Your Pet's Best Friend

The Fur-Ball Tree Returns

  At this holiday time of year, we think about giving and receiving gifts, and about helping those in need.  Kennett’s Humane Officer, Tena Petix, has been going above the call of duty in helping the animals in her care.  Dr. Everett Mobley and Dr. Carol Brigance and the team at Kennett Veterinary Clinic are helping her help again this year with “The Fur-Ball Tree”, the pet’s version of an “angel tree”. 

During the month of December, you can bring a donation for the shelter animals to Kennett Veterinary Clinic at 1704 Saint Francis Street on the west end of Kennett.  Donations can be monetary, food, treats, towels, blankets, or pet-toys.  When you bring in a donation, your name will go up on the The Fur-Ball Tree, and you will receive a $5.00 credit toward your own pet’s next examination at Kennett Veterinary Clinic.

Last year in December of 2010, clients responded by donating generously,  and nine bags of pet food, twelve blankets, eighteen towels, a bushel of toys and treats, and $315.00 in cash were soon under the tree.  We’d love to see even more this year.

So help the animals (and help your own pet) by bringing a donation to The Fur-Ball Tree at Kennett Veterinary Clinic, on Saint Francis St., on the west side of Kennett.

Diagnostic Workup Success - that almost wasn't.

This is Molly.  A few days ago she was presented for an examination.  She had been limping a little the night before and just didn't feel well.

There was no lameness when she came in, but she didn't have much mojo.  She didn't seem in any distress really, just no energy.  She also had not wanted to eat much.  There was no fever, nothing seemed swollen or out of place, and I couldn't find a sore spot anywhere.

She lives in a fenced yard, so trauma didn't seem likely, even though she shares it with another pretty big dog.   There just wasn't really anything to put your finger on, but you could tell she was unhappy.

I was about to send her home with some anti-inflammatory medicine, thinking she might have slipped and made a bad landing in the mud the night before.  Then her owner said, "You know she usually chews on everything, but she doesn't want anything today."  I asked, "Everything, as in a lot of things that aren't food?"  She replied in the affirmative.

With that piece of information, I thought of all the dogs with foreign body intestinal blockages I have seen who had no specific outward signs -- they just didn't feel good. "Let's take an X-ray of that belly. We probably won't see anything, but I'd hate to miss a ridiculously obvious foreign object."  Okay, let's do it.

The abdominal X-ray looked normal, but there was a little bit of the chest on the film, too.  When I looked at the whole film, the chest part looked "funny" (funny-strange, not funny-haha).  We took pictures of the chest.

There was what appeared to be a significant amount of fluid in the chest.  That will make you feel bad.  We tapped her chest - it was blood.  Internal bleeding will also make you feel bad.  In your chest, it will squish your lungs and eventually keep you from breathing, even if you don't go into shock first.

Even though there was no history of exposure to rat-poison, we filled her full of vitamin-K (the antidote).  That stuff makes the dog a free bleeder, and bleeding into the chest (hemothorax) is not uncommon.  Since my associate is pretty knowledgeable in Chinese medicine, we also started the herbal preparation called Yunnan Baiyao, as it helps to get the body's own clotting mechanisms into high gear.

The alternatives to rat-poison were not happy ones: a bleeding tumor, some other abnormal structure that had begun to bleed, or some other heretofore unnoticed bleeding disorder in the dog.  All of those have a terrible prognosis, not to mention that referral to a surgical specialist was not in the cards.

Thankfully, Molly has responded well to treatment and seems about normal now.   Who takes a full set of X-rays every time a patient just "doesn't feel good"?  Nobody.  A chance remark, a look at the wrong place, and we got an accidental look at the right place.  And I almost sent her home with some pain-killers.  Serendipity, it's called.

Is there a good alternative to Immiticide treatment?

Eric writes:

Thank you for all the information regarding heartworm prevention and treatment. There is a lot of misunderstanding. We are an animal welfare group who took in a dog which tested positive for heartworms. The dog has received ivermectin weekly + doxycyline daily for two weeks, paused a week, and will receive another week of doxycycline.

A few studies conclude doxycyline + ivermectin kill adult heartworm: "Results indicate that the combination of these two drugs causes adult worm death." http://www.ncbi.nlm.nih.gov/pubmed/18433753 There is also internet talk of a "slow kill" method.

