October 16, 2007

Demodectic Mange again

Some time back I wrote a post on demodectic mange.  I had a great "before" picture, but the case was lost to follow-up.  This is a different case, and this time I do have the "before" and the "after" pictures.

Demodex_before_2 Shadow is a youngster who suffered a grievous injury to her left front leg.  After a period of two weeks of trying to salvage the limb, her immune system was shot, and the demodex mites had gone crazy.  Many hair follicles were damaged and secondarily infected and bleeding. This is the kind of case that lets you know where the term "red mange" came from.  Her leg had to be amputated, and treatment was begun for the demodex.   She had been treated for several weeks at this point, but the treatment regimen wasn't really intensive enough.  This picture was taken on her first visit to KVC.  She looks miserable, and she was.

We started her on a higher dose of cephalexin (antibiotics) than the previous doctor, daily dosage of ivermectin, and medicated baths twice weekly.  I also prescribed a nutritional supplement called Immuplex.  It's supposed to boost the body defense system and she surely needed that.

After_8_weeks_2 Shadow is much happier these days.   She will probably remain a carrier of the mites in small numbers (as most normal dogs are), and we will try to minimize stressful events in her life that might get her resistance down.  Motherhood is out of the question for her, as she would likely relapse, plus producing puppies with the same problem... plus she might lose her sweet, girlish figure.

August 09, 2007

Hamster surgery

As pocket pets go, the hamster can be a little demanding.  If not handled regularly, they can become aggressive, and they are great escape artists.  On the other hand, they can be mighty cute.

Hamster2 Little "Reighty" here had two skin tumors.  One looked  like an inflamed wart, and the other looked almost exactly like someone had slipped a Juinor Mint under his skin (which makes me think it may be a melanoma - pathology results will take a few days to get back).  Naturally, with a fragile little guy like this, you worry about anesthesia, but good old Sevoflurane gas worked great. Five minutes after his tumors were removed and his skin sutured, he backed his head and shoulders out of the mask (that accomodates a dog's nose).  In ten minutes he was walking around his cage.

It's really cool to see folks as committed to the health of a pet whose retail value is about one tenth the cost of his care.  Just like with dogs, cats or whatever:  I don't just want a pet, I want this pet.  Maybe someone could even learn to love me...though I have outgrown my cute stage.

April 07, 2007

Why dogs stink

"He smells like a dog", the client says.  Being as he is a dog, this doesn't seem to me to be a problem, technically.   If, being a dog, he smelled like, say, a camel -- now that would be a problem.  Of course, this is not the truly stinky dog. Every dog has a tendency to smell a little strong when wet.  If you can love your dog when he's wet, then you really love your dog.  Something about being wet, or even just a really humid day, brings out that "doggy" odor.  That's not too bad, though.  Nothing a little bath or a little deodorant (like Elimin-Odor, or Fresh-n-Clean) won't fix.  In fact, some clients complain about the dog smelling "doggy" when I personally cannot even detect an odor.  Admittedly, my nose is not sensitive at this point, so I do ask the staff to come in and give their viewpoint (smellpoint?).

Then there is the ever popular, "let's find something dead and roll in it".  It's a taste treat, a fashion accessory and a designer fragrance.  Again, nothing a bath (or two) won't cure.

Some dogs, however, are truly stinky.   A small minority of stinky dogs have an odor that arises from an internal illness.  Dogs with chronic and advanced kidney failure can have so much waste accumulating in their bloodstream that it makes their breath smell like ammonia (or urine).  Some seriously unregulated diabetics have so many ketones (fat break-down products) in their blood that their breath smells like acetone (the stuff in nail-polish remover).  These are not going to be long-term stinky dogs.  In fact, without some intensive care they are not going to be long-term alive dogs.

Long-term stinky dogs tend to either have personal hygiene problems, anal sac problems, mouth problems, skin problems, