Calcium

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May 3, 2016
It was a very odd week. Monday started out with an African Grey parrot that was rushed in because of odd seizures observed by the owner. Popeye made the trip in a cat carrier since he couldn’t perch, and when I opened the grated door I had to laugh : a sizeable grey parrot with a dark maroon tail was fluttering convulsively but at the same time reaching out greedily to gobble down some peanuts just out of reach. He had figured out how to roll just right with each shake of his wings and was inching ever closer. Popeye wasn’t at all perturbed by his mild convulsions but was very upset that the peanuts kept evading him. After a brief discussion where I learned that he was fed almost exclusively on sunflower seeds I drew some blood tests and treated him for a calcium deficiency. Seeds may be high in protein and fat but are notoriously deficient in calcium and trace minerals. No single food item will ever provide complete nutrition to any animal. Popeye’s recovery was dramatic.

On Tuesday an owner presented his middle-aged Dachshund “Dracula” for a second opinion. The little dog just seemed to have muscle twitches all the time. He’d had some blood tests run, but nothing conclusive had turned up and regular anti-seizure medication had been of no help. Dracula lived a quiet life, mostly indoors and had never had any other medical issues. He trotted around the exam room, with a fine tremor marring his step. He wasn’t shaking from anxiety, nor did he act oddly in any other way. Looking over the chart shared by my colleague I noted that his blood calcium test was quite low. Since any single test may occasionally be off due to lab error I recommended we repeat these tests as a starting place. Again, his calcium levels came back very low. Diagnosis : A disorder of his parathyroid gland, which regulates calcium in the body. Treatment with calcium and Vitamin D supplements provided immediate relief while his case was fully worked up.

When the Green Iguana showed up on Wednesday I had a sneaking suspicion that I was having a “run” on calcium related issues. The lizards’ lower jaw was puffed out, looking mismatched to her upper face. She had an odd crook in her front leg from a “folding fracture”, indicating soft bones. Once again I investigated her diet and light exposure – never outdoors in natural sunlight (no creature was bred to live totally indoors!) and fed iceberg lettuce, no dark leafy greens, no vitamin supplements. Diagnosis : Metabolic Bone Disease or “Iguana Rickets”. Real sunshine and an improved diet did wonders for her.

By Thursday the staff had started to joke about it. Our 10 o’clock appointment was a young man with a muscular Pit Bull puppy, only 12 weeks old. The puppy had broken both his front legs. As I observed the heavy bodied male, named “Oscar”, I noted that he was unusually cheerful as he ran around the room, clumsily trying to chew on my assistant’s pants leg. He looked bow legged in front and indeed, both of his wrists (carpi) bulged and kind of knuckled over. He was walking on these legs, which a dog with a fracture usually cannot do, as it’s too painful and the bone actually can’t support weight as it slides apart. Questioning brought out the history of a puppy fed an exclusive diet of steak and hamburger. Oscar’s owner was proud of his beautiful dog and wanted to provide only the best for him. He had spared no expense by feeding an all-meat diet. What I was looking at was a very old-fashioned case of rickets or osteomalacia (soft bones). Without a balanced diet – and without bones meat alone is deficient in calcium – Oscar’s rapidly growing bones had softened and he couldn’t support the weight of his own body. The bones had started to fold down. Caught early, a corrected diet of simple commercial puppy food could reverse the process and over time the bones will straighten, though not always 100%. Happily, within two weeks Oscar was moving more normally.

The body is a marvel. Calcium is rich in many foods: dairy products like cheese, yogurt and milk, dark leafy greens, fish canned with their bones, bone meal by-products. Calcium is added to all pet foods formulated commercially, just as it is added to products like orange juice for people. But eating calcium rich food is not enough. The body requires Vitamin D3 to absorb and use the calcium taken in. Dogs, cats, birds and reptiles can all make their own Vitamin D when exposed to natural sunlight, through a complex interaction with UV light on their skin. Vitamin D is found naturally in egg yolk, fish oils and fatty fish like salmon or tuna, and cheese. Many animals, especially birds and reptiles, don’t naturally eat these foods and if kept deprived of sunlight (indoors/caged) will develop rickets, broken bones, and even seizures or death because they cannot make the Vitamin D they need. Even if their diet includes a calcium supplement they will suffer. For this reason special UV lights are recommended for indoor pets and at least weekly outings into real sunshine. All diets should include both fresh foods and commercial foods fortified with Vitamin D and Calcium, from turtle pellets to bird feed and other pet foods. Leave the balancing up to the professionals!

