http://www.petmd.com/blogs/thedailyvet/rss en http://www.petmd.com/blogs/thedailyvet/jintile/2013/june/treating-the-solitary-mast-cell-tumor  

The most straightforward example would be a dog presenting with a solitary mast cell tumor. In such cases, with rare exception, surgical removal with wide margins is the treatment of choice. We recommend the surgery entail the removal of 2-3 centimeters of “normal” appearing skin surrounding the tumor, and one layer of tissue below the tumor.
 
Owners are often surprised when I show them exactly how wide and deep these surgical margins should be in a quantitative sense. However, this is the best way to ensure the entire tumor is removed in order to limit the potential for regrowth of the tumor, and/or assure cells are not left behind that could spread to distant sites in the body.
 
Such wide surgical margins may translate into biopsy margins of only a few millimeters (meaning only a small region of “normal” tissue is present between the last visible tumor cell and the edge of tissue where the scalpel blade cut). When a biopsy returns, we hope to see more than 5 millimeters of clear tissue in all directions — anything less is generally considered an incomplete excision. It’s very important that the biopsy include surgical margins so oncologists know what to recommend to owners.
 
Even if a dog presents with more than one mast cell tumor at the same time, surgery will be the recommendation. Sometimes it can be tough to know “how many tumors are too many,” and I must use my best judgment as to when to recommend intervention with medical therapy instead of surgery.
 
Radiation therapy plays a large role in the treatment of canine mast cell tumors, primarily for tumors unable to be entirely removed with surgery.
 
In its most simplistic form, radiation therapy entails bombarding the remaining tumor cells with high-energy beams of radiation. Treatments are usually administered daily, and each is performed under a short period of anesthesia. Dogs tolerate radiation therapy very well, and side effects are usually limited to some transient changes within the skin, although this will vary depending on the location of the tumor.
 
Radiation therapy is most effective when used after surgery, but in some cases it can be used prior to surgery (e.g., for very large tumors or tumors in regions where surgery is not feasible). This tends to be a more palliative option, and the best outcomes occur when radiation is combined with chemotherapy (see below).
 
Chemotherapy has a role for mast cell tumors, but is often less effective than surgery or radiation therapy. I recommend chemotherapy for all grade 3 mast cell tumors, any tumor has already metastasized to a distant site, and for some cases of narrowly excised “high-risk” grade 2 tumors (though the role of chemotherapy for such cases remains somewhat controversial).
 
Chemotherapy can also be used to treat dogs who present with multiple mast cell tumors at the same time, or who have tumors too large to be removed surgically.
 
*
 
Next week we will explore the types of chemotherapy that are available for treating mast cell tumors.
 
 

Dr. Joanne Intile
 
 
Image: chalabala / via Shutterstock
 ]]> http://www.petmd.com/blogs/thedailyvet/jintile/2013/june/treating-the-solitary-mast-cell-tumor#comments TheDailyVet Wed, 19 Jun 2013 11:00:00 +0000 30485 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/pmahaney/2013/june/Californians-plagued-by-plague-infected-squirrels  

The plague is a disease caused by a bacterium called Yersinia pestis. According to the Centers for Disease Control (CDC):
 
Humans usually get plague after being bitten by a rodent flea that is carrying the plague bacterium or by handling an animal infected with plague. Plague is infamous for killing millions of people in Europe during the Middle Ages. Today, modern antibiotics are effective in treating plague. Without prompt treatment, the disease can cause serious illness or death. Presently, human plague infections continue to occur in the western United States, but significantly more cases occur in parts of Africa and Asia.
 
So, the possibility that your companion canine or feline could be exposed to the plague and pass the disease on to you, your human family members, or other pets is very real. The potential for zoonosis (transmission of illness among different species) is an important consideration for anyone inviting a pet into their home.
 
In 2011, USA Today featured the article Sleeping next to pets could be harmful, study says, which garnered significant attention among pet owners and those of us in the business of providing health care. In the piece, Bruno Chomel, a University of California Davis School of Veterinary Medicine professor, stated that close contact, such as that which occurs when pets sleep in our beds, could contribute to the spread of a variety of infectious organisms. Chomel noted Bubonic plague, Chagas disease (brought on by the protozoan Trypanosoma Cruzi), and cat scratch disease (caused by the bacteria Bartonella sp.) as the zoonotic diseases of concern.
 
Unfortunately, instead of emphasizing a common sense approach to pet care (see my tips below), this article struck fear into the hearts of pet owners by sending the message that our cats and dogs should be banished from the bedroom. According to Chomel, “There are private places in the household, and I think our pets should not go beyond next to the bed.”
 
Recently, plague-causing bacteria were identified in California ground squirrels that had been captured from two camp grounds in the San Diego area. According to a U-T San Diego story, Plague Found in Three Ground Squirrels, health officials are deterring people from having contact with squirrels and other wildlife.
 
Not every squirrel carries the plague, and there’s a low likelihood that people or other pets will encounter the bacteria from direct contact with squirrels. Yet, a bite from a plague-infected squirrel could potentially spread the disease. Generally, the disease spreading culprits are the fleas that take their blood meals from the squirrel. Chris Conlan, supervising vector ecologist for San Diego County’s Vector Control Program, said that "luckily, the fleas that are transferring plague from squirrel to squirrel much prefer to bite squirrels instead of people.”
 
Yersinia bacteria may be diagnosed in a few animals during routine surveys, yet no cases have occurred since 2011. The disease has some history in California. A Department of Public Health report lists 62 human plague cases in California from 1926 to 2013; 39 people survived and 23 died.
 
In general, using good sanitary habits can help prevent disease transmission from your pets or wildlife. My top five tips for keeping yourself and your animal and human family members free from undesirable pests include:
 
 

Avoid all contact between you and your pets with wildlife, and take measures to prevent both wild and roaming domesticated animals from entering your yard.

Thoroughly wash your hands with soap and warm water after touching your pet. Additionally, don’t let your pet lick your hands, face (especially no French kissing!), or other body parts.

Provide a bath with a pet-appropriate shampoo every 7-30 days (weekly to monthly).

Use veterinary prescribed oral or topical parasite preventative medications to keep ectoparasites (fleas, ticks, etc.) and microorganisms (bacteria, viruses, parasites, etc.) off of your pet’s fur and skin.

Vacuum your home (and empty the canister or throw away the bag far from your house) and wash all bedding on a weekly basis.

 
These tips are all common sense practices, but we occasionally need to be reminded of their importance. Hopefully, both you and your pets will stay plague-free this summer and year-round.
 
 

Dr. Patrick Mahaney
 
 
Image: Thinkstock
 ]]> http://www.petmd.com/blogs/thedailyvet/pmahaney/2013/june/Californians-plagued-by-plague-infected-squirrels#comments TheDailyVet Tue, 18 Jun 2013 11:00:00 +0000 30476 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/lhuston/2013/june/are-you-and-your-cat-prepared-for-an-emergency  

Make a plan ahead of time. Don’t wait for a disaster to strike. By then, it may be too late. Be sure to include your cat in your emergency plan as well. Here are some pointers.
 

Never leave your cat behind if you need to evacuate your home, even if you believe you will only be gone for a short period of time. Sometimes unforeseen complications occur. Once you are out of the area, you may not be allowed to go back for your cat.

Pack an emergency kit and keep it handy. You should have a carrier large enough to house your cat if necessary. A collapsible carrier is acceptable and can make storage easier. Be sure to mark the carrier clearly with your cat’s name, your name, and your contact information. Include pertinent medical records in your emergency kit, including a list of any medications your cat needs to receive as well as vaccine certificates and licenses, if applicable. Pack food and water, enough to last for at least a few days for your cat. Don’t forget to include food and water dishes as well as a litter box. If your cat requires medication, keep at least enough to last for a few days on hand in your emergency kit. Keeping a first aid kit in your emergency kit is a good idea also. You can prepare your own or purchase a commercial pet first aid kit. Include a list of important phone numbers in your emergency kit also, including your veterinarian and an emergency veterinary facility, if available.

Be sure your cat has identification. Ideally, your cat should be wearing an identification tag or collar of some type that includes your contact information. Consider including a mobile phone number where you can be reached at all times. A microchip is also a good idea and can be essential if your cat gets lost in the confusion. The microchip may be the only link back to you if the identification tag/collar is lost. Be sure your cat’s microchip is registered and that your contact information is up-to-date.

Know where you will go in the event of an emergency. Whether the plan is to stay with a friend or family member, or in a hotel, be sure your cat is welcome. Remember that shelters such as those sponsored by the Red Cross frequently do not allow pets. Another option may be to board your cat at a local kennel facility or veterinary hospital. Keep in mind though that, in the event of a widespread disaster, local businesses may be affected as well. The veterinary hospital, kennel, hotel, or even the friend/family member you included in your plan may not be available to help. Consider formulating a plan that includes a local solution for housing as well as an alternative plan for housing further away, hopefully outside of the danger area.

Make sure all of your family members know the plan. Designate an area outside of your home to meet if you become separated. Consider asking a neighbor or someone else nearby to rescue and look after your cat if an emergency occurs while you are away from home.

Place stickers on your windows, doors, and other entrances into your home notifying emergency personnel entering your home that you have pets. You can usually obtain stickers from your local fire department.

