent more stones from forming. Different types of stones can require different diets. The diets that are labeled as "urinary" diets or "good for urinary tract health" in the grocery store are NOT the same as prescription diets, so do not substitute these for a diet your vet has prescribed!

The bottom line: If your vet recommends a prescription diet, there's probably a good reason.  Don't substitute another diet without talking to your vet. If the diet is too pricey for you, or your pet just doesn't like it, there may be other options, and your vet can probably help you find one. Or you may want to seek the help of a board-certified veterinary nutritionist, such as those found at PetDIETS.com and Balance IT . These specialists can work with your vet and with your pet's medical records to help recommend the best food for your pet, whether prescription or homemade.



Lilies: Not so pretty if you're a kitty...

All the flowers are in bloom, and most of the time this makes me happy—except when I see my least favorite flowers: lilies. Despite their beauty, I just don’t like lilies: nothing that hurts cats can ever look pretty to me. 

 It seems like many people don’t know that lilies are very very poisonous to cats. Every single part of the lily plant and/or flower are toxic to kitties; they cause severe kidney damage, which is often fatal. This is true of all different kinds of lilies. It just takes a little nibble—and we know how much the kitties like to nibble on plants.

Please, everyone, spread the word! Tell everyone you know who has pets. When you see someone buying lilies at a flower shop, make sure they realize that they should not bring lilies into their homes if they have cats, or give an arrangement that contains lilies to anyone who has a cat. If someone at work gets flowers, help them make sure there are no lilies lurking in the arrangement. 

If we all tell everyone we know about the dangers of lilies (maybe we should all send an e-mail to everyone in our address book, and ask them to do the same), then one day no cat will have to suffer or lose their life because their owner didn’t know what could happen. 

And of course, if you ever suspect that your cat may have eaten any part of a lily plant- bring her to the veterinary emergency clinic right away! Immediate care can be lifesaving!



Choosing a veterinary practice...

I had a really fun day Sunday at NBC’s Today Show with pet lover, Lester Holt. We talked about my new book, Vet Confidential and introduced two adorable pets from the ASPCA in NYC who are looking for a home, Tommy the beagle and Tanner the cat.  If you missed the segment, check it out at msnbc.com .  

 And if you know anyone looking for the sweetest beagle or the friendliest tabby cat, please have them check out Tommy and Tanner at the ASPCA shelter on 92nd Street in Manhattan.



It's summertime...

I am so glad that summer is finally here—it’s such a pleasure to enjoy being outdoors again, and to step outside without getting all bundled up and bracing for that cold air. 

As a vet, though, there are lots of things to worry about in the summer. Seems like pets get into all sorts of warm-weather trouble, and so I do want to talk about a few things we can all watch out for to keep our furry kids safe.

It might sound obvious, but one crucial factor for pet safety these days, when we are all keeping the windows open, is having screens in all those windows. This is especially true for those of us who live in the city in multi-story apartment buildings. Cats just don’t have the survival instincts it’s sometimes assumed they do (in fact, “curiosity killed the cat” is a lot more like the truth), and it is very common when it gets warm outside for veterinary hospitals to see lots of cats who have been terribly injured by falling (or jumping) out of open windows. Of course that doesn’t include the poor cats who don’t survive and thus never make it to the vet’s office. Dogs have also been known to fall out of windows—so please everybody be sure to put nice solid screens in all your windows. If you are a renter, you can buy the “accordion”-type screens that can expand to fit most window sizes, and are easy to use without complicated installation. 

Of course window screens also keep out those pesky mosquitoes, who can infect both dogs and cats (yes, cats!) with heartworms. That’s another warm-weather worry: heartworm disease, although these days, with the wacky weather we’ve been having, most dogs and cats should be on a heartworm preventive year round, since we can have days that are over 50 degrees almost any time of year in a lot of areas. So please make sure that your pets are on a heartworm preventive, and if you haven’t been religious about giving a preventive recently, ask your vet whether your pet should be tested—the earlier heartworm disease is discovered the better. 