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

 

The Bladder

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April 6, 2016
I thought we could talk about bladders today. Before you grit your teeth, let me say that it’s bound to be a lighter subject than body issues that lead to discussions of Milk of Magnesia or Preparation H. A far better organ system for public discussion. Bladders hold a deep fascination for my office staff. Instead of guessing how many jelly beans are in a jar, they often wait spell-bound to see how much urine that little dog can release on a waiting room plant. One client who frequents our hospital has a particularly clever little Yorkie who always manages to spray out a puddle despite our diligence and speed. Unfailingly, the good woman will say “My, he’s never done that before.”

Each day the kidneys filter the blood that flows through your veins, removing waste and impurities. Most of the blood continues to recycle to the rest of the body, but a small percentage of fluid and the filtered waste must be eliminated for continued good health. This fluid is called urine. In most mammals urine looks like a clear watery fluid, usually a shade of yellow, and is composed of excess body water, salts, and other waste. The yellow color is caused by the pigment urochrome, a breakdown product from hemoglobin. When dehydrated, the urine color may be darker yellow or orange as this pigment concentrates, indicating the need to drink more water. Each beat of the heart sends 20-25% of that blood flowing straight to the kidneys. Once urine is manufactured in the kidneys it travels from the kidneys via little tubes called ureters to the bladder, the holding tank in the body’s plumbing system. It is stored there until the pet voluntarily decides to empty their bladder, through another single tube called the urethra, to the outside. The act of emptying the bladder is called micturition or urination or voiding or peeing. Of course, all of these body parts can develop problems of their own, but the most common diseases revolve around the kidneys or the bladder. Kidney infections are not nearly as common as bladder infections, though often people confuse the two. Bladder infections may be caused by bacteria ascending up the urethra, because the bladder is the first stop from the “outside”. Today we will limit the discussion to dogs as the bladder problems seen in cats are often quite different in cause and treatment.

Prada’s Mom suspected a bladder infection when she observed blood in the urine. Female dogs are affected more often than males. Some affected pets may strain to urinate or may urinate very frequently or in unusual places. Although some dogs are depressed, Prada, a tiny snow-white Maltese, appeared bouncey and pain free. An examination was performed to determine if the bladder wall felt normal or was thickened. The bladder may have unusual “lumps” which could be cancerous growths or actual bladder “stones”, real rock-like growths that can fill the inside of the bladder. A urine sample was taken to analyze for bacteria, crystals, blood and other signs of disease. Sometimes the urine must be cultured to determine what kind of bacteria is affecting the dog and which antibiotic will best treat the infection. Because this was Prada’s second bladder infection in one year, a culture test was performed after obtaining her urine sample by cystocentesis, a sterile needle tap directly into the bladder. This method is preferred for a bacterial culture over a “catch” of urine because there will be no contamination from the pet’s hair or the environment as the sample is obtained. Chronic or repeat bladder infections may lead to the formation of bladder stones due to the chronic irritation of the bladder lining. These will require surgical removal in most cases. Bladder infections should never be minimalized as they can in turn ascend further up to the kidneys, which is potentially life threatening. Prada’s culture highlighted the best antibiotic choice for her and she responded quickly to her medication.

There is a small but significant obstacle to the pursuit and study of diseases of the bladder : obtaining the sample. Home catch, free catch, cystocentesis…. Apparently this has confounded veterinarians long before me! One very old veterinary text book neatly summed it up thusly : “Take about a dessert-spoonful of the dog’s urine (which you must use your own judgement how to obtain: place, for instance, a clean damp sponge at a spot where you think the animal will stale)…..”. Good to know I’m not alone!

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

Biteth Like A Serpent

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March 29, 2016
It was near the end of four years of vet school and we were feeling pretty tough. With Board exams behind us, jobs or vacations all set, my classmates and I were just wrapping up the final pieces. Among other things this included looking into health insurance now that campus charity would not be there to cushion us.

The American Veterinary Medical Association, or AVMA, at that time offered a group insurance plan for veterinarians. Enticingly, full coverage was extended to everyone, no exclusions or waivers, as long as you signed up before actually graduating (this was in 1982). And they brought it right to our doorstep, holding a meeting in a classroom setting. Their plan was offered by one insurance company. We had the choice of one insurance agent, who handled the Sacramento area and probably made a bundle in June commissions before we scattered far and wide into others’ territories. If female and interested in maternity coverage you had the choice of one plan. The decision being out of my hands I was only mildly interested in what the man had to say. The charts and overlays flipped past. Plans A, B, and C. Daily hospital rates. Deductibles. Don’t die in San Francisco if you’re trying to save money.

