Stories

Chemotherapy in Lymphoma

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

November 30, 2015
Chemotherapy is a long word. The definition doesn’t do justice to the fear derived from a term that means only “chemical treatment”. In reality, “chemotherapy” is a word primarily used for a group of cytotoxic drugs, cell killing medicine used in the treatment of cancers. Cancer is a disease that can occur in any body part, any cell line of the body. Cancer occurs when that particular type of cell goes haywire and starts to divide abnormally, faster and faster, so these abnormal cells become a big mass that invades and overgrows the normal healthy cells. This abnormal mass of cells will eventually infiltrate, overwhelm, and kill the normal cells of the organ or body part they grew from. Finding medicine to combat all the different types of cancer that occur is a challenging job, and the drugs used often come with side effects which are themselves feared.

“Ruby” is a beautiful mahogany coated Irish Setter. She’s a little over 7 years old now, and enjoyed some success in the show ring when she was younger. Her owners bred her after careful consideration and her pups were highly sought after. She was retired from the show ring and breeding and had been happily ensconced as a beloved house pet for many years when one night while brushing her out her owners noted two firm lumps along her jaw line. They didn’t seem painful to Ruby, but on closer examination it looked a little like she had human Mumps. Ruby ate all her dinner that night and was playful on her walk but they decided to get this checked out anyway.

We saw her two days later and found things much as her owners reported. Bright eyed, active, in good weight, Ruby was playful for her exam. Pressure on the swellings below her jaw seemed a bit uncomfortable – she wiggled backwards during that part of the exam. The swellings were located where the back of the mandible, or jaw, meets the neck, a common site for lymph nodes. Lymph nodes filter lymph, a body fluid, cleaning it of bacteria and other toxins before the lymph is returned to the general blood stream. As sentinels for infection trying to enter the body, many kinds of disease might cause them to swell up a bit as they swing into action to defend the body. Ruby was examined along the several key points of external lymph nodes found over her body. We detected two more suspect lymph nodes that seemed enlarged.

As with so much of medicine, there is a standard protocol that is usually initiated, sort of the building blocks of investigation into diagnosing a disease. These steps cannot be lightly skipped, as one should always start out looking for the most common of problems and adding on further tests as deemed necessary to answer and understand the disease completely.

On this day we recommended performing needle aspirates of the masses and a blood panel.  A needle aspirate is a straightforward procedure: a needle is attached to a medium sized syringe and gently inserted into the antiseptically cleaned mass in question. The syringe must be large enough to exert enough suction to withdraw a sampling of cells from the mass. Sometimes liquid is present, sometimes nothing appears to come back into the syringe. The needle is carefully separated and then the open syringe reattached to “blow” the cells collected onto clean glass slides. These slides will be stained and examined at the laboratory to identify WHAT the mass is, if there are signs of infection, abnormal cells, perhaps what type of organ it is from. The blood panel does a general check for all body systems and functions, though it will not detect a specific cancer (barring a blood cancer leukemia).

Ruby’s aspirate confirmed that the masses under her jaw were her lymph nodes. In a normal adult dog over 80% of the lymphocyte cells are small, round “Mature” cells. In Ruby’s aspirate more than 50 % were big immature blobs of cells. Ruby’s blood panel was actually normal. Additional tests of x-rays and an abdominal ultrasound were recommended to check for enlargement of any internal lymph nodes. Her chest x-rays were clean, but the abdominal ultrasound revealed another enlarged node.

These tests were completed in less than a week. With this information we were able to stage Ruby’s Lymphoma cancer and she was considered a good candidate for chemotherapy. This started as a once a week treatment as she cycled through four different medications each month. Vincristine, Doxorubicin, cyclophosamide, asparaginase and prednisone may all be used in the treatment of Canine Lymphoma. Side effects from the chemotherapy can include the same kinds of problems many people report, such as nausea, vomiting, diarrhea, hair loss and worse. The reality is that we treat multiple dogs and cats with chemotherapy for a variety of cancers every year and rarely see discomfort from these things. This is a blessing for both pet and owner and allows us to both recommend and administer chemotherapy comfortably.

Within 2 weeks the lymph nodes under Ruby’s jaw had dramatically returned to normal size. Her owners were unable to tell that she was on medication of any kind, except for a healthier appetite spurred by the prednisone, a steroid. Without chemotherapy, Ruby might have lived 90 days. Although chemotherapy has put Ruby in remission, it is not a permanent cure, and she still requires treatment every couple of weeks, but Ruby is an 8 month cancer survivor and going strong!

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

Atresia Ani and Medical Jargon

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

October 27, 2015
They say communication is the key to understanding. Hmph! Many years ago I was in conversation with a Southern grandmother. “I like Datsuns”, she told me. Encouraged by this opening, I nodded in agreement, saying that I believed both the Datsun and Toyota cars to be very dependable. Warming to the subject, I began to share a story about my Aunt Bea’s wonderful little car when the woman interrupted me, frowning. “I was talkin’ about Datsun DOGS”! There was a beat of silence. “Oh, oh, of course, Dachshunds!” I spluttered. I can’t remember the rest of that conversation for the life of me, but it was only one of many lessons I absorbed over the years as I’ve struggled to explain pet maladies and medical eccentricities to my clients….