Other nasty summer insects include our friends the ticks and fleas. Ticks transmit all sorts of scary diseases—Rocky Mountain spotted fever, Lyme disease, ehrlichiosis, babesiosis, hepatozoonosis—the list goes on and on. Fleas, of course, make pets miserable, can cause hot spots and allergic breakouts and all sorts of uncomfortable skin conditions, and can even cause fatal anemia from all the blood they steal from the poor pet. So if you haven’t already done it, it’s time to talk to your vet about which flea and tick preventives work best in your situation and geographic location. 

Another summer hazard that really frightens me is radiator coolant used in automobiles, i.e., antifreeze. This can be spilled when cars overheat, leak, or when people change their coolant. This is a great reason to have a professional change your antifreeze—you don’t want this stuff anywhere near your home. It’s fatally toxic to both humans and pets—so watch out for antifreeze on the sidewalk, road, or driveway, or lingering in puddles of water. It’s usually green and sometimes red, but never let your pet drink from any puddle because any of them could be contaminated. 

All pet parents should be cautious when exercising pets on warm days, but especially those who have flat-faced (brachycephalic) dogs such as Bulldogs, Pugs, Boston terriers, etc. These guys cannot pant effectively (which is how dogs cool off since they don’t sweat) because of their squashed noses, so if you’ve got a brachycephalic buddy or an older or overweight canine friend, it’s best to avoid going outside during the hottest part of the day, and to avoid vigorous activity when it’s very warm out. Heatstroke is a real danger, and if you suspect it, get your pet to an emergency facility immediately, cooling the animal down on the way. 

Of course we all know to NEVER leave any animal in a parked car but I will say it anyway: NEVER LEAVE A PET IN A PARKED CAR! Cracking the window doesn’t really help, and you cannot believe how quickly a car’s interior can heat up—this has been shown in several dramatic studies—so don’t make the mistake of thinking it’s okay to just run into the bank for a few minutes. The best plan when it’s warm out, honestly, is probably just to leave your pet home safe. 

I could go on and on: I still haven’t talked about sunburn, and skin cancer (yes, pets can get skin cancer from the sun too), and the danger of drinking salt water at the beach (dogs can be really silly sometimes)…but I am starting to sound like the proverbial wet blanket! So please, enjoy the weather, enjoy the summer, enjoy your pets—just be careful out there!



Coughing Cats and the Invisible Hairball

Did you know that asthma is a common problem in cats? We don’t know what causes it in every cat, but we do know that secondhand cigarette smoke can set it off or make it worse, just like in kids.

Sometimes cat owners don’t realize their cat is coughing because it looks so different from a person coughing. The best way to describe it is “a hairball without the hairball”. The cat crouches down, sticks out his neck, and makes a noise like he’s gagging or trying to bring up a hairball…but nothing comes up. If your cat does this, he may have asthma.

You can read about feline asthma at www.fritzthebrave.com, a useful website with lots of good information. One great new development for cats with asthma is an inhaler for medication. Yup, an inhaler for cats (don’t worry, they don’t have to purposely inhale, the medicine is puffed into a little mask that is placed briefly over their face). This is a wonderful invention because the steroid medicines that lots of cats with asthma are given as pills or shots can cause diabetes and other problems. Putting medicine straight into the lungs by inhaling it means the whole body isn’t getting medicine it doesn’t need. You can take a look at the inhaler by going to www.aerokat.com, and clicking on animal health. You can read about how the medicine is used by going to fritzthebrave.com and clicking on Dr. Phillip Padrid’s protocol.

And please don’t smoke around your pets! This can cause not only asthma but also cancer and other problems.



Safe Anesthesia for Pets

If your pet ever needs anesthesia, it is essential that a modern, safe protocol is used, and that your pet is closely monitored. When evaluating whether your pet will have the most careful and current method of anesthesia, these are three of the most important factors to look for.

1. First, find out the type of anesthesia that is used by the practice. The current standard of care is that most patients undergoing surgery are anesthetized using one of the latest types of gas anesthesia. Only very brief procedures such as a replacing a splint or clipping the hair over a minor wound should be performed under injectable sedation. The two modern types of gas anesthesia commonly used by veterinarians are isoflurane and sevoflurane. Halothane, an older gas anesthetic, is not as safe.

