Stories

Innocent / Tale of The Clinic Cat

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

August 2, 2016
Ladies and gentlemen : the story you are about to hear is true. Only the names have been changed to protect the innocent….I take pride in offering good customer service. Which when it collapses, I have been known to say in a hushed voice “Wow. We don’t just drop the ball, we drop kick it into the closest wall.” What follows is a true story. Really.

The family was super nice, a throwback to Andy of Mayberry and Dona Reed. They presented as a mother and father with their sweet 4 year old daughter and brand new puppy. The Mom wore lipstick and a flowered dress. The daughter said cute things and blew kisses. The puppy was a miniature Dachshund and needed vaccinations. Simple enough, a service I provide daily and could do standing on my head. Or is that expression “in my sleep”? In the end, it wouldn’t matter a bit how experienced I was. I was doomed to fail from the moment they said “hello”.

The puppy was adorable and his examination went well. He was calm for his vaccination, which I appreciated because a shrieking puppy often sets off the children and then the mother joins in hysterically and suddenly everyone is snapping at each other and there aren’t enough princess stickers to calm everyone down. I have spent years developing a vaccination technique where I am rarely bitten by either the dog or the mother. These things are more important than you might think. I waved goodbye as I reminded them that the puppy was due back in a month for its next puppy shots and turned my attention to the next patient.

Within two hours they were back. The puppy was quiet, his tail dragging, running a fever, tiny body bumpy with hives. We re-name everything in medicine (not me personally, I just had to memorize it like a foreign language), so properly the allergic skin reaction was called urticaria. I expressed surprise (I was, it’s not that common to see a vaccine reaction) and concern (I was, though there was no indication of shortness of breath, difficulty breathing or vomiting, an indication of a severe allergic reaction called anaphylaxis which can lead to death). I treated the reaction with an antihistamine injection and advised them that we would modify the vaccine type for the next visit. In addition, they could start children’s Benadryl at home the day before to minimize any reactions. They toddled off and the puppy recovered beautifully overnight.

On his second visit the puppy underwent vaccinations without further surprises and we were all grateful. We also performed surgery that day, taking care of a small umbilical hernia that pouched open from his belly button area. The surgery went smoothly and his recovery was uneventful. The family picked him up that same afternoon and took him home, nestled safely in their arms. They were back the next day. He had chewed out his stitches. I re-anesthetized him and put them back in, adding an Elizabethan collar (the cone of shame) and placing him on antibiotics. I talked the Mom down off a ledge every day for the next week as the puppy fell over his cone, refused to eat with it on, threw up his medicine and in general did not cooperate with the program. We got through it.

In a parallel universe, back at work, we had a Clinic Cat. He went by the unimaginative name of “Barney”. This had nothing to do with purple dinosaurs or an Andy of Mayberry character, but originated as he did : he started life as a barn cat and eventually adopted us and moved inside. A big orange tomcat, we fixed him up, literally and figuratively. Barney knew the exact length of a dog’s leash and would calmly sit down and wash his face exactly 4 inches beyond its reach. Clients were always on their best behavior because other animal lovers were watching them and who could stand that pressure? Sometimes we had to spray water at Barney to get him to move before the dog stroked out. He was an unusually gentle cat and greeted many people and their pets. If you didn’t own a dog he could have a very calming effect.

Certainly the child with the miniature dachshund was entranced by Barney. The cat had withstood the affections of several Clinic Children many times over and we considered him the perfect clinic mascot. Until said child and her miniature dachshund puppy chased him under a bench, cornering Barney. Barney lashed out, inflicting a long scratch directly over the child’s eyebrow. All heck broke loose. The daughter’s trust in pets was broken. The child was hurt. She was a beautiful child and this could leave a scar on her face. It might become infected. These were all valid concerns and I sent the family to their pediatrician on my dime. Barney’s career ended and he went to a real home with a proper backyard and no dogs to torment. I vowed to never keep another Clinic Cat. And when the family moved away the following year I breathed a  sigh of relief that nothing could go wrong again!

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

The Spleen

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Dr Mc Blog

 

July 19, 2016
“Tank” was adorable. An enormous Golden Retriever puppy, he had moved into the long-legged gawky teenage stage most pups go through and was ripe for the adjustments necessary to bond with his foster family, who had volunteered to train and socialize this puppy for Guide Dogs for the Blind. Guide Dogs for the Blind has been around since 1942. They place service dogs each year with blind and low-vision people who benefit from renewed activities and lifestyle once accompanied by their “Seeing Eyes” dog.

