Veterinary Medicine

Anesthesia : Science or Art?

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October 13, 2015
The body doesn’t always perform, live or die, as expected. The medicine that worked before in a given situation, doesn’t. Or wondrously, against the textbook prediction (prognosis) a full cure is effected when…. It shouldn’t have? Of all the internal medicine problems, the surgeries, the diseases and treatments that veterinarians must try to explain to their clients, it is possible that anesthesia is the most difficult subject to explain and often creates more anxiety than the surgical procedure accompanying it.

Anesthesia is the administration of a chemical substance by pill, injection, or as an inhaled gas that will induce a state most similar to heavy sleep, but at a level of decreased consciousness where pain is not felt. This allows surgery to take place. “A chance to cut is a chance to cure!” was a motto endorsed by my surgical professors. Most veterinarians learn very quickly that no matter how great a surgeon they become, it is as nothing if their patient does not wake up afterwards. Anesthesia is indeed a very important factor in the final outcome.

There is much that goes into the training. With todays’ computer applications, you can punch in a pet’s weight, age and species and the computer will print out a list of combinations and choices of anesthetic for that particular patient. Ahhh, but here is where the art of science comes in. Science, applied to a living creature, is not that cut and dried. Is the patient very tiny or young? She might not take deep, regular breaths under anesthesia and may require assisted ventilation. How to best smooth out the adrenaline rush of a frightened pet so he’ll transition easily into anesthetic sleep? Is the patient very thin or very fat? A heart murmur? Epileptic seizures? So many different considerations must be factored in to choose a correct anesthetic regimen.  Each patient’s case is reviewed individually. Your veterinarian will perform a pre-operative exam looking for signs of underlying disease that might complicate anesthesia. What must be tolerated in an emergency will be refused for an elective surgery : for example, a cat with a snotty nose will be refused a spay surgery.

Most pets receive a preanesthetic medication, called a “pre-med”. This is often a mild tranquilizer or sedative mixed with medication to dry up respiratory secretions. The pre-med serves multiple functions : it dries up fluids, keeping the nose and airway passages clear and it helps to calm and quell that adrenaline rush, as  pre-medicated patients actually need less anesthetic agent throughout their surgery. Pre-emptive pain medication may be given at this early stage, which has been proven to tamp down pain so much before surgery that pain never peaks as high after surgery.

Pre-meds are given about thirty minutes before surgery. The drowsy patient is more relaxed for the second phase, anesthetic induction. Induction anesthetic brings the pet rapidly into deep sleep, often via an intravenous injection. Small patients may induce themselves into sleep with the same anesthetic gas that will be used throughout surgery. If induction is not followed by maintenance with a gas anesthetic it may only last for 5 minutes! This initial state of unconsciousness allows placement of an endotracheal tube, a long flexible tube through the mouth into the windpipe, or trachea, which creates a wide-open passageway for air, oxygen, and the anesthetic gas to be delivered. From this point your pet keeps itself asleep by regularly breathing this anesthetic gas in and out. Monitoring equipment that follows your pet’s heart rate and other parameters are used while under anesthesia. A variety of anesthetic gases are used today in veterinary medicine and can be reversed by simply disconnecting from the machine. The majority of pets in a short procedure, under one hour, will awaken in a few minutes and be walking within 15 minutes!

There is much anxiety about anesthesia, the fear of going to sleep and never waking up, of an unexpected death. The reality is that there are few complications with anesthetics using the drugs and protocols available today. Surgery is recommended for the health benefit of your pet, to repair broken bones, remove cancers, etc. and these benefits far outweigh the risk from anesthetic complications for most pets. Many of our pastimes, whether driving a car or playing in sports, are more risky. I sincerely hope this gives you a foundation for understanding the art and science of anesthesia.

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

 

Seizure Disorders

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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 Pancreas

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Dr Mc Blog

July 28, 2015
Don’t you wonder how some things ever came to be named? Now the word “pancreas” comes from an anatomist named Ruphos of Ephesus, around 1 or 2 AD. In Greek pancreas means “all flesh”. And it IS a pale pink scrawny L-shaped ribbon of an organ sitting in a crook of small intestine near the right side of the stomach wall. Nothing you can really get your hands on during surgery. In fact, you don’t WANT to get your hands on it during surgery. The pancreas is notoriously sensitive to rough handling and maybe handling of any kind and as a young surgeon I worried that if I had to gently nudge it to one side to access some intestine or heaven forbid hooked it when trying to locate a recalcitrant uterine horn (uterus) during a spay surgery that my patient would have a belly ache for days afterwards or maybe die. That part turned out to be not so true but even after 30 some years of exploring abdomens I am still skittish about handling the pancreas and try to avoid any surgical contact.