Then came the part that was just for us, customized care for the lucky veterinarian. Rabies coverage. Disability coverage, strongly recommended for the solo practitioner. Hunh? Before I could take in the implications of “disability”, he threw out “dismemberment”. Enthusiastically the presenting agent gave a few examples, vividly sharing several gory stories. Hot stuff. I sat up straight. Dismemberment? DisMEMberment? What kind of profession was I going into? What would my mother say? I personally was going forth to save lives, perform miracle surgeries, educate the world about the wonders of modern veterinary medicine………….and someone was suggesting that an ungrateful little wretch of an animal might try to chew my face up and tear me limb from limb? Unheard of! Monstrous! I had been bitten, kicked and had my nose broken all in the line of duty but it had never crossed my mind that I might come way eyeless or armless. Too startled to absorb this information quickly I was still on “indignant” and barely registered when he got to “death”. Disability, dismemberment and death. Satisfied that he’d covered the fine print the insurance agent moved on. I never heard another word of his presentation.

I’m happy to report that the above never happened. Not that some pretty good efforts haven’t been made by some less-than-pleased patients. The danger of a pet attacking you is slight, but everyone should keep in mind a saying that a veterinarian once passed on to me, “ALL dogs bite”.  In March, 2015 the AVMA published a study, available to view on-line “Dog Bite Risk and Prevention : The Role of The Breed”. If you peruse the article and lists of breeds you will note that popular breeds are higher on the list, perhaps incorrectly black-listed simply because there are a LOT more of them. You are certainly more likely to be bitten by a Chihuahua in Merced than a Briard. Be cautious around stray dogs. Don’t tolerate mouthing by your own pet. Don’t give your dog bones when children are near. In short, never let your dog think that it’s alright to bite you or anyone that you have introduced to your dog. Including (smile!) your veterinarian.

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

Skin Care plus MRSA

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March 1, 2016
Have you heard? There are new scrubs, mousses, lotions, creams, and wipes to improve your PETS’ appearance! For some reason these are not appearing in “Vogue” magazine or even “Dog Fancy”. Since I can’t skim a popular magazine in line at the grocery store without encountering pressure to rejuvenate my own skin, I don’t understand why all these products for pet appeal aren’t making big news. Perhaps skin care for animals just hasn’t caught on yet. Although I’m not entirely sure – I’ve heard there’s a blueberry facial mask out there, plus things like milk baths and rose water nail soaks for the (overly?) pampered pooch. Who knows? I heard of a doggie salon that gave the owners coupes of champagne while they waited. Perhaps that’s the force behind the trend.

For those of us in the less glitzy trenches, we refer to skin care as “dermatology” and the new mousses, wipes, etc have been formulated to address common health problems addressed daily in veterinary medicine.

Skin sores that bubble and break open on your pet may be the result of a bacterial staphylococcus infection. “Staph” is considered a normal inhabitant on the surface of the skin, until it goes rogue and breaks out as whiteheads or bubbling pus-filled lesions. In humans there is an increasing fear of an antibiotic resistant form of staph called “MRSA” (pronounce it “mersa”), which in simple terms means a staph bacteria that is resistant to the antibiotic methicillin, by extension the family of antibiotics headed up by penicillin. This bacteria takes advantage by invading the body through a wound, at a surgery site, or even a scraped elbow and is feared because it cannot be readily treated by the old tried-and-true antibiotics. The bacteria has simply found a way to survive, to overcome the tools fighting to destroy it. Because people in hospitals are at higher risk, due to their lowered immune resistance, stress, or fresh surgery sites, MRSA infections are feared. Pets can also develop a methicillin resistant staph infection, though it’s a slightly different bacterial strain called staph psuedointermedius, or MRSP (I say “mersip”. No one has corrected me yet). The veterinary community continues to monitor the prevalence of this infection and at this time it is not considered a risk to humans or other pets. When we find a skin infection not healing as expected we often recommend a culture swab be taken to diagnose both the type of bacteria and identify the best antibiotics to treat the problem. This is how we diagnose MRSP infections. One of the treatments is a mousse that cleans bacteria off the skin. It can also be used to bathe the pet, prior to an orthopedic or other major surgery, decreasing the risk of post-operative complications. There are anti-bacterial skin wipes, also.

