Your Pet's Best Friend

Heartworms just keep on coming.

Old Yeller Alert

The weather is finally getting cold here in southeast Missouri.  Motorcycle riding will be reduced to the bi-weekly ride to "blow out the cobwebs"-- twenty minutes of freezing while wishing I was home already.  You'd think the mosquitoes would all be gone, but they are still flying around inside my house.  We live in a swamp... a drained swamp, yes; a reclaimed wet-land, even...  but still a swamp.

Back when the only heartworm preventive drug was DEC (diethylcarbamazine), it had to be given every single day, or it didn't work.  So you're going to feed the dog every day, you pet it every day -- just give it the pill  while you're at it (or the liquid, or the chewy treat).  That's fine for dogs that don't object to being medicated.  For those that do object, however, it was a real ordeal.  If your dog puts up a big fight every time you have to give that once-a-month heartworm preventive, you can feel real satisfaction about  a job well-done.  Sure, it wasn't easy, but you got it done: you did the best for your dog.  Once a month, it feels good.  Every single night of your life... not so good.  People don't get a dog so they can fight with it.  People who had to deal with that would talk themselves into the notion that they could stop their heartworm preventive when the weather cooled off.  It ain't so, at least it ain't so here in the swamp.

We have so many mosquitoes for so much of the year that we really have to give the preventive medicine year-round.  With large-breed outside dogs, sometimes they still get heartworms, even so.  You surely can't skip months here and there and expect the dog to stay free of these parasites.

That's why I was so surprised when taking the history on Max the Labrador Retriever three weeks ago.  It was our first time to meet Max.  He had suffered some bite wounds to the top of his head and his ears (ouch).  His owner told me that he had been treated to clear out adult heartworms in 2005, but had not been taking the preventive medicine since then.  WHOOPS!  The heartworm treatment clears out the adults, but has no effect on the development of new ones. More mosquito bites will mean more heartworms, unless you keep the guy on preventive medicine (Heartgard 30, Interceptor, Sentinel, Revolution, etc.). "As soon as he gets over these wounds, we need to get him up to speed on the heartworm situation.  He probably already has some new adult worms."  Truer words were never spoken.

Today they found Max by the back door, stone dead.  Post-mortem exam showed extensive hemorrhages throughout his lungs.  He had more than 50 worms in his heart, plus worms throughout his pulmonary arteries.  He didn't die of heart failure, but from the damage the worms did to the arteries in his lungs. He drowned in his own blood.  It was a sad day, and even sadder because it didn't have to happen.

Little puppies need early check-ups.

In one way, these two cases seem similar: very young puppies who were doing lousy, and now they are on the mend (though hardly up to their potential -- they could, and will, be so much better).  In other ways they seem totally different, yet they still share one underlying factor: they waited WAY too long to seek medical attention.  I could call it bad veterinary care, but mostly because there was no veterinarian involved.

Angel was a freebie.  Her owners were puppy-shopping, and the breeder told them that they could have Angel at no extra charge, since "she may not live".  She was half the size of her littermates, had very little appetite, and was very thin.  Like most commercial breeders [breeders who raise dogs the way farmers raise pigs], these folks don't give the puppies much individual attention.  Everything is done on a herd-health basis.  When the puppies are two weeks old they get this.  When they are three weeks old, they get that.  It's all cookbook.  This is a practical way to handle things, and most of the pups will do okay (providing your cookbook has the right "recipes").  However, when an individual has special needs, the cookbook approach just doesn't get it.   

While her breeder had vaccinated and de-wormed her, she had not had any diagnostic testing.  A stool exam showed that she had coccidia (a microscopic one-celled parasite -- since it's not a worm, de-worming doesn't get rid of it).  We started treatment for the parasite, but she didn't respond very fast. In fact, she lost weight in the first ten days, from 1.8 pounds down to 1.7.  She required fluid therapy, as she had become dehydrated, in addition to being thin and under-developed.  She still had to be hand-fed, and just didn't get much better until we also gave her a jump-start with anabolic steroids (fortunately, she's not planning an athletic career, so we're not worried about her getting disqualified and losing her medals).  After her second 10 days of treatment, she's up to 2.5 pounds and getting better every day.

Without the individual attention (that she COULD have had weeks earlier), this beautiful little puppy just wouldn't have made it.