So what does a pancreas do? The pancreas serves two very important yet distinctly separate functions in the body. One is an endocrine (hormonal) function, as the pancreas produces the hormone insulin. When this system runs amok, pets suffer from diabetes mellitus, often called “sugar diabetes”. The other cells of the pancreas exert exocrine (enzymatic) control and produce amylase and lipase, two enzymes that help digest food in the small intestine. When these exocrine cells malfunction, the digestive enzymes are released willy nilly into the pancreas, not the intestine, where they start to digest the wrong thing. This is the disease Pancreatitis. Inflammation of the pancreas and surrounding abdominal tissue as these enzymes eat away at it is so marked that it may be seen on an x-ray. Tremendous pain over the anterior abdomen is often present. The pancreas is most stimulated to produce its digestive enzymes by high fat foods and protein.

Kahlua was a doggie princess. A little pudgy in middle age, she was lovingly treated to her fair share of dog food and table goodies, often high in fat. One day she started to vomit her dinner. She was sluggish and screamed in pain when her owner gently picked her up around her tummy. In our office she was running a low grade fever and cried when her anterior abdomen was palpated. Among her blood tests a special test for pancreatitis, the Spec Cpl (specific Canine pancreatic lipase test) was positive. Both amylase and lipase scores were in the thousands. When we told her owner the news he was ghastly quiet. Finally he raised his eyes and told me quietly that he had just lost his wife to pancreatic cancer. Kahlua was all he had left of her. He didn’t need to say more. I couldn’t rule out cancer that early because there is no blood test to rule out cancer of the pancreas. If cancer is present, it may be the size of a small pimple and won’t always show up on an ultrasound scan. We would have to proceed with standard treatment for pancreatitis and if Kahlua did not improve as expected would review our other choices. After several days on intravenous fluids to flush out her body and absolutely no food (do NOT want to stimulate the pancreas during this time!) Kahlua brightened up considerably and was no longer painful over her tummy. Her signs of infection responded well to antibiotics and when we gave the all clear and offered a tiny meatball of a bland low fat food she gobbled it down and never looked back. Despite this brush with serious disease Kahlua never had another problem with her pancreas, though she did maintain a low fat diet for the rest of her long life. She was another lesson in proceeding cautiously when discussing any particular ailment of a pet that humans might share, as all too often I find that my diabetic patient has a diabetic owner, or that heart disease or cancer “runs in the family”. Kahlua was 7 years old when she developed pancreatitis and lived another 10 years beyond that, a princess to the end.

Christine B. McFadden, DVM
drmc@mcmenagerie.com

Miliary Eczema in Cats

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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

The Teeth

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Dr Mc Blog

April 22, 2015
What’s a subject you can sink your teeth into? Dentistry! (oh, go ahead and smile. Ha! Your teeth are showing!). Puppies are born “gumming it” and gradually little nubs of baby teeth come in. Baby teeth are correctly called “deciduous” teeth, which I find hilarious because there are deciduous TREES that lose their leaves every fall, like an oak or a maple, and who compares losing a body part with the tree in their front yard?

By 6 weeks of age most puppy teeth, all 28, have fully erupted and are quite sharp. Teeth are valuable for ageing a young puppy. The first deciduous incisors fall out around 4 months of age, the canine or fang teeth at 6 months of age. Most dogs have all 42 of their adult teeth by 8 months of age. Whew- no wonder they teethe on shoes and garden hoses! Exceptions to this rule are every Yorkie on the planet and a few other super teensy breeds who prefer the “delayed dental eruption” plan, their personal dental plan wherein they often refuse to lose ANY baby teeth naturally. These retained or leftover baby teeth must be pulled later under anesthesia. Two sets of teeth may seem kind of crocodile-cute, but the reality is that they will entrap food and eventually rot out both baby and adult teeth. We’re talking real health issues here, so much more than a pretty smile.