Another new product is an eye wipe to assist dogs with epiphora, a condition where the pets’ tears spill down his or her face. A compound, porphyrin, in the tears causes a brown stain to form which is both unsightly and, staying wet, allows bacteria to breed which can lead to infection around the eye. The constantly wet skin may scald and create open sores under the eyes which is very painful. Dog and cat breeds with flat “pushed-in faces” like Pugs and Persians may be anatomically predisposed to problems of tears spilling out onto their faces. Once your veterinarian has determined that the tear ducts are open and draining properly and ruled out other medical causes, you may be directed to these wipes to keep the condition from escalating into painful sores.

Pets that are completely white haired, with no other color or pigment, are at higher risk of sun-related skin cancers as they sun bathe in our backyards here in the Central Valley. In cats red, scabby crusts may form on their ear tips or around the nose. In dogs it often begins on the thin skin of the nose or as deep purple blotches on the tummy near the back legs. Human sun screens may not be safe for your pets because they will eat it, literally, as they lick themselves! Zinc oxide (the white glob on the lifeguards’ nose) is toxic to dogs. Some dogs will tolerate hats or wear protective T-shirts, but the best idea in our hot summers is to simply keep these at-risk pets indoors during the day as much as possible.

In medicine there is always a new discovery around the corner. None of the skin care products I get to review will remove the laugh lines from Fido or Kitty but they do come with the promise of remedying a skin affliction. Please celebrate by raising your own glass of champagne.

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

 

 

Variety Is The Spice Of Life

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February 17, 2016
They say variety is the spice of life. I am fortunate to have an extremely interesting career! In the past eight days I have seen one rabbit with an ear ache and spayed another. A lizard presented with scoliosis, curvature of the spine, caused by underlying malnutrition. I saw a cat with a very odd skin mite that may not have been diagnosed in Merced before! By the simple act of pressing scotch tape over the cat’s dander and looking at this under the microscope I found a mite I’d never seen before. My colleague, Dr. Klingborg, identified it from a derm (skin) meeting he’d attended in November and now we’ve held several discussions on the presence of this mite in Merced (it is considered to be contagious between cats). And always, the “usual” mix of cats, dogs, and birds. Today while performing spay surgeries (an ovariohysterectomy surgery) on cats I opened up one female cat only to find parts of a mummified fetus in her abdomen, causing no known distress to her before today. I completed the surgery and explained the situation to her owner, using digital photos taken during the surgery. Another veterinarian in the practice, Dr. Lauppe, was doing an orthopedic surgery on an injured knee while Dr. K removed a cancerous mass and attended to a dog that had been attacked by another dog (BBBD – Bit By Big Dog). A guinea pig with an eye ulcer came in and the Zoo needs a review on the Mountain Lion’s diet. A delightful Labrador had five enormous rotting teeth extracted and went home on antibiotics and painkillers. In two weeks he’ll be soooo much better! A lady called about a duck she thought might have eaten a tiny battery (the battery could corrode the stomach and cause heavy metal poisoning. All waterfowl are at risk of ingesting odd metal objects – they just like shiny objects). A woman (I never got her name) brought in a hummingbird that “fell from the sky”. We mixed up sugar water, revived the uninjured bird and sent it off with her to be released where she found it. An abuse case was brought in by Animal Control and a pregnant dog with three puppies stuck inside presented for a Caesarean section, performed beautifully by one of the other vets. I saw a Sulcata African tortoise with a mild upper respiratory disease and discussed the special dietary needs the new owner would want to address. Obtained from a Tortoise rescue group, the Sulcata’s shell mounded up on top, called pyramiding of the carapace. Much like the lizard with the deformed spine, it indicated an improper calcium and vitamin D ratio, the tip of the iceberg for signs indicating malnutrition.

February is National Dental Month for Dogs and Cats and most veterinarians who care for companion animals focus special attention on dental care this month. In veterinary medicine we are not focused on the whitest smile to impress someone! You are most fortunate if you have never experienced a tooth ache. Some dogs present with teeth so brown with mineralized plaque and calculus that it looks like moss has grown on them. That bad breath smell is from the bacteria growing along and under the gum line. The same bacteria that can dislodge and spread to the heart or kidneys. Cats demonstrate “jaw chatter” if you touch a tooth with a neck lesion cavity near the gum line – you can observe this incredibly painful response after you peel your cat off the ceiling. Most dogs and cats continue to eat despite foul teeth – please do not judge your pet’s dental pain by whether they haven’t starved to death! Over the years I have heard countless times of pets that “acted years younger” once their abscessed teeth were removed, their mouths healthy again. Call your vet today – there are some great deals out there this month!