You can't really see how scabby and nasty Duke and Elvis are here. This is definitely their "good side".  What you can see is that they are wide-awake and interested in what's going on.  That's a far cry from four days earlier when they were presented with sub-normal body temperatures.  Elvis was laid out stiff and couldn't even swallow. We're talking weak. Besides having a lot of hairless, scabby areas (due to Sarcoptic Mange, aka scabies), they were also heavily parasitized with intestinal worms -- hookworms and roundworms.  They were the dog equivalent of cold, scabby raisins (shriveled, as it were)  If we had seen them a week earlier, treatment would have been quick, simple and cheap.  As it was, Elvis had to be gradually warmed to a normal body temperature before he could be treated with anything.  I was amazed to see him come around after about thirty minutes, as he looked so bad that I really feared he would die.  It is so great to see them looking fat and sassy (though still scabby).

With both cases, I have to give credit where credit is due.  Medicine only does so much, and these guys got intensive nursing care at home.  Their folks picked up the ball and ran with it once we got them started.

On the other hand, I have to admit that it makes me a little whacky to see these guys get critically ill when a simple check-up early on would have averted the problems.  Puppies should have their first check-up and de-worming at about 3 weeks of age.  Their second check-up and first vaccines at around six weeks of age.  If they aren't doing well, DON'T WAIT THAT LONG.  This seems so simple. Maybe it's too simple, and folks are looking for something more complicated.  Beats me.

Happy Thanksgiving

My home was built in 1909 by my great-grandmother.  Her children were grown and moved out, but she built it big enough for them to come back and gather there.  My father knew it as his grandmother's house.  I knew it as my great-aunt's house.  It remained the gathering place on holidays even when folks were coming from Texas and New York.

When my wife and I came back to Kennett in 1979, we moved into the family home-place and we felt really good about becoming the stewards of the gathering place.   As the older generations passed on, my siblings moved back and started their families here.  Our home remained the holiday gathering place for a long time, simply because the other folks had tiny dining rooms.  As their homes expanded with the size of their families, the gathering began to rotate, and it has been several years since we hosted a holiday dinner.

My daughter is away from family on the holiday for the first time in her 23 years, and we miss her.  It reminds me of the only Thanksgiving I spent away from family.  I was cleaning stables at the Equine Center, trying to get a good reference when I applied to Veterinary School.  The other part-time student and I drew lots for the holidays.  He would be working Christmas, and I would be shoveling on Thanksgiving.  My supervisor invited me to eat dinner with his family, which was nice, but it wasn't the same as being with my own family.

Today the gathering returned to our home.  I find that, of all my blessings, I find myself most thankful for the times we spend together as family.

Should have used the muzzle

This guy looks like such a nice dog.  His owner told me, "You know, he gets irritable sometimes.  Maybe you should use a muzzle."  I posted previously on why I am a little reluctant to put the muzzle on.  For some reason, I continue to labor under the delusion that my reflexes are faster than a dog's.  I won't say that they never are, but I would have to say that often they are not.

This is a couple of days later.  The bleeding has stopped now, as has the throbbing.  The good thing about having a hole punched through your thumb-nail is that you won't have to drill a hole to relieve the pressure.  I'd really like to blame this one on someone else, but of course I cannot.  The nice lady told me I should use a muzzle.  She's a nice lady and I think she's honest, as well. 

The other good thing about the hole in my thumb-nail is that it reminds me to pay attention to the pet's owner.  It is not unlikely that they know more about their pet's personality than I do. 

So, until that hole grows out, I'll probably remember to put a muzzle on the dogs that need it.

Dogs running loose

I took Old Red out for a spin this afternoon and there were an exceptional number of dogs running loose.  It was a beautiful fall day with a little nip in the air, the kind of day that makes the horses "feel their oats".  These dogs were loping happily along the roadside, in and out of yards.  I managed to miss them all, which is pretty important for a motorcyclist.  Road hazards can be generally classified as squishable versus non-squishable.  Dogs are not too squishable, so you really can't run over them successfully ("successfully" meaning here that you keep rolling forward with the shiny side up and the rubber side down).

For a dog, getting successfully run over could be defined as having injuries that are fixable.  I've posted on HBC (hit by car) before, but this has been a bit of a bad week for it... dogs being unsuccessfully run over, I mean.  A swell Labrador's rear end was fractured to the point that multiple expensive orthopedic surgeries would be required, and that with no guarantee of normal function.  Last night a beautiful Great Dane puppy's head was smacked hard enough to scramble his brain.

Maybe loping along free and unfettered is the dog equivalent of riding a motorcycle.  Maybe the E.R. physicians have the same opinion of motorcyclists that I do of letting your dog run loose.  On the other hand, I always wear my body armor and I spend a lot of time watching out for cars... and dogs running loose.