Dogs use their teeth like we use our fingers – teeth are their primary tool for prehension, picking up, grabbing, testing, tasting things. Teeth keep the tongue firmly seated in the mouth, instead of hanging out. Teeth, by the simple act of chewing, keep the jawbone firm and strong – without teeth the bone will lose density and atrophy, maybe fracture. Not too long ago dentures were very common amongst our grandparents and we spoke of “gumming it” and how the dentures didn’t fit well – due to lose of bone density. Dentures aren’t an option for our pets. Teeth, of course, help our pets to eat. A service dogs’ teeth may be used to apprehend a criminal or to gently tug a handicapped person into a position of safety.

One big difference for a pet versus a person in the world of dentistry is the rather sad fact that when a puppy loses its baby teeth, it only needs care for its adult teeth for 14 or 15 years, on average – in a human, we are expected to make ours last 80 years or so. I’m not sure ours are constructed any better. But it does explain the emphasis people place on twice yearly teeth cleanings, daily brushing and flossing. Did you know that we recommend daily brushing of your dogs’ teeth? Annual cleaning would be awesome.

When your veterinarian gazes at your dogs’ mouth and politely recommends a dental cleaning, is it just to bring back a whiter smile? Probably not, though whisking away the brown moss and calculus covering those teeth would make everyone happier. All teeth start out covered in white enamel. The salivary glands empty over the back teeth, providing gentle lubrication of the gums and lips and even a small amount of enzymes to start food digestion. Anyplace that you have moisture will attract bacteria, and it is bacteria, living on the sugars from food, that leaves that soft yellow build-up on the teeth called plaque. Thousands of bacteria are piling up on your pets teeth right now! Plaque can be removed with a toothbrush. Toothpastes are formulated just for pets, in flavors they like (think chicken or salmon), fluoride added because this helps kill the bacteria that causes plaque, and without the detergents that make our toothpaste foam up (look – it must be working!) but might irritate a dogs sensitive stomach if swallowed. Brushing your dogs’ teeth daily is well worth it.

Over time plaque mineralizes and turns brown. This hard brown stuff is called “calculus” and must be scraped off – but wait a minute before you reach for your pliers or allow some unlicensed person to “clean” your dogs’ teeth. As you scrape and wrench inside your dogs’ mouth, you literally gouge the enamel, leaving deep ruts that bacteria settle into even more rapidly, and yes, you have just assured a Fast-Track pass to faster decay and damage. The ultrasonic scaler used by veterinarians and dentists alike is safe and effective at removing plaque and calculus. Any micro-abrasions created on the teeth surface are then smoothed out by the polishing afterwards (and you thought it was just foo-foo stuff to make them shine! Silly you).

I used to be more polite. I might look in a mouth and say a tooth was mobile. I’m not sure what people thought – I wanted to test drive it to see how it handled corners? I’ve dropped that approach. Now I just say their dogs’ teeth are rotting in their head. That sparks a little interest. If the dog cooperates, I like to put everything on full display. All dogs should have teeth. Their importance to the body’s over-all health is often underestimated. In just the last two weeks I have cared for several interesting, though not unusual, cases. I had an older Poodle whose upper fang tooth abscessed. The base of that tooth rests against the thin plate of bone that separates the nose from the mouth. When the root rotted so did the bone. Now there was a hole or oro-nasal fistula present. Imagine sucking bits of food and water up your nose every time you ate. Oral surgery was required to fix the problem. A Dachshund presented with a fat swelling below her left eye, not an eye problem, no sir, but an abscessed big premolar leaking into the sinus below the eyeball. A major tooth extraction and antibiotics fixed that. A 3 month old Queensland pup has a baby tooth in his lower jaw erupting inwards : when he closes his mouth the incorrectly placed tooth is literally poking a hole into the roof of his mouth. Ouch! We’re contemplating interceptive orthodontics. And these were very ordinary cases, expected in an ordinary week. Teeth are meant to last time a life time – with proper care.

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

Heartworm

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Dr Mc Blog

March 24, 2015
Moonshadow gently waved his tail from side to side, tongue pink as he greeted us. The older black lab moved with a stately grace across the exam room, a gentle cough escaping from his throat. “There, did you hear that? Why is he coughing like that?”, his owner queried anxiously. I stared down at him, mind running through possibilities. Moonshadow was old, so I had to put cancer on the list. Not a happy place to start. I said nothing as I began a full exam, checking out his teeth, moving over areas where lymph nodes lurked, probing his tummy, riffling through his fur. Moonshadow cooperated with everything, seeming to enjoy it all as one big petting fest. I pulled out my stethoscope and listened carefully to his chest, timing his heart rate and listening to his lungs expand and contract with each breath. A lot of times you don’t hear much listening to healthy lungs, maybe a quiet whoosh. Today I was hearing crackles and rales, sort of like Rice Krispy cereal when you first pour the milk on. Not a good thing to hear. I stood up from the floor where I’d been kneeling at Moonshadow’s side. He side-swiped me with a lick of appreciation, then coughed gently with the extra effort. His owner, in her late twenties, shifted from foot to foot anxiously. “We’ve been through so much together. He’s travelled across the country with me.” Her voice trailed off, tears threatening. Her dog walked over to her and pushed his head up under her hand.