2. Second, any patient under anesthesia should have an IV catheter in place if possible. During an anesthetic emergency, the catheter is used to quickly deliver potentially life-saving drugs and fluids

3. Third, patients should be intubated while under anesthesia. Intubation, which is the placement of a tube in the trachea (windpipe), greatly increases the safety of a patient under anesthesia. The tube delivers oxygen to the patient to keep levels adequate, and if his breathing slows or stops, or his oxygen level drops too low, the tube can be used to assist the animal in breathing. During respiratory or cardiac arrest, the tube can be used for prompt resuscitation. In addition, while the animal is anesthetized and unable to swallow or cough on his own, the tube prevents saliva, blood, or regurgitated food from entering the trachea and lungs.

Monitoring

With current technology, there are many ways to closely monitor a patient under anesthesia. The oxygen level, heart rhythm, and blood pressure can be measured continuously. This type of monitoring is crucial in preventing anesthetic fatalities; by warning the doctor and technician that the patient’s oxygen level or heart rate is falling, it allows intervention to occur before it is too late.

Ideally, the practice should use equipment that allows all three of these vital signs to be followed during anesthesia. At a minimum, the pet’s oxygen level and pulse rate should be monitored during the procedure by a pulse oximeter, which displays the blood oxygen level and heart rate continuously. It is safest if a technician or another doctor monitors anesthesia while the veterinarian performs surgery, as it is difficult to effectively focus on both patient monitoring and the surgical procedure at the same time.



Pet Food Recall Advice

In the wake of the recent Menu Foods recall of millions of containers of pet food, concerned pet owners are seeking advice. Pet owners whose pets ate the contaminated food are panicked and wondering where to turn, and many pet owners across the country and beyond are considering how to feed their pets in the future.

Advice for those whose pets ate the recalled food:

1. Check the lot numbers and container dates on the Menu Foods website to ascertain whether your pet did indeed eat the tainted food.2. If your pet did eat any of the affected food, bring your pet to the veterinarian for blood and urine analysis immediately.

2. If your pet did eat any of the affected food, bring your pet to the veterinarian for blood and urine analysis immediately.Your veterinarian will perform blood and urine tests to determine if any kidney or other organ damage did occur.

3. KEEP any tainted food that you have, in sealed containers, for testing if necessary. Also keep all receipts, labels, and records of when and where you bought the food and when you fed it to your pet, as well as a record of any symptoms your pet has shown.

4. If your pet's blood test and/or urine test are abnormal, and your pet is acting sick (decreased or absent appetite, vomiting, weakness), your pet will likely need to be hospitalized for aggressive care in order to attempt to help the kidneys. This may require referral to an internal medicine specialist or to a facility with a veterinary Intensive Care Unit offering 24-hour care.

5. If your pet's blood and/or urine tests show mild kidney damage but your pet is acting fine, your veterinarian may elect to treat your pet with a prescription kidney diet or other outpatient care, and monitor the kidneys closely, for example with another blood test in a week, and then regular blood tests every 3-6 months after that.

Advice regarding what to feed your pet:

1. Immediately discontinue feeding any of the recalled foods.

2. Many owners are asking if they should feed their pets only dry food. It's important to realize that dry food could have just as easily been tainted, and contains grains even more often than wet foods do.

3. At this point, only the recalled foods are known to be affected. One option is to feed another food that is as similar as possible so that your pet will be likely to accept the new food. If your pet is used to moist food, there is no reason at all to switch to dry food. (See my previous blog regarding dry food for cats.) I personally prefer to use foods that do not contain by-products.

4. Some owners are also asking about cooking for their pets. This option is fine as long as you feed a diet that has been balanced by a veterinary nutritionist! Cats in particular are at high risk of nutrient imbalances or deficiencies, so it is very very important to feed a complete and balanced diet. One great website for homecooked diets for pets is petdiets.com. This website is run by board-certified veterinary nutrionists. I am not a fan of raw diets due to the very real risk of contamination with microorganisms or parasites, but balanced home-cooked diets are great if you have the time and energy.For other general advice and info, or any other questions regarding pet poisons or toxicity, you can call the ASPCA's Animal Poison Control Center at 888-426-2245.



