Cough, Hack, Gag, Enough!

/ Dr. Christine McFadden / Leave a comment

 

Dr Mc Blog

October 4, 2014

Today we are referencing the coughing dog. Dogs only; cats, which are indeed a world unto themselves, need not apply. Cats want their own column. Besides, there’s lots more coughing dogs out there and plenty to discuss about each of the many possibilities behind a dog’s cough.

First, it can be surprisingly hard to determine if the complaint IS a true cough. A cough should sound like an outward sort-of-explosive breath. If smokers hadn’t been virtually banned from California, everyone would know what a true cough sounds like, but as it is there is room for doubt.  Always remember that dogs have no social compulsion to be dainty and will not try to subvert a cough into a fake sneeze or whistle. They “hack”. They may gag, but here we enter a grey area, as a dog that can’t draw breath well enough may almost vomit – but most of the time chest symptoms are different than stomach issues. I am filled with admiration for the client who can graphically imitate their pet’s cough in the clinic. On occasion I defer to the ubiquitous cell phone and request the client record a home video of the act. Is the cough productive (think wet, slimey goop coming out, maybe colored yellow or with blood) or dry?

Once we have established that a true cough is present, we can mull over the algorithm or medical pathway that leads to a diagnosis. Internal medicine is like a treasure hunt. If you enjoyed “CandyLand” as a child you will love going from clue (symptoms) to clue (diagnostic tests) as you follow the path to final diagnosis and treatment.

There is the heart cough, when leaky valves inside the heart don’t regulate blood flow properly and fluid pools in the lungs. The lungs, unsuccessfully, try to cough the excess fluid out. Or the heartworm cough. The heartworm, Dirofilaria immitis, is a mosquito transmitted worm that grows in the bloodstream and nests in the heart and lungs. Signs frequently include shortness of breath and coughing.

Bronchitis occurs in dogs, both allergic or infectious : viral, bacterial, fungal. The infamous diagnosis “Kennel Cough” springs from this group. Valley Fever falls into the fungal group. True bacterial pneumonia is relatively rare in dogs.

Foreign objects that have been aspirated or breathed into the chest, like our Valley foxtail weed awn, can set up an infection that may lead to coughing.

Chest masses and cancers, whether primary from the lung itself or metastasized, having spread to the lungs from another cancer site in the body, will take up physical space in the chest and lead to a cough.

Less malign causes are sometimes as simple as breed/body type predisposing conditions. Some breeds have a hypoplastic, very tiny trachea – it’s like trying to breathe through a straw. Others may suffer from a collapsing trachea. These conditions are common in both tiny and brachygnathic (pushed-in face) breeds – think Yorkies and Olde English Bulldogs.

I’ll tell you Jade’s story. Jade is a bouncy tricolor Rat Terrier who rarely kept more than 3 feet on the ground as she danced around. That day in February she was unusually quiet. In addition to that, her owner had heard a soft cough at home. I heard muffled lung sounds when I listened through my stethoscope. Hmmm, no leaky  heart valves and she’d had a negative heartworm test a few months back before starting on preventative medicine. We took chest x-rays, which showed a cloudy area on one side of her chest. Her bloodwork showed no sign of infection or anemia. I asked all the usual questions, but was stumped. Permission to do a chest tap to look at the fluid was granted. We drew out pure blood! Despite the negative answer to questions about mouse bait exposure, we tested Jade to see if her blood was clotting – and it wasn’t! I diagnosed a rodenticide toxicity. The missus had been doing some spring cleaning two days earlier and found an empty box of mouse bait in an unused closet. She’d tossed it without another thought.  Many mouse baits stop the body’s ability to clot blood and the animal that eats it bleeds to death, ANY animal. Bleeding may start anywhere, though it was unusual that Jade began to bleed only into her chest. The good news is that all veterinary clinics keep the antidote on hand and within hours Jade was making a full recovery. Her cough disappeared as quickly as it came.

If your dog is coughing Jade strongly recommends that you consult your veterinarian early on. We have only touched on a few of the diseases that share the symptom “coughing”. Stakes can be very high with a dog that coughs. Had her owner waited, Jade would not have been able to share her story with you today.