I asked to run a blood panel and take a set of chest x-rays. The x-rays would show me any masses in his chest that could be cancerous or might point to an odd disease like the fungal infection Valley Fever. I could evaluate his heart size and shape and find markers for other lung diseases. The bloodwork would check for signs of infection, diabetes, thyroid disorders and see if his liver and kidneys were functioning ok. Not much point in making a diagnosis of one problem and later finding out that my patient’s renal function was toast. Obtaining a complete picture up front was in the best interests of my patient so I could help him – or know that I couldn’t, should that be the case.

One of the blood tests was for Heartworm, Dirofilaria immitis, a long spaghetti-like worm that lives in the blood stream, bobbing around through little capillaries and veins as larvae until they eventually grow up and take up residence in the lungs and heart. There can a fistful of worms clogging the heart. Nothing microscopic about it – unfortunately, the patient is usually dead when you get to see it that graphically.

Heartworm goes through one of its life stages in the mosquito. It is when the mosquito bites your dog, sucking out a bit of blood (the mosquito’s meal) that it injects the microscopic larval form of Dirofilaria into your pets’ bloodstream. If you give your dog the heartworm preventative EACH MONTH it kills off all first-stage larvae encountered and the story ends there. If your dog isn’t protected by a heartworm preventative, or you forget to give it for a couple weeks (even if you re-start it and get back on track), then there is a window of opportunity for the first-stage larvae to grow on to the second stage and into the adult worms living in the chest. The whole process from mosquito bite to worms clogging the lungs and heart can take up to 2 years. The symptoms your pet shows may range from something mild like restless sleeping to wheezing to full out coughing and heart failure.

Todays’ tests are very sophisticated, requiring only a few drops of blood to detect antigen, the bodies’ response to invasion by a foreign invader, in this case the heart worm. If your dog does test positive for heartworm, a second test is done to look for actual microfilaria larvae circulating in the blood, which helps stage the disease progression and predict the prognosis for your pets chances of beating this disease.

Is there a treatment for dogs that have heartworm? Yes, an injectable form of arsenic. Can some dogs die from the treatment or get very sick from it? Yes. Does the treatment work 100% all the time? No. Once a dog has had heartworm and been successfully treated do its lungs go back to normal? It depends. Sometimes. Can cats get heartworm? Yes, statistically 5-10% as often as the dogs in a given area of California.

In February 2015 there were two (2) cases of heartworm diagnosed in local dogs : a little Yorkie in Merced and a medium sized dog that lives in Atwater. Both are house pets and neither has ever travelled outside of town. For years we have known that pets that travel to the foothills, such as Mariposa or Sonora, are at very high risk; also the Delta area of Stockton. Most of the United States is infiltrated, so ALL travelling dogs and cats should be on monthly preventative. Heartworm is HERE in Merced County. Most dogs can be protected for less than $100 a year. Talk to your veterinarian about the best choices for your pet and family.

And Moonshadow? He tolerated the arsenic treatments. His lungs were permanently damaged and he needed medicine for the rest of his life to keep the post-heartworm immune reaction under control. He was a dog that appreciated everything done for him and gave another two years of love to all he met in his journey through life.

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

 

 

Snap the Cat and the Broken Jaw

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Dr Mc Blog

October 22, 2014
His name was Snap. He had some Siamese in there somewhere because he had huge blue eyes and a white body with orange fur on his ears, tail and feet, a color we call “flame point”. A stunning kitten, he was all male : big, rangy body with long legs, on the prowl to explore my exam room as soon as he was set free from his carrier. Outgoing, slightly aggressive, he was not a cat to take well to indoor confinement. Fortunately Snap’s owners had a large yard and felt their kitten could grow up there safely. No animal is bred to live a life totally indoors, never seeing the sunshine.