The elderly woman sat expectantly in the client seat we provided in our exam room. In my hands I held a tiny eight day old puppy. She had brought the puppy to me because it had stopped nursing that day and she was quite anxious that all go well for her charge. I examined him, checking the roof of his mouth for a cleft palate or other deformity. His ears were pressed tight to his head, his eyes still unopened. His heart sounded normal. The puppy appeared to have been eating well, with a full, rounded tummy. As I lifted up his tail my eyes stopped. I carefully twirled him in my hands for a closer inspection. The skin under his tail was smooth, unbroken by any opening that should have been there.

Oh. I looked over at his owner, still sitting up straight in her chair, a kind smile upon her face. As our eyes met she appealed to me, “Do you know what’s wrong?” I nodded slowly, my mind racing over the possibilities for treatment and successful outcome. Because I could think of none, I was slow to respond.

“Your puppy has a congenital defect, Atresia Ani,” I replied.

The woman’s smile widened. “Good, so you can fix him?”

I realized that my medical diagnosis made no sense to her – oh, so many hard-earned terms thrown out the window over the years, as I struggled to re-phrase body diseases into language comprehensible to all! I stared at this good woman fixedly and tried again. “You see, he was born without an anus.”

I must have been rocking in my agitation, as the woman began to gently move backwards and forwards in slow rhythm to match. “Yes”, she nodded, “I’m glad you can help him. When will he be better?”

The pressure was unbearable as I realized I still had not conveyed his diagnosis to her. Another tense silence and I suddenly blurted out “Your puppy was born without an asshole!”

Shock at my language and immediate comprehension registered in her eyes. The smile faded. Neonatal medicine was rudimentary thirty years ago in veterinary medicine. The condition of Atresia Ani is found in newborn puppies, a congenital defect characterized by the malformation or even complete lack of an anus. The intestine cannot empty. The puppy cannot defecate. Feces builds up inside, bloating the belly. Death ensues. Atresia Ani is rare, but when seen is more commonly found in female dogs of the Boston Terrier or small Poodle breeds. Surgical correction is not simple : the tube of intestine, the rectum, cannot just be connected to a newly created opening in the skin to connect the two. Without an anal sphincter there is no way to open and close, no way to regulate defecation. Feces will drip out at any time, called fecal incontinence. This is not appealing to most pet owners, faced with a lifetime of diapers, careful hygiene and skin care.  In extreme cases of Atresia Ani part of the intestine may not have developed at all. To asses a case for surgery requires in-depth radiographic study. In addition, one must be certain no other congenital defects exist which would adversely affect the outcome. This case was entirely beyond the scope of a general practitioner and seemed unthinkable in a patient weighing less than 150 grams. How the puppy survived for so many days was itself a sad miracle. The puppy was being poisoned by the body waste he couldn’t eliminate and I had to recommend humane euthanasia. The client was lovely about it, though saddened that we could not help her puppy. There were other healthy, thriving puppies at home. But it was this little one that needed her care who had tugged at her heartstrings. I remember her fondly, and her puppy, of no particular importance to the world, but he mattered to her and she made his short life matter to me.

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

The Ex-Husband

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

October 20, 2015
Some days I find myself spending most of my waking day with other people and their pets rather than my own family. I think that’s why I enjoy a homey feel at work, books on the shelves, paintings on the walls. And I love getting to know our clients, learning their stories as their lives intertwine with mine. Sometimes the pet stands out, sometimes the people.

One young woman showed up two years ago with her much loved but very old dog. When a pet has been with you since childhood the attachment goes deep. In this case, cancer was involved. Although we were able to ameliorate many of the side effects of the disease, eventually her dog passed away.  I did not know if I would ever see her again.

Six months had passed when I noticed her name on the day’s calendar with the annotation “new pet”. And that is how I came to meet “Sadie”. Sadie was a Rescue, a Shephard mix that seemed a poor choice for adoption. I would not have selected this timid animal cowering between her new owners knees, none too certain she’d found a safe haven. The dog looked like she wanted to bite someone, and I was the most handy! Sadie was not a young puppy, either, making these temperament problems even less susceptible to change. I kept my distance across the room, asking questions and studying this unlikely pair, letting the dog get used to hearing my voice. Hopefully, time to collect her wits about her.

I abandoned the usual approaches and carefully took a seat in the other chair, next to Sadie’s new owner. We continued talking and eventually I was able to touch Sadie and perform an exam, though lightly. I did my best to avoid anything that might startle Sadie or make her snap at me as fear and bad behavior during one visit will build into more problems at the next. Amazingly, over the course of the next eight months, I saw Sadie several times and each visit she was visibly more relaxed and much easier to work with. There was no longer any question of her biting. (Having said that, let me impress upon you the maxim “all dogs bite”, given enough pain, fear or whatever!)