Christine B. McFadden, DVM
drmc@mcmenagerie.com

My Stint as “The Ostrich Vet”

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Perhaps you are familiar with the ostrich craze that swept America in the 1990’s? These enormous non-flying land birds from Africa were seen as the ultimate in sustainable goods : High protein, low fat meat, extracting up to 60% of useable food from the average bird. Standing over 6 feet tall and with the average male ostrich weighing 250 lbs, this meant over 125 pounds of steak per bird. The hide could be used for high-end leather handbags and shoes while the feathers are highly sought after by the costume, millinery and fashionista trade. Very little of an ostrich goes to waste. Add in the calculation that an adult female can produce upwards of 35 eggs per year (read $$$$) and you’re talking some real possibilities here. The fact that support facilities and  processing plants for meat and feather production didn’t exist in the United States did not dim their enthusiastic reception here.

 

Ostriches are birds. So SOMEBODY had to provide their medical care. Enter the Avian Veterinarian. Now way back when, when I was bucking for the honor of becoming a Board- Certified Avian Practitioner, I was champing at the bit for this very opportunity. I lucked out! Several ostrich farms set up business right here in Merced County! Smaller farm holders jumped on the wagon and introduced other ratites, the Emu and Rhea, also large land birds. Emus hail from Australia and may be viewed at our own Applegate Zoo as Good Citizen ambassadors from our sister city in Australia.

 

Where to start? Well, first you must catch your ostrich. As most farmers lacked any kind of facility and cattle chutes don’t fit ostriches, I had to rely on a sweatshirt sleeve. Just roll a cut-off sleeve over your arm. Offer something to the curious ostrich and as it stretches its head over the fence quickly grab the beak and slide the sleeve over its eyes. Once blinded, the bird will quiet down and become very docile. I did this successfully exactly once. All other times, if it could out run me  – at speeds of 40 mph – it did. One farmer called me out to examine his limping ostrich. I blocked half the afternoon and off we drove, my assistant and myself, way out past Winton. No one thought to ask if he had confined the bird. I wasn’t used to making ranch calls and we just assumed he would supply the cowboying, we the medical expertise. I was wrong. The bird was running freely over quite a large section of hilly pasture, dotted with rocks. If the bird was limping it wasn’t obvious to me as it disappeared out of sight behind a thicket.

 

Fortunately for me most of the birds I was called out to examine were very ill and non-mobile. Unfortunately for the birds, an adult ostrich that is down is highly likely to die.

 

So when adult bird medicine proved less than successful I turned my interest to egg and juvenile problems. The eggs didn’t hatch. If they did, the yolk wouldn’t properly absorb into the abdomen (kind of like your belly button not closing up properly. Only they needed the yolk to live off the first few days, both for food and maternal antibody transmission). If they made it past the first day they had to be trained to eat by another ostrich or they’d starve. Without enough exercise their legs turned crooked and they couldn’t walk. Juveniles had to be dewormed and some contracted the pox virus just like local chickens, developing black spots on their face and beaks. Everywhere I turned it was a mess.

 

We were all scrambling for answers. Ostrich care was a hot topic amongst veterinarians, with an ostrich-only conference formed to address their unique birdy needs. On the drive to Las Vegas to attend this conference our car over-heated in some desert town where I was stuck with three children under 6 years of age and a husband who knew nothing about cars and wanted lunch. Neither a gas station nor a fast food place was to be found. The husband asked for an airport because it wasn’t fun and he wanted to go home. I couldn’t even find him a Greyhound bus. (Yes, I looked). It was not an auspicious start to the conference, which I eventually attended…..I found few answers to the medical problems of ostriches but heard a lot from veterinarians investing in them. The hotel provided only showers in which to bathe small children and I gave up in defeat and came home. A few short weeks later I was called out in the early morning to an ostrich that had been brought down by a pack of stray dogs. I drove out to the farm through a torrential downpour. The bird lay in the mud, exposed to the rain. So was I. He had a deep laceration on one side with no other visible wounds. I deemed he had a decent chance of survival, so we decided to sew him up and treat him for shock and infection. Using local anesthesia, I was able to care for the wound. Someone fashioned a shelter out of hay bales and tarp. Surgery completed, I slid and slipped my way through the rain and mud back to the car, sterile instrument tray tucked under my arm. The hair spray on my head had clumped together in tufts not unlike moist cotton candy. I looked like mud. And then I felt the little creatures running over my head, little ostrich lice. Now I know as well as the next person that lice are “species-specific”, that they couldn’t actually, like, BREED on me. They were just having a little fun. One shower and they’d be gone. I knew that. Nonetheless, it was at that moment that I questioned my dedication to the ostrich.

