Your Pet's Best Friend

Don't miss the concert in the park!

 

Quicksand: struggle, and you just get in deeper.

I wish that I had seen this sign when I looked at the appointment schedule today.  Wolf was just in for his annual check-up.  "By the way, he's got bad breath."  Actually his breath isn't so bad.  That's his ears you smell.  They are full of stinky pus.  "Well, I guess he has been shaking his head every now and then." I reckon he has.   I've talked about why dogs stink before, but this post is about something else.

It's not uncommon for a pet to be presented for one problem and, lo and behold, I find more than one problem... or a completely different problem.  Of course, nobody wants to make two trips when one will do, so we try to handle as much as possible during the visit.  Unexpected problems can naturally make the visit take more time than was allotted on the appointment schedule.  Now we're running behind, but maybe we can make it up. 

The people who are waiting are not the people whose problem is causing the delay.  They suffer because the guy ahead of them has more problems than we scheduled for.  It's not fair. It's not good for business either.  Everybody has something they'd rather do than wait.

So I try not to let these things get away from me. If it's really some big deal, then we need to schedule a special time to take care of it.  Unfortunately, sometimes these things are like quicksand.  You do one thing, and it sucks you in a little deeper... and deeper... and deeper... aaaaagh! I can't breathe!

Wolf's ear was so sore, he wouldn't let me examine it fully, so I had to sedate him.  No problem: I can look at someone else in the other exam room while he's getting sleepy. [ Now I've stepped in the quicksand.]  Gee, he's not sedated enough -- that ear's too painful.  We'll have to give him some more. [I'm sinking up to my knees now.]  Still too painful; we'll have to have him inhale a little gas and go all the way to sleep. [Waist deep now]  Geez, there's a ton of stuff in these ears and it doesn't want to clean out easily.  Well, he's already anesthetized, so we need to get the job done.  We can't just knock him out for nothing!  [Nothing above the surface but my head and shoulders now -- THROW ME A VINE!]

It takes another 20 minutes to get things cleaned out and find there's a polyp deep in the canal that is the source of the problem.  No way to get that today -- too much swelling and infection.  He really will have to have another visit to handle that.  Cortisone to shrink the swelling and antibiotic flushes to get the infection under control and we'll see him back next week. [Slow, steady swimming motions finally get me out].

If I could have predicted the future, I  wouldn't have started that mess today.  Sometimes you just don't know there's quicksand on the trail.

Getting really hot, really fast.

Here's a picture from our Philmont trek in 2004.  We constantly reminded the Scouts (and each other) to keep drinking lots of water.  Even if you don't feel hot, you're losing a lot of water.  You'd think I would take my own advice, especially when it's such good advice.

I headed out to the country yesterday (on my "afternoon off") to vaccinate and blood test some horses.  The horses are all caught up, shouldn't take long.  Even though it was 97 in the shade, my truck is air-conditioned.  I'll stay in the shade, wear a big hat, it's nothing strenuous.  Besides, I like hot weather. I didn't take any water with me. Whoops.

It was hot: the horses were all wet with sweat and they were just grazing in the yard.  Still, it was no big deal filling out the paperwork, filling a few syringes, poking the first three horses.  Horse number four acted like a nut (it may not have been an act).  She seemed calm enough grazing, but when we shortened the lead rope, her front end headed skyward.

The owner has had some medical problems and wasn't strong enough to hold the mare.  His younger help were strong, but not skilled in restraint.  I tried to get them to help me get her pivoting around us, but they couldn't get with the program.  My straw hat got mashed down on my head when she slung her head at me. I finally managed to get an ear, then her nose, then circle her until she was tired, and then I was able to apply the twitch.  At that point,  she was happy to stand still for her blood test and vaccinations.

It's been quite a while since I've had the necessity to "cowboy up" like that, and I wasn't much anticipating that kind of exertion.  Suddenly, I was really hot.  I must have looked a little rough, as the owner asked, "Would you like something to drink?"  Well, I'll probably be okay until I get back to town.  "All I've got is Gatorade."  I'll take one.  [It was grape flavored, and I haven't drunk a grape soda since I puked up 12 ounces of Nugrape in the Ozarks 46 years ago.]  Eight ounces, two gulps, straight from my mouth to my pores.  I never felt it hit my stomach (though, of course, I know it did... probably).

I've written about heat stroke before, and this is a good time to think about it.  When it's this hot, it doesn't take much to put you over the edge.  Dogs are at greatest risk if tied out so that they can get tangled up.  Even dogs that are free to do as they please can overdo it.  If you're outside with the dog, encourage them to stop and cool down, hose them with some cool water, get them a drink.

If you can overheat in a hurry, without noticing it coming on, as smart as you are, then so can your dog.