In order to prepare a puppy for his or her future responsibilities and to bond with people they benefit from leaving a kennel situation and moving into a home. A youngster needs to learn basic manners, basic obedience training, be properly housebroken and above all, be loved. Many future guide dog puppies are placed in homes through 4-H programs. They may live with their foster family for over 12 months, when they are returned to the Guide Dogs for the Blind school for temperament testing and suitability as a Companion Service Dog. A puppy that passes this test will be enrolled in further training, at the end of which they are matched with their Human. The foster family is invited to attend the Graduation Ceremony and meet the new Team (Guide Dogs may remain the property of the School). Dogs that do not pass an entry test will first be offered back to their foster family before being placed in a pet home.

Thus it was that Tank came home to roost. Large and ebullient, he was deemed a little too frisky to take his job seriously and flunked out of the program. Far from hanging his head in shame, Tank was overjoyed to be reunited with his first family and never looked back. He demolished hoses, lounged in the swimming pool and ate them out of house and home. On his visits to the Clinic we put on our “calm” faces – when pleased to see you (and Tank was pleased to meet everybody!) Tank could literally knock you over with his enthusiastic greetings. Subtlety was foreign to Tank, but his doggie charms were irresistible and he was so cheerful that we all loved him.

That was 11 years ago. Today Tank is nearly 12 years old. His owner has brought him in because he is very quiet, too quiet even for a dog that has calmed down with maturity. His weight has dropped, though not because of a diet. His gum color is a little pale, suggesting the possibility of anemia. Most horribly, I can feel a large mass in his abdomen. I keep my head down for a moment, bent over the dogs’ back as I consider what I shall say. Before I have to look his owner in the eyes. That first moment when unspoken fears are acknowledged.

We discuss tests, his age. Tanks’ owners agree to pursue a diagnosis.

The blood tests deliver both good and bad news. Tests confirm that Tank is anemic. But his liver and kidney function are good, other internal organs good. X-rays demonstrate a large undefined mass in his abdomen. We continue to an ultrasound examination of his abdomen, which helps to identify the spleen as the mass. We are breathless as the machine’s probe moves up to explore Tank’s liver. One of the most horrible cancers a dog can get typically involves both liver and spleen. Tank’s liver appears to be clean; we cannot identify evidence of cancer spreading there. We must now consider the option of other disorders of the spleen.

The spleen is an interesting organ. Looking like an elongated red-purple colored tongue, it sits near the stomach. The spleen is the largest filtration system of old blood cells in the body. In addition, it produces a portion of the new red blood cells the body needs and cells for the immune system. That said, a spleen can be removed and the animal can live a perfectly normal life, no special medications or supplements needed. Because it is filled with blood, the spleen can develop large blood clots called hematomas, which can burst open. The dog will bleed to death. It can twist upon itself or develop tumors. Any disease or trauma that causes a ruptured spleen may lead to death by rapid bleeding out into the abdomen. It is splenic cancer that is the most feared; because of its close connection to the bloodstream this cancer spreads rapidly.

We discussed the options. Tank might have hematomas of the spleen. Removed surgically, his prognosis would be excellent. But we might open him up and find evidence of a spreading cancer that had gone undetected by our other tests. Worse, in the early stages, cancer might have spread at the cellular level but not be evident until long after surgery. Often the trained eye of the surgeon cannot visually differentiate between a hematoma or cancer, so we could go to surgery, remove the spleen, performing a splenectomy, only to find out days later that the results of the biopsy test at the lab were cancerous. The family needed time to confer. Ultimately they agreed upon proceeding to an exploratory abdominal surgery, where we found a gigantic spleen. It was bulbous and lumpy, an angry dark purple color that spread from one side to the other and, once removed, was found to weigh over 3 pounds (when healthy it had probably weighed less than 6 ounces). Tank came through surgery fine. In less than 24 hours he ate a healthy breakfast. He went home the day after the surgery, wagging his tail at being relieved of that tremendous weight. Within 2 weeks Tank was rapidly putting on weight (sigh) and appeared restored to his old self. We all rejoiced when the pathology report could not detect any cancer, but pronounced the cause : splenic hematomas. Tank’s future appears bright and we all look forward to his cheerful greetings to come.