Christine B. McFadden, DVM
Valley Animal Hospital, Merced

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

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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

Rabies

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Dr Mc Blog

May 29th, 2014

I’m going to talk about something scary today. Not an alien life form but a very real live virus called rabies. Rabies didn’t die out with Old Yeller – it is still very much with us, and definitely present in the wildlife of Merced County. In fact, Merced is considered an endemic area for the disease. We have positive cases every year! In the 30 plus years I have lived and worked here, I have watched both the Public Health Department and Animal Control cooperate to monitor Rabies positive cases turned in to the County. They map where the rabid animals were discovered, watching for “hot spots” of possible contagion in the wildlife. Positive rabid bats and skunks have been identified, often after a dog or cat has carried it into the house or killed it. But what about the animals that just quietly die in the wild, that may be carriers of the disease? This, of course, is how it is spread. Consider: Rabies virus enters the body through a direct bite or contact with the mucous membranes (eyes, mouth, nose). Once there, it slowly spreads into the nervous system, eventually reaching the brain. There is NO CURE for the disease at this point. In fact, only because the virus multiplies and spreads so slowly is it possible for post-exposure immunization to work and save human lives. Rabies is diagnosed after the brain of the suspect animal has been inspected. There is no way to diagnose the disease in a living patient.

California is considered to have a high incidence of cases – over 400 cases in wildlife reported annually. Skunks and bats are the most frequent wildlife involved, but other carnivores such as  raccoons, foxes, coyotes and bobcats are often positive.

Each year one or two cases of human rabies is reported in the United States. Since 2002, 21 of 24 reported human rabies cases in the US were linked to bats, per the Center for Disease Control (CDC). July 24, 2013 a young girl was bitten by a rabid bat at the Oakland Zoo- it was not an exhibit animal, just local wildlife. She received post-exposure immunization and is fine. Easter in Bakersfield, California of 2012 was grim for the family whose pet cat bit their child, after itself contracting rabies from area bats. In June, 2011 an 8 year old girl from Willow Creek, California actually survived the disease after intensive treatment at UC Davis’s Childrens Hospital. She is only the third person in the US to survive rabies without receiving the post-bite immunizations. Most people die or become vegetables. In countries where vaccination vigilance is not as high as the United States, rabies is a serious threat : 60,000 people die from this entirely preventable disease every year! Three “islands” are isolated enough to have no rabies : Hawaii, England and Australia. Travelling with pets to these places is a complicated process as they strive to remain rabies free, protecting people and their indigenous or native wildlife from sure death.

Because wildlife cannot be vaccinated against Rabies, your FIRST LINE OF DEFENSE is to vaccinate your pets, the carnivores at highest risk of coming in contact with wildlife. ALL DOGS and CATS should be vaccinated against rabies. And you should never approach wildlife, especially when they seem sick.

If your dog or cat is bitten by a bat or suspect carnivore that isn’t available for brain examination it is presumed exposed to a rabid animal. If the bat or skunk is confirmed positive and rabid and the dog or cat is NOT current with rabies vaccination protection it may be recommended that it be immediately destroyed. If the pet is current on vaccination, by law it will still be isolated for anywhere from 10 days to 6 months, depending on the individual circumstances of the case.

If a human is bitten, whether it be a pet or a stray dog or cat, or any wildlife, it should immediately be reported to a physician. If the animal is available, it will be quarantined or its’ brain will be examined to check for rabies. The type of bite, animal involved, vaccination history and other factors will determine the recommendations made by your physician and public health authorities.

This is where your money for those darned rabies licenses go. This is what it’s all about. The message : Vaccinate your pets against rabies. It’s the law – and it’s a good one!

Christine B. McFadden, DVM
ValleyAnimalHospital
drmc@mcmenagerie.com

Talking Birds

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Dr Mc Blog

May 26, 2014

Now birds are an altogether different sort of animal. It goes beyond having feathers instead of fur – they are NOT mammals. And somehow “animals” and “mammals” share a bunch of “m’s” and the words start to sound the same and it all becomes very confusing. So let’s get back to the basics – birds are NOT mammals. Ignoring the occasional exception to the rule, it’s kind of interesting that birds have feathers instead of fur, have scales and claws instead of pads and paws, fly much better than they walk or run, and lay eggs instead of giving live birth to their young. Baby mammals receive nourishment from their mother’s milk. Birds regurgitate already chewed up food into their babies crops! Ewww! Science fiction come to life! The crop is a modified stomach, though birds do have a true stomach called the proventriculus, and a gizzard or ventriculus for heavy duty grinding of food. If we narrow bird-dom down to the parrot family we find a group of birds that are highly companionable, brightly colored, and can even talk human! Research with an African Grey parrot named Alex at ASU University demonstrated he could think and figure things out at the level of about a 3 year old child. If you haven’t spent time with a toddler lately, watch out! For example, Alex could differentiate not just a wooden key from a metal key, but a green, square wooden key. Parrots are noted for the use of “tools” such as sticks to obtain food, a sign of higher intelligence.