Do you have any advice for animal welfare groups or others with a budget that would not involve Immiticide? There are also such frequent shortages of Immiticide, it appears to be an annual event. Thank you.

For some reason, my reply is not posting to the original blog thread, so I am publishing it here.

Hello, Eric,

The American Heartworm Society has withdrawn its endorsement of so-called "slow kill" or "soft kill".

First, while some of the worms may die with long-term (like two years)administration of ivermectin and doxycycline, you cannot be certain of clearing the dog.

Second, the dog's problems with treatment arise from dealing with the death and movement of the worms within the pulmonary arteries.  We want to keep the dog's activity restricted until the dead worms have been dissolved by the body's defenders.

It takes at least five weeks for the dead worms to be cleared from the circulation.  With the Immiticide, we know when the worms will be dying (within a week), and can watch the dog accordingly. 

If you are treating long term with other medications, you would have to keep the dog's activity restricted for years, as you have no idea when (or if) the worms will be dying and moving.

The frustration with Immiticide shortage and expense is something I feel pretty personally.  While I have an adequate supply at present, I had none for several months.

My experience with humane organizations has been that resources are limited and must be allocated where they can do the most good.

When there was no indication that Immiticide would be available, the American Heartworm Society recommended monthly ivermecin (Heartgard, Iverhart, etc.) and 10 mg/kg of doxycycline twice daily for one month.  The doxy inhibits the Wohlbachia (beneficial symbiote of the heartworm)for an additional two months after giving it for one month.  Thus, they recommended repeating this at 3-month intervals.

If I were in a shelter environment, I would follow that protocol.  This is what one would do in the month prior to starting Immiticide treatment anyway.

The adopting owner just has to realize that he/she is taking on a bigger commitment when adopting a pet with heartworms.  There isn't a quick fix.

Thanks for reading and writing.

This wound looks worse than it is.

I saw this little kitty today for a very nice lady who wanted a second opinion.  Her cat received a big wound in the left flank about six days ago.  Her regular veterinarian sutured the laceration and sent her home with antibiotics.  That seems like a good plan.

She was upset because the wound is opening up now and it just doesn't look good to her.  She was even afraid it might open up and let the cat's "guts fall out".  That would be bad, I think you'll agree.

A little questioning reveals that the kitty seems to be feeling well and eating well.  That's good.  No fever when I checked her temperature.

A closer look at the wound lets us see that while it is open, there are no pockets of fluid around it and the wound is not deep.  The exposed raw tissue looks pretty healthy.  There are a few stitches present, but many appear to be missing.  And what's that black stuff in there?

I've talked about crushing injuries time and again (here and here).  I really believe what has happened here is that the wound edges were damaged in the initial injury.  The other veterinarian sewed it together nicely, but the tissue he sewed died.  Then it started falling off (the black stuff is dead skin).  Really, for that scenario, this looks pretty good.

The owner and I discussed our options.  I could certainly have made fresh edges on the wound and scraped it out and re-sewed it.  It would look nice, and I'm pretty sure it would have healed well.

On the other hand, I'm not sure that the cat would be any more comfortable and heal any faster than if I just put a bandage on to protect the tissue from drying and other trauma.  So that's what we did.

The owner was quite convinced that the other doctor had done the worst job in the world.  She hasn't seen a gazillion wounds like I have. 

The other doctor did what was technically appropriate, but he did do a poor job in letting the owner know what to expect.  Some of these things are not going to get totally fixed on the first visit.  She could have been happy with the first doctor with a little more communication.

Don't feel bad about asking your veterinarian for more information and clarification.  They won't think you're stupid - they'll just realize that they haven't done their job of explaining as well as they need to.

Seizures - Why? Is it time to start medicine?

I received an email with a question about seizures today

I have had my little chihuahua (female, about 4 or 5 years old, weighs approx. 7 lbs)---she is having seizures. Today she had 2 back to back, first time for that. I live in NM & the seizures have started about 18 months ago & seem to have been limited to the cooler temp. time. My vet said that not to worry about it, but I am. She urinates while seizing, her back legs totally go out, today all 4 went out & during the second seizure she fell over. I am worried. Do you have any information you can give me to help her?

I can only give you the general guidelines that I follow, as per what the neurologists have recommended to me. I am certainly not a neurologist, nor an internal medicine specialist.  Without actually seeing your pet, I cannot really give you definite advice.

Seizures are caused by something having a bad effect on the brain tissue, anything from head trauma to brain infection to a tumor to "idiopathic".  Idopathic means "self-caused", and what it really means is that we have no idea what's going on.  EEG, MRI, C-T scan all look okay, but the patient has seizures.  Epilepsy (which usuallly starts at a young age) comes under this category.

The brain is the body's "electrical switchboard". The form of the seizure can vary, depending on which area of the brain is affected.  One can see anything from altered behavior (staring at the wall), to loss of consciousness, to twitching of a single body part.  The most common types are tonic-clonic (very rigid, legs extended, head drawn back, muscles rigid and quivering), and convulsive (down, paddling and jerking with all legs).  These are often accompanied by emptying of the bladder and bowels.

Seizures typically go through three phases.  The actual seizure is referred to as the "ictus", so you have the pre-ictal, ictal, and post-ictal phases. 

In the pre phase, one can see that the patient is "not right".  They used to call this the aura in human medicine.  "Something's happening to me..."  This may last for a few seconds or longer.

Then the actual seizure occurs, with outward signs as noted above.  This can last seconds, minutes, even hours.  In very severe cases, the seizure will not stop without medical help, and the patient could die.  Seizures that do not stop within just a few minutes require emergency medical care.  When the seizure goes on for long periods of time, permanent damage may result.

The post-ictal recovery period is variable in length.  The patient is no longer doing the seizure activity, but they may be unconscious, or just very "out of it".  Gradually they return to normal function, going from  "Where am I? Who turned out the lights?" to completely normal in outward appearance.  With a first seizure this can all take place in such a short time that the dog is normal by the time people finish describing it to me on the telephone. 

It is not uncommon for the owner to rush the dog to the clinic, certain that he is dying, and find him bopping around the room having a great time by the time they arrive.  They have rushed in wearing their pajamas and the dog acts perfectly fine.  They feel like idiots, but it is just how the condition proceeds.  It's good that the dog (or cat) is okay, and we spend some time talking about how to monitor the condition.

Each seizure can cause additional damage.  Thus, while some dogs have one seizure and never have another one, the typical course is for the seizures to gradually become more severe, longer lasting, and more frequent.

Because of this, some neurologists have recommended starting anti-convulsant medicines if a dog has had three seizures, no matter how far apart they are.  While this may prevent further damage, it seems a bit much to start twice-a-day, every day, medicine if a dog is having a mild seizure lasting 10 seconds, once every year or two.

We always start by checking a blood chemistry panel to be sure that there are no obvious problems with liver, kidney, blood sugar, or electrolytes.  If this is normal, I ask the owner to keep a log, noting every seizure's date, form, length, time to full recovery, and the circumstances that preceded the seizure.  The log allows us to make a more objective determination about whether the condition is getting worse.

If seizures are coming frequently (every couple of months), if they are severe, if they are long-lasting (minutes), if they won't stop without medical treatment, or if we have cluster seizures, we start anti-convulsant medicines.

A cluster seizure means that you are having multiple seizures in a day, or seizures daily for a few days.   This is always an indication to start medication, in my opinion.

Does two seizures in a day constitute a cluster?  I can't answer that without looking  at the whole case.

Once you start medication, you will continue giving it daily (maybe twice daily) from now on.  After you've been on it for a couple of weeks, you'll bring the pet in to check the blood levels of medication.  This will have to be monitored periodically.  The pet will need to be examined twice yearly (at least) in order to legally continue prescribing controlled substances (drugs like phenobarbital, the most commonly used anti-convulsant drug).  Aside from being good medicine, it is a legal requirement.

Most seizure patients can achieve good control of their problem with minimal side effects.

Grassbur (Sand bur) pick-up: easy and fun

Necessity is the mother of invention, but ingenuity is the daddy.  Sometimes little triumphs can give you a lot of pleasure.

The KVC exercise yard and front lawn have become infested with grass burs (also known as field sandburs).  Patients are picking them up for me, but they don't like it, and neither do I.   Spending twenty minutes picking the burs out of a fuzzy dog is no fun for the dog or anybody else involved.

You can find lots of advice on eradicating the plants, using fertilizers, lawn builders and pre-emergent herbicides.  Okay, fine.  What about the gazillion burs that are already all over my property?  The pre-emergent herbicide is supposed to keep them from germinating next year and multiplying the problem.  Even if I believe that, how am I going to keep my patients from getting covered with the ones that are all over right now?