 

My ostrich practice faded away (just say “no”) and it was all a mute question when the American Veterinary Medical Association (AVMA) decided that ostriches were not birds but livestock and therefore I wasn’t covered as a Small Animal/Exotic practitioner to provide care. I didn’t fight it.

 

Christine B. McFadden, DVM

drmc@mcmenagerie.com

 

 

Hyperthyroidism in Cats

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Zack was long and lean, his black tiger stripes sharply outlined, muscles rippling as he prowled around the exam room. A Domestic Shorthair cat (DSH), he claimed two humans as his own and they were devoted to him. Zack was magnificent in his prime, weighing in at 14 1/2 pounds. As a kitten he liked to chew on electric cords. His owners claimed he got zapped and was “slow” for months but assured me he eventually returned to normal. Since “normal” included enjoying being vacuumed, I always had the sense that Zack liked to live on the edge. He had tons of personality! When Zack was 10 years old he was brought in because he was visiting the litterbox with unusual frequency. In addition to frequent urination he had lost weight, down to 11 pounds. The rest of his examination was not unusual and I suggested we check some lab work, running both blood and urine tests. The initial tests came back very high in glucose (sugar) in both the blood and urine, suggesting Zack might have diabetes. We ran another test, fructosamine, which in a cat tells us how high his blood sugar has been for the last 2-3 weeks. Zack’s test was very high, confirming Diabetes mellitus (sugar diabetes). He was started on daily injections of insulin and responded beautifully. He ate more slowly, urinated only a few times a day, and re-gained his lost weight.

 

Zack was maintained on this therapy for four years. As he entered his senior years you would never know that he had an affliction. His owners had incorporated his insulin injections into their daily routine and Zack thrived, bossing them pretty badly. When he was 14 years old Zack came in for his annual exam, but things weren’t quite right. He was eating heartily but had dropped in weight again. Was it the diabetes or was he just “getting old”? His muscles had thinned with the atrophy of age and he moved more slowly, perhaps a bit of arthritis? He was a little less black, a little more grey in his tabby markings. Zack was also a whole lot more grumpy about submitting to a blood test!

 

This time the tests came back positive for Hyperthyroidism. An over-active thyroid gland was producing way too much thyroid hormone (T4). People talk a lot about hypothyroidism, the opposite condition when not enough hormone is produced and the body becomes sluggish, often obese. Hyperthyroidism in cats is the exact opposite. When the cat has too much thyroid hormone circulating in its blood stream the body’s metabolic rate increases. Excess thyroid hormone stimulates the heart to beat faster and may cause enlargement of the heart or even lead to heart failure. High blood pressure (hypertension) can damage the eyes, kidneys, heart and brain. The underlying cause for hyperthyroidism in a cat is a tumor, commonly a thyroid adenoma which is overwhelmingly benign and unlikely to spread anywhere else in the body.

 

If the tumor in the throat is very large it can sometimes be removed surgically with great success. Because of the disease effects on the heart and kidneys in these older cats the risk of surgery and potential damage to the parathyroid gland that sits side-by-side must be thoroughly considered before surgery is recommended.

 

Most cats will start a course of methimazole, an oral medication that reduces specifically the production of thyroid hormone. Very effective, it controls the disease but cannot eliminate it. Each cat is monitored via blood tests to maintain their T4 at optimal levels. If the cat has kidney function problems, the T4 will be kept higher because the increased blood pressure is beneficial to perfuse the ageing kidneys. It’s a delicate balance. Once a cat is regulated on medication and the T4 level desirable, an owner may also consider referral to a center for thyroid irradiation. The thyroid gland needs iodine to function. It is easy to attach a radioactive particle to iodine, which is selectively picked up by the thyroid and then destroys the abnormal gland, leaving all other body tissues alone! Woohoo! A cat treated with irradiation will be cured of the tumor and hyperthyroidism! The down side of radiation therapy, admittedly a big one, is that the procedure is expensive, well over $1,000.