Although veterinarians traditionally receive training in a wide number of species, from companion dogs and cats to livestock cattle and horses, they are all mammals. Birds are very different. Birds don’t even have normal lungs, but do most of their breathing through cellophane-like little bags throughout their body called air sacs. Some of these air sacs invade the larger wing and leg bones (pneumatic bones), which keeps bone density lighter and helps to deliver oxygen directly where needed for long flights. Pretty amazing!

Since I have been known to say that I have a license to practice medicine and surgery on every living species on earth, with one exception (you), it’s probably obvious that it is the diversity of working with birds that makes them fascinating. Parrots in particular, large and small, are so interactive that they are a joy to study. Sylvester Stallone referred to parakeets as “flying candy” in one of his movies. Of course, working with them up close and personal brings certain features to the forefront. Like beaks. They all come with them and yes, they all bite. That little 30 gram parakeet can dig just so into your cuticle and the lumbering Macaw, a 2 to 3 pound parrot (454 grams to the pound) is capable of breaking fingers. We treat them all with respect.

Birds are adaptable. One of my staff, Amanda, recalled a little bird that had crippled legs. Her owner wrapped the bird in a little shirt with a piece of Velcro, and herself had a broad patch she had sewn onto her clothes. Sure enough, the little bird could fly around, then return to her owner via her personal landing pad.

And if you thought kids say the darnedest things, try birds. Say one bad word once (chances are you said it loudly and with energy) and the bird has it nailed forever. One client taught his Amazon to say “Let me outta here!”  I wasn’t aware of this until the bird boarded with us. This was in a small clinic where the ward rooms were very near the exam rooms. Sound carried. You can imagine the look on my clients face – and mine – when suddenly someone started to scream “Let me outta here! Let me outta here!” I actually had to show a few people that indeed it was a talking bird before I could calm them down (the bird thought he was hysterical – we began to feed him special treats about a half hour before afternoon calls to occupy his little mind).

My favorite story of all, though, centers around a woman staff member who opened the clinic early Saturdays. Pat loved her job and usually rushed down extra early to be the first one there, so she was by herself that day, walking from room to room as she checked on patients. She had just turned on the lights as she entered one ward and was crossing the room to open another when behind her she heard a soft voice say “I know what you like”. The hair rose at the back of her neck and she froze – just as the Mynah bird screeched “bananas!” Bananas indeed. Took about 5 years off Pat’s life and we had to post a sign after that warning everyone when that particular bird stayed with us.

 

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

Tucker / Alopecia X Skin Disease

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Image

We call ‘em “alligators”, the little feisty dogs that try to snap off the tips of your fingers. Since most veterinarians have something scheduled the rest of their day, we resist these efforts at dismemberment as skillfully as possible. With a smile on our face. But Tucker was pretty charming, despite his snapping teeth. Weighing in at 7 pounds, 3 ounces, I had known this little Pomeranian since he was a puppy and they don’t come any more beautiful. Half his weight was surely hair, luxuriant deep black with gold highlights. He and his red-headed Pomeranian sisters looked like real stuffed toys and we loved to see them come in. I didn’t hold it against Tucker that he didn’t like needles. It happens.

 

So when the little guy showed up and didn’t make an effort to protest my ministrations I was worried. He didn’t look good. Most obviously, his coat was dull, with big round patches falling out over both shoulders. His weight hadn’t changed any and my exam didn’t reveal anything particularly wrong, except his balding. So I ordered a batch of blood tests and we waited for the results.

 

And it was easy! Have you guessed? A thyroid disorder! Classic, text book case of low functioning hypo-thyroidism. Now the thyroid is a gland in the body that regulates “metabolism” – energy levels, if you feel warm or cold, hair growth, even some effects on the way your heart beats. In dogs, the most obvious outward sign is symmetrical hair loss on the body and lethargy – and Tucker was all that to a “T”! Just reading the lab report I glowed. It was good news for my patient, because the thyroid replacement hormone treatment that Tucker needed was as easy as a pill, and very affordable. Just give twice a day and Presto! magic hair regrowth! I called his owners with the good news and we began treatment right away. Bonus: I had recently joined my clinic in on-line Blogs, and thought this would be the perfect case to follow on-line.