 
We would all like to believe that emergencies happen only to others, that we will never be faced with such a situation. And I hope that’s true for all of you. But, if the worst does happen, taking the time beforehand to be prepared can save precious moments. Those moments just might be responsible for saving your life or the life of your cat.
 
Do you have an emergency plan in place? What important points have I forgotten to mention?
 
 

Dr. Lorie Huston
 
 
Image: John Morton / via Flickr
 ]]> http://www.petmd.com/blogs/thedailyvet/lhuston/2013/june/are-you-and-your-cat-prepared-for-an-emergency#comments TheDailyVet Mon, 17 Jun 2013 11:00:00 +0000 30473 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/aobrien/2013/june/what-to-expect-when-your-mare-is-expecting  

The majority of fetal growth occurs in the last trimester of pregnancy. For the mare, this means her nutritional requirements will increase and she will begin to actually “look” pregnant starting around her seventh or eighth month of pregnancy. Every mare is different, so be sure to talk regularly with your veterinarian about your mare’s specific dietary needs.
 
Regular exercise and routine hoof maintenance should be kept up during pregnancy, and the mare should receive booster vaccines for a contagious virus called equine herpesvirus, which can cause abortions if contracted by the mare. Mares in early pregnancy can still be ridden, but riding should stop when she is in her third trimester. However, she should still be allowed out on pasture to graze.
 
One vital aspect to a pregnant mare’s health is the type of grass she is grazing. Pregnant mares in their third trimester should not graze in pastures containing fescue grass. Some types of fescue are infected with a certain fungus that causes a variety of very serious complications, such as prolonged gestation, agalactia (meaning the mare cannot produce milk for her foal), and premature separation of the placenta, a term called “red bag,” which causes oxygen deprivation for the foal.
 
As the anticipated date of foaling nears, the mare will begin to “bag up,” meaning she will begin producing milk and her udder will swell. Waxy plugs will begin to form on her teats and some mares will even begin to drip some milk. There are commercial kits available for purchase that will test a mare’s milk for levels of calcium. These numbers are fairly good predictors of when the mare will foal.
 
As the mare gets close to foaling, make sure you have the necessary supplies. A properly equipped basic foaling kit should include, but is not limited to, the following items:
 

veterinarian’s phone number

flashlight and batteries

plenty of clean, cotton towels

tail wrap

iodine

Ivory soap

clean bucket for water

KY jelly

gloves (preferably long-sleeved OB gloves)

large trash bags

thermometer

stethoscope


 
In the hours before actual foaling occurs, the mare will exhibit certain behavioral patterns. She will become restless, look at her flank, get up and down repeatedly, and may pass small amounts of manure. These clinical signs are similar to when a horse has colic. For a mare about to give birth, these signs are produced because of the start of uterine contractions.
 
The process of foaling proceeds in three stages. Becoming familiar with each stage will help you monitor progress and know when to call your vet for help. Stage 1 occurs when the mare’s water breaks. This signifies the rupture of fetal fluids called allantoic fluid, which surrounds the fetus in the placenta.
 
Almost immediately after Stage 1, the mare will begin having very strong abdominal contractions. This is the beginning of Stage 2. During Stage 2, the foal has moved into the birth canal and is ready to be delivered. Normally, the foal is positioned with the front feet first, followed closely by the nose.
 
Ideally, when in proper alignment, the first thing an assistant should see is two front feet with the soles facing downward, one hoof slightly ahead of the other, followed closely by a nose. If any of this is not seen, the vet should be called immediately, as this indicates the foal is in an incorrect position which may lead to problems with delivery.
 
Stage 2 happens quickly. A foal’s birth is often described as “explosive” because it happens so fast, usually less than twenty minutes. Most mares will lie on their side when pushing, and then the strong contractions stop after the foal’s hips are out. Stage 2 is finished when the foal is completely delivered. If Stage 2 takes longer than roughly forty minutes, or if it appears no progress has been made at any point during this stage, the vet should be called.
 
Within an hour of birth, the foal should be standing or making strong efforts to stand. The mare will normally lick and nuzzle the foal to dry him off and encourage him to get up and start nursing. Stage 3, the final stage, occurs when the mare passes the placenta. This normally occurs within a half hour of birth, and should occur no later than three hours after the foal is born.
 
The mare will have mild contractions during expulsion of the placenta. As the mare is passing her placenta, do not try to help by pulling it out. This may result in tearing it, leaving a piece still inside the uterus, which can make the mare very sick. If you are worried about the mare stepping on the placenta, you can tie it in a knot above her hocks. Once the placenta is passed, place it in a trash bag and keep it in the refrigerator for the vet to examine when she arrives to check on the newborn foal.
 
If the placenta is not passed within three hours, call the veterinarian. Retained placentas in mares are very serious, as they can cause life-threatening infections of the uterus, which can result in blood infections and severe hoof inflammation called laminitis.
 
Once the foal has arrived, make sure his nose is free from any membranes so that he can easily breathe. The umbilical cord usually breaks on its own and within a few hours of birth, should be dipped with dilute iodine in order to keep it clean. The umbilical area is a common area of infection in foals.
 
Your veterinarian should come out within about 24 hours of birth to examine the foal and mare. In the meantime, during the foal’s first few hours, make sure he is nursing. It is imperative for newborn foals to consume adequate amounts of the mare’s first milk, called colostrum. This milk is filled with antibodies that the foal needs for immune protection.
 
Some mares are not able to produce colostrum with enough antibodies. To determine if your foal has consumed enough colostrum for sufficient immune protection, your vet can draw a blood sample from the foal and measure antibody levels. If these levels are low, the foal can receive a plasma transfusion to bolster his immune system during the first few weeks. As the foal grows, he will then start producing his own antibodies.
 
Once your foal and mare have received a check of health from the vet, you can relax and enjoy the newborn! Foals grow quickly and are a joy to watch as they learn to run on their long legs and explore their environment. Careful monitoring will help ensure your foal has a strong start at life.
 
 

Dr. Anna O’Brien
 
 
Image: DragoNika / via Shutterstock
 ]]> http://www.petmd.com/blogs/thedailyvet/aobrien/2013/june/what-to-expect-when-your-mare-is-expecting#comments TheDailyVet Fri, 14 Jun 2013 11:00:00 +0000 30470 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/ktudor/2013/june/vaccination-programs-for-puppies-and-kittens  

 
Maternal Antibodies and Vaccinations
 
Unlike humans, mother animals cannot pass antibodies to their gestating babies prior to birth. The placenta of animals does not allow the transfer of immunity while in the uterus. Newborn animals receive their protective antibodies from the colostrums, or “first milk,” of mom. The intestinal tract of newborns will only allow the transport of entire antibodies in the colostrum from the intestines to the blood in the first 72 hours of birth. After that time period, colostral antibodies are treated like any other dietary protein: broken down and absorbed partially.
 
Provided that mom’s vaccine status is current, these newborns will be protected by the absorption of the antibodies in the colostrum. These antibodies will be their highest after consumption and decrease over time and disappear by about 16 weeks of age. During the time between birth and 16 weeks these maternal antibodies will protect the newborn against viruses, including those in vaccines.
 
Vaccines are designed to expose an animal or person to a modified version of viruses in order to stimulate immunity to these viruses without causing disease. Maternal antibodies destroy these vaccine viruses, so vaccines given when mom’s protective antibodies are high in the blood stream will offer no protection to young animals.
 
In any litter of kittens or puppies many antibody scenarios are possible:
 

Mom has no vaccination history or has had only recent vaccines, so her colostrum has few antibodies.

Mom’s vaccine status is great and all or some of the litter suckled well during the first 72 hours, receiving great antibody protection.

Some newborns were poor at nursing and received few antibodies.

Mom’s colostrum production or delivery was insufficient so the whole litter received inadequate antibody protection.

Any combination of the 4.

 
Without blood testing for each virus, we veterinarians have no idea about the immune status of each newborn in each litter. This uncertainty has led to standard vaccination programs for young animals.
 
Vaccination Programs for Kittens and Puppies
 
Kittens and puppies are capable of responding to vaccines quite early in life. Those that did not receive adequate colostrum will respond to the initial vaccines and begin developing their own antibodies. Newborns that received adequate antibodies will not respond to vaccines because mom’s antibodies will interfere. Since we don’t know the status of each individual newborn or the exact time that colostral antibodies will be low enough to allow successful vaccination, we vaccinate every 3-4 weeks until 16 weeks of age. At some point during that period one or more vaccines will “take” and all newborns of any litter will be protected no matter when they started, with or without mom’s antibodies.
 
The number of vaccines an animal receives depends on when the vaccination program starts, not where it ends. The majority end at 16 weeks when we are certain colostral antibodies are ineffective. The earlier the programs begin the more vaccines the newborn will receive. Vaccination programs have nothing to do with “boostering.”
 
Many veterinarians recommend at least two sets of vaccines for kittens and puppies, starting with their vaccinations after 16 weeks. Whether this is necessary for all of the common viruses is subject to opinion and depends on the particular formulation of the viral vaccine. For instance, most veterinarians agree that it is probably a good idea to give two initial Feline Leukemia vaccines since the effectiveness of this vaccine to prevent disease appears to less than vaccines for other viruses.
 