Sadie came with a few problems. She had a bit of a runny nose and her paws turned beet red and swelled up. Perhaps as a reaction to meadow grass on one of her walks? Each time the problems responded well to medication and her owner is documenting general events in Sadie’s life to differentiate whether contact irritants or an allergen might have caused these reactions. As examples, cigarette smoke is an irritant; heavy pollens in the Valley air may cause hay fever, an allergic reaction. Sometimes the way the body reacts looks the same. Through documentation of her activities we hoped to be able to avoid Sadie’s “triggers”.

Sadie dropped in for a visit today because her ears were bothering her again. She greeted me as I came into the room and allowed a full examination, though I admit this was still from the chair next to her owner. (It works!). After we’d discussed her medical condition I admired the incredible progress her owner had made in socializing this dog. Many people rescue an especially “sad” case but few have the knack to turn them into happy socialized pets that interact with and enjoy the world around them. Then both pet and people are miserable for years to come. It was tremendously uplifting to see the change in this dog. I asked her owner how Sadie was doing in the home environment.

“Great!” she said. “My Mom says I’ve gone too far, that I’ve spoiled her. She’s (Sadie) doing well with men, too. Well, except my ex-husband. My Mom had him over to her house last Sunday for a recipe. I haven’t seen him in 10 years. Sadie did NOT like him!” She laughed happily. “She’s a good judge of character.”

I said, “Wait a minute, what’s this about a recipe? Why did your mom have him over?”

“Oh, she replied, “his banana cream pie. She’s been using his recipe all these years and she thought hers was missing something, so she asked him to come over and make it with her. She kept saying, you didn’t write that down before!” Sadie’s owner scowled briefly. “I think hers is better anyway.” We were both laughing by now. “Yes!” I said, “That pie sounds amazing! You must name it “Darlene’s Ex-Husbands’ Banana Cream Pie Greatly Improved!”

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

 

Seizure Disorders

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

September 9, 2015
There was a tremendous commotion at the front door. I looked up to see a tiny ball of fur writhing in circles in the open doorway as her owner struggled to balance the door and simultaneously pick up her pet. Just as I reached them, the dog suddenly stopped her flailing, stood up, shook her coat and trotted the rest of the way in. Her owner looked up at me and shrugged wearily. “Coco does this every time she comes in for a bath.”

Really? Her dog had a SEIZURE every time she was groomed? I found this incredible. Actually, I didn’t believe it. There were some gaps in my medical training which Coco was going to neatly plug. Oh, I knew a lot about seizure disorders. A seizure or convulsion is when the brain has an electrical misfire and the body loses control, most often recognized when a pet falls to the ground, its legs jerking uncontrollably. In humans this is called a grand mal seizure. Any kind of animal may suffer from a seizure, sometimes as simple as staring blankly at a wall, to chasing butterflies to a full-blown fit.

There are many causes for seizures. One big group that lumps many chemicals together is “poison”. Thirty years ago strychnine poisonings were still being seen here in Merced – leftover coyote bait? I don’t know. Most of those chemicals are long gone and illegal today. Some have been replaced by less toxic yet effective products. The snail bait metaldehyde that can lead to seizures and death in pets is slowly disappearing as an iron chelate compound takes its place.

Many pets which have their first seizure at home scare their family no end, but are up and running around like normal by the time they arrive – emergency! at the clinic. Why do we ask you to come in? Because we don’t know if your dog will stop seizing on its own, and when the seizure continues over 10 minutes or longer, called status epilepticus, your pet may be at risk of dying. Dogs in status epilepticus, for example, may need to be completely anesthetized to allow his or her muscles to unclench from their rigor, and may have to be kept heavily sedated for a prolonged period of time. This requires hospitalization, IV fluid support and intensive nursing care.

If your pet DOES have a seizure, try to time it (yes, it feels like an eternity!). Most last less than 2 minutes. Do NOT try to grab your pet’s head – it may bite you. Dogs do not swallow their tongue while seizing. Most pets recover quickly from a seizure. If not on emergency, have your pet seen by a veterinarian as soon as possible.

If the pet is not still seizing when brought to the hospital we will want to run some blood tests. There are a wide variety of organic diseases that may lead to a seizure. Oddly enough, low blood calcium is one. Calcium is not only needed for strong bones, but it is vital for every muscle contraction, including the beating of the heart. A mother dog with a large litter of pups or possibly a poor diet may present in tetany when milk production drains her body of calcium. Low blood sugar is a common problem in toy breeds. Electrolyte disturbances, the body’s salts, can lead to seizure like activity. The liver, the pancreas, the parathyroid glands, the brain! It all becomes very complicated. Many times when we find a problem on the blood tests we can treat the underlying disease specifically and the seizures will disappear. Sometimes, when the blood tests are normal and the seizures recurrent, we diagnose Epilepsy. If there is reason to be concerned about brain cancer a test by CT brain scan is available for pets at several centers in the Valley.

