Your Pet's Best Friend

Kidney failure

Here’s a portrait of a nice, healthy kidney, but that’s not the kind we’re talking about. We are talking about pets with kidney failure. Does that mean "it’s over"? Maybe yes, maybe no. Kidney failure (or renal failure, as we scientific types like to say) can be acute or chronic. "Renal failure" means that the kidneys are not working well enough to clear waste from the bloodstream. We measure BUN, creatinine, and phosphorus levels (among other things). The patient may be producing lots of urine (or not), but when these wastes rise above normal levels, we know the kidneys aren’t working well.

BUN is Blood Urea Nitrogen, a waste-product that can fluctuate rapidly in the course of a day, being influenced even by how much you eat and drink. It still shouldn’t get much above 30. It can rise to double or triple that value, or even more. Creatinine levels change slowly, over a period of days, and phosphorus levels don’t start creeping up until the kidneys have really gone south.

This could be chronic -- the culmination of a long-standing, slow deterioration, and there is just not much functional kidney tissue left. Or it could be acute – the kidneys just suddenly got sick; they aren’t functioning, but they are not destroyed, either, and they could get well. Sometimes the only way to find out is to treat the patient and see if they respond.

You start out with about four times as much kidney capacity as you need. You could get by with half of one healthy kidney, and you have two whole ones. Thus, you could have a slow, gradual long-term destruction of the organs. Until you get down below 25% of kidney tissue, you still feel okay. Even when you get below 25%, your body can stand the increased levels of waste and become accustomed to them. When these guys finally get sick enough to quit eating, when they get nauseated and start throwing up, they are beyond saving. BUN is 100, other values up, and things don’t look good.

On the other hand, the kid whose kidneys shut down because of an infection will be just as sick, and his numbers may be just as bad. Yet, with appropriate treatment he could get well.

How do we know whether your pet’s kidney disease is acute or chronic? Can you tell by looking at the dog? This dog looks pretty good, beautiful hair coat, but she has lousy numbers – very high levels of waste in her blood. She looks awfully good, but her kidneys don’t look so good.

When we ultrasounded her kidneys, they looked shrunken and misshapen, as in this diagram. Her owners wanted to treat her, even though her prognosis didn’t look good. Intensive fluid and diuretic therapy were instituted, but she just did not respond. She couldn’t respond, as she just didn’t have the functional kidney tissue. Things won’t always be that clear-cut, though. Sometimes the kidneys really won’t look bad on the ultrasound, even though the damage may be severe and irreversible, whether chronic or acute.

This little dog doesn’t look nearly as healthy as the last one, and she is several years older, and she had lousy numbers when she came in.

Her ultrasound looked okay, but that was no guarantee. This is a sick kidney, but it hasn'treally changed shape.  This dog is a classic illustration of the principle that sometimes the only way to tell if a patient is treatable is to treat them. In this case, we also saw evidence of kidney infection in her urine specimen, so we hoped that intensive therapy with I.V. fluids and antibiotics might turn her around.

And so it did. Here she is the next day, feeling great, and eating, and she is still trucking along months later. If we had tried to "tell by looking", I’d have given her up. I’m glad we gave her our best.

Fledgling birds

Here's our annual bird's nest in the kennel window, sheltered under the eaves.  We've seen the momma sitting, and flying back and forth.  It's empty now, which I wouldn't have noticed, as we try not to bother them, but a fledgling nearly landed on me when I got out of the truck this afternoon.  Soon the calls will be coming.

"I've just found this baby bird that's fallen out of the nest.  What should I do?"  Leave it alone.  This fledlging bird is too big to stay in the nest, fully feathered, an "adventurous teenager", not a helpless baby anymore.  So she hopped out and is learning to hop around and fly.  Mother is nearby and watching her, bringing food when necessary.  If you pick her up, she'll just hop out of the nest again. If you take her in the house, you have drastically reduced her chances for survival. You're not a very experienced at finishing her "raising", and teaching her to survive in the great outdoors.  She probably won't survive your good intentions.