Deep Pyoderma

The June issue of Veterinary Forum magazine came, and was sitting on my desk (on top of the pile of journals and stuff).  The cover illustration is the teaser for an article about treating pyoderma (Translation: Pus in the skin, or skin infections).  It was really weird to have Star come in looking like she'd gone to the beauty-shop with her fashion magazine, saying "I want to look like this."  Life imitates art.

The article is about treating deep skin infections, primarily those caused by surface skin bacteria that have gone crazy.  Everybody has staph bacteria on their skin, but unless you scratch it open, or your immune system is lying down on the job, they just stay on the outside.  When they go deep, it can take months to clear the infection.

Even if you pick an antibiotic to which the germ is sensitive (the magic bullet), it takes about three weeks to grow a new layer of skin.  You won't clear these deep lesions with one week of treatment.  If the problem is really severe, the patient will need antibiotics until looking good, and for 3 weeks afterward (or longer).  Topical therapy with medicated shampoos and rinses are often required.

You also need to look for underlying causes.  There is always a reason for this (though you may have trouble figuring out what that reason is).   You check a skin scraping for mange mites, and make an impression smear cytology (smear the goo out and stain it, look at it under the microscope). Blood-work may reveal thyroid problems or other medical conditions that would lower the pet's resistance to infection.

A biopsy may be required to tell whether this is really an infectious process, or some other disease that the surface bacteria have simply used as an opportunity to enter.   A portion of the biopsy (tissue that you remove for analysis) can be sent to be cultured to find out what germs are growing there, and what medications are best to treat them.

Skin conditions can rarely be diagnosed just from their outward condition.  Star "looks just like the picture".  However, her pen-mate is developing similar lesions.  It isn't very likely that they both developed the same medical condition that allowed Staph bacteria to go crazy.  In fact, we are looking at the possibility of Blastomycosis (a bad disease).  False negative tests, multiple underlying causes, lots of possible reasons for the same outward appearance: it's why you don't find a lot of veterinary dermatologists around.

Demodex follow-up... again

  Here's Ellie Mae again, back for another check-up, two weeks later.  I had to shave a spot in order to do my follow-up skin scrapings.  She has no areas of hair loss, no scabs, no scale, no nothing except healthy-looking hair and skin.  Two skin scrapings yielded the shriveled carcass of one dead mange mite.  We're almost home.

Demodex follow-up returns

At our four weeks follow-up, Ellie Mae was a lot better.  This picture is a re-run from that last visit.  Today, at 7 weeks of treatment,  she looks almost normal from a distance.  Her skin isn't lumpy-bumpy anymore.  It's obvious that her new hair is shorter than her old hair, but that's not a problem.  She's feeling a lot better, too.

You can see a big difference here in the top view.  What you can't see is that there are still quite a few patches where the hair is thin.  Still, even in those patches, I had to do three different skin scrapings before I found one single adult mite.  Contrast that with her first visit where a single scraping produced a multitude of mites in all life stages.

Our end-point will be a combination of normal-looking skin and no mites detected, plus two more weeks of treatment.  I think we're getting there.

Happy Birthday to Me

Most of the cards I received were variations on a theme: "Man, you're old, ain't ya?"

You know, "Congratulations, you're officially too old to die young."  Thanks.

I liked this one much better: "Distinguished, yet youthful".  Inside, "It's a look not everyone can pull off."

Even if it's not true, I like it.  Everybody has to grow older, but you don't have to grow up and be old.  The Lost Boys had the right idea.

"In the Womb: Animals", by Michael Sims

A couple of months ago, I received an email asking if I would like to review this book.  I looked at some of the pictures they sent (which you'll see here) and immediately said yes.  Unfortunately, it took me some time to get around to reading the whole book. Yes, it's a picture book, but there's a lot of good information in the text, as well. 

I don't watch a lot of television, so I missed the accompanying TV series on the National Geographic Channel.   If they repeat it, I think it would be worth watching.

The book begins by reviewing the reproductive physiology of dogs, with which I am pretty familiar.  The information is very good, and contained no glaring errors.  From this I extrapolate that the rest of the book's information is similarly accurate.  While I enjoy the pictures, I hate to think that I'm soaking up a bunch of inaccurate data, and I really don't have the background to evaluate what the author says about the more exotic species.

When we get into kangaroos, sharks, dolphins, elephants and more, I must admit I'm out of my depth.

I reckon I could call my old classmate, Dr. Dennis Schmidt, about the elephants, as he is one of the foremost experts in the world when it comes to elephant reproduction.  I wish that I'd had this book, or that he'd already been famous for that twenty years ago.  This story really plays better as performance art, but the gist of it is that two drunks came in wanting me to settle a bet about "how elephants make love."  You can just read the book... about their question, that is (not about the whole story.  Maybe I'll make a video and put it on Youtube).