Do Pets Get Breast Cancer?

Many pet owners don't realize that pets also suffer from breast cancer. In veterinary medicine, the term that is used is mammary gland tumors, and these tumors are very common in dogs and cats.

Cats generally have 8 mammary glands, arranged in 4 pairs. Dogs usually have 10 glands arranged in 5 pairs, though the number varies with the size of the dog. Mammary gland tumors in dogs and cats can be benign (non-spreading, and cured by surgical removal), or malignant (having the potential to metastasize to other areas of the body and cause death). Cats and dogs differ in the proportion of benign versus malignant mammary gland tumors. In cats, around 90% of mammary gland tumors are malignant. In dogs, less than 50% are malignant.

How can mammary gland tumors be prevented in dogs and cats?

The best way to prevent mammary gland cancer in dogs and cats is through spaying at a young age. To prevent breast cancer, it is important that a pet is spayed before she ever goes into heat. Some owners believe that dogs and cats should have one heat cycle before they are spayed. This is not true! Dogs who are spayed before their first heat cycle have only 0.5% as much chance of developing breast cancer as dogs who are not spayed. That's one-half of one percent; meaning that a dog spayed before her first heat is 200 times less likely to develop breast cancer! After just one heat cycle, the risk rises 16 times higher. Cats spayed before their first heat have 91% less chance of developing breast cancer than unspayed cats. After just one heat cycle, the risk rises.

To be sure your pet is spayed before she goes into heat, you will want to have the surgery performed before she is 6 months old. Around 4-5 months of age is a good time to have your pet spayed, as vaccinations are generally completed by 4 months.

Detecting mammary gland tumors

Just like in people, performing breast exams in dogs and cats is very important. Early detection is key. For example, cats with mammary tumors removed when the tumor is less than 2 centimeters in size have a median survival time of 4 1/2 years, while cats with tumors removed that are bigger than 3 centimeters in size only have a median survival time of 6 months.

Once your dog or cat is 5 years old, perform a mammary exam on her once a month. Gently feel the tissue under and around each nipple. Very small mammary tumors often feel like a bb pellet under the skin. If you feel even a tiny lump or firm area, bring your pet to the veterinarian immediately.

Treatment of mammary gland tumors in pets

The main treatment at this time is surgical removal. Depending on the situation, your pet may have only the affected mammary gland removed, several glands in the area, or all the glands on that side of her body. The tumor that is removed will be sent to the lab for a biopsy to tell you if it is benign or malignant. If the tumor is malignant, you may want to ask your veterinarian for referral to a veterinary oncologist for further advice and treatment.



Dry Cat Food: Should Carnivores Eat Corn Meal?

Feline nutrition is truly a fascinating topic. I could talk forever about how cats evolved, and how important an understanding of their evolution is to feeding them properly. But for now, let's just focus on the topic of dry cat food.

Domestic cats evolved in the desert. Their ancestors lived entirely on the prey that they caught, and got their liquids from the bodies of the prey as well. Needless to say, they had to develop the ability to exist without much water. And they did: cats are extremely good at concentrating their urine so as to conserve water. A cat's urine is much more concentrated (meaning it has a lot less water in it) than a dog's or a person's, for example. They also have a less sensitive thirst mechanism, since living in the desert there was no point to going around feeling thirsty all the time. So cats don't get as thirsty as other animals when they are dehydrated either. (That's why older cats with kidney problems often need their owners to give them fluids under the skin).

How does this connect to feeding them dry cat food?

Well, cats who eat dry cat food take in a lot less water than cats who eat moist food. Because they evolved to get liquid from their food, they don't make up for the lack of water in the food by drinking enough to compensate. So their urine becomes very very concentrated, and guess what - this causes crystals to form (remember chemistry class? Or think how you can only dissolve so much salt or sugar in a little water- if there is not enough water, the crystals don't dissolve).

So cats who eat dry food are more likely to form crystals and stones in their bladder, and in boy cats who don't have a very big opening (ahem), this makes them more likely to develop a life-threatening urinary obstruction. Ouch!