Snap grew quickly, losing his first kitten baby tooth as he approached 4 months of age. Most kittens gain about one pound a month as they grow, but Snap gained more – he was going to be BIG! His owners reported that Snap, who got his name when he ran to them every time someone  snapped their fingers, had added fetching to his repertoire. Green beans were a favorite for some odd reason. Snap never ate the beans himself, but his family hated to be wasteful and found themselves researching new green bean recipes as they tried to keep up with his passion. Thanksgiving was the only time of year they could look forward to without guilt (add canned mushroom soup and French fried onions for a traditional casserole).

When Snap was neutered at about 6 months of age he was just losing his baby fang (canine) teeth and looked quite adorable. Neutering helped to suppress his urge to wander and would markedly decrease the likelihood of fights with other cats, which in turn could expose him to diseases like feline leukemia, feline AIDS (FIV, the Feline immunodeficiency virus, NOT infectious to people) or problems like abscesses. “Tomcats”, an old fashioned expression for unaltered or intact male cats can also develop “stud tail” – you don’t want this folks, however manly the name may sound. It’s a greasy patch that dirties the hair of the upper tail. Yech! And the urine of an intact male cat has a unique smell that can only be called a “stench”. It’s hard to draw breath in the same room. The good news is that one surgery and the smell, the greasy tail, and all just go away and you are left to enjoy your cat.

If the average cat weighs 10 pounds, Snap was out to prove that he was anything but average. By 2 years he was 14 pounds of lean muscle, extremely athletic and he enjoyed accompanying his owners on their nightly neighborhood walks. He was a powerful hunter of toy mice. He could jump from a standstill straight up ten feet. He talked frequently, expressing his disapproval if they were a little slow serving him breakfast. Snap had scheduled petting times, also, and showed his displeasure if one was missed by turning his back to the family when they finally came home.

But one night it was Snap who didn’t come home.

The following day we received a phone call that he had been found and was being rushed down to the hospital. And oh, the look of him made our collective stomachs drop. The beautiful fur was wet from mud and blood. His jaw hung crookedly and his nostrils were plugged with clots of blood. He was able to stand and even walk, though there were long scratches abrading one side of his body. It was obvious that Snap had been hit by a car, thrown through the air, and slid hard coming down. The broken face had been the site of impact.

Animals suffer from concussion the same as people. Snap’s pupils were pinpoint (meiotic) but he was responsive and even in a daze he was able to follow visual cues to show us he could still see. We started him on IV fluids and shock therapy and under gentle sedation assessed and cleaned his wounds and took x-rays of his skull. It was pretty bad. He had fractured the center of his lower jaw, so the right side of the mandible was split from the left. Worse, his upper jaw or maxilla had broken and the pieces shifted so that part of the roof of his mouth, the hard palate, was shoved upwards on the right, crunching into his nasal passage and sinus. Oddly, the soft tissue of the hard palate, though bruised, was intact. We were able to wire the lower jaw together on the spot. There wasn’t much we could do about the roof of his mouth but wait and see. All the teeth still overlapped correctly, so he could close his mouth properly. We inserted a feeding tube down his esophagus to the stomach and threaded it out the side of his neck to facilitate eating during recovery. And what a recovery. By day 3 his pupils were normal and his attitude improving. By day 5 he was eating soft food on his own, so IV fluids and feeding tubes were removed. Snap went home, returning to have the wire in his lower jaw removed 6 weeks later. Snap lived to be 15 years old. He never liked to have his mouth examined after all that and his face was a little crooked, but we knew he’d made it when he left a green bean on his owner’s pillow one night.

Christine McFadden, DVM

Valley Animal Hospital

Fleas Part Two : Is Zero Tolerance Possible?

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Dr Mc Blog

September 14, 2014
In my previous column on fleas we discussed the mode of action and the suffering and disease which fleas inflict upon dogs, cats, and occasionally people.  I stated that the tapeworm of dogs, Diplydium caninum, did not infect people. Dr. Jerry Menefee of Los Banos called to tell me how much he enjoyed my column and to gently correct me: there have been a few cases of human infestation with the dog tapeworm, called Diplydiasis, primarily when a young child or infant has actually eaten an infected flea (same as the dog or cat) and the worm develops in their intestine. There is rarely any sign of illness, just little tapeworm segments passing in the diaper! Treament for the child is the same as used for the dog, with excellent success. I could find 2 medical papers printed on separate cases, one published in 1993, another in 2003. Diplydiasis appears to be extremely rare (but oh dear, aren’t you running to check the calendar to see if you’re up to date on your flea control?); I shall expose the mysteries of “human tapeworm”, an entirely different group of worms, in a future column. Today we are exploring methods of flea prevention, critical in our area because, as noted in Part One, our local climate favors fleas – we are a flea hospitality haven!