 

That was in April of last year. I followed up with Tucker in May and was disappointed not to see much improvement. By June he was still bald, but his blood test was low, indicating lack of response to the medication. I conferred with my colleagues. We increased his doseage, but saw no response judging by his baldness; however the blood test read normal T4 levels by now. As the months passed I consulted an endocrinologist (hormone disease specialist) and tried a different form of thyroid replacement. Tucker remained apathetic during his exams, and worse, began to lose even more hair. It just kinda fell out – he never scratched and his skin was smooth underneath. Through all of this his owners were patient and kind to me, which only made me more frantic. This was my EASY case, the “give him a pill and I can make miracles happen” case. Please note the word “I” in there. Forgotten was the idea to showcase him in my blog.

 

By October it was clear that he was losing a lot more hair. I decided maybe he liked me after all, he was so passive on exam. Desperate, I consulted yet another endocrinologist. This good doctor suggested the possibility of “Alopecia X” (alopecia is fancy doctor speak for “bald”), a poorly understood disease that mimics other hormonal disorders but responds to neutering, and after rambling on about this or that faint possibility, suggested we neuter Tucker. Many dogs with Alopecia X respond to this “treatment” – but no guarantees.

 

So we did. Now, several weeks post-operatively, Tucker has regrown hair over 75% of his body. His glorious mane has yet to return, but by golly, his spirit has certainly perked up! The little guy growled at me through his whole exam today and I must say that I am most grateful!

 

Christine McFadden, DVM

drmc@mcmenagerie.com

 

Heavy Metal

/ Dr. Christine McFadden / Leave a comment

 

Dr Mc Blog

May 21, 2014
She was all white, an itty bitty poodle, and absolutely miserable.  Trouble was her gums were white, too. And when you look in a dogs mouth, the gums should be bubble gum pink (exception : dogs with Chinese heritage may have black pigmented gums and tongue – called a flowered tongue – like Chow Chows). A dog that pale is anemic, meaning they don’t have the normal number of blood cells circulating, and no blood means no oxygen and no nutrients are being carried throughout the body. Anemic pets are very weak. Little SugarCube was also vomiting and had bloody diarrhea. As a veterinarian I see a fair bit of diarrhea (ask me, please!), but it is uncommon to have one so severe that the dog looks like it’s bleeding out. Nothing in SugarCube’s history gave me a clue as to cause : she was a house dog, with no exposure to rat or mouse bait (rodenticides), she didn’t travel so exotic parasites were unlikely, she was older and vaccinated so forget parvo, and her diet was neither varied nor was she given bones that might upset her stomach.

When faced with a problem like this, we start at the beginning : basic blood work and x-rays. These two simple tools are the building blocks upon which so many further diagnostic tests depend. They rule in – or out- many possibilities of disease causes. Because we can run these simpler tests in–hospital, we knew within the hour that SugarCube had a life-threatening form of anemia, a hemolytic anemia, where the body is bursting its own cells but, more oddly, she had a metallic foreign object in her stomach. It was shaped liked a hoop earring, which the owner identified but couldn’t place when the dog might have gotten it. This was one of the few times when my work with birds came in handy for another species. Birds frequently chew and bite on odd objects and frequently present for “heavy metal toxicity” (nope, not a music over-load). Both lead poisoning and zinc toxicity are treated the same in birds, but symptomatically there’s one huge difference : both can kill, but only zinc causes a hemolytic anemia. So as we stared at these x-rays, I hypothesized that the foreign object in Sugarcube’s stomach was poisoning her and we had to get it out. But how on earth was she going to live through surgery? There wasn’t time for the antidote to work, even if we had enough on hand for a dog (we didn’t and the stuff, Calcium versenate, isn’t stocked by regular or human hospital pharmacies). We began treatment to shore up her immune system, started IV’s to stabilize her, and began a blood transfusion. Within hours of entering our hospital, we took SugarCube to surgery.

We entered her abdomen, going right through the belly button, and quickly examined her intestine, spleen and other abdominal organs. Gently palpating (feeling) her stomach, the metal ring could be felt. Fixing it in place with a finger, we sliced into her stomach and removed….a penny. A copper Lincoln head penny! That had been in her stomach for so long that the natural gastric juices (weak hydrochloric acid) had worn away the face and created a hole in the middle of the coin, faking us out that it was an earring when seen by x-ray! (Trivia break : Copper pennies minted after 1981 are filled with : zinc! Thank you birds – all the ducks, geese, and an occasional chicken that swallow pennies). Our diagnosis was confirmed and with the source of her poisoning removed, we quickly sewed everything back up and awakened SugarCube. She went on to make a full recovery .