Epilepsy is still incompletely understood. It may be inherited or may occur secondary to severe head trauma, like being kicked by a cow. Often we diagnose “idiopathic” epilepsy meaning “I don’t know why”. Most epileptic cases are treated with similar medications, regardless of underlying cause. Anticonvulsant medications work through their sedative effect on the brain, calming the electrical impulses so they do not cross the excitement or seizure “threshold” that results in a “fit”.

While the onset of most seizures is never understood – so there is no preventing nor anticipating the next one – Coco set out to prove that yes, doggie drama queens do exist! We ran her blood work. Normal. We started her on anticonvulsants. She seizured “like always” at her next bath. We changed meds. Another seizure with the suds. Her owner swore that Coco never had a seizure at home. We never saw a seizure with vaccinations! Not over a blood draw! Not with the clippers! Something about running water and shampoo just pushed her over the edge. It was not worth medicating her for such infrequent events. Though possibly less stylish, Coco was home bathed after that and sternly warned to stay out of mud puddles!

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

 

 

 

The Scam

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

July 28, 2015
I know we all hear about credit card fraud, identity theft, and internet scams, but it is still shocking when it happens to you.

There are many ways to obtain a new pet. My guess is most of them come to us as strays or we go in search to rescue a pet from a local animal shelter or humane group. Some are given to us as a gift (a little risky), some purchased on impulse from a pet store window, others found in a newspaper ad or off Craig’s List. Those looking for a particular breed of dog or cat, bird or reptile may research the breed, interview breeders and go on waiting lists as they wait patiently for the “right” one. In the age of the Internet you have an opportunity to connect with breeders all over the country, potentially finding some truly exquisite animals that are not available locally.

I have many clients who have found wonderful dogs this way. With the ability to review photos and see videos of their choice, they can even watch their puppy “grow up” from birth. This requires interaction with the breeder, signed contracts, deposits and yes, some faith. Until you physically have the puppy in your arms there is still a possibility of disappointment even with extensive communication on both sides. Perhaps your beautiful new puppy is already larger than an adult should be for that breed. Maybe his eyes run or her knee dislocates. Now you have the extra expense of fixing it. Things that a breeder may accept or not have noticed may bother you. But if this is not the puppy of your dreams or there are truly serious health issues you must consider how you will return the dog to the breeder. This should be considered and written out between both parties in advance, as returns across country are not simple. Most reputable breeders accept returns, even full refunds (read your contract carefully first) but most also require that you return the pet on your own dime. Average flights for dogs run over $100, a lot of dimes. Just for the opportunity to meet a dog you might not have accepted in the first place. And ALL puppies are cute! Needless to say, very few are returned, however unhappy the first meeting may be. By and large I have observed that most pet owners accept a few flaws and enjoy years of companionship with their internet-found pets.

But the Internet has allowed all manner of people to put up pets for sale. Reputable show breeders who carefully breed for the finest qualities in their dogs; backyard breeders who have purebred dogs which they’ve bred for fun (doesn’t mean they aren’t pretty or loveable!); the “Puppy Mills” which churn out “pedigreed” dogs in large batches, with a minimum of care towards congenital defects and sometimes minimal care, period; and….some that offer puppies for sale when they have none – a total scam!

We recently went online, searching for a specific breed in the Bay Area. We wanted to stay local enough to go check out the puppy but broaden our search as there was very little choice locally. This seemed like a good idea. Immediately a website popped up, advertising for a multitude of breeders from various cities around the Bay. All had pictures of puppies for sale, some referred you to personal websites where you could view their kennel. Prices seemed good. Hmm, maybe too good. But they had testimonials! And before they would talk with you, you needed to answer several questions about yourself, asking if you could provide a “forever home” and promised to care for this puppy with all your heart and did you have a veterinarian?  Initial contact was easy and if you like instant gratification, wow! They could have the puppy on your doorstep within 10 hours. From Delaware. Or Texas. But wait, didn’t it say Bay Area? Yes, but they had to go care for their ill father and took the puppy with them (the ad was placed 2 hours earlier). To make a long story short, be wary of a quick deal. Question a price too good to be true. If the puppy is no longer in the city or state listed when the ad was placed, walk away. Ask to see a current photo with an object in it, like your first name on a card. Their camera is broken? Move on. If at all possible meet the puppy first. If you are considering a purchase in the thousands of dollars (not me), the price of an airline ticket to meet your puppy in person may be reasonable. Even a meeting in a public supermarket parking lot will give you a chance to fully look your pup over before making the decision to open your heart and home to a new family member.

Christine B. McFadden, DVM
drmc@mcmenagerie.com
Valley Animal Hospital, Merced

Cat Scratch Fever

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

July 9, 2015
My mother wanted more articles on cats, but this time she’s gone too far. While her cats swirled about her feet in a breakfast feeding frenzy one nudged her along a little too hard, breaking skin. Three days later she almost landed in the hospital as her leg swelled up, an angry red color.

Diagnosis : Cat Scratch Fever.