If a pest has been around this long, there’s been plenty of time to try to get rid of it. Because some pets and people seem to attract more than their fair share of attention and get more bites, researchers tried changing the way skin smells. As it turns out, fleas are NOT put off by garlic or B vitamins, nor are they scared away by clove oil, tea tree oil, cinnamon, lemon, etc. Whether ingested or applied topically, these products only make you or your pet less socially acceptable to other like creatures. Not recommended. It has been theorized that some dogs and cats are better able to groom out fleas with their teeth, so appear to be flea free and escape the ugly monikker “fleabag”.

So we’re talking pesticides to control pests. Thirty years ago we used flea powders, sprays and flea collars, all powered by chemicals in the carbamate and organophosphate family of pesticides. This group of chemicals were not at all selective to fleas – used improperly, they could poison your pet and you. It’s what we had (our “zero”), and we were desperate. The collars worked sometimes on very small pets, since they only covered the neck. Powders would do the job, if you could stand the dust all over your pets’ coat. Sprays were very effective, but required near daily application because as soon as your dog rolled in the grass they were lost in the dew. Forget spraying a cat- one puff and that cat was in the next county. Dips were also effective, though again, none lasted two weeks as dogs roll in the grass…..removing the substance. Most flea dips were toxic to cats, so if applied incorrectly to a cat it would die unless emergency treatment was sought. I spent hours counselling on time consuming methods of flea control that no one thanked me for.

Pest control companies were kept busy spraying yards and houses in an effort to control the flea in the environment. One product, malathion, a mainstay in pest control years ago, to overcome flea resistance had to be sprayed over your entire yard every 10 days to have any efficacy at all according to UC Davis! DIY (do-it-yourself) friendly, it was not. Again, clients were grumpy to receive this news. Today there are a rotating group of pesticides used by pest control companies to fight the flea and prevent resistant strains from developing. Environmental control in the yard is very important; even if your own pet never leaves home, wildlife and roaming pets will almost certainly introduce fleas. Your pet does not live in a bubble!

And then a new generation of medications were discovered. Wonderstuff. Applied topically to the skin of the pets neck or given as a chewey pill, and only ONCE a month, this stuff is amazing! This stuff works! Several products exist for both dogs and cats, all kill fleas within 12 hours of contact with the pet. Reinfesting fleas, flea eggs and larvae in the environment are killed following contact with the treated dog or cat. If you do no environmental control, expect it to take about 90 days to clean up your flea problem. Some of the chemical names we’ll discuss are imidacloprid, spinosad, fipronil and afoxolaner. Ahhh, what’s in a name? Tongue twisters all – the brand names are easier. Curiously, most of these products weren’t developed specifically for your pet.

Spinosad is a pesticide developed to safeguard our food supply, used commercially on fruit and vegetable crops. Spinosad is considered an “organic” insecticide found in a bacteria from sugar cane. Spinosad is considered a natural product, given a Class B designation for pregnant women: No evidence of risk in humans.  It is used on people in medication for human head lice. On dogs and cats it has been found effective primarily against only the flea.

Imidacloprid, another flea fighter available for dogs and cats, is also used on crops and home back yards. Acting as a neurotoxin to insects, when used IN THE YARD, it is a systemic chemical that is taken up by plant roots to its leaves, where sucking/chewing insects will ingest it and die. There has been some question if imidacloprid may adversely affect honeybees (colony collapse disorder), though bees do NOT chew flower or plant parts.

Fipronil is an insecticide that affects the nervous system of insects via pathways that don’t exist in mammals. A broad spectrum insecticide, it is highly toxic to fish and bees. It is widely used for protection of rice crops, field corn, and golf course lawn care. Humans can prevent tick bites by applying it (as directed) to their ankles and wrists. Fipronil can kill rabbits – do NOT use on rabbits for flea control! That said, for years the State of Hawaii has required the veterinarian-only application of Fipronil, specifically, to all dogs and cats 10 days prior to travelling to the state. Fipronil has been widely questioned in honeybee colony collapse disorder.