What about corn meal? Well, dry cat food is often composed mainly of corn meal. But wait, cats are CARNIVORES. Their bodies evolved to utilize animal proteins, not grain. They are not designed to run on carbs, and their bodies don't know what to do with all the carbs in dry food...so the carbs are converted to fat, and voila!  before you know it you've got a fat, potentially diabetic cat on your hands. Corn meal is very inexpensive, so it's a nice cheap ingedient to put in dry cat food, but it is a completely unnatural diet for a cat.

The solution? Ideally, cats should be feed non-dry food (such as canned, pouch, or a <em>balanced</em> homemade diet) at specific mealtimes, such as twice a day. Another problem with dry food is that carnivores also aren't designed to nibble constantly, and this may also contribute to the development of diabetes since cats who do this need to manufacture a lot more insulin every day. You need to be careful though- cats can get very upset if you change their diet, and a hunger strike can lead to liver problems. It's important that cats like their food. The more non-dry food in their diet, the better, but plenty of cats live long, happy lives on dry food, so if your cat is addicted, don't despair!



Thirsty Dogs: Canine Cushing's Disease

Cushing's disease, more properly called hyperadrenocorticism, is a common hormonal condition in dogs. It occurs in people too, although it is more rare in humans.

The disease is caused by an excessive amount of hormones produced by one or both of the adrenal glands, most commonly a hormone called cortisol. Dogs with this problem can have a variety of symptoms, including increased  thirst and urination, hunger, skin or urinary tract infections, a pot belly, thin or darkened skin, and panting. They can develop diabetes or high blood pressure, as well as other serious health problems. The symptoms and health consequences will continue to worsen over time unless the condition is treated.

What causes canine Cushing's disease?

To explain what causes canine Cushing's disease, I need to first tell you a little about how the body works. Dogs (and people) each have 2 adrenal glands, one by each kidney. The adrenal glands produce a number of hormones, including cortisol. Cortisol may sound familiar to you because we use related cortisone-type medications for many purposes in human and veterinary medicine; cortisol is the natural hormone usually produced by the body in minute amounts. The body needs cortisol to remain healthy, but too much of it, whether produced by the body or given as a medication, can have side effects.

The "boss" of the adrenal glands is another gland called the pituitary gland, located at the bottom of the brain. The pituitary gland tells the adrenal glands how much cortisol to manufacture at any given time. Therefore, Cushing's disease can be caused by a malfunction of either the adrenal glands themselves, or their boss the pituitary gland.

In most dogs with Cushing's disease, it's the pituitary gland's fault. The pituitary gland develops a little tumor (technically a small brain tumor), and this tumor tells the adrenal glands to make too much cortisol. They obediently follow instructions, and then the dog suffers from the effects of too much of the hormone. Both adrenal glands become enlarged from all the extra work they are doing. In some dogs, the pituitary tumor becomes large enough to cause neurological signs.

In a minority of dogs, one of the adrenal glands develops a tumor, and it's this adrenal tumor that produces too much cortisol. In this case, one adrenal gland will be big, and the other one will be small, since it has nothing to do with its buddy doing all the work. A skilled ultrasonographer can perfom an ultrasound exam of the adrenals, and see which situation is occurring in a particular dog. It is very important to determine which type of Cushing's disease a dog has, pituitary or adrenal, because the treatment is different.

If there is a tumor on the adrenal gland the best plan is to remove it surgically if safely possible. These adrenal tumors are malignant about half of the time. If it is the pituitary gland at fault, most dogs are treated with medication  that decreases the adrenal glands' production of cortisol (such as a drug called Lysodren or mitotane; or another called trilostane), since surgery on the pituitary gland is very difficult due to its location under the brain. This surgery is being developed for dogs however, so stay tuned. Some dogs actually require radiation therapy if their enlarged pituitary gland is causing trouble.

Therapy of Cushing's disease is very rewarding but can be quite involved, so many general veterinarians choose to refer these patients to a veterinary internal medicine specialist for treatment.