Headway in research looks promising for vaccines that are not subject to colostral interference. This will allow a more defined vaccination program and reduce the number of initial vaccines.
 
 

Dr. Ken Tudor
 
 
Image: Thinkstock
 ]]> http://www.petmd.com/blogs/thedailyvet/ktudor/2013/june/vaccination-programs-for-puppies-and-kittens#comments TheDailyVet Thu, 13 Jun 2013 11:00:00 +0000 30468 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/jintile/2013/june/the-dreaded-mast-cell-tumor  

The more cases I see, the more I find myself repeating those humbling words over and over again when talking about this challenging disease.
 
Most dogs develop mast cell tumors in their skin or subcutaneous tissue. They may also develop tumors internally, but this is less common. The tricky part comes when the skin tumors spread internally, or an internal tumor spreads to the skin. It can be nearly impossible to determine the “chicken or egg” in those cases.
 
Some dogs will be diagnosed with a mast cell tumor when a lump that’s been present for many years is finally tested one day. Other dogs will develop a rapidly growing tumor that changes dramatically in a few short days to weeks. Some will have only one tumor over their entire life, while others will have a dozen or more develop in a short period of time.
 
I’ve also seen dogs that develop a new tumor every year like clockwork. I would also venture to guess it’s probably the most common “second cancer” I diagnose in dogs I’m treating for a completely different tumor type.
 
Mast cells are immune cells that normally play a role in allergic reactions and inflammatory responses. They reside within many tissues of the body, and dogs have a great deal of these cells located within their skin. Mature mast cells contain granules, which are basically packets of chemicals. When signaled by an allergen or the immune system, mast cells will release the chemicals by a process called degranulation. The chemicals can cause changes locally, right at the area where they are released, and can also travel through the blood stream to affect distant organs and tissues, and even the entire body, in what is known as an anaphylactic reaction.
 
We don’t really understand completely what causes mast cell tumors to develop, but we do know they are more likely to occur in certain breeds of dogs, including Boxers, Boston Terriers, Beagles, Pugs, Labrador retrievers, and Golden retrievers (to name a few). This suggests a likely genetic component to their origin. Chronic skin inflammation and chronic topical application of irritants may predispose dogs to developing tumors.
 
We also know that between 20-30% of mast cell tumors will have a mutation in a specific gene called c-kit. This will come up again in a future article discussing treatment options for mast cell tumors, and is the target for a new class of chemotherapy drugs called tyrosine kinase inhibitors (see article on Palladia).
 
For cutaneous mast cell tumors, one of the biggest predictors of how “good” or “bad” it will behave is something called the grade of the tumor. The grade can only be determined via biopsy, which means either a small portion of the tumor, or the entire tumor, needs to be removed and evaluated by a pathologist.
 
The most common grading scheme for mast cell tumors in dogs is something called the Patnaik scale, where tumors will be classified as either a grade 1, grade 2, or grade 3. The vast majority of grade 1 tumors will behave completely benign, and surgical excision is considered curative.
 
On the other side of the spectrum are the grade 3 tumors. These are invariably malignant, with a high chance of regrowth after surgical removal, and a high propensity to spread to lymph nodes, internal organs, and even the bone marrow.
 
Perhaps the toughest of all to know how to treat are the grade 2 tumors. Most grade 2 tumors behave very much like grade 1 tumors, but a small subset will act very aggressively, and it’s difficult to predict which ones will do so. Some information can be garnered from the biopsy report itself, but often we are making our best “guesses” as to what to do.
 
Because of the confusion surrounding the grade 2 tumors, a new grading scheme was proposed about two years designed to place all tumors into one of two categories. Using this new scheme, a mast cell tumor is designated as being high-grade or low-grade. Finally, it seemed the muddy waters would be cleared and tumors could simply be designated as “bad or good.”
 
As is true for so many things, new isn’t always better to some people, and not every pathologist has readily adopted the two-tier scheme. I do find it actually very helpful for a pathologist to include both designations on a biopsy report, and more and more pathologists are doing so as this newer system seems to be slowly catching on.
 
Although more than 80% of skin lumps and bumps on dogs are completely benign, and although most canine cutaneous mast cell tumors behave in a non-aggressive fashion, it’s still very important to have any new or old lump or bump evaluated by your veterinarian (see Evaluating Lumps and Bumps).
 
Never assume a skin tumor is benign, or just a “fatty tumor” by feel. At minimum, a fine needle aspirate should be performed to determine the cause of the lump. Take it from someone who’s been fooled one too many times by this cancer.
 
 *
 
Next week I’ll discuss treatment options for mast cell tumors in dogs, including surgery, radiation therapy, and chemotherapy.
 
 

Dr. Joanne Intile
 
 
Image: Thinkstock
 ]]> http://www.petmd.com/blogs/thedailyvet/jintile/2013/june/the-dreaded-mast-cell-tumor#comments TheDailyVet Wed, 12 Jun 2013 11:00:00 +0000 30465 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/pmahaney/2013/june/paraphimosis-pet-emergency-or-owner-embrassment  
Recently, I was just about to take an afternoon power nap when a text from a client came through with an attached picture. As I did not want to have an unanswered message dwelling on my brain and affect my sleep, I picked up the phone and laughed out loud when I saw the photo and associated text.
 

My client sent me an image of her fluffy, white male Shih Tzu-Poodle (a Shihpoo?) mix lying on his side, which exposed his belly and a little, pink surprise: the glans penis extruding from his prepuce (foreskin-like sheath that covers the penis).
 

 
The text inquired: "Why is it still peeking out? What should I do?"
 
Having faced this issue many times in emergency practice, especially while doing emergency work, I recognize that this clinical presentation can alarm the pet owner and potentially escalate to a more severe health issue if not properly addressed.
 
Paraphimosis is the medical term for this condition. Mirriam Webster defines the term’s components as follows:
 
Para — beside, alongside of, beyond, or aside from
 
Phimosis — tightness or constriction of the orifice of the foreskin arising either congenitally or postnatally (as from balanoposthitis) and preventing retraction of the foreskin over the glans
 
When it comes down to it, paraphimosis occurs when the glans penis is unable to be properly retracted within the foreskin (prepuce).
 
Is Paraphimosis a Serious Health Concern?
 
The condition becomes more serious when irritation and dryness occur on the surface of the penis after the glans has protruded for minutes to hours (to days?) and comes into contact with environmental surfaces (the ground, carpets, etc.).
 
Additionally, edema (swelling) will occur as a result of restriction of blood flow back from the head of the penis. This further prevents the glans from retracting and restricts the proper flow of urine through the urethra, which leads to bladder enlargement and discomfort.
 
How Is Paraphimosis Resolved?
 
Resolving paraphimosis can be relatively simple or complex, depending on the length of time that the problem occurs and the amount of irritation, trauma, and swelling occurring in the glans penis.
 
An owner can apply some lubricant (personal, sterile surgical, moisturizing lotion, other) to the glans penis and gently try to press it back into the prepuce (or slide the prepuce forward over the glans).
 
If hair from the prepuce is sticking to the glans and preventing proper repositioning, then electric trimmers can be used to carefully trim away the hair. Scissors are not recommended, but they can be used if trimmers are not available, the scissor operator can work with confidence to cut only the hair (and not skin), and the animal can be properly restrained.
 
Additionally, a highly-osmotic solution, like 50% dextrose solution, can be applied to the surface to promote the movement of liquid out of the penis. On a more severe scenario, the prepuce tissue may need to be surgically cut to create a larger opening for the penis to be retraced.
 
It’s most ideal that a trained veterinary professional performs the treatment beyond the owner’s ability to lubricate and readily replace the penis to its natural position.
 
Can Paraphimosis Be Prevented?
 
One of my top paraphimosis prevention tips is to keep the hair at the tip of the prepuce cut short. This reduces the likelihood that hair will stick to the penis to prevent it from properly retracting into the prepuce.
 
It pains me to see a dog return from being groomed sporting a fresh haircut and an artistically-styled frond of hair at the tip of the prepuce (like a Merkin … Google it). Not only does this increase the likelihood that paraphimosis will occur, but the collection of urine, environmental debris, white blood cells, bacteria, and other substances can contribute to urinary issues, including infection, that ascends into the urinary tract from the outside world.
 
Additionally, prevent your male dog from humping other dogs, your mother-in-law’s leg, and his favorite stuffed animal.
 
Fortunately, my client’s dog’s paraphimosis was resolved the DIY (Do It Yourself) way with a gentle, lubricated push. From now on the hair is being trimmed shorter, so I hope his manhood stays put in its proper place.
 
 

Dr. Patrick Mahaney
 
 
Image: tenten10 / via Shutterstock
 ]]> http://www.petmd.com/blogs/thedailyvet/pmahaney/2013/june/paraphimosis-pet-emergency-or-owner-embrassment#comments TheDailyVet Tue, 11 Jun 2013 11:00:00 +0000 30463 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/lhuston/2013/june/adopt-a-cat-month  

Unfortunately, only one of four shelter cats actually ends up in a home. Nationwide, it is estimated that 2 million cats are euthanized every year. That equates to 5,650 cats every day. In California animal control facilities alone, between the years 2000-2010, 2.5 million cats were euthanized. In 2010, 276,052 cats were euthanized in these facilities.
 