Afoxolaner is in the newest class of chemical, this one without apparent crop/plant use. It’s sole use is flea AND tick control in dogs. It’s a new isoxazoline parasiticide (I had to read that, why not you?) – its’ claim to fame is that it controls both fleas and ticks via an oral medication for an entire month. Tick control has always been difficult in dogs, and there are many serious tick-borne diseases. The class of isoxazaline drugs may be a breakthrough for livestock that suffer from both ticks and tick borne diseases worldwide.

The flea is here to stay. With considered use of the available products you may be able to control you and your pets’ exposure to fleas and the consequences of flea bites. We aren’t talking eradication. You are not expected to reach Zero.  As for your children, your home and yard, the truth is that flea control on the pet is not deemed of sufficient quantity to add to or create environmental issues at this time. Most of the products we’ve discussed are carried home from Garden Centers and Big Box stores by the quart and gallon weekly as yard and grass treatment for indiscriminate use and disposal by the homeowner. These products all appear much safer for mammals – you, your children, your dogs and cats – than previous options, and every year newer products are developed as we all cope to care for each other and our earth.

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

The Flea and Zero Tolerance : Part One

/ Dr. Christine McFadden / Leave a comment

 

Dr Mc Blog

September 7, 2014
One of the more curious things worth pondering is the realization that “zero” is only as low as your ability to measure something, any given parameter, to zero. How much of a given substance is found in your food, how much radioactive activity persists in the ground, how fast a ball flies from the pitchers hand is all measured by a variety of instruments created by man and only as accurate as the instrument currently in use. As technology advances we are able to detect smaller amounts, faster movement, ever tinier invisible particles – and our previously accepted “zero level” decreases accordingly. Fascinating!

Enter the flea, ctenocephalides felis, the common flea of both dogs and cats despite its’ Latin name. The flea has been with us for centuries. A small wing-less creature, it can safely be described as a parasite to most of us, if we accept the definition of parasite to be an organism that exploits or lives off another organism while contributing nothing to its wellbeing. Why do we care what this little insect gets up to in its daily life?

For starters, fleas rarely appear to be doing good deeds. Once an adult flea has pounced upon a dog or cat, it will feast upon its blood (blood meal). In very small, young, or very ill pets enough fleas can together literally suck them dry of their lifeblood, leading to severe flea anemia and death.

While taking that blood meal, the flea actually injects its mouthpart or proboscis into your pets’ flesh which also introduces its saliva. Not only does your pet feel little flea feet crawling all over its skin, it can feel the sting of the bite and worse, develop an allergic reaction to the flea saliva, which will make him itch and break out in a rash. The ultimate reaction is a pet so allergic that they scratch off their hair, their skin, and develop oozing, painful sores called “hot spots”. Medical attention is required to get these under control quickly. Your veterinarian can literally start turning this condition around in hours! Hot spot and other allergy medication does not take days or weeks to work!

Which came first, the flea or the tapeworm egg? In a twist of fate, the tapeworm egg of Diplydium caninum lays on the ground or carpet. A flea larvae MUST eat it for the tapeworm to continue to develop. So the flea larvae eats the tapeworm egg. When the flea bites your pet, the tapeworm larvae is spit out on their coat. Your dog or cat turns to lick at the stinging flea bite and ingests the tapeworm larvae, which is swallowed and grows up inside your pet to become long ribbons of worm segments looped together in the intestine. Often these live segments break apart and are passed in pet feces. You may literally see wiggling flat worms (proglottids to you science types) in pet droppings or even around your pets’ tail. Once dried, they may look like rice or dried sesame seeds. They do not pass daily, so if left untreated don’t be fooled that they’ve naturally gone away if you don’t see them for a week or two. They’re still there.

Ok, so far we’ve discussed fleas on cats and dogs :
anemia, even death;
creepy crawly flea feet running on them;
allergies, hot spots;
tapeworms.

What about people?Some people are bitten by fleas. The bites can be painful, and may cause an allergic skin reaction. The kind of tapeworm, Diplydium caninum, that dogs and cats carry is NOT the tapeworm you hear people can get (they must eat a flea to get this kind of tapeworm – highly uncommon).

But there IS a zoonotic (spread from animals to people) infection fleas CAN transmit: murine typhus, a rickettsial bacteria that may be harbored in feral or pet cats, opposums, and other animals. Murine typhus is an under-discussed suburban vector-borne zoonotic  disease. In the United States California, Texas and Hawaii have had outbreaks. In California, the southern areas of the state are vulnerable. Orange County reported two (2) cases of murine typhus in 2012. When one case was reported in a young girl the county trapped feral cats and opposums near her elementary school searching for the probable source of contagion.  This disease usually responds well to antibiotics and people are easily cured. However, it is uncommon and initial diagnosis can be difficult. The primary recommendation to decrease the risk of murine typhus? 1) Do not feed feral or wild animals near your home. 2) Apply flea prevention/control products to your pets.