 

The upside for cats is that the oral medication is very effective. Most cats are well controlled with this medication and live out a normal lifespan. Super-Cat Zack is entering his 16th year and is as feisty as ever!

 

Christine B. McFadden, DVM

drmc@mcmenagerie.com

Canine Obstetrics

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January 5, 2016
Have you ever wondered about the similarities between pregnancies for dogs versus people? If you were to ask a dog, you might be surprised. Molly was a Miniature Schnauzer, black and silver, who had undergone a planned breeding. Following the textbook, Molly was bred on Days 9 and 11 after showing the first signs of her heat, or estrus cycle. She “took”. Early on Molly cried when she tried to jump onto the couch. Only 3 weeks into a measly 63 day gestation (compared to a woman’s 40 week gestation), we were pretty sure she felt tugging in her tummy as her uterine ligaments stretched to support the expanding womb. Her owner made a step-up to the couch for her. She was switched to a high protein, calcium-rich puppy food during the pregnancy and would continue this food through her lactation. Her girlish figure didn’t change much during the first 5 weeks when, kaboom, she blossomed out with a full tummy (anyone relating here?). Although her appetite had been ravenous after the intial weeks, in late pregnancy Molly began to eat small meals as the pressure from her pregnancy compressed her stomach and diaphragm. She waddled. She was easily winded, no more chasing butterflies. Treats sounded fantastic and had to be closely rationed.

One of the interesting things about dogs is the shape of their bicornuate uterus, which has a tiny uterine body but very long “horns”, tube-like structures along which multiple fetal puppies can attach and grow. As the uterine horns expand with the growing puppies, the support cradle of uterine ligaments must also stretch and a close outside observer may witness the primparous (first pregnancy) dog’s discomfort as she moves about. After day 45 of the pregnancy x-rays may be taken to ascertain the number of pups to expect, as the skeletons are well-calcified. On an x-ray the puppies look like little fish. We count only the skulls, as backbones and legs can appear tangled together (though in reality each puppy is safe inside its own placental sac). An ultrasound can also be performed to assess the number of puppies (ultrasound may be less accurate in determining fetal number) and check for fetal heartbeats. Knowing how many puppies to expect is very helpful when the time comes – for the mothers sake you want to be certain her labor is over and there are no retained, unborn puppies stuck inside.  As the pregnancy progresses, it is fascinating to note that the puppies in one sense send out a signal to the Mom that they are ready to be born! Each puppy has its own placenta, the little birthing sac they grow inside. Puppy and placenta will secrete hormones to start the birthing process, relaxing the pelvic ligaments and assisting the body to open up for delivery. It has been suggested as hypothesis that singleton pups (only one inside) are more likely to need a Caesarean-section (a surgical delivery) because one puppy placenta may not make enough hormones to set things in motion. The hormone oxytocin facilitates actual contractions, and may be given by injection if your veterinarian needs to assist the labor process. An oxytocin intravenous drip, as used in people, is not effective in dogs.

Molly tried to make a nest in her owner’s closet, carefully raiding the hamper for suitable soft clothes. Doubtless the scent of her owner was reassuring – nevertheless, they put her own bed in place and retrieved their things. Birthing is messy. As the time for the whelping (parturition) drew near, her owners found it valuable to take her temperature rectally twice a day. The body temperature drop is caused by the sudden drop in the hormone progesterone when birth is imminent. At home a dog’s temperature may normally run between 100 to 101 degrees. In many expectant dogs, the temperature will drop sharply within 24 hours of going into labor. If you see the thermometer registering 97 degrees, time to stay close!

One Thursday night Molly went into labor. She had skipped her breakfast and seemed to be distracted during the day. Finally, it was obvious that she started contractions. You could see her stomach scrunch up as they became harder! Molly huddled near her owner, panting furiously. She was a little surprised by the pain, scared. After about an hour, Molly delivered her first puppy with a short scream (it hurt), then turned to help open the placenta and lick her firstborns face. Had the dog pushed hard with no results for over an hour her owners would have brought her in to the veterinarian.  The pup squealed with it’s first breath and Molly properly chewed through the umbilical cord. In 20 – 30 minute intervals, she delivered a litter of 5 healthy puppies. After a change of bedding, she rounded them all up and they began to nurse. A most successful outcome. Fourteen hours later, Molly’s owner delivered her own healthy baby. It was a busy house!

