Dog

Femoral Head Ostectomy and Mercy

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

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

The dog has it made.

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

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

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

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

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

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

Merced’s Loss

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

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

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

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

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

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

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

Christine B. McFadden, DVM
Valley Animal Hospital, Merced

 

The Teeth

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Dr Mc Blog

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

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

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

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

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

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

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

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

Pretzel and the Dislocating Knee

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Dr Mc Blog

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

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

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

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

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

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

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

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

Christine B. McFadden, DVM
Valley Animal Hospital, Merced

Heartworm

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Dr Mc Blog

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

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

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

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

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

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

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

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

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

 

 

Foxtails

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Dr Mc Blog

 

March 10, 2015
At home I mark the seasons by watching the ever changing flowers along our roadsides and gracing our gardens. Spring brings the first forsythia flowers of bright yellow sunshine, the pink and white magnolia blossoms. At work I am waiting for the veterinary equivalent of that first harbinger of spring, the foxtail weed sticker.

It’s coming, that moment when I look at the chart of my next patient and read “cause for visit : foxtail in ear”.

The foxtail is the seed head of several weedy grasses. Sometimes called wild barley, several different grasses produce an awn or sticker that is pointed and barbed like a miniature badminton birdie. As your dog or cat brushes through the tall grasses the foxtail will catch in their fur, working in deeper by means of the pointed base.  Foxtails burrow deeply wherever they enter, travelling in one direction, prevented from backing out or falling out by their bushy tail.

The most common sites for foxtails to lodge in a pet are the ear and between the toes. The eyes, nose and vulva are also vulnerable, though foxtails can burrow into the skin anywhere, especially in thickly furred or matted animals.

Not only are the burrowing weeds painful, they can cause serious infections and abscesses wherever they enter the body. The sticker does not break down inside. It’s pointed end can burrow through ear drums, into eyeballs and travel up legs from the toes. Unless removed, a foxtail can eventually lead to death. Foxtails breathed into the nose can lodge there and run the risk of being inhaled into the lungs if not promptly removed. Foxtails eaten may escape the stomach and tunnel through the internal organs. Foxtails can kill.

Although you can’t always prevent contact between your pet and a foxtail, you can decrease the risk by taking the following steps :

  1. Don’t let your pet run through grassy fields or empty lots filled with weeds.
  2. Brush your pet after a trip outdoors, paying special attention to the face and feet. Gently separate each toe to look for tiny tan stickers between the feet.
  3. Pets with short, slick coats are not immune to picking up a foxtail, but there’s no denying that long silky hair or “feathers”, found in dogs like the Spaniel breeds or Golden Retrievers, attract the stickers. Thick, curly coats – think Poodles or Chow Chows – can also be foxtail magnets. These breeds may do better if their lower legs, toes and underbelly are trimmed short for the summer. A dog groomer can do this safely and easily for you. A “Summer Strip” that shears a long-haired dogs’ coat to an overall length of about ½ inch helps protect heavily coated dogs from picking up the stickers, with the added bonus of cooling your pet off during our hot summers.
  4. If possible, remove all weeds from your yard in the very early, green stage. Mow the weeds down, rake up and dispose. It is the dried seed head, in its bid to reproduce and spread far and wide, that detaches from the mother plant and hitches a ride on your pet to be carried to new fields. Elimination in the green stage is far easier to control and prevents further dispersal of seed heads. Foxtails are not readily air borne, but once dry “jump” off the plant onto whatever brushes against them.

Signs that might lead you to suspect that your pet has encountered a foxtail might include the following, especially if just after a walk or run :

  1. Your pet suddenly holds an ear down, shakes or rubs his head vigorously, crying out if you touch the ear.
  2. Repeated bursts of paroxysmal sneezing, so hard it looks like her nose might hit the floor.
  3. An ugly swelling between the toes, limping on one or more feet.

Most foxtails must be probed for and removed under anesthesia. Those lodged in the ear offer the sporting chance that, moving quickly enough, one can grab the offending sticker and be done with it. It’s the closest we come to a rodeo in small animal medicine. Given that the ear is awfully close to the teeth there can be a bit of a rush as the veterinarian eyes his or her prospective patient, calculating the odds of success.

Hmmm, the moment is here.” Check ears, foxtail”. The first patient this spring? A Newfoundland, the sort of dog that ought to live at the North Pole where there are no foxtails, and pick on someone his own size, like a polar bear. This dog looks to be about 150 pounds and growing by the second. Probably eats vets like they’re cheetos. And judging by his head tilt and red ear, it hurts, BAD.

We try the calm, business-as-usual approach. Let’s take a little peek here…. Nope. Next the hold-on-to-him, person on each end approach. Uhn-uh. Three people try to restrain his head. Help! Finally, a moment of stillness and we’ve got it! Quickly a quarter inch foxtail is extracted from the ear. Everyone takes a collective breath. The ear is cleaned and medicated. The Newfie is delighted, giving us doggie high fives with his nose which knock us into the wall. We all beam at each other. Success is sweet today. We know there will be more foxtail challenges tomorrow.

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

Cough, Hack, Gag, Enough!

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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?

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

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

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

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

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

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

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

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

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

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

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

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

The Flea and Zero Tolerance : Part One

/ Dr. Christine McFadden / Leave a comment

 

Dr Mc Blog

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

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

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

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

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

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

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

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

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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mange / Demodecosis

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

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

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

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

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

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

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

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

Christine B. McFadden, DVM
drmc@mcmenagerie.com