This is really a neat book, with amazing photos.  I'm  a "how did they do that?" kind of guy, and I wish there were an appendix about the photography.  How much was done endoscopically? How much is computer simulation, plastic models or what?  This is never addressed.  That sort of technical background certainly is not the thrust of the book, of course, but I'd surely like to know.

I would recommend this book to any animal lover without hesitation.

Demodex Follow-up

So here's a follow-up to the case of Ellie Mae.  I promised pictures and follow-up, and here we are.

The treatment of choice for dogs with demodectic mange is daily dosing with 400 to 600 mcg/kg of ivermectin.  The problem for Ellie Mae is that many Collies carry the MDR1 gene mutation, and these dogs cannot take that kind of ivermectin dose.  The low dose in Heartgard-30 is fine for them, but the humongo doses needed to treat demodex may kill dogs who carry the MDR1 gene mutation.

Not all Collies have the gene mutation, and you can test for it, so that's what we did.  While waiting for our test results, we started Ellie Mae on daily milbemyin (Interceptor - same dose daily as for monthly heartworm prevention - effective but pricey).  I had to order my DNA test kit (and now you can send blood samples, as well as cheek swabs), so I couldn't send the test off right away.  I thought that the dog would still look bad enough for my "before" picture when she came back for the test, but it was 12 days before the kit came.  After 12 days of treatment she was already dramatically improved.

Her back doesn't look bad at all at 12 days.  Her neck is still a little crusty, but her back looked worse than that on "day 1".

Day 22 - we get the bad news.  Ellie Mae DOES have the MDR1 mutation, and cannot safely take the big doses of ivermectin (inexpensive) and our best bet is to continue the oral milbemycin.

Day 29 - Here she is for a recheck and her back looks essentially normal, though she needs to grow some more hair. 

The neck is still a little crusty, but mucho improved.  The skin infection is pretty much gone. We're down to bathing the bad spots with benzoyl peroxide shampoo (SulfOxydex) and giving the oral milbemycin.

How long will she get treated?  Until she looks completely normal.  Then I'll shave a spot and do another skin scraping.  If I find mites, we'll continue treatment for two more weeks and check again.  When we can't find mites, we'll treat for two more weeks.  Then we'll call it good (and hope it is good).

How are these people affording daily Interceptor?  Well, you know what they say: it's an ill wind that blows nobody good.  A while back, we over-purchased on boxes of Interceptor single doses -- the "bulk pack".  We didn't use it before it went out of date.  So here I am with a box of expensive tablets that I can't send back, and I can't sell.  They're sure too good to throw away, though.  That's what Ellie Mae is taking.  My bad inventory management is her good fortune.

Are Heartworms getting worse? A Seminar: Part 6 of 6

Doxycycline’s Role in the Treatment Process

This also relates back to our problems with heartworm treatment.

Doxycycline kills L3 and L4 larval stages of the heartworm, and it decreases embryogenesis (the production of microscopic baby heartworms -- microfilariae).  It has intrinsic anti-inflammatory effects.  It greatly inhibits Wohlbachia, which is a symbiotic rickettsial organism needed by Dirofilaria immitis (the canine heartworm) to survive. 

When you treat with Doxycycline at 10mg/kg/day for 30 days, it will clear microfilariae and it will shrink adult worms.  [Doses twice this high have been recommended, but some dogs do not tolerate the dose as well.]

We know that more inflammation is produced in the dog when worms die with Wohlbachia present, than in dogs with worms where the Wohlbachia have been suppressed with Doxycycline.

Clinically the effect is not very great in dogs that have few worms and no microfilariae. [Dogs who have been taking year-round preventive medicine, but develop a positive blood test]  In dogs that have not received preventive medicine, who have more worms present, the beneficial effect is more noticeable.

It would be advisable to use Doxycyline in dogs that one suspects to have a significant worm burden and who are not in need of immediate treatment.  It is combined with Ivermectin given weekly during the month of Doxycycline treatment, prior to giving Immiticide.  This should eliminate microfilariae, shrink the adult worms, and reduce the amount of inflammation associated with the death of the adult worms.

Conclusion

This is not a very satisfying conclusion to my seminar, but this reflects the fact that I don’t have a good answer to my problem.  I don’t know the cause of the apparent preventive medicine failures, nor why it is more difficult to eliminate adult worms and microfilariae than it used to be.  I'm starting to get used to it, but I've become used to dog-bites, too, and I don't like that either.

I don’t have a strategy to improve the situation, which is why I was eager to share experiences and information with the other veterinarians and the parasitologists.  I’m looking forward to seeing what the future holds here.