Which brings us to the crux of this article. How to prevent fleas on your pets, in your home, on you? Because if you live in Merced County, we provide everything a flea needs to flourish with our long seasons of warm weather and mild winters. We are a flea hospitality haven! Please tune in for Fleas: Part Two : Searching for Ground Zero

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mange / Demodecosis

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

August 27, 2014
People love the word “mange”. “He’s just a mangey old alley cat” someone will say. Used as a description for a pet with scruffy fur or unsightly skin, most people don’t realize that mange is a group of very specific skin diseases caused by parasitic mites. There are different sorts of mites, all possessing eight legs and often only visible under a microscope. There are two kinds that commonly affect the dog.

Sarcoptic mange is caused by an ugly little mite, sarcotes scabei, that burrows into the skin of both dogs and people. Often called “scabies”, it is feared primarily because of its transmission both from dogs to people and between people. Excellent treatment protocols are available for this disease.

Demodex or demodectic mange is an entirely different skin disease. First, it is NOT contagious to other pets or people. Second, the demodex canis mite burrows very deeply into the hair follicles of the skin and is sometimes harder to treat than sarcoptic mange. Puppies contract it while nursing from their mothers (strange but true). There is some thought of either an inherited predisposition or a depressed immune system allowing the pups to express the disease visually, as not all pups in a litter may be affected. When first seen, a puppy may display only a bare patch around one eye. It’s not painful and doesn’t itch, but usually looks so unsightly that it causes immediate alarm. Often the mite doesn’t show up until the pup is over six months of age, which confounded scientists trying to understand the connection between exposure and disease expression for years. For some puppies the disease can be far worse than an unsightly bald patch. The entire body may lose hair in a case of generalized demodecosis, with scabs and sores erupting as a secondary bacterial infection kicks in. Edema and swelling of the face and feet are common, making a pup truly miserable. These puppies are extremely ill, their immune system is gravely compromised and some may die.

Because the skin can only react in a limited number of ways to any disease, signs of hair loss, open sores and itching can be caused by a variety of problems : other parasites, allergies, staph and other bacterial infections, fungal infections. A veterinarian needs to examine your pet to make the correct diagnosis. A skin scraping is diagnostic for demodex- but not always for sarcoptes. A sharp blade is used to literally scrape any potential mites off the skin and the slide is examined under the microscope. Positives are slides that wiggle back at you!

Fortunately, there are several treatment options available for demodectic mange. Thirty years ago a breakthrough dip was discovered, which revolutionized the old “cover ‘em in tar” treatment. Today that dip is less frequently used as new oral and topical medications have been developed, which when combined with antibiotics and medicated shampoo treatment protocols have greatly improved the cure rate for this disease. Once treated, dogs are cured of demodex, though if allowed to breed there is a strong risk they will pass it on to some of their offspring.

Perhaps my most memorable suspect demodex case occurred a few years back. The young German Shorthair Pointer presented with some hair loss around her muzzle. The skin scraping was negative, so I started a fungal culture for ringworm. Cultures take about two weeks to run their course. When the ringworm culture was negative, the Pointer returned for a recheck. The lesions were spreading, red sores and deep cracks tracing from the bridge of her nose down the sides of her face and lips. The rash was especially bad just below her eyes, though her eyelids were surprisingly clear, the skin untouched by disease. The rest of her coat remained beautiful. I again did a skin scraping, and when negative, repeated the test. Negative. Convinced as I was that this must be demodex, I told the owner that we would start therapy immediately before this could spread further.

When I next saw the dog she was the picture of health. Her face was completely clear, new hair growing in on smooth skin. I glowed. Success is wonderful. It was the client, of course, who set me straight. A bachelor who did most of his own cooking, and not too elaborate, thank you, he frequently fixed up a can of beans. Seems the Pointer liked beans too, straight from the can. He caught her burying her nose in deep to reach that last drop.  Her face cleared up as soon as he found another disposal system for the cans. My antibiotics probably helped the secondary infection but there was no denying that my years of training had let me down. The medical texts on mange variations do not mention bean-can-itis.

Christine B. McFadden, DVM
drmc@mcmenagerie.com