"What if I cat or dog finds her?"  That will be bad, but we can't really police the law of the jungle.  When minding our own business increases the chance of survival, that's what we need to do.

If you find a little downy chick of a baby bird, it's okay to put them back in the nest.  The mother bird WILL NOT reject them because you have touched them.  If you can find the nest, do put them back in.  It is possible to hand rear the birds, but without seeking good information on how-to, and making a significant commitment, you will not succeed.

We all want to make a difference, but sometimes the best thing you can do is to mind your own business and let the birds mind theirs.

Long-time Scouter

Here's a link to a story about my wife's receiving the "Thanks II" award for her work in Girl Scouting.   [Third from the left, back row,the only lady in uniform]  I cannot adequately describe how proud I am of what she does, and how much I appreciate her.

Yesterday, I went up to Camp Lewallen to run the climbing tower for our Cherokee District camporee.  The camp-master gave me an "attaboy" at the campfire that night, describing me as a "long-time Scouter".  I'm only working on my tenth year, here.  Compared to my better half, I'm a just a newbie. 

A visit from the DDAC

My sister, Leah Mobley, is the director of the DDAC (Dunklin Day Activity Center for developmentally challenged adults).  Her dog, Toodles, had some skin tumors removed recently and came back for suture removal today.  She made the visit a field trip for the DDAC clients.  They met some dogs, walked some dogs, and helped with the removal of Toodles's stitches.  It was a change of routine for all of us.   The clinic is not usually quite so full of people.  [Although there is the occasional "Snow White" - one big person and seven little people - when the whole neighborhood appears with one beloved dog.]   It was just a regular day after that: back to our normal chaos.

Haws syndrome - the third eyelid is showing.

Cats and dogs have a third eyelid.   Normally you don't see it, as it stays tucked down in the corner of the eye.  There are tear-producing glands on the back side, and periodically it sweeps across the eye like a windshield-wiper, spreading the tears during the blinking process.   When the outer lids droop, they close together.  When the third eyelid (nictitating membrane) droops, it slides out over the eye.  Most of the time, it just indicates that the pet is feeling crummy.  If an animal is really feeling low, it may cover most of the eye, which leads to frantic phone calls saying "My dog's eyes have rolled back into his head!!"  Of course, that couldn't really happen, as it would rip off your optic nerves when the eyeball rolled around 180 degrees.  The pale third eyelid can resemble the white of the eye (sclera) and that's what fakes people out.

This cat has Haws syndrome (and I can't find out who Dr. Haws was, so let me know if you know.  Of course, it could be called "haws syndrome" because "haw" is another name for the third eyelid.  But that's so mundane... and it doesn't really explain anything.  Why not just call it "third eyelid syndrome"?  But I digress).  The cat seems to feel fine except for the third eyelids showing.  This is believed to be caused by intestinal irritation, as in an animal with a heavy worm burden, or colitis.  The mechanism is poorly understood (I don't think it's the same as "You're so full of ____ your eyes are brown", but since we don't really know...).   

There are lots of write-ups on this if you Google it, but I just happened to get this cool picture, so I'm adding yet another piece of informational flotsam to the web.  The syndrome usually resolves over a few weeks as mysteriously as it appeared.  De-worming may help,if that's what the problem is.  Some may benefit from treatment for intestinal inflammation.  I wouldn't give them an enema to lower the "brown" content, though.

First parasites of spring - fly-bites, mosquitoes and ticks.

Suddenly, it's warm.  Too bad I wrecked my motorcycle.  Even worse, the insects seem to have burgeoned almost instantaneously this spring.  It's made a week of firsts.

This wad of heartworms was removed from a Beagle who was only two years old  and dying because of them, sad to say.  Most dogs, even with no heartworm prevention at all (like this dog) would make it three or four years.  We just have so many mosquitoes here (which is how you get them), and they are coming out already.