The Pressure is On: Hypertension in Animals

Lots of people have high blood pressure, and we all know that this can be very dangerous. When we go to the doctor's office, the very first thing they do is check our blood pressure. But has your pet ever had her blood pressure checked? Should she? Just like people, animals can develop high blood pressure. This can cause strokes, blindness, and other problems in pets. High blood pressure in animals can be caused by hormonal imbalances, aging kidneys, cancer, and other conditions. Sometimes we don't ever figure out why a particular animal has high blood pressure. But it is very important to diagnose and treat high blood pressure in our pets before it causes serious problems.

Which cats or dogs should have their blood pressure checked? Well, definitely every animal with any type of kidney problem should have their blood pressure checked every few months. It is common for veterinarians to see pets with kidney disease who have suddenly gone blind because of undiagnosed hypertension. This happens because the high blood pressure causes the retinas at the back of the eye to detach. This is preventable with medication.

Hypertension in pets can also be caused by hormonal imbalances such as Cushing's Disease (a condition where the adrenal glands produce too much cortisol or other hormones), and hyperthyroidism (overactive thyroid glands). Pets with these conditions should certainly have their blood pressure monitored. We also see high blood pressure in pets with certain types of cancer, such as a tumor on the adrenal gland. As I mentioned, sometimes we never find out why a particular animal has high blood pressure.

If your pet has any of these issues, she should definitely have her blood pressure measured. Probably every dog over 5 and every cat over 7 should have their blood pressure checked each year at the time of their annual physical.

If your pet is in one of these categories and has never had his blood pressure checked, ask your veterinarian to do so. And make sure you use a veterinarian who has blood pressure measuring equipment in their office- not all do, and this equipment may save your pet's vision - or his life.



Ultrasound for Animals

Ultrasound is a wonderful technology that has saved the lives of many animals. It's good for you to understand what it is and who performs it on animals just in case your pet ever needs it.

Ultrasound scans, also called sonograms, use high-frequency sound waves to form images of tissues within in the body. Ultrasound technology is similar to the sonar used by bats and ships at sea. The sound waves are reflected by the patient’s tissues, and these reflected sound waves are recorded and displayed as a visual image. This occurs in “real time”, meaning that the images are immediately displayed on a screen that looks like a television or computer monitor. Because the images are displayed in real time, the doctor can not only form pictures of the organs and tissues, she can also observe certain things as they happen, such as blood flow, heart beats, and other activity within the body.

Abdominal ultrasound is used when a veterinarian suspects an animal has disease in one of the organs or in the abdominal cavity itself. For example, the veterinarian may have discovered an abnormality on a blood test that indicates a problem with an organ such as the liver or kidneys, or the veterinarian may feel something unusual in the abdomen on a physical examination. The animal may have symptoms suggesting a problem in the abdomen, such as vomiting or poor appetite.

Ultrasound can be really useful to help figure out why an animal is vomiting. When a dog or cat has been vomiting, one of the things veterinarians worry about is that the animal may have eaten something that is causing an intestinal obstruction. Animals eat all sorts of crazy things: toys, corncobs, rubber bands, shoes…you name it.

Although we cannot always see objects within the intestinal tract using ultrasound, we are at least often able to determine that there is some type of obstruction. With the amazing machines used today, we can often see something as small as a string that an animal has swallowed and that is tangled in the intestines. By confirming our suspicions quickly, we can rush the patient to surgery before it’s too late.

Who performs ultrasound scans on pets?

Veterinary radiologists receive the most training in performing ultrasound exams. If one is available in your area, a radiologist is a good choice. Veterinary internal medicine specialists also receive ultrasound training during their residencies, and in addition have advanced knowledge of the diseases of the abdominal organs, and so are very good at interpreting the results of the ultrasound scan and making recommendations. If your pet ever needs an ultrasound, your veterinarian can refer you to a radiologist or internal medicine specialist.

Anyone can buy an ultrasound machine but there is a world of difference between a radiologist who completed an intensive three-year residency program and a doctor who took a weekend course or just bought a machine for his practice. Unfortunately, an unskilled ultrasound exam can do more harm than good, since inaccurate results may lead to incorrect diagnosis or treatment. Make sure to protect your pet by having an expert perform the ultrasound exam.



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