Cat Scratch Fever, more properly Cat Scratch Disease, is caused by a little known bacteria, Bartonella henselae. Because cats themselves rarely suffer any effects from this bacteria, your veterinarian is not “looking” for it. Oddly enough, statistics from the Center for Disease Control (CDC) in Georgia report that up to 40 % of cats may harbor this bacteria on their claws or teeth sometime during their life, with the most likely period being when they are kittens. This, of course, is when young cats are most playful, most likely to play bite or scratch during a wrestling match. If your skin is broken the Bartonella bacteria has an opportunity to start an infection in you – the human. The cat will be fine.

Even more oddly, your cat probably picked the bacteria up when it was scratching at a flea! Infected fleas carry the bacteria, and your cat will get flea dirt caught under its nails or in its’ teeth. Once a person’s skin is broken, the bacteria is transmitted through the saliva or from under the cats nail. Even allowing a cat to lick an open wound which you may have (irritated mosquito bite?) may transfer the bacteria. We’re back to flea control, again! In our mild climate, fleas are a reality year round in Merced. If you think you have them under control, keep treating – keep it that way!

Washing any scratch or bite wound will prevent most people from developing an infection. Once Bartonella has taken hold, it can be readily treated with antibiotics by your physician. Your cat does not require treatment. On rare occasion an infection with Bartonella can land a person in the hospital for intensive care.

Does Bartonella EVER bother the cat? Maybe. There are tests to demonstrate if anti-Bartonella antibodies are present in the blood stream. This only proves exposure to the bacteria, not current infection. Rarely an ill cat, perhaps with an eye infection, may be tested for Bartonella. If you have high concern about acquiring a new cat or are faced with a family member who is immunocompromised and must guard against any disease encounter you can request these tests for your cat and even a course of treatment as a preventative, though it can’t guarantee against future re-infections.

My mothers’ cats are on flea control and are older, but one of them goes outdoors and inevitably brings fleas back into the house. I knew the source of infection and how to contain it. I must admit it was interesting to follow how her physician handled it. As a veterinarian, I am familiar with the rejection one must inevitably face when serving in a “helping profession”. Everyone wants to help. They want to help even more when it’s outside their scope of expertise – it’s so tempting to give advice! I am sometimes the last stop in a desperate quest to heal a pet, after the owner has purchased a variety of compelling exotic potions over-the-counter or whipped up a guaranteed home remedy recommended by the neighbor’s cousin passing through town.  My mothers’ leg improved slowly but surely under the extremely watchful eye of her physician (he even offered to make a house call to check on her over the weekend). So it was with some interest as I followed her recovery to hear her inform me that she was going to have the gardener check her leg that day. That gave me pause. I double-checked. The gardener? I silently chewed this over in my mind. She was seeing her physician every other day, if not daily. Her veterinarian daughter was stopping by every night. The gardener?  It felt good to know these things didn’t happen just to me. I wondered if the gardener would argue the merits of herbal remedies….? I could tell this was a turning point for the better in her case and that I could step out now. And her physician? A miraculous cure. My hat’s off to you, Dr. De La Pena.

Christine B. McFadden, DVM
drmc@mcmenagerie.com
Valley Animal Hospital, Merced

Femoral Head Ostectomy and Mercy

/ Dr. Christine McFadden / Leave a comment

 

Dr Mc Blog

June 3, 2015
She named her “Mercy”, a nod towards her future as an elementary school mascot. She was a cute little black and white ball of fluff, guaranteed part Border Collie. Part what else wasn’t mentioned. A bright puppy, Mercy suffered no fools. People wielding needles were not popular with her (picture a grown veterinarian trying to explain how vaccinations are lifesaving to a tiny puppy throwing a tantrum. Score : Puppy 1/ vet 0). By the time she’d been through all her puppy visits and spayed Mercy had had it! She began to stalk me when she saw me, sounding the alarm far and wide to all who’d listen. If I ignored her and walked away she’d bounce after me, stiff legged and barking in staccato yaps. If I turned to her she’d stop and lower her head to graciously allow me to pet her – but growled under her breath the entire time. Mercy is not good advertising for me.

Mercy takes her school duties seriously, snuggling up with children who need a friend and a furry hug while they find their way through problems. Mercy doesn’t choose sides on the playground. She has been known to dress up in ridiculous costumes for a rally or fundraiser. Most of all, Mercy can be depended upon to dispose of unwanted lunch items without tattling.

The dog has it made.

So I was a little surprised to find her in my office early one Monday morning. At a family picnic over the weekend she had joined in some doggie games and got rolled. She came up limping in back and hadn’t used the leg since, though bravely she didn’t cry. Her big brown eyes followed me quietly. After a gentle exam I recommended we start with a set of x-rays taken under sedation, so she wouldn’t feel further pain during the necessary manipulation to get good pictures of her bones.