Offer everyone your best.

I learned some years ago to always offer my best to the client.  While it is certainly possible that they may not desire or be able to afford Plan A, they surely won't ask for it if they don't know what it is.  With every patient, my job is to offer what I believe to be the highest standard of care.  Offering anything less is a disservice to the pet and to the client.  You certainly cannot judge by a person's clothes or the car they drive.  People who are well-to-do may decline complete care and people who appear near destitute may make whatever sacrifice needed to care for their pet.

Sometimes it's a little difficult to get fired up about treating the pet's dental problems when the owner's smile reveals a few scattered green snags passing for teeth.  If their own dental hygiene is not a priority, how important will the pet's mouth be?  On the other hand, their own dental problems might make the pet's dental situation more real to them.

You might think that the pet's previous care would be a pretty good indicator of what folks will do in the future, but you can certainly be surprised there, as well.  When taking the history, I tend to get less optimistic when I find that the pet runs loose, hasn't had a checkup in years, doesn't take heartworm preventive, and the condition is long-standing or brought on by what appears to be egregious neglect.

You never know, though. Sometimes it's the guilt factor, sometimes people really were meaning to do all that stuff and just didn't get around to it.  Tonight we had a big pup who had been accidentally (how else?) run over in its own driveway.  She had lots of fleas, ear mites, no heartworm preventive, and no puppy boosters.   Not good, I'm thinking. Yet, her folks stepped right up to the plate and are doing what it takes to make her right.  "I guess we've been neglecting her."  Man, we've just got to go on from where we are now.  That's all there is to do. If beating up on you would take us back in time and fix it, I'd be all for it... but it won't, so pat yourself on the back for doing the right thing, and let's get on with Plan A.

You look like Barney

No, not this Barney.  I frequently give programs on veterinary medicine to school classes, Scout troops, and so forth.  This week the first-graders had a story in their reading book about a veterinarian.  Two of the teachers are clients and asked me if I would come and speak to the class, which I did.  Kids that age may have questions at question time, but just as frequently they simply want their turn in the spotlight.  Hence "questions" along the lines of "I had a dog once and he was brown."  That's okay, though.  I just try to catch everybody who gets a hand up at least once, maybe twice.  With the questions, you answer, and with the statements you acknowledge and everybody's happy.  Sometimes kids can't think of anything, so they just repeat what the last kid said. "I had a dog and it was brown, too!" The only time it got to me a little was at a preschool class where the first kid's dog had died.  "I had a dog and it died, too!" Twenty kids with dead dogs...jeez.  Thank goodness the first kid didn't say I killed it.

As I said, I'm used to that.  On this trip, though, the kid's question is "Do you ever watch Andy Griffith?  You look just like Barney Fife."  "Thanks, kid, I get that a lot."  That's not strictly true, though.  I used to get it a lot from my wife and daughter whenever I put on my Scout uniform.  In fact, I've tried to roll with the punches and be a good sport (not my strong suit), saying, "I like Scouting because it's one place where I'm not the only guy who looks like Barney Fife."  Deep down inside, though, I don't really think that I look like Barney (not that that's necesarily a bad thing, you understand).  For one thing, I think I have a much stronger chin than Don Knotts.  And what about the glasses?

Here I am at the beginning of our Philmont trek in 2004.  I realize the picture's not that great, but I cropped it out of the group shot.  Barney Fife?  I don't think so.

This is after 10 days on the trail and 12 days without a shave.  You can see that really I look more like a young Gabby Hayes.  Barney Fife, indeed.  Hmmph!

Paresthesia and the Pelvic Fracture revisited

I posted on pelvic fractures a while back, and I didn't really get into the soft tissue complications.  They are certainly possible, and I guess what's really amazing is that we don't see more of them.  You could have the urinary bladder ripped loose from its moorings, or it could be ruptured by the same impact.  After any kind of severe trauma, you need to monitor the patient's urine output.  Sometimes a full bladder is damaged, but doesn't rupture until a few days later.  I once had a cat patient who seemed to be doing well for the first three days after being hit.  Then she started getting more depressed and dopey.  Her urinary bladder had ruptured and her wastes were pooling in her abdomen instead of leaving by the back door.  This is something that's fixable, but you have to realize what's going on before it's too late.

There are a lot of nerves around the pelvis as well.  Right now we're dealing with a very challenging case.  Little Mickey was hit back in July and seemed to have no other injuries outside of the pelvic fractures.  With pain control, he seemed to be doing well, and was up walking on 3 legs in a couple of weeks.  Unfortunately, he didn't seem to be using his left hind leg much.  The sciatic nerve controls a lot of the leg muscles (as in the diagram) and it certainly could have been damaged in the original injury.