Those statistics are staggering in and of themselves. Add to them the fact that, in many areas of the country, springtime marks the start of “kitten season.” By June, most shelter facilities are faced with a large influx of kittens, all of which need homes.
 
Where do cat owners actually obtain their cats? Interestingly, less than 1/3 of cat owners adopt their cat from a shelter or rescue facility. According to 2012 American Pet Products Association (APPA) statistics:
 

41% of cat owners obtained their cat from a friend or relative.

29% were adopted from a shelter or rescue facility.

10% were bred at home.

19% were obtained by other means.

 
Even more surprising is the fact that only 2% of the cats that end up in shelters ever find their way back home. Likely, many of these cats are or were previously owned. However, a lost cat is three times more likely to be found by non-shelter means such as a neighbor finding the cat or the cat returning home on its own. When returned via a shelter facility, it’s usually because the cat was wearing an identification tag or had a microchip.
 
Obviously, shelter and rescue cats need our help. I encourage you to consider adopting a cat, or maybe even two cats. It would be wonderful if we could see the cat adoption rate soar, not only in the month of June but afterwards as well. However, please be sure you are fully prepared both physically and financially to care for your new pet if you do decide to adopt. CATalyst Council addresses some of the things you should consider prior to adoption in this recent news release.
 
If you do decide to adopt a new cat or kitten, you can get some tips on caring for your new charge in this previous petMD post: Caring for Your New Cat.
 
If you decide that you are not prepared to adopt a new cat at the current time but would still like to help, there are many options. Consider volunteering at your local shelter or rescue. Donations are almost always welcome as well. Donating cash is always an option but many shelters and rescues also welcome donations of food, blankets, towels, litter, and other supplies.
 
 

Dr. Lorie Huston
 
 
Image: Dustie / via Shutterstock
 ]]> http://www.petmd.com/blogs/thedailyvet/lhuston/2013/june/adopt-a-cat-month#comments TheDailyVet Mon, 10 Jun 2013 11:00:00 +0000 30460 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/aobrien/2013/june/when-horses-become-compulsive-cribbing  

Cribbing is a specific type of stable vice where the horse presses down with his incisors on a firm surface, such as a fence post, stall door, or gate. With the incisors on this surface, the horse will press down and back, arching his neck and gulping in air, and making a distinct belching noise. This behavior is not only destructive to barns and fences, but also causes excessive wear on the horse’s incisors. Cribbing may also be linked to gastric ulcers and certain types of colic, but this has not been conclusively proven in studies.
 
So, why would a horse exhibit such bizarre behavior? Veterinary behaviorists agree that the main root cause of such stereotypic behavior is lack of appropriate physical, mental, and social stimulation. Chiefly, this comes down to how we house our horses.
 
Thinking back to the way horses evolved as a prey species, combined with the fact that mustangs, feral horses, and horses housed in a “natural” manner do not exhibit such behaviors, it’s not surprising that a common way horses are kept, namely in a stall and fed distinct meals of high concentrate carbohydrates, leads to innate stressors on the horse’s psyche, resulting in behavioral problems. Horses are meant to graze upwards of sixteen hours a day, walking along pastures and, as herd animals, socializing with others of their species. Take away these natural elements and you are asking for trouble.
 
Curing a cribbing horse is often unsuccessful. This compulsive behavior is so entrenched that even putting a cribbing horse out on pasture 24/7 usually does not rid him of this action. Frustratingly, cribbers are very good at finding something to crib on. There are cribbing “collars” on the market that attach around the horse’s throat. These collars prevent the horse from tensing his neck muscles when gulping for air during cribbing behavior. This physical deterrent sometimes helps, but there are some horses that crib despite the collar. For this reason, some boarding stables are unwilling to house a horse that is known to crib.
 
By far, prevention of such behaviors is worth way more than any “cure.” Raising horses so that they have access to pasture, herd interaction, and plenty of roughage is key to preventing compulsive behaviors. If pasture use and herd interaction are limited, providing ample hay to allow for a simulated grazing schedule will help. Although grain is needed for growing horses and those with intensive training schedules such as racehorses or other competitive athletes, most other adult horses don’t need the “hot” energy such diets provide. In the end, the closer to nature we can keep our horses, the healthier they are.
 
 

Dr. Anna O’Brien
 
 
Image: Thinkstock
 ]]> http://www.petmd.com/blogs/thedailyvet/aobrien/2013/june/when-horses-become-compulsive-cribbing#comments TheDailyVet Fri, 07 Jun 2013 11:00:00 +0000 30447 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/ktudor/2013/june/balanced-homemade-meals-for-dogs-and-cats  

 
The Study Recipes
 
The researchers analyzed 200 homemade recipes. 67% of the recipes were from two veterinary textbooks and nine pet care books. Four of these sources were authored by board certified veterinary nutritionists. The other 33% of the recipes were obtained from 23 different websites. 64.5% of the recipes were written by veterinarians and 35.5% of the recipes were authored by non-veterinarians.
 
The Findings
 
Of the 200 recipes, only nine recipes met or exceeded the National Research Council’s (NRC) Recommended Allowances or Minimum Requirements for all essential daily nutrients. Nine recipes exceeded the nutrient minimums established by the Association of American Feed Control Officials (AAFCO). All but one of those recipes meeting the NRC or AAFCO standards was authored by a non-veterinarian.

95% of recipes authored by both veterinarians and non-veterinarians were deficient for at least one nutrient and 85% had multiple deficiencies. The most common deficiencies were zinc, choline (a vitamin-like nutrient), vitamin D, vitamin E, copper, calcium and EPA/DHA (omega-3 fatty acids). In some of the deficient diets, deficiencies of vitamin D, vitamin E and choline were less than 50% of the NRC Recommended Allowances.

Nine recipes exceeded the NRC Safe Upper Limit for vitamin D, and six recipes exceed the Safe Upper Limit for EPA/DHA. 6.5% of the recipes included garlic or onions, which are considered toxic to dogs because of their potential to cause the destruction of red blood cells and lead to anemia.

92% of the recipes were vague and required one or more assumptions on the part of the owner concerning actual ingredients, preparation method or supplements. 29% of the recipes did not even include necessary supplements. 85.5% of the recipes did not include feeding instructions.
 
Not Surprised
 
The findings in this study verify my observations when I started my research on homemade diets. The lack of attention to detail by veterinarians, even those who are board certified in nutrition, and non-veterinarians may have serious long term problems for those wishing to feed quality homemade diets. We are already beginning to see an increase in puppies and dogs with osteoporosis presenting in veterinary hospitals.

The upside of the study is that it verified that recipes analyzed by available databases of human foods (providing that specific preparation was followed) were consistent with the chemical analysis of randomly chosen recipes. This means that if an author of a homemade recipe can provide a USDA database comparison of their recipe compared to NRC and AAFCO requirements for all essential nutrients (42 for dogs and 44 for cats) then the recipe is probably adequate.

The researchers of the study suggest that recipes include a safety margin of quantity of nutrients to allow for individual difference in digestibility and absorption of nutrients. Such recipes should exceed both NRC and AAFCO for all nutrients without exceeding the Safe Upper Limits. Table 1 is an example of the type of information that an author, or commercial food manufacturer for that matter, should be able to provide.

The amino acid taurine and the essential fat arachadonic acid should be included for cats. They should also specify the supplement brands that will provide the necessary levels of nutrients. If they are unable to provide all of this information, keep searching.
 

 
 
 

Dr. Ken Tudor
 
 
Image: Thinkstock
 ]]> http://www.petmd.com/blogs/thedailyvet/ktudor/2013/june/balanced-homemade-meals-for-dogs-and-cats#comments TheDailyVet Thu, 06 Jun 2013 11:00:00 +0000 30440 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/jintile/2013/june/waiting-for-doctor-right
While engaging in my typical routine of slathering myself in sunscreen with an SPF of 50 (I’m an oncologist after all!), I discovered a mole present just lateral to my umbilicus (that means just to the side of my belly button for you non-medical people out there) that was now significantly larger and more raised in appearance than I ever remembered.
 

My first reaction was of sheer vanity, and I immediately tried to figure out ways to cover up the alien-like creature growing along my stomach so not to cause any alarm amongst the other regular attendees at the pool. My second reaction was, “This needs to be evaluated by a dermatologist ASAP!”

I knew better than to try and obtain an appointment on a Saturday afternoon, and figured I would wait until Monday to start calling to find a doctor who accepted both my insurance and new patients. It was then I thought about what would happen if a similar event occurred with one of our owners.

At our hospital, owners can call 24 hours a day, 7 days a week to schedule an appointment. We truly have an “open door” policy for our specialty services, which means there is 99.9% chance a pet will seen within a few hours of calling. What a far cry from our expectations for our human doctor counterparts.

Monday morning I began my quest. Immediately, I became frustrated because I needed to logon to my insurance company’s website in order to even begin to search for available options. After struggling for 15 minutes to recall my user name and password (who truly remembers the exact spelling of the town in which they are born AND their paternal grandfather’s middle name?), I finally was able to type “Dermatologist” into the query box and anxiously awaited the results.