We discovered that Mercy had dislocated her hip. The head or ball of the upper thigh bone is cupped inside a socket, called the acetabulum, of the hip. It swivels securely here, held in place by the depth of the socket and one very strong ligament.   This ball-and-socket joint allows tremendous range of motion and is very difficult to separate. Usually only blunt trauma, like hit-by-car can create a strong shearing force that breaks the ligament, yet not the bones. Mercy had not had a severe accident, but the clue to the underlying cause for her leg to succumb to a lesser injury was there on the x-ray : Mercy’s hip socket was flat, not deeply cupped. It had been so much easier for a quick blow to snap the ligament since the whole set-up was already relatively unstable. Once knocked out of place the strong thigh muscles kept the leg pulled forward.

Mercy was already under anesthesia for the x-rays, so after notifying the owner of her diagnosis we manipulated the head of her femur or thigh bone back into place. This is called a “closed” reduction of a dislocated leg (as opposed to an “open” or surgical reduction).The procedure went smoothly, probably for the wrong reasons : it was easier to pop back in place because it was more of a slide over the flattened edges of the acetabulum than a real “pop” into place. We bandaged her leg in an old fashioned sling and sent her home. On re-check 2 weeks later we found, not surprisingly, that her femur had slipped back out of place and we moved on to a salvage surgery called a femoral head ostectomy – translated backwards it means “to cut off the head of the femur”. It sounds awful and I’m surprised more people don’t faint when confronted with this description. The ligament cannot be repaired or replaced. Left alone, the ball part of the bone will grind into the pelvic bones, creating severe pain. However, remove the ball, leaving an unconnected “stick” of thigh bone but with all muscles attached and the leg will align where it should and a strong band of scar tissue called a “false joint” will form over time. Small dogs and cats will often have 100% recovery, larger dogs may exhibit a small sway to their gait. Mercy was walking on her injured leg before the sutures came out.

It’s been a couple of years now and I suspect most people have forgotten she ever had the injury. A testament to the benefits of orthopedic surgery, Mercy walks and trots just fine. (Mercy does not deign to run. A dog of her stature has no need to comport herself in such common fashion. My suggestion that a few too many corn dogs might be slowing her down was rejected with disbelief. Shame on me!).

Though Mercy continues to energetically terrorize me whenever we meet, I have one small revenge. As she has grown, it’s become obvious that very little of a Border Collie’s genes are included in her genetic makeup. In fact, while she was routing me one day I was reminded of a scene straight out of the Wizard of Oz, where a little dog of similar build bit the leg of a neighbor lady (soon to become the Wicked Witch of the West) and started that whole journey through the tornado…… I now call her “Toto” and darned if she doesn’t come running up to me for a long pet, growling the entire time. We have reached a mutual understanding and I am content.

Christine B. McFadden, DVM
drmc@mcmenagerie.com
Valley Animal Hospital, Merced

Miliary Eczema in Cats

/ Dr. Christine McFadden / Leave a comment

 

Dr Mc Blog

May 27, 2015
My mother has complained of a dearth of articles about cats. Here you are, Mom. The domestic feline or house cat is believed to have appeared as a companion as early as 7,000 or more years BC. Whether part of ancient religions or welcomed as a mouse catcher, the cat was also made to be a pet. Although today many argue the value of a cat compared to a dog, statistics indicate that there are as many, or more pet cats in the world as dogs.

Cats are athletic, inquisitive, intelligent and independent.

One such special cat was Alfred. A sleek golden orange tabby, he had grown into a magnificent 12 pound, well-muscled  cat. Alfred ran his house, assuring punctual meals with scheduled outdoor exercise and afternoon naps in between.  He was about three years old when his owner noticed that his coat was looking a little patchy, and when she picked him up to pet him she felt tiny scabs over his back. Alfred seemed a little irritable when she tried to pet him, squirming away as if his skin hurt. This would not do, so off Alfred and owner went to the vet!

Close examination revealed that Alfred had scratched at himself, evidence of itchy, or pruritic skin. The fine little scabs were clustered close together over his skin, with a few slightly bald patches where he must have scratched off some fur. The working diagnosis for a cat with this kind of skin condition or dermatopathy is called “miliary eczema”. “Miliary” meaning “a rash that resembles tiny seeds” and “eczema” meaning inflamed skin, often itchy or red. This is sort of a catch-all term that describes the rash but not necessarily the underlying cause.

Most often a rash might occur in response to an allergy. But allergy to what? In Alfred’s case his owner medicated him monthly with a flea preventative and indeed, there was no evidence of flea “dirt” (blood sucked from an unlucky pet, passed through the flea’s rudimentary digestive system, and deposited in the fur as flea poop) or any live fleas on the cat. Flea allergies are the most common cause of miliary eczema in cats. Other possible sources of allergens might include contact allergens, something the cat might walk on or roll in, or airborne pollens.

Diet might be another cause of allergies.