Here we have the first case of fly-bite dermatitis this year.  Flys don't have the needle-like proboscis of the mosquito. When they bite, it's more like a knife and a sponge.  They make a little cut, then sop up the blood that runs out.  Get a few hundred tiny cuts, and you've got a big sore on the dog's ear.  On a floppy-eared dog, it will be the base of the ear like this guy.  If the ear is erect (like a German Shepherd or Chow), the tips of the ears will be the damaged area.  You need to put a first-aid cream with local anesthetic (like Neosporin Pain Relief, or a generic equivalent) on the spots, then cover with insect repellent, like VIP ointment.  Don't put the insecticide in the sore places - it burns and they won't leave it on.

And here's the first fully engorged tick of Spring.  She looks a little wrinkled here, because I killed her with insecticide spray after I removed her from her dog.  I guess I should't be so surprised, but gosh, it seems early to have this kind of problem already.  These bugs are not as pretty as the first flowers of spring, which are blooming everywhere around southeast Missouri now.

So, it's not too soon to crank up your Frontline, put your VIP ointment on the ears, and keep that heartworm preventive going (like you should have been year-round).

More Prodigal Great Dane

If you saw the previous post, you may remember how skinny and awful Pepper looked.  After a few weeks of regular groceries, she is much improved.  The best news is that her attitude is even more improved.  She is trusting, friendly, cooperative and obedient, and very cheerful in her new home.  I predict that another month of good nutrition will have her looking even better.  I do love a happy ending.

Hip Dislocations

So here we are with our hip joint back in place, taped up in a "sling", but still under anesthesia.  It usually takes a lot of force to dislocate that ball-and-socket joint, so it's unusual to have a big dog like this with her hip dislocated and no other major injuries.  If there's that much force, it usually breaks a few other things, too.  Calli here just has some road-rash and minor cuts to go with her injury.

We medical professionals call this a "coxo-femoral luxation".  "Dislocated hip" just doesn't sound scientific enough for us cool guys.  Most can be replaced without surgery (though some cannot).  Most of the time, the head of the femur (the "ball") is displaced in front and above the socket.  Then the muscles lock up in a spasm, so that even under anesthesia it is really hard to manipulate things back to their normal alignment.  You have to fatigue the muscles by pulling on them and manipulating the hip.   Bigger dogs have bigger muscles and are more difficult to manipulate. It took about 45 minutes for this one on Saturday night (which is unusually long).  I began to wonder whether my own muscles would turn into dishrags before Calli limbered up enough to pop back in place.   It reminded me of when I had my shoulder dislocated the first time -- a complete separation, they called it.  The next day my wrist hurt worse than my shoulder (I think they pulled on it pretty hard when they put things back in place).  It didn't hurt as badly as the shoulder did when it was displaced, though.

Sometimes it feels almost right, so you stop and take an X-ray.  It's still out, so back to the tug-of-war.  When you finally get it right, everything moves smoothly and the muscles relax.  You push hard while you manipulate the hip so that you mash the blood clots out of the socket and make room for the femoral head.  Then you tape things up.  Those muscles and ligaments are really stretched out, and they need time to tighten up and heal a little before the dog puts weight on the limb.

Most dogs return to normal activity in a couple of weeks.  That hip may get arthritis before the other one, but not for a few years (we hope).

Calli went home with her sling, instructions to rest (on a 10-months old Lab: good luck with that!) and pain meds, of course.  We'll be rechecking her soon.

Heartworm preventive medicines may not be 100% effective.

This is the sort of "can of worms" one hates to open. Yet I feel the need to open a discussion. I am concerned that heartworms (at least in our area) are starting to become resistant to all the preventive medications that we have.

I have been practicing in a severely endemic area for heartworm disease since 1978. Starting in 2006, it seems as though "the rules have changed" with regard to the prevention and treatment of canine heartworm disease. The problems that I have encountered are mirrored by other veterinarians in my area. They are experiencing the same frustrations. My Novartis representative has been working from Missouri south to Louisiana. In an unofficial conversation, he indicated that he had heard it was primarily a problem in the Mississippi valley, with the problem being worse as one goes farther south.