Imagine my surprise when my search returned > 60 names, organized simply by geographical distance from my current address. This was how I was supposed to decide who is capable enough to evaluate the strange creature growing on my skin?

Names were listed simply by radius (with a remarkable number of doctors located within 0.1 miles). No information was available on qualifications, number of years in practice, gender, area of expertise, or even whether or not the office accepted new patients or not.

Drawing off my experience working in large veterinary referral hospitals, the most reasonable approach seemed to be to first try the dermatologist’s office located within the same building where my internist was located.

I dialed the number and after several rings and an approximate 4-minute wait time, I was transferred to an impersonal recorded voice informing me to listen closely as “their menu options had changed”.

By changed, this voice clearly meant they would run through all possible permutations of why an individual would contact their office in a 10 second span, ordering me to press any number from “1” to “9” in what I perceived as an aggressive and condescending tone. Of course, I found myself opting for the dreaded “press zero to repeat these menu options” option, as my hearing skills and cognitive abilities did not measure up to their expectations

After finally being patched through to a live individual, I then begged to schedule a new appointment to have my abominable mole evaluated. “Dr. Dermatologist’s first available appointment is on July 15th. We have a cancellation for tomorrow at 11 a.m. if you can make it then.”

Stunned silence ensued, as I thought 1) July 15th? Really, that is the FIRST available time the doctor is available to see me, when there are not less than 15 other dermatologists in a quarter-mile radius from her office?; and 2) In order to see her tomorrow at 11 a.m., I would have to cancel all of MY OWN morning appointments, and that would not go over well with my owners!

So I did what any other accepting human being would do and took the first available appointment and then cold-called about five other dermatology offices in my area. The EARLIEST available appointment with a doctor was AUGUST!

So I did what any other accepting human being would do and settled on taking the first available appointment with a physician’s assistant early next week.

When owners call our hospital — which, I would venture, are for non-critical, yet emergent appointments — we do everything to fit that pet in the same day. Pets newly diagnosed with cancer are offered appointments as soon as they call, often even on the same day.

True emergencies are referred to our wonderful critical care doctors, mainly because we know that there is no room to make those pets wait even just the ½ hour to an hour that I would need to finish up another appointment before seeing them.

Owners are never patched through to an automated answering service and if the phone rings more than twice before someone picks up, it’s probably because the receptionists is temporarily working alone, and helping another distraught client check in or check out.

Why is there such a difference in the expectation for veterinarians as compared to our own health? Why do we accept less timely and impersonal care for ourselves, yet the demand we have for our pets is so high?

I think the question speaks volumes to the state of healthcare in our country right now. And I have such mixed emotions when owners say, “I wish I had a doctor who was as easily accessible as you.”

Truthfully, after my experiences trying to make a simple appointment today, so do I.
 
 

Dr. Joanne Intile
 
 
Image: Kati Neudert / via Shutterstock
 ]]> http://www.petmd.com/blogs/thedailyvet/jintile/2013/june/waiting-for-doctor-right#comments TheDailyVet Wed, 05 Jun 2013 11:00:00 +0000 30422 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/pmahaney/2013/june/amazing-stories-of-animals-who-survived-ok-tornado-2013  

Upon moving to Indiana from Rhode Island as a kindergartner, I never expected to routinely partake in tornado drills. Although my family never directly suffered any major loss from some of the storms that shook our windows and knocked limbs off of trees in suburban Indiana, the memories of such experiences remain today.

The recent tornados striking Moore, Oklahoma brought back memories of the seemingly inescapable fear associated with nature’s brutal force. As I now live in southern California, I’m faced with a whole different brand of natural disasters (earthquakes, wildfires, mud slides, road rage, etc.). I’m not faced with the unsparing meteorological force of tornadoes.

Yet the media’s coverage of the aftermath made me feel like I was right there. The day after disaster struck, a CBS Evening News reporter spoke to Barbara Garcia, who told the harrowing story of enduring the tornado and then losing her "little dog" Bowser (also known as Bowsie) to the storm. The assistant to the reporter had a very keen eye in noting some movement among the rubble. Moments later the rubble constraining an alert and determined Schnauzer was cleared and the fortunate pooch emerged, seemingly unharmed.

CBS news reporter Anna Werner shot a follow up video up with Garcia, who shared the good news that Bowsie was fine, but circumstance prevented him from getting any medical attention. "I was going to take him to the vet," Garcia said, "but money is an issue. Nobody has any money. I can’t get [money]. My bank is closed. I have no checks. I have no I.D. I have nothing. I even had to borrow a pair of my friend’s reading glasses."

Fortunately for Bowser and Garcia, Werner said that many good-hearted people heard of their situation and are helping the duo get back on their feet.

Another remarkable story emerged when a cat was discovered after having been missing for six days since the tornado. Dallas Morning News reported that 13-year-old Justin Hulme Rangel discovered Egor, a 13-year-old feline, who was thought to be permanently lost by his owners, Geoff and Jo Humann. Egor was found trapped in his litter box in the remains of the Humann’s home. Rangel found the litter box squeezed against a table, looked inside, and found Egor. Rangel stated, "I figured after six days, he was gone. But he started to move and we dug him out."

Oklahoma Department of Agriculture Food and Forestry’s pet triage performed Egor’s initial evaluation, then he was transferred to the Oklahoma State University College of Veterinary Health Sciences Teaching Hospital.

Dr. Danielle Dugat, who cared for Egor from the start, speculated that moisture provided by rain may have permitted Egor to survive so many days without access to familiar water sources. Dugat said, "Honestly, he looked good despite the fact he was dehydrated. He was still looking around and was very bright but very weak."

petMD is doing its part in "Helping Pets in Oklahoma" by sharing information on:
 

The efforts of the Bella Foundation to help tornado victims through volunteerism and donation of supplies.

Hill’s Pet Nutrition Disaster Relief Network, which donated pet food and bowls to organize outlets for distribution to dogs and cats in need.

The Blogger Disaster Response Network, a collaboration between BlogPaws, WorldVets, and the American Animal Hospital Association (AAHA).

 
Disasters like the Moore tornado always reinforce the need for pet owners to have a disaster preparedness plan. My top recommendations include:
 
Properly Identifying Your Pet
 
Safely returning home is more likely to occur if the lost pet wears up to date identification. Fit your pets with a cervical (neck) collar tagged or embroidered with at least their names and your phone number, e-mail, and address.

As collars and tags can fall off or be removed, have your veterinarian implant a microchip into your pet’s subcutaneous (fat) space.
 
Knowing Your Pet’s Location
 
The urgency of an emergency may cause your pet’s location to be unknown. Cats and small dogs escape stressors and harmful situations by seeking refuge under a bed, in a closet, or in another safe spot (as Egor did in his litter box). Larger dogs typically have a more obvious presence, but they can instinctually flee from any scene unbeknownst to their owner.

Always be aware of your pet’s location in your house, yard, or public space. Knowing a pet’s habits, including preferred locations for napping, nesting, or hiding, can improve the likelihood they’ll be found.
 
Securely Transporting Your Pet
 
Natural disasters often force people and pets to suddenly flee their homes. To ensure our pets’ in-flight safety, it’s important to have a means of providing secure transport.

Use a rigid or soft airline-approved carrier for cats and small dogs. The name, species, color, breed, and weight of your pet, along with your contact information, should be clearly featured on the carrier. For medium and large breed dogs, use a cervical collar or chest harness and leash.
 
My well wishes go out to all of the human and animal families of Oklahoma experiencing hardship after the Moore tornado.
 
 

Dr. Patrick Mahaney
 
 
Image: Simon Law / via Flickr
 ]]> http://www.petmd.com/blogs/thedailyvet/pmahaney/2013/june/amazing-stories-of-animals-who-survived-ok-tornado-2013#comments TheDailyVet Tue, 04 Jun 2013 11:00:00 +0000 30406 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/lhuston/2013/june/feline-hyperthyroidism  

This excess thyroid hormone has a number of effects on your cat’s body. Symptoms commonly seen in cats with hyperthyroidism include:
 

An increased appetite (sometimes described as a voracious appetite)

Weight loss (often despite an increase in appetite)

Increased thirst

Increase urination

Vomiting

Diarrhea

Restlessness/hyperactivity

 
Besides these symptoms, several other complications can occur in cats suffering from hyperthyroidism. Heart disease can occur as a result of the toxic effect of the circulating thyroid hormones on the heart. High blood pressure (hypertension) is another potential complication.

Kidney disease is also commonly diagnosed concurrent with hyperthyroidism in cats. Cats suffering from both diseases may need treatment for both and the diagnosis of kidney disease in a cat with hyperthyroidism can affect the cat’s prognosis.

There are several options for treatment of cats with hyperthyroidism.
 

Radio-iodine treatment, or I131 treatment, uses radioactive iodine to kill the diseased tissue in the thyroid gland. Most cats undergoing I131 treatment are cured of the disease. However, these cats must be monitored for hypothyroidism after treatment.

Surgical removal of the diseased thyroid gland is another potential treatment. Like I131 treatment, surgical treatment is curative but these cats also must be monitored afterward for hypothyroidism.