Christine B. McFadden, DVM

drmc@mcmenagerie.com

Valley Fever In Dogs

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I have followed with some interest the newspaper stories on the invasive fungus, coccidiodomycosis, that causes Valley Fever in people here, up and down the Central Valley. Coming from Arizona years ago, another dry, warm climate where the Fungal infection is extremely common, I learned a lot about Valley Fever, if for no other reason than you won’t pass the Arizona State Boards to practice there if you don’t. It’s just that common in Arizona, the fungal spores picked up in the dry winds blowing off the mountains and desert, settling in the lungs and bodies of two especially susceptible species : Man and his best friend, the dog.

This is not your everyday little athlete’s foot fungus or swimmers ear kind of yeast that creates mildly aggravating rashes and inspires odd TV commercials. While most fungi like a moist environment, they have trouble getting past the body’s great defense : skin. Coccidiodomycosis (we’re going to shorten that to “VF” for Valley Fever pretty quick here) is a “systemic” fungi, meaning the fungal spores invade deep inside the bodies’ systems and organs. I know of 3 different systemic fungi common to the United States, each found primarily in its own region of the country. For us in the Central Valley desert and arid parts of the West, we have to deal with Valley Fever.

It was July of 2011 when Mr. Cardwell brought his dog in. Named “Tick”, she was a hound of mixed pedigree (a bit of a mystery, but every girl needs that) going into her 11th year of age. “Tick” had been coughing for a couple days, just a little tickle in her throat but rather persistent. The common stuff we were looking for ran the gamut from Kennel Cough to Heartworm disease to Congestive Heart Failure to Cancer and then some. Every veterinarian’s mind has a ticker tape running through a list of disease possibilities that rivals any Wall Street machine.

We noted she had a high fever. Her weight was good, even plump. We took a set of chest x-rays, and there on the images that captured the outlines of her heart and lungs we could see a fuzzy white shadow lurking low in the right lung. Hmmm. Unfortunately, indistinct shadows are not enough to make a diagnosis (choices, always other possibilities!) and Tick didn’t seem so very sick to Mr. Cardwell. Reasonably enough he asked to treat her for something like Kennel Cough ( a story on that disease complex later, please), so we complied with a course of antibiotics and cough suppressants.

Which was all well and fine, but no one consulted Tick, and she wasn’t having any of this medicine stuff. No way, no how. After a couple of trips back to our hospital  to discuss new ways to get a pill into her, we weren’t sure if her failure to improve was because she wasn’t getting her meds or if it was time to go further in our diagnostic tests. Ten days after we’d first examined her, Tick’s fever was down, but so was her weight. She’d lost 4 pounds (she started at 28) and her lungs sounded dry and crackly. The coughing was persistent, though still more of a wheeze. Mr. Cardwell gave the ok for a battery of general blood and urine tests, which revealed that she did not have heartworm and that most of her organs were functioning well but she had a terrible infection driving her white cell count up over 36,000 (normal’s probably around 8,000).  I liken the white cells of the body to Soldiers marching off to battle disease and infection : 36,000 soldiers is a huge army. What WAS that white stuff in her lungs? We sent out a blood test checking for Valley Fever. Tick’s tests were positive on 2 out of 3 run for coccidiodomycosis. Bingo! Definitive diagnosis!

With this information, and knowing that her other tests and body organs were normal, we could recommend a treatment plan, one where she would take a powerful anti-fungal pill for a minimum of 6 months (such a long time!), and knowing that some dogs immune systems never can quite fight it off and either require medication the rest of their life or, worse, may not tolerate the strong pill necessary to save them.

Tick started her pills the next day. They had to be hidden in home cooked chicken smushed in a cheese ball. We didn’t mind. Five days later she had lost another 1 ½ pounds and was sleeping a lot, but her owner reported the cough had slowed considerably. Within 2 weeks she was jumping onto the bed at home ( it’s the little things you don’t notice fading away sometimes), had no cough, and was firmly addicted to Velveeta cheese.