Since “miliary eczema” defines only the appearance of the rash, other clues to its cause may be found by noting where the rash occurs on the body. For example, if a rash has broken out near the ears, your vet may look for ear mites. Both bacterial and fungal skin infections may cause similar looking rashes. After questions about your cat’s environment, in particular about any changes or recent introductions to your home or yard, your veterinarian will try to pinpoint a precise cause. Sometimes a skin biopsy is recommended for definitive diagnosis. In some instances the underlying cause is never fully understood.

In Alfred’s case the rash appeared to be a response to an unknown allergen and a trial medication with an injectable steroid was administered. This kind of steroid is a glucocorticoid, not the anabolic steroids infamously abused by some athletes. Cats are somewhat unique here, being resistant to the effects that steroids have on dogs (and people) – they suffer far fewer side effects such as hunger and thirst, as a general rule, but they also respond less well to steroid medications in general. Most cats require injectable medication rather than oral steroid medication for allergies.

Alfred was most gracious about receiving an injection in his derriere and went home to convalesce. Overnight his owner reported that he seemed more comfortable, less restless. By day three Alfred was no longer over-grooming himself (it had crept up so slowly she hadn’t noticed his frantic licking increasing) and was eating at a leisurely pace, not jumping about as if suddenly pricked by something. Within the week the little scabs began to dry up and melt away, leaving smooth skin underneath. By the second week it was clear his fur was growing back in. Alfred was once again a gorgeous golden mini panther!

Alfred was lucky. As the effects of the medication wore off around week six there was no sign of recurrence of the rash. For many cats, if the owner is diligent about flea control their cat will remain clear skinned. For others, a combination of injectable or oral medication may be necessary year round to keep their cat comfortable.

Christine B. McFadden, DVM
drmc@mcmenagerie.com
Valley Animal Hospital, Merced

Merced’s Loss

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

May 5, 2015
In the wake of this weeks’ horror story it has been very difficult to write about a pet disease or the function of a particular body organ. I have been in practice in this town, this community for over thirty years. I have seen incredible acts of kindness towards all manner of animals and I have witnessed cruelty and abuse towards many pets. The story of Lucious is perhaps the most violent case of pet abuse I have ever heard of in Merced.

Dogs and cats are called “companion” animals because of all that they give to humans in the way of companionship. Companion by definition being “a helpful friend”. Some say there are more pet dogs and cats in this country than children. That homes with children are very likely to own a pet dog or cat. Seniors are noted to have special bonds with their pets. The handicapped rely on service pets to assist them physically (and may be their best buds). Peace Officers and Military personnel count on them to have their backs. Dogs and cats, it seems, are everywhere, there is one to fit anybody, a pet to fill virtually every need.

Pets love you. You will never feel alone with a pet. They follow you around the house. Like kids, they wait outside the bathroom door until you’re done. Or inside, if you forget to shut the door. They’ll garden with you. When the kids have all grown up and left home they’re there, waiting to be touched and petted when maybe you don’t get the hugs you were used to. Pets are right there for the child who needs to talk to someone when no one else understands. Pets cuddle and will often sleep under the covers.  They hog the bed. They help you brave the dark. Pets coerce you to join them in outdoor outings, get some exercise. They bring you back to the simple things in life, like enjoying a nap in a sunbeam coming through the window. They are there to go on walks with you. They rarely snore when you’re talking to them. They won’t switch channels on you, either. They’re pretty much always willing to join you in the kitchen and in case your clock batteries run down they’ll keep you on time for meals. You are loved whether or not you have wrinkles, a bad hair day, or belch. They aren’t impressed by a degree nor do they care how much money you make. Their love is the closest you may get to “unconditional”. Dogs and cats do require some food, water, a few basics. Veterinary health care will fulfill most of their medical needs. Vaccinations, deworming, parasite prevention being key for all life stages. You add food and love to the recipe and it usually turns out alright.

As I write this my dog is at my feet, having followed me over to the computer. A cat sleeps nearby, having considered the situation and being somewhat put out that I won’t (cannot) make lap space at present. The rest of the household is asleep. I am not alone. According to the American Humane Society of the United States, in 2012 62% of all American households owned at least one pet.

I am not alone in the greater community of Merced that was horrified to learn of the brutal attack and ultimate death of a Merced dog last week. No need to repaint the ugly scene. I find words inadequate at such times. Animal abuse is reportable for the sake of the animals. Animal abuse is reportable for the sake of people, as pet abuse has been linked with a heightened risk of domestic violence towards children and women especially. Our lives are intertwined, all peoples, all animals on this planet.  Laws are in place to process this catastrophe in our community.

Dogs and cats serve many roles throughout our lives. We hear of the “human-animal” bond – is that just some fancy jargon for a college paper to label or define the inter-dependence we all share in this world? Looking past the analysts and academic studies of people and how we relate with pets (which most of us understand intuitively), there was a shocking reality that came to light when Hurricane Katrina devastated New Orleans in 2005. Disaster preparedness plans were in place – rescue groups swung into action – and the world watched in horror as some people chose to perish rather than leave their pets behind to die in the flood, because the plans called for saving people first – and only. Resources were limited, time of the essence. But leaving people right in front of you, to die, was unthinkable. The numbers of people who refused to abandon their pets was high enough that the Red Cross and communities have since been advised to redraw their plans so that people with pets can be accommodated without compromising the priority of rescuing all people in a disaster.