Things got worse, and the toes became traumatized from dragging the paw.  The owners were unable to keep a bandage on it, and finally Mickey chewed off a couple of toes.  With that kind of problem, and no use of the leg anyway, we were forced to amputate.  We expected that to be the end of the story, but it is not.

This should be a happy little stump -- plump, round, and slick as a mink.  Unfortunately, Mickey continues to chew on his stump.  The neurologists believe he is suffering from paresthesia.  That means that he has weird sensations as a result of the nerve damage.  Everything hooked to the damaged nerve has sensations of prickling, tickling, burning or crawling or something. [Formication: the sensation that small insects are crawling around on you.  Not to be confused with that other word that's almost the same, appearing frequently in the King James version.] 

There is some hope that the nerve will heal eventually and that this will pass, but nerve healing (if it does occur) can take six months or longer.  In the meantime, combinations of medications are used in the attempt to relieve the dog's distress: opioid pain-killers, anti-inflammatory doses of cortisone, and other drugs whose primary use is something else (like anti-seizure, anti-depressant, etc.), but which seem to help with  this. 

What a mess.  As I said, with the way things are put together here, the great wonder is that it doesn't happen more often.  I don't know how many pelvic fractures I've seen, but this is my first paresthesia. I don't like it.

End of Daylight Savings Time again

The weather has been perfect yesterday and today, low seventies, clear blue skies and no wind.  I was able to get in a ride on Old Red both days, but had to start "an hour later" today.  The shade you bless on hot days was an unwelcome interlude today. We wanted all of that setting sunshine we could get.  The air was as clean and sweet as it ever gets in Swampeast Missouri.  At least it was in the fields that haven'thad chicken-house litter or gin trash spread on them for fertilizer. Those stink pretty nearly as bad as a pig farm.  There are still scattered cotton modules in the fields.  Lots of bugs broke on my face-shield, and that probably won't happen again until spring.

I'm leaving the little clock on my fork-nut set on daylight savings time.  It's my promise to myself that spring will come again.

She can't go to the bathroom

Old Yeller Alert

A while back, I posted about Curly Sue having blood in her urine.  She turned out to have a bleeding disorder instead of a urinary problem.   Last week, she developed a urinary problem.   One day my receptionist asked me what the dose would be for a mild laxative. "They say that Curly Sue is straining to have a bowel movement."  I suggested some Metamucil, but also suggested that they be sure whe was urinating okay (even though female dogs rarely become obstructed -- their urethra is short, straight and stretchy, so it doesn't get stopped up very easily).

The next day, her owners called back and decided that they had been mistaken: she wasn't having trouble defecating, she was actually straining to urinate.    I wasn't too surprised by that, as the squatting and straining looks pretty similar.  Since female dogs rarely have blockages, I suspected that she had a bladder infection. When they told me that she was making frequent attempts to urinate, but producing very little, I was even more sure that cystitis (bladder inflammation) would be the problem.  However, as Sherlock Holmes once said, "It is a capital mistake to theorize in advance of the data."

When Curly Sue walked in, she was dripping urine in a steady trail of drops.  That does not go along with a bladder infection.  With the bladder infection, you feel you like really, really have to go, even though you just went and got emptied out.  If you just got emptied out, you wouldn't be dribbling.  If you're incontinent and can't stop dribbling, you wouldn't be having to strain.  Something doesn't jibe here.

She could have had  a stone lodged in the urethra, causing a partial blockage (rare though that is in females), but she didn't.

She could have reflex dyssynergia.  This is a weird neurological condition where your "squeezing-out" muscle and your "hold it in" muscle aren't in sync.  When the "squeeze" is on, the "hold it" should be off and vice versa.  In those dogs, when they strain to empty, their sphincter paradoxically shuts down and tries to hold it in.  When they quit trying to squeeze, the sphincter opens and they dribble.

She could have had that, but she didn't.  Her abdomen was tense, and when I ultrasounded her bladder, it was hugely full.  Then we found the big mass of tissue surrounding the neck of the bladder.  The ultrasound alone couldn't tell you exactly what it was, but it was a big mass that normal dogs don't have.  It proved to be cancerous and inoperable and the end of the trail.

Curly Sue had a long life, and dodged a big bullet in the summertime.  I guess all good things come to an end, but she will be greatly missed.

One more lesson in how hard it is to make the diagnosis over the telephone.