Listening to her lungs through my stethoscope wasn’t quite as great an experience – that raspiness was to remain for a long time – but over the ensuing months Tick’s blood counts slowly normalized and she regained her weight. One year later she was finished with medication and deemed fully recovered, as do approximately 80% of treated dog cases. ( You may find more information at The Valley Fever Center For Excellence at the University of Arizona). Only her daily Velveeta cheese serves as a reminder of Ticks’ terrible near death experience with Valley Fever.

Christine McFadden, DVM

drmc@mcmenagerie.com

 

Obedience

/ Dr. Christine McFadden / 7 Comments

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Ahhh, man loves obedience. He loves it in his wife (remember those wedding vows?), he loves it in the laws, and most of all, he loves it in his dog.

An obedience trained dog does not grow on trees, however. It is amazing for me to listen to people complain about their dogs behavior when they allow him or her into the house after leaving them outside alone all day! To be a part of your family your dog must SPEND TIME with the family!

An endorsement for the value of obedience training was once graphically enacted out in my waiting room. I watched one afternoon while an elegantly dressed woman, complete in velvet jumpsuit and heavy diamonds, was positively muddied by her large collie as it alternately jumped on her, strained away from her, caught it’s chain around her ankle – by the time she reached the exam room the woman was disheveled, exhausted and quite frankly didn’t give a darn about her pet’s health. She hated that dog.

There’s a lot to be said for the value of signing your dog up for an obedience course. Yes, you can probably teach your dog to sit on command very easily – especially in the kitchen with a treat. But a good obedience class takes you both so much further. It will teach you how to communicate with your dog and train you in leash etiquette and social manners so that your dog will listen and behave even with the distraction of other dogs around. This is invaluable – your pet will be under control on walks, at no risk of running away or being hit by a car. You will both be confident of your bond and can enjoy trips, camping, travels to beaches and picnics – your dog will be welcome everywhere as “family”. That is the magic which obedience lessons confer upon you.

I must insert a small disclaimer here, a bit of “fine print” that not every dog is a cookie cutter success in obedience work. Each breed has strengths to build from, each pet will introduce their own personality into the mix. Sometimes even veterinarians who have trained and shown their dogs in obedience trials (me) can encounter challenges. Years ago we had taken in two puppies simultaneously, very different breeds : a Bouvier des Flanders and an Irish Wolfhound. Now Bouviers are often used in police work, and are widely recognized for their intelligence and agility. Irish Wolfhounds are a “giant” breed, with a great history and “backstory” – hunting down wolves and all that – but the modern dog is docile and frankly, are snooze hounds. 180 pound snoozers, that is. The afternoon their basic training commenced I had my older son, Stan, assisting. I demonstrated the basics of initiating “heel” and “sit”, then turned the Bouvier over to him and was pleased to see immediate results. Eager to please and loving the attention, the Bouvier managed about 20 sits in 5 minutes. I turned my attention to the Irish Wolfhound. It was a warm afternoon. We started off with a slow walk, and then I asked for a “sit”. My dog stared at me. Confidently, I corrected him while gently pushing down over his hindquarters. Nothing moved. His tongue lolled out as he began to pant and looked longingly back at the house. I pulled up on his leash harder and pushed down on his back, repeating my command ( Rule #1 : Never repeat yourself or the dog won’t learn to respond the first time you give a command. Every rule has its exception, right?). Again, those big brown eyes searched my face wonderingly. I placed both hands firmly on his hindquarters and pushed with all my might, yelling “Sit!”. Ever so slowly, he lowered his elegant backside to the ground. Phew! Elated with this progress, I circled back to position ( the dog is supposed to do that, but never mind), took up the slack in the leash and firmly commanded, “Heel”, stepping forward. I was jerked back because the dog never moved. I turned to face him and there, plain as day, his face reproved me for not being able to make up my mind! First I wanted him to sit and now that he was sitting I wanted him to get up, well, wasn’t that the silliest thing ever.

We stared at each other for several moments. He refused to move until I turned his head towards the house and said fine, let’s call it a day. Eventually that Bouvier learned to heel and spin on a dime off leash……but the Irish Wolfhound only learned how to swing himself on the back porch.

I always recommend obedience training to my clients. What you and your dog get out of the classes may not result in military precision obedience maneuvers but you’ll definitely bond over the experience. If you are truly interested in trialing your dog at obedience shows there are some breeds you are unlikely to consider. But if you’re looking for a great lap dog for a football team, have I got the dog for you!

Christine McFadden, DVM
drmc@mcmenagerie.com