Take note : the human-animal bond is very, very strong. Respect for all life is paramount in our interactions on earth.  My sincere condolences to the community of Merced for our recent loss.

Christine B. McFadden, DVM
Valley Animal Hospital, Merced

 

Pretzel and the Dislocating Knee

/ Dr. Christine McFadden / Leave a comment

 

Dr Mc Blog

April 7, 2015
“Call me Pretzel”, the note said. I peered over the top of it to look at my patient. She was aptly named, wriggling and dancing on the exam table, tongue flashing as she air kissed in happy anticipation of meeting me. “Well, alright then! Pleased to meet you, Pretzel!” I greeted her. With a surge of energy she tried to jump towards me and instead collapsed in a heap as her back leg buckled under her. I righted her with one hand and glanced at her chart again. “Sometimes lame” it read.

I looked again at Pretzel, a little toy breed dog weighing less than 10 pounds. She was just over 1 year of age. Her owner reported that although her little dog usually ran around happily, recently she had noticed that sometimes she picked up one of her back legs when running, or might kick it out behind her then resume her pace. Pretzel didn’t like to jump as much as she used to, and occasionally gave a little cry when landing on her rear legs. As I examined her, I gently pressed on her tiny kneecaps, or patella’s, and felt the right kneecap slip out of place, bumping over the groove at the bottom of the upper thigh bone, the femur, that was supposed to hold it in place. The kneecap slid to the inside of her leg – but as soon as I straightened the leg, it popped back into place. Diagnosis : Luxating patella, also called a dislocating kneecap.

Dislocating kneecaps are very common in many toy breeds. In some breeds it is estimated that over 50% of all puppies are so afflicted, a hereditary predisposition that is evident by a year of age or sooner. Some people believe that as these toy breeds are bred for ever smaller “extreme” sizes more anatomical problems crop up. Certainly these dogs were bred for looks, as lap companions and not as “working dogs” –  attention to strong teeth, big muscles and performance were not a first priority.

The knee of a dog is an interesting joint, being very similar to that of a human in general construction. Kind of bony, it is held together by tendons and ligaments, without much muscle to cover and protect it. Hard working, it must flex and bend with every step taken, as the entire backside of the body is supported on it. So can you picture all this? The big heavy femur with this small sliding patellar bone-and-ligament-show that connects and allows bending when attached to the lower tibia/calf bone. What keeps the patella in place? It is supposed to be nestled deep in the valley of the femoral groove, and helped to stay there by being firmly attached in a straight line to the bony ridge of the tibial crest below it.

In toy breeds, the femoral groove is often formed FLAT. Imagine! With nothing to cup it, the patella is at the mercy of the inner pull of the thigh muscles and off it goes, dislocating sideways towards the inside of the knee. Because the dog was born that way, it doesn’t know that that’s not the way it should be; truthfully, although they walk a little oddly, most young dogs don’t show serious discomfort. But as the patella bobs back and forth over the rim of the distal femur, it rubs ever so slightly, just a touch of friction….and eventually arthritis. At first just a little breakdown of the cartilage covering the bone. Over time, as year pass, from an erosion of the cartilage little pits and bumps appear and the knee becomes more painful. Eventually some dogs become so crippled they can no longer use the leg at all. Surgery is too late by then.

Pretzel, happily, was young and could benefit greatly from corrective surgery. It was easy to recommend it – all the telltale signs were there, from the hard pop when her knee dislocated (painful!) to the changes in activity her owner recognized at home. After x-rays to be certain she had no other orthopedic problems that might affect the outcome and to document the flattened femoral groove, she was taken to surgery – there is no other remedy for such a knee – and her knee rebuilt. A new groove was fashioned deep into the femur and the surrounding joint capsule and ligaments were tightened to hold it in place while healing. Although Pretzel’s leg was straight, in some crooked-legged breeds the tibial crest will also be transplanted.

In case you’re wondering, large breed dogs also can develop dislocating knees, though for most it is caused by some kind of accident or trauma. Surgery is always a necessity in these cases.

During surgery we looked at her original bone, where a thin line of angry red could be seen on the inside rim where Pretzel’s patella had been rubbing as it popped back and forth. We couldn’t undo that damage, but we could stop it right there, and with no further rubbing there was a good chance she would have minimal arthritis in that joint as she aged. Once the groove was deepened, the kneecap sat firmly in place! Pretzel awakened to a fully functional knee for the first time in her life. Helped by anti-inflammatory and pain medications she was walking gingerly in the first few days; had her stitches out by the second week, and began swimming in her bathtub at home as a form of non-weight bearing physical therapy. Within 6 weeks Pretzel was flying across rooms again, taking couches in a single bound, and dispensing crazy doggie kisses to all comers.

Christine B. McFadden, DVM
Valley Animal Hospital, Merced