Some years ago when I had the problem, I sewed an old worn-out blanket into a tube, put a piece of PVC pipe through the middle to weigh it down, and dragged it across the yard.  It worked pretty well then, but it was a bust this time.  I used two blankets, picked up a lot of burs, but you can't tell the difference.

For a moment I had the unworthy thought of borrowing a bunch of fluffy dogs and chasing them around the yard.  Then I thought of buying fluffy slippers for the staff, but they would fill up with burs so fast that you wouldn't get much done.

Then I had the idea of the week: disposable fluffy slippers.  We got some fuzzy fabric remnants and I cut them into shoe-sole size pieces.  Attached front and back with a little duct-tape, and I went for a test run while taking the boarding dogs for their evening walkies out back.  The dogs got a much longer walk than they might have otherwise, because it didn't take long to get excited about my new hobby.

Oh, my gosh, does it work!  You just walk around, or stomp those burs if it makes you feel better (and it does).  When the fuzzy gets full, you just tape on another set.  The burs stick to the cloth so well that you don't spread them to other areas.  It's like a Swiffer for grass burs.

The downside: it's kind of addictive.  I went through about six sets and had to make myself quit.  I finally have a weapon that works, and it is so satisfying.  There are lots of burs left, little islands to conquer, but their days are numbered.

 

What is Pyoderma?

A client writes in, "What is Pyoderma?"

Pyoderma means "pus in the skin".  That is, infections in the hair follicles.  Probably not fatal, but certainly very uncomfortable: sore and itchy.

Most are secondary to some other condition: An allergy or mite infestation or contact irritation or fleas can cause excess scratching.  This damages the skin and opens the body's defenses, and bacteria that live on the surface with no problem can invade and cause problems.

A dog with low thyroid function or other systemic disease can have poor body defenses, also allowing the surface bacteria to do undue harm.

The bacterial infection in the skin needs to be treated with antibiotics and medicated shampoos, but you also need to find and treat the underlying cause that allowed the bacteria to get a foothold.  Otherwise, the problem will only partially resolve and will come back.

Pain after Heartworm Treatment

A reader writes in today:

Had our cocker spaniel treated 5 hours ago with his first shot.
For the past 5 hours, he can not get comfortable, fidgets, lays in unusual positions.

When walking, his right rear leg is toeing-in and his walks clumsily, often positioning that right foot too far under his body.
In just the last hour, he has started some toe-dragging with that right foot. Not severe, and he corrects upon moving further into the stepping process.

Also, he has started to drool excessively. Both ears are wet as if he drank from a flat bowl.

Have given him 2.5 mg Diazepam to try to make him more comfortable.

Forgot to mention ... the vet had to stick him twice unsuccessfully and then changed needles and successfully administered on the third try.
Do you think he is just experiencing more pain than usual because of the three 'sticks' at the site, or should we be concerned that something else is going on?

 My Reply:

Please call your veterinarian and let him/her know what is happening.

The medicine in the treatment (Immiticide) can cause a lot of inflammation at the injection site. This can occur no matter how smoothly things go and how little it seems to bother the dog at the time.

This can range from being absolutely undetectable to a dog that is crying constantly with pain. Diazepam helps with anxiety, but has no pain relieving properties to speak of.

Please contact your veterinarian about this, as human 0ver-the-counter products can be harmful to your dog. However, it sounds very much like your dog needs pain medication.

The pain usually subsides in a couple of days, and most dogs don't have this type of reaction, but the ones that do get painful do need some help.

The difficulty in walking may indicate that the inflammation is causing enough swelling to put some pressure on a nerve root.  This can be very temporary, but certainly needs to be addressed.

Call your veterinarian and report this situation.  He/she will decide what anti-inflammatory or pain-controlling measures are needed to help your dog.  He/she can't help if they don't know about it.

What to do now that Immiticide is in short supply.

A reader writes in:

Hi. I have a 12 year old mixed breed who has been on Heartguard preventative most of his life. Unfortunately, he recently tested positive for heartworms. We live in the South, and he is an outside dog.

Anyway, the vet said because of his age and the expense that we should just give him prednisone, doxcycline, and sentinel, and that he would eventually suffer from congestive heart failure.

Will this regimen even help? What exactly will it do? What is the pattern of treatment? The vet mentioned to give him the prednisone alternating months. What do you recommend for the frequency of these meds?