Christine McFadden, DVM
drmc@mcmenagaerie.com

 

Feline Urinary Syndrome or FUS, FIC, FLUTD

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

December 21, 2015
I think he was already 90 when we first met. The blue eyes, the felt hat reminded me of my own grandfather. A little shorter than me, he was a kind man who had moved to the States when his family emigrated from the Azores. It had been a long time since he worked on a dairy, and his companion now was a black and white cat, Jimmy, vividly marked like a Holstein cow. On that first meeting, Jimmy was just in for a check-up and vaccinations. We talked more about Mr. B’s wife, who had passed away after eating watermelon. He blamed himself for letting her eat the seeds – she loved watermelon so much that she’d inhale chunks heedless of any seed that went with it. He knew the seeds had killed her. I suspected cardiac arrest was the underlying cause from the rest of our discussion. That afternoon we forged a bond that grew over the years. Jimmy’s owner lived independently in a small house in the country. When he could no longer drive a car he rode a three wheeled bicycle, humming along the back roads for miles at a time.

Jimmy came and went as he pleased, growing a little plump under the tender loving care of home, plied with a variety of foods on a near daily basis. One morning Mr.B brought him in, both quite agitated. Jimmy was having trouble walking, crying out, and Mr. B said he kept trying to pee at home. He didn’t think anything was coming out.

When I placed my hand over the cat’s abdomen I immediately felt a hard ball inside, about the size of a baseball. Just that gentle touch yielded a scream of anguish from Jimmy that made us all jump. That ball was the cat’s bladder, swollen near to bursting because the outlet was obstructed. The tube that carries urine from the bladder to the outside is called the urethra. Tiny bladder crystals or struvite, sometimes called “sand” had formed in Jimmy’s bladder. The crystals precipitated from a combination of minerals found in his food, often magnesium, ammonium, phospate. Thirty years ago we called this the Feline Urinary Syndrome. We blamed the diet – no one knew why, or which cats – and knew it could occur in both male or female cats. The crystals irritated the lining of the bladder and urethra, causing swelling, thickening, and pain when urinating. In male cats, the urethra is longer and narrows at the tip, so they can obstruct. If a big clump of “sand” passes at one time it acts like a cork, stopping up the bladder so no urine can pass. Of course, the kidneys are the last to know, so they stay on the job making urine, which fills up the bladder until it can’t get any bigger (or it ruptures). Everything comes to a screeching halt and the kidneys start to shut down (post-renal kidney failure). At this point the cat has a relatively short time to get help – under 24 hours – before it dies.

Treatment at the veterinary hospital is immediate; this is not a procedure that can be safely put off until lunch. Risks are high. The cat must be anesthetized and a urinary catheter threaded carefully backwards up the urethra (retrograde) using a sterile flush if necessary to break down the obstruction. The catheter is placed directly into the bladder and sewn in place, often for 1 or more days. An intravenous catheter is also placed to immediately flush the system and get the kidneys up and running. Blood tests tell the picture of the degree of kidney disease. The cat will have more blood tests before coming off IV’s to be certain that kidney function has been regained. Oddly, most of these cases are not infected with bacteria, though we use antibiotics to prevent a secondary infection once an indwelling bladder catheter is in place. Other names for this syndrome now include Feline Interstitial Cystitis and Feline Lower Urinary Tract Disease.

A change in diet may prevent recurrence of crystal formation. This requires a Prescription diet from your veterinarian. The food maintains the urine PH in a very narrow range that prevents formation of more crystals. In dire circumstances when a cat obstructs a second time, a surgery called a perineal urethrostomy (big words!) is life-saving. The surgery widens the urethra 3-4x more than before. The cat may still form crystals, but it shouldn’t be able to obstruct again.

Jimmy responded well to treatment and readily accepted his new diet. He died from other causes about 2 years later. His owner grieved. It was springtime, and Mr. B had his door open to let in the fresh breeze. He dozed off in his recliner and was startled upon awakening to find a black and white cat, boldly patterned, winding herself through his legs and around the coffee table. He knew it wasn’t Jimmy, but? He named her Susie. She had come to stay. Every time I saw them together we would marvel at how Jimmy must have sent her.

FUS=feline urinary syndrome;FIC=feline interstitial cystitis;FLUTD=feline lower urinary tract disorder. If you like words.

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

Chemotherapy in Lymphoma

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

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

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

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

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

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

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

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

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

Christine B. McFadden, DVM
drmc@mcmenagerie.com