Medical treatment with methimazole is probably the most common treatment choice. This medication can be administered by mouth or can be formulated into a transdermal gel which can be applied to your cat’s ear. Methimazole is effective in controlling the symptoms of hyperthyroidism. However, it does not cure the disease and, if this treatment option is elected, your cat will need to receive the medication for the rest of his life.

Feeding a diet restricted in iodine is a newer alternative for treatment of feline hyperthyroidism. Like methimazole treatment, this alternative is not curative and your cat will require lifelong treatment.

 
According to Dr. Ellen Behrend, who presented some new facts and knowledge about feline hyperthyroidism at the 2013 American Animal Hospital Association conference, cats undergoing curative alternatives for hyperthyroidism (I131 or surgical treatments) tend to have longer survival times than those cats undergoing medical or dietary therapy alone. This finding is particularly important for cats that are diagnosed with hyperthyroidism at a younger age.

Another finding that Dr. Behrend reported is that compensatory hypothyroidism is more common in treated cats than previously believed and treated cats need to be monitored accordingly. She also mentioned that correcting compensatory cases of hypothyroidism where applicable can improve kidney function and help resolve some cases of kidney disease, in turn giving these cats a higher quality of life and potentially prolonging their lives.

Another potentially more disturbing finding reported by Dr. Behrend is the possibility that sarcomas, an aggressive form of cancer, may be responsible for more cases of feline hyperthyroidism than previously reported. This finding was reported in one study and needs further validation and exploration. At this point, the significance of the finding is questionable and we’ll have to wait to see whether further research supports the findings in this study. Hyperthyroidism caused by sarcoma of the thyroid gland could be significantly more difficult to treat than that resulting from other causes and this finding raises serious concerns about survival rates for these cats.

Have you had a cat that suffered from hyperthyroidism? How did you elect to treat the disease? We invite you to share your experiences.
 
 

Dr. Lorie Huston
 
 
Image: Alexey U / via Shutterstock
 ]]> http://www.petmd.com/blogs/thedailyvet/lhuston/2013/june/feline-hyperthyroidism#comments TheDailyVet Mon, 03 Jun 2013 11:00:00 +0000 30392 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/aobrien/2013/may/when-horses-choke-what-to-do
Choke in humans is caused by something lodging in the trachea blocking the airway. Choke in horses is caused by something lodging in the esophagus. A choking horse can breathe, but a choking horse cannot swallow.The primary cause of choke in horses is a lump of poorly chewed food. Horses that “bolt” their feed, meaning they eat too fast, are at risk of choke as they try to gulp down as much feed as quickly as possible. Older horses with poor dentition and the inability to properly chew their food are also at risk. Certain types of feed can also predispose a horse to choke. Pelleted feeds are the worst culprits, as these compressed pellets tend to be very dry and then expand a certain amount when exposed to moisture.A choking horse is pretty easy to diagnose based on clinical signs. The horse is usually, and understandably, anxious, and while standing still will be tense with its neck extended, trying repeatedly to swallow. Sometimes they have the appearance of gagging. They are usually drooling and may be seen playing in the water bucket. Sometimes, feed and saliva are coming out of the nose. Usually, you cannot feel the lodged mass along their neck — heavy musculature prevents this from being palpated.The most important thing to do with a choking horse is sedate it and let it relax. Sometimes, merely the act of drug-induced relaxation is enough to calm the spasming esophagus so that the bolus can pass. The next step is to pass a nasogastric tube. The “stomach tube,” or NG tube, is a long plastic hose that is inserted very carefully into the horse’s nostril and passed into the esophagus. With a case of choke, the tube will only go so far until it hits the obstruction. Then the fun starts.With the tube placed, you attach a funnel to the end and start pouring water down the tube (don’t worry — with the tube in the esophagus, you aren’t going to drown the horse). When the water reaches the obstruction, it will stop. Then you empty the tube. This gradual process will begin to soften the lodged lump until finally, sometimes after an hour of this, the water will finally go all the way to the stomach and then you have a little celebration party because your poor arms are in danger of falling off from holding the funnel and hose up above your head.After you unblock the obstruction and sternly tell the sedated horse to stop being such a pig and CHEW the food before swallowing, you’ve got some medication to give. Firstly, the horse’s throat will greatly benefit from some pain medication to relieve the inflammation that the obstruction and your tube have caused. Secondly, always always always place the horse on a round of broad-spectrum antibiotics. Choking horses are at risk of developing aspiration pneumonia, as it is so easy to accidentally inhale a bit of food or icky gooey saliva during the time when the horse cannot swallow. And no one wants to fight a case of aspiration pneumonia, because you normally lose.Thirdly, before you hop in your truck to go home, advise the owner not to feed the horse for about 24 hours. This allows the throat some time to rest. Then they will need to slowly ease the horse back to food by first offering only the mushiest, wettest bran mash they can create. No hay and no dry feed for a few days, and then slowly introduce these back into the diet.For prevention, if the horse is a piggy eater, try placing some large stones in the feed bucket. This forces the horse to slow down and pick around the rocks instead of just taking huge chunks of feed and gulping them down. For older horses, sometimes dental care every six months is necessary to maintain a somewhat healthy mouth. Horses prone to choking shouldn’t be fed pelleted feed.     Dr. Anna O’Brien ]]> http://www.petmd.com/blogs/thedailyvet/aobrien/2013/may/when-horses-choke-what-to-do#comments TheDailyVet Fri, 31 May 2013 11:00:00 +0000 30301 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/ktudor/2013/may/opting-out-of-rabies-vaccinations  

The hope is that these letters will prevent exclusion from services such as air travel, boarding and day care, grooming, and most importantly, licensing, despite the lack of vaccinations. What is interesting about this phenomenon is that it is increasing despite the fact that vaccination protocols in pets are commonly every three years instead of the old yearly protocols.
 
The Legal Right to Opt Out of Vaccinations
 
There is no legal requirement for pets to be vaccinated for diseases that protect their health. Vaccines that help prevent the common well known infectious diseases of cats and dogs were all developed to improve the health of pets and reduce the contagion of these major diseases.

Because pets are considered property, it is the owners’ right to determine the level of health protection they wish for their pets, and they are free to choose which vaccines they want or whether to vaccinate at all. It is also the right of any business, even veterinary hospitals, to deny services to unvaccinated animals in order to protect the health of other pets and patients. More and more pediatricians are denying service to parents that have opted out of vaccines for their children. These doctors fear potential waiting-room contagion in other yet-to-be vaccinated children or those that may have yet to develop full immunity.

Immunity is not necessarily established after one or two sets of vaccines (also a subject for a future blog) in humans or pets. Also, many diseases in humans and pets are on the rise again due to parents and pet owners opting out of vaccinations against these diseases.

All veterinarians agree that there are occasions when vaccines can be delayed until a pet’s condition is resolved or improved. But absolving an animal from all future vaccinations simply because it is has a chronic condition or is old is questionable. There is no hard, universal evidence that vaccinations are detrimental to these animals or that they will cause disease or cancer. In fact, unvaccinated infirm or geriatric animals may be at higher risk if exposed to contagious diseases.

Vaccine reactions most commonly occur in younger pets, not in older, ill pets. Animals that have had previous allergic episodes can generally be pretreated with medication to prevent or minimize vaccine reactions. With the exception of previous, vaccine-specific anaphylactic reactions (life-threating systemic failure), opt out letters are not appropriate for animals with a history of allergic vaccine reactions.
 
Rabies and Pet Licensing
 
Rabies vaccines are not given to pets to protect the animal, they are given to protect humans. Public health departments, the agencies that determine rabies vaccine protocols, are only concerned about the welfare of humans, hence all of the regulations regarding rabies vaccines, especially in dogs. These regulations are not without reason. With the exception of three children in recent years, rabies is always fatal once a human begins to display symptoms. The American Veterinary Medical Association reports 55,000 annual deaths worldwide due to rabies and 1-2 deaths annually in the U.S. Skunks and bats are the leading vectors of rabies in the U.S. In some areas fox and coyotes are also a threat. Because many states classify cats as wanderers they are not subject to public health laws related to rabies except in individual jurisdictions. This short story will demonstrate why this is a problem.

I have always required that my patients have a current rabies vaccine in order to protect my staff, in case they are bitten by an uncooperative pet. I had a client who insisted that she would not comply and I politely refused her further veterinary services. Two years later she came back to the practice somewhat apologetic. It happened that a bat flew into her apartment and bit her two unvaccinated cats. The bat was found to be rabid. The cats were immediately vaccinated and all turned out well. What might have happened if the bat had escaped without her knowing that it bit the cats?

There is no evidence that a rabies vaccine every three years will harm older or chronically ill pets. Research indicating the association of vaccines, particularly rabies vaccines, and fibrosarcoma in cats has yet to prove a cause and effect.

With rare exceptions, opt out letters are not appropriate for rabies vaccines.
 
 

Dr. Ken Tudor
 
 
Image: Byelikova Oksana / via Shutterstock
 ]]> http://www.petmd.com/blogs/thedailyvet/ktudor/2013/may/opting-out-of-rabies-vaccinations#comments TheDailyVet Thu, 30 May 2013 11:00:00 +0000 30340 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/jintile/2013/may/choosing-a-career-path-in-veterinary-medicine  

Unlike some of my peers who knew exactly what they wanted from the minute they entered the clinics, the decision wasn’t simple for me. Each option had proverbial pros and cons and benefits and drawbacks. I wasn’t entirely sure how to proceed.