My answer:

Heartworms actually are mostly located in the pulmonary arteries, the blood vessels that take blood from the right side of the heart to the lungs to get oxygen. Their presence in these tubes interferes with the circulation in the lungs, and makes the arteries themselves inflamed. This can cause swelling, which narrows the opening in the artery, further interfering with this blood circulation.

Even when there are no worms in the heart yet, this difficulty in the lung blood vessels makes it more difficult for the heart to do its work. This causes excessive wear and tear on the heart.

Doxycycline inhibits a microorganism called Wohlbachia that benefits the heartworms (much as the "good" bacteria in our intestines help us). When the dog takes doxycycline, the heartworms become weaker and physically smaller. Thus, they cause less interference with the dog's circulation. Doxycycline is also a little bit of an anti-inflammatory medicine.

Prednisone is a form of cortisone, which is a potent anti-inflammatory medicine. If the worms are causing swelling of the blood vessels (making the opening smaller, and more difficult for the heart to work against), the prednisone can open things up again.

There is currently a severe shortage of Immiticide, the drug used to kill adult heartworms. Until it becomes available again, the American Heartworm Society is recommending that dogs be managed in the way that your veterinarian is recommending.

I think that your veterinarian's recommendations are very reasonable, considering your circumstances. If you have more questions, please take the time to let him/her know. Many times we think that we are great communicators. If nobody calls back, we just assume all their questions have been answered. If you have more questions, I'll bet that your veterinarian will be happy to discuss them with you.

Testimony to Good Nursing Care

A stray cat had kittens out in a fellow's shed.  She took off and abandoned two  of them.  One of them had already died, and the second was just dragging himself around a little.  This tender-hearted gentleman brought in the surviving kitten.  He had been working at feeding it formula.  

He was pretty sure about the date of birth, and the kitten was right at two weeks old when we first saw it on June 25.  The little guy should have weighed 8 ounces, but he only weighed five.  He was very thin, and potbellied, like your average starving refugee.  There was plenty of flea-dirt on him, and we didn't think he could afford the extra blood loss.

So, we treated him for parasites, deworming and got rid of the fleas.  We showed the owner how to stimulate the little guy to eliminate after each feeding, and recommended bumping up the frequency of the feeding.  At this age, they can't really maintain body temperature without some help from mama.  Thus, a heating pad needs to be provided, with the option to get on or off, as needed.

He seemed a little better over the next couple of days, but on June 30, he seemed to be shutting down.  He had gained only about 8 grams (less than 1/3 of an ounce).  His eyes were mattered shut and he was at least 10% dehydrated.  We gave him fluid therapy, and some glucose for energy.

The next day, he was reported 100% better.  The day after that, he was crashing again with  diarrhea, and his legs were weak again.  He was up to six ounces now, gaining one ounce in 7 days.  Four ounces would be a more normal rate.

More fluids, started on Albon suspension for possible coccidia (a microscopic one-celled parasite that causes malabsorption of nutrients, and eventually diarrhea).  We also sent home some Nutri-cal to use between bottle-feedings.

Day 17, and he's up to ten ounces (should be 17 or 18).  He had been doing better, but his eyes are all cruddy with discharge.  We re-dewormed him, and started an antibiotic eye ointment.  He was still taking the Albon.  Still taking a bottle, too. 

Day 19, now he's coughing a little, but the good news is that he will eat solid food, at least he'll eat really soft solid food (Hill's A/D is about the consistency of soft-serve ice cream).  We changed his antibiotic, too.

Day 21 - He is feeling better, up to almost eleven ounces, and owner is feeding a teaspoon of A/D every three hours.

Day 23 - Up to 11.5 ounces, and feeling much better, hardly coughing at all now.

Day 39 - Up to 22 ounces, starting to look like a winner, eating better and time for re-deworming.

Day 61 - He weighs nearly three pounds and he's just a little over three months old, so he is just about caught up.

The point of this heart-warming story is that here at Kennett Veterinary Clinic, we didn't do much.  Sure, we gave fluid therapy, prescribed medicines that helped, and so forth.  All the real work was done at home:  all that hand-feeding every three hours... for weeks, noticing every time that something started south, rushing him right in whenever things changed, constant tender loving care.  You can't dispense that in a bottle, and you can't give it in a "shot". 

The good nursing care is what saved this little guy, and the owner is the nurse who deserves the credit.