We routinely test all dogs for both microfilariae (baby heartworms in the blood) and heartworm antigen (adult heartworm protein in the blood) at their annual examination. In years past, I always detected a small number of heartworm-positive dogs which had allegedly been on year-round prophylaxis (as we recommend). Some few of these would prove to have an obvious deficiency in compliance. When I asked, "Is it possible that he missed a dose?", the folks would start looking at the floor and shuffling their feet. "Well, you see, Aunt Tillie was sick, and the boy was on a traveling team with the baseball season, and the motor in our car blowed up and…". Which is to say, yes, it is possible that he missed a dose.

On the other hand, each year we had four or five patients whose owners had bought plenty of preventive medication. These were folks whom I believed perfectly honest in their report of administration, and competent in their administration. With this small number of apparent product failures each year, it was easy to attribute the failure to things like the dog clandestinely vomiting under a bush. Nobody watches his dog 24 hours a day. So even though the owner was 100% conscientious in giving the medicine, and the medicine near 100% effective, these rare failures were easy to attribute to the weak link in the chain: the dog.

In 2006 and 2007, we have gone from 4 or 5 apparent product failures per year to 4 or 5 per month. Almost all are large-breed, outside dogs. We have the same percentage of failure among all the different products that we use. Interceptor/Sentinel (which we use in the majority of our patients), Heartgard 30, and Revolution. With this ten-fold increase in incidence of the problem, I am very concerned that the parasites are becoming resistant to the avermectins (EVERY heartworm preventive on the market except for Sentinel and Interceptor) and to milbemycin oxime (the active ingredient in Sentinel and Interceptor).

The drugs are far from useless, however. In fact, I believe that they are still preventing almost all of the heartworm infections from reaching maturity. In a previous post, I noted that a dog’s problem with heartworm treatment is pretty directly related to how many adult worms he has to deal with. These dogs who have been on year-round preventive (and turn up positive for heartworms anyway at their yearly physical) rarely show signs of thrombo-embolic complications after adulticide treatment. This would indicate that these dogs have very few adult worms present. For this reason, I believe that the preventives are largely effective, though no longer 100%.

Again, though the number of heartworm prevention failures has risen dramatically, it is still a very small percentage of our patients. Almost all have been large-breed, outside dogs, and our practice is in an area with a heavy mosquito population during the warmer months (and a few skeeters nearly all year). I certainly would not stop giving the preventive medications.

I certainly would give the medicine year-round, and I certainly would have my dog tested every year. When we can document the dog’s previous "clean" status, and document the preventive medicine purchases, the manufacturers have been very good about paying for the dog’s treatment under their guarantee programs.

Bad decisions and minor consequences

This picture was taken right before I decided to scoot up the ladder and help that guy over the wall.  I made a bad decision. The young man is a great Scout and his buddies could (probably) have done it without my help -- I was there to observe and advise.  This young man also weighs 215 pounds.  It turns out that I am really supposed to be in a lighter weight class in the Scout-lifting competition.  My back is getting better, but it's a slow process.  Still, it was a good day, and I think the memories of the boys' success will outlive the soreness in my back.  For one thing, I took pictures of the boys, and I'm not taking a picture of my sore back.

Last week, I dumped my motorcycle and came away with only a couple of bruises and a sprained wrist and elbow. Everything but the elbow is hunky-dory already and I rode the motorcycle home (after a good Samaritan helped get it out of the ditch; my headlights were full of minnows and my saddlebag sleeps with the fishes).  A new headlamp and mirror (and a few hours of wrenching) will put me back in business.  I made a bad decision about how fast to enter a curve.

In both cases, I've learned a valuable lesson and feel lucky to be able to go about my business.  It's hard to be very annoyed about any of the usual things when I think about how I might be in a hospital bed, or permanently disabled.  Instead, I'll be pretty much okay in a few more days.  Then I can get back to complaining about the small stuff...  punctuated by giving thanks for being spared.