Career indecision wasn’t really a new concept for me. Although I’ve wanted to be a veterinarian for as long as I can remember, the “kind” of vet I wanted to be evolved as I aged.

As a very young child, I wanted to be a vet who treated only puppies and kittens. I’m not sure exactly when I discovered this idealistic notion of what a vet did was not even close to being true, but once it did, I know my goals started to change a bit.

As a “horsey” kid growing up on Long Island, I spent my pre-teen years dreaming of being a racetrack veterinarian. After realizing the thoroughbred racing industry wasn’t nearly as akin to the glamorous world of the Black Stallion novels as I once thought, once again I found my romantic notions of veterinary medicine shifting.

I spent time contemplating a career as a zoo vet or conservationist, but as is true for so many things in life, things eventually came full circle, and by the time I was accepted to veterinary school, I decided I would be a general practitioner and spend my days treating companion animals.

This was, of course, before I knew what specialty veterinary medicine entailed. Once I started vet school, I was exposed to a caliber of medicine not unlike what is available for my own health. Specialty medicine appealed to my intellectual side and my creative side. After a few years I knew it was the path I wanted to take.

I struggled with what would be the ideal specialty for me to pursue. Truthfully, oncology was the furthest from my mind. One of my biggest concerns was the astronomical amount of finances directed towards saving the life of only one dog or cat, as compared to what could be spent towards helping so many animals in a shelter or rescue organization.

It’s not unusual for owners to spend $5,000 or even $10,000 when treating a pet with cancer. Some owners will spend $20,000 or more on pets treated with surgery, radiation therapy, and chemotherapy. Of course I recognize this is not even close to an option for the vast majority of people, but for a small group of pet owners, there is literally no price to be put on their pet’s healthcare.

I’ve been thinking a lot about the disparity in the different “fields” of veterinary medicine. Some racehorses are worth millions of dollars as unproven yearlings and there are immense expenses related to their veterinary care. I routinely recommend treatments costing several thousands of dollars for a single animal, knowing I’m not likely to cure them of their cancer, but I’m typically able to extend their lifespan by months to years. Even “routine” veterinary care for dogs and cats can run into hundreds of dollars per visit to the vet. Yet there are so many pets in shelters who may never be afforded the chance for advanced treatment should it arise, or worse yet, are put to sleep for lack of space, or for a treatable, but expensive, medical condition.

As veterinarians, I think we each struggle with the reality that we simply cannot save every animal, and I still battle with the financial aspects of my chosen career more often than I would like. Maybe it’s more pronounced in a field such as oncology, but it’s not at all exclusive to my chosen specialty.

Is it wrong for an owner to spend the same amount of money on one pet that could be used to help so many more? Everyone will have his or her own convictions when answering this question. Until you are in the position of having to make that actual choice, I think it’s best not to respond at all as your answer could be very surprising under different circumstances.

Just as my career goals changed over time, so may a person's opinion on the “value” of a pet, especially if it were your own animal you were making that decision about.
 
 
 
Dr. Joanne Intile
 
 
Image: DmitriMaruta / via Shutterstock
 ]]> http://www.petmd.com/blogs/thedailyvet/jintile/2013/may/choosing-a-career-path-in-veterinary-medicine#comments TheDailyVet Wed, 29 May 2013 11:00:00 +0000 30325 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/pmahaney/2013/may/lyme-disease-tragic-effects-on-pets-and-us  

I treated Lyme disease — a bacterial disease caused by Borrelia burgdorferi — many times while living in Washington, D.C., but never in Los Angeles. As the warm and dry climate of Southern California doesn’t support the life cycle of the tick as well as the seasonally warm and humid climate of the East coat, the majority of my patients rarely are bitten by ticks or contract tick-borne diseases. Yet I still recommend the use of anti-ectoparasite products and making lifestyle choices to prevent illness-spreading bugs from getting onto our pets. What you may not know is that we also must take certain precautions when dealing with this potentially life-threatening and often chronic illness.

I lived in East Lyme, CT as a child but was fortunate to never come down with the disease during my time there or in other tick-endemic areas. My brother was not so lucky. He had a mild case of Lyme Disease as a child, but fully recovered. A good friend and fellow pet-media colleague, Nikki Moustaki, was also not so fortunate. She still endures the daily struggles of managing the chronic illness of Lyme Disease.

On so many occasions, I’ve seen the clinical signs of fever, lethargy, muscle and joint soreness, decreased appetite, and others in dogs, but I’ve never diagnosed nor treated a person. So given that May is Lyme Disease Awareness Month, I reached out to Moustaki to learn of her first-person experience enduring the hardships associated with Lyme Disease.
 
1. What were the first clinical signs of Lyme Disease you experienced and are they still occuring?
 
About three days after the tick bite (which I thought nothing about, having been bitten by dog ticks many times, not realizing it was a deer tick), I contracted what I thought was the flu. After seven days I got a little better, but then got worse again. I know now that this symptom was not due to the Lyme Disease, but was due to one of the co-infections I caught along with Lyme: Colorado Tick Fever, which is a self-resolving virus. After about two weeks I started to feel better. Then, one morning I woke up feeling terrible. I tried to get up and realized that I was paralyzed on the left side, blind, and could not speak. I could think, but my body wasn't working. Those were the most dramatic symptoms, which resolved as the day went on. I dragged myself to a neurologist, who said there was nothing wrong with me.

After that, my symptoms included profound fatigue, migraines (lasting 10 months), visual disturbances, weakness on the left side, brain fog, inability to access language, inability to type (words came out jumbled), very loud ringing in the ears, trouble balancing and walking, tremors, seizures, creaky neck, wooziness, insomnia, memory loss, inability to concentrate, hallucinations, stammering/difficulty speaking, numbness in left hand/inability to use left hand, forgetting how to perform everyday tasks, getting lost in areas I was familiar with, low body temperature, and heart palpitations, among others. My case is all neurological, so they call it Neuroborreliosis, because the Lyme bacteria, which is a spirochete (shaped like a spiral), is called Borellia.

After 18 months of treatment, I have golden days, sometimes weeks now, where I feel kind of normal. Not perfect, but not horribly sick. For the most part I still struggle with symptoms, but now it's six to eight symptoms rather than thirty. I was also diagnosed with Rocky Mountain Spotted Fever, Relapsing Tick Fever, Cat Scratch Fever, Thypoid Fever, and Colorado Tick Fever. These are just a few of the "bonus diseases," the co-infections, that many Lyme Disease patients contract from the initial tick bite. I still have symptoms from the Cat Scratch Fever (Bartonella) — that's another infection that's difficult to treat and eliminate.
 
2. What were the treatments for Lyme Disease you received and were they successful?
 
It took nine months and 17 doctors (including three emergency room evaluations) to achieve my diagnosis of Lyme Disease, an illness that should be far more widely understood among doctors but is not. Veterinarians know much more about this disease. I finally found a Lyme-literate physician who easily diagnosed me with Lyme. Before that, I had been taking a variety of medications for misdiagnosed illnesses.

I started with five months of Doxycycline and improved a lot, but not without copious suffering. With Lyme, you don't just "get better." You get worse before you get better, a phenomenon called the Herxheimer reaction (or Herx), also known as a healing crisis.

I did some intravenous antibiotics and infusions of vitamins for several months. Then I started on a combo of Azithromycin and Ceftin, and have been on those for nearly a year. When I try to go off of them, I'm back in bed, unable to function, within three days. The meds are obviously keeping some bacterial activity at bay, but they aren't really killing the bugs entirely. I have also pulsed these antibiotics with Metronidazole (Flagyl), which is supposed to bust the cysts that the Borellia bacteria create to protect themselves. I did get a little better when I was doing that, and may do it again.
 
3. Have you ever had a pet infected with Lyme Disease?
 
All of my dogs get yearly testing for Lyme and have all been negative, but I suspect that my darling Pepper, who has since passed away, had Babesia (another tick-borne bacteria) and was never treated for it.

I feel so sorry for dogs with Lyme because they can't tell their owners how bad they feel. I can only hope that most veterinarians are up-to-date on the signs of this illness in pets.
 
4. What is your advice for people who are infected with Lyme Disease?
 
The one thing that Lyme patients need to have in excess is patience. This is a very difficult infection to cure once it has gotten into your brain and joints. Also, you're lucky if you can find a doctor to treat you in the proper way — many doctors don't even believe that this disease exists, if you can fathom that. It exists in all of the lower 48 states and in many other places in the world.
 
 

Dr. Patrick Mahaney
 
 
Image: Bork / via Shutterstock
 ]]> http://www.petmd.com/blogs/thedailyvet/pmahaney/2013/may/lyme-disease-tragic-effects-on-pets-and-us#comments TheDailyVet Tue, 28 May 2013 07:00:00 +0000 30321 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/lhuston/2013/may/preventable-illnesses-on-rise-in-cats  

There are some very troubling statistics regarding cats and their health.
 

Obesity has increased with 58% of all cats reported to be either overweight or obese. Even more disturbingly, many cat owners are unable to recognize that their cat has a weight problem. The majority of cat owners with overweight or obese cats believe their cats to be within a normal weight range. Even more disturbingly, many people are amused by the image of a fat cat. Too often, the health risks involved with increased weight are overlooked or ignored by cat owners.