Christine B. McFadden, DVM
drmc@mcmenagerie.com

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

 

 

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

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

 

Chemotherapy in Lymphoma

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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

 

KCS or Dry Eye

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

November 16, 2015
His name was Chipotle. A mismatch for a name if ever I saw one. The timid salt-and-pepper curly coated little Shih Tzu weighed in under 20 pounds and his tail trailed after him over the floor as he puttered around the exam room. Happily I noted that he wasn’t sweeping up any dust balls. There was nothing of a fiery chili pepper about him and I wondered briefly how he got his name. Then he looked up at me. Oh dear. Under long eyelashes I could only see matted hair and mucous covering what should have been his luminous eyes.

I scooped him up and brought him closer to me on the exam table. He stood quietly, the little feather duster tail wagging slowly as he gazed blindly up at me. Both eyes were covered by a sticky, thick layer of mucoid film, which covered a thick coat of brown pigment overlying the corneas. The whites of his eyes were streaked red from inflammation. They looked very painful. Chipotle cocked his head as I bent over him, using an ophthalmoscope (kind of a fancy flashlight) attempting in vain to penetrate deep into the back, or fundus of his eye, where the optic nerve is. But the pigment was so thick over his eyes that I couldn’t see more deeply.

I finished his examination, noting that he also had a chronic ear infection but that over-all he was in good shape, with an excellent weight and coat. I turned to his owner, an earnest man who had recently relocated to our town and was very anxious to find out what was wrong with his dog. To my surprise, he had actually been treating the dog with a prescribed medication. The owner knew it wasn’t working. He had been using it for so long I wasn’t sure if the original problems with the dog’s eye condition might have started out as something else and now changed. Certainly this medication was not effective.

I explained to Chipotle’s owner my thoughts about his eye lesions and discussed the diagnostic tests we needed to perform. First on my list was a Schirmer tear test. Special tiny strips of sterile absorbent paper are gently placed just inside the eyelid for 60 seconds. The paper wicks up the liquid in the pet’s tears. The strips are measured in millimeters, already marked on the strips. Anything over 15 millimeters in 60 seconds is normal. Anything less than 10 mm is suspect for a condition called “Dry Eye” or Keratoconjunctivitis sicca (KCS).

KCS is a horrible condition. For reasons often unknown, frequently ascribed to a problem with the immune system, the dog’s eyes have stopped producing tears from the lacrimal glands. In normal eyes, every time a pet blinks the surface of the eye, the cornea, is covered by a thin film of tears that keeps the cornea moist. Without tears the cornea dries up. Ulcers or holes in the corneal surface may occur. Over time brown pigment covers the dried cornea and that thick ropey mucous appears. The dog will go blind. Every bit of this process is extremely painful.

Chipotle flunked his Schirmer’s tear test. His right eye had a score of 2 mm, his left zero. We also ran a blood panel to rule out immune associated disorders like thyroid disease, diabetes mellitus, lupus and other diseases. Chipotle’s blood tests did not show a clear cause for his KCS.

The recommendations for Chipotle were to clean his eyes of the thick mucous at least twice a day with a sterile saline solution, found in over-the-counter contact lens cleaning products. This would allow his topical eye medications specific for KCS to penetrate better. There are at least two medications used to stimulate tear production in the dog (sadly, they are not terribly effective for the rare cats who develop this disease) : cyclosporine and tacrolimus. Both require twice daily application for the rest of the dog’s life. Eye infections, ulcers or other secondary corneal diseases may require additional topical medications. It’s a daunting prospect to face the requirement to treat your dog twice daily, every day, forever – or he’ll go blind.

Chipotle’s owner was committed to his little dog, but seemed apprehensive about actually using the medication. “He’s mean”, he said. Huh? This little droopy dog? Since I do this for a living I offered to demonstrate how to apply the medication. Which was the precise moment that Chipotle earned his name, as he came to life with a fierce burst of barks. Fiery indeed! Shih Tzu’s are blessed with small, rounded teeth and I’d be pretty embarrassed to be bitten by one (did I put that in writing?). It wasn’t too hard to devise a treatment method and off they went. On recheck 4 weeks later I was startled by the transformation in this little dog! His corneas were still covered by the brown pigment, though that would thin over the coming year, but the mucous was gone. His Tear test was over 15 mm in both eyes. Clearly the pain was gone, as Chipotle bounced all over the room, tail swishing wildly. Most miraculous of all, his bad temper at home about “medicine time” was gone and his owner confirmed that he had his “old dog back”.

Christine B. McFadden, DVM
drmc@mcmenagerie.com

 

Atresia Ani and Medical Jargon

/ Dr. Christine McFadden / Leave a comment

Dr Mc Blog

 

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

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

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

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

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

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

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

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

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

Christine B. McFadden, DVM
drmc@mcmenagerie.com