As a result of the weight issue, diseases like diabetes are on the rise as well. The incidence of diabetes in cats has increased by 16%, affecting roughly 64 of every 10,000 cats.

Dental disease also is a major problem for many cats. The majority of cats (70%) exhibit some degree of dental disease by three years of age. If left undiagnosed and/or untreated, the cat’s mouth will only get worse with age. Dental problems can be quite painful for an affected cat. Dental disease can easily impact your cat’s quality of life.

Fleas also are being seen more commonly in cats, with a 12% increase in the number of cats diagnosed with fleas. Fleas can cause a variety of problems for cats. Cats with flea allergies can become extremely uncomfortable as a result. Fleas can also carry parasites and other diseases that can be transmitted to your cat. Similarly, internal parasites are more common now as well.

 
These statistics are particularly worrisome because these are diseases that are preventable with proper health care. Unfortunately, the number of cats visiting their veterinarian for an examination has decreased in recent years. Cats as a species see their veterinarians much less often than their canine counterparts.

Many cat owners mistakenly believe that routine veterinary visits are not necessary for their cat and only bring their cat to their veterinarian when symptoms of illness occur. One of the problems with that strategy is the fact that cats are masters of disguise when it comes to illness. Symptoms, depending on the disease, can be so subtle that even the most observant cat owner may not immediately notice. By the time the symptoms become obvious, it may be much more expensive to treat the cat. Worse, it may even be too late to save the cat in severe instances.

What can you do to protect your cat?
 

Schedule regular veterinary checkups for your cat. Your cat should have a thorough examination at least once to twice a year. Cats with chronic illnesses may require more frequent examinations.

Feed your cat a quality diet and keep your cat lean. Avoid overfeeding so that your cat does not become overweight.

Talk to your veterinarian about what you can do to care for your cat’s teeth. Even if your cat will not allow brushing, there are options that can help.

Use a safe effective flea and tick product to keep these pests away from your cat.

Have your cat’s fecal sample checked periodically and take appropriate measures to control intestinal parasites.

Talk to your veterinarian about whether your cat needs heartworm prevention as well.

 
Being proactive with your cat’s health by practicing preventive health care will not only ensure your cat a longer, happier life but also will save you money in the long term.
 
 

Dr. Lorie Huston
 
 
Sources:

Banfield State of Pet Health Report, 2012 National Pet Obesity Survey
 
 
Image: hoogmoet / via Flickr
 ]]> http://www.petmd.com/blogs/thedailyvet/lhuston/2013/may/preventable-illnesses-on-rise-in-cats#comments TheDailyVet Mon, 27 May 2013 11:00:00 +0000 30319 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/aobrien/2013/may/urinary-stones-in-goats-and-small-ruminants  

Whoever was in charge of the design of a male small ruminant’s lower urinary tract should be fired. Firstly, the shear length of the male goat’s urethra is enough to increase risk of blockage. Secondly, there is an incredible hairpin turn in the urethra after leaving the kidneys, a prime location for things to get stuck. Thirdly, a little something called the urethral process is a popular hang out for stones (more on that later). Fourthly, castration prior to the onset of puberty (which is usually the case in goats and sheep) prevents dilation of the urethra to its full mature diameter. All of these aspects of the male small ruminant anatomy set them up for collecting urinary stones.

What, then, so readily causes urinary stones in small ruminants?

Dietary imbalance is the most common cause of urinary stones in goats and sheep. Too much grain and too little roughage, such as grass and hay, throw minerals such as calcium and phosphorous way out of whack and they begin to coalesce as sludge in the urine, a sludge that then binds together to form stones, in some cases like that way an oyster builds a pearl. Unfortunately, since many sheep and goats are raised for meat in the U.S., most young stock are fed high concentrate diets to quickly fatten up.

The hallmark sign of a “blocked” goat or sheep is straining. However, this often appears to the owner as constipation. Large animal vets learn very quickly that an ER call concerning a constipated male sheep or goat is actually an animal with urinary stones.

The first step in helping these animals is examination and then amputation of the urethral process. The urethral process is an anatomical structure unique to small ruminants. It is quite literally the end of the urethra that sticks out beyond the penis — again, whoever designed these creatures at least deserves a demotion. The trouble with the urethral process is that it is narrow and therefore a very common place for obstruction. A blockage at this point in the urinary tract causes the urethral process to appear dark in color and swollen.

After sedation and local anesthesia, the urethral process should be removed. If the animal is lucky, this removes the source of the obstruction and urine flow is restored. My first case of urinary obstruction happened this way and will forever be etched in my mind because when I confirmed urine flow after amputation, I got a strong stream of goat urine right in my eye! (I’ve learned to point things AWAY from my eyes since then.)

If urine flow is not restored, then things look bleaker. This means the obstruction is higher up, such as in the hairpin turn I mentioned earlier, or even in the bladder. There are a few surgical options, but none are really permanent fixes. They each have complications and management issues. Oftentimes, if we can’t restore flow after urethral process amputation, euthanasia becomes the only real humane option.

Prevention is extremely important for urinary calculi in small ruminants. For farmers feeding livestock on high grain diets, I stress the importance of obtaining a proper balance of calcium and phosphorous and encourage adding a urine acidifier such as ammonium chloride to help prevent the formation of stones. On a visit to a new goat or sheep owner, I try to remember to show them my tube of urinary calculi to impress upon them the important of prevention.
 
 

Dr. Ann O’Brien
 
 
Image: Dudarev Mikhail / via Shutterstock
 ]]> http://www.petmd.com/blogs/thedailyvet/aobrien/2013/may/urinary-stones-in-goats-and-small-ruminants#comments TheDailyVet Fri, 24 May 2013 11:00:00 +0000 30296 at http://www.petmd.com http://www.petmd.com/blogs/thedailyvet/ktudor/2013/may/consumer-pressure-changing-livestock-production
 
Cattle Production Standards
 
Dr. Temple Grandin, the pioneer in humane handling and slaughter practices, observes that “when livestock are brought to a slaughter plant today, they are less agitated, less often shocked with prods, and more likely to have a humane death than they were prior to the late 1990s.”

Much of this is owing to Dr. Grandin’s revolutionary designs in cattle handling and processing equipment. If you have not seen the movie Temple Grandin I urge all of you to do so. Through her kinship with the emotions of livestock she was able to meet the challenges of her own autism while adjusting to college life, later translating that into designs and techniques for handling cattle and other livestock. Her insights are the theory behind the popular pet clothing designed for decreasing anxious and fear behavior in pets.

As the author of the animal welfare standards for the Meat Institute Foundation, Dr. Grandin feels meatpacking plants are meeting humane standards. These plants still face challenges from livestock producers that ship old, lame or cattle unaccustomed to close human contact. Often the stress of shipping compounds the “wild fear” these animals already have. But she notes that just as large retailers, responding to their customers, have pressured positive changes in meatpacking practices, the meat packers are applying pressure to improve conditions at their suppliers’ farms.

Dr. Jennifer Walker, the director of dairy stewardship at Dean Foods, is working on the development of a welfare program for dairy cows that could be used throughout the dairy industry. The concept is to set the bar much higher for the standards of conditions so that producers who do not comply may find limited markets for their products, and will view compliance as a major brand move to protect their reputation among consumers.

The National Milk Producers Federation has recently implemented the Farmers Assuring Management Program. Its goal is to provide a data bank of dairy practices to stimulate improvements that can translate to quality assurance for product retailers. Presently 70 percent of the milk produced in the U.S. comes from dairies participating in this program.
 
Pork Production Standards
 
The National Pork Board’s director of animal welfare, Sherrie Niekamp, indicates that the major pork meatpackers are requiring swine producers to participate in the Pork Quality Assurance Plus certification program. The program requires on-site evaluations to identify needed improvements and compare quality with the program’s expectations.

As an example, this program has “shown farm employees that they can move swine through barns and onto trucks more quickly and without electrical prods by changing the lighting and bringing five or six at a time rather than 20.”
 
Poultry Production Standards
 
The United Egg Producer Certified program has “made a major difference in the housing and welfare of birds,” said Gene Gregory, former president and CEO of the United Egg Producers. With the endorsement of restaurant and grocery trade organizations, 85 percent of eggs produced in the U.S. come from participating farms. Many of these producers are proud of their accomplishments and would not revert to old practices even if program guidelines were rolled back. Many producers have installed conveyor belts to catch manure and prevent in from falling on birds below. It also improves air quality for the birds and workers.

Veterinarians have known for some time that practices that promote greater welfare for livestock will improve their health and productivity. The increased cost of production was always the balking point from producers. Now that consumers have shown they are willing to pay for these higher costs in order to ensure the humane treatment of their food, meatpackers and producers are less resistant to change and are in fact leading the way. There is still much work to be done but this carnivore is pleased with the winds of change.
 
 

Dr. Ken Tudor
 ]]> http://www.petmd.com/blogs/thedailyvet/ktudor/2013/may/consumer-pressure-changing-livestock-production#comments TheDailyVet Thu, 23 May 2013 11:00:00 +0000 30300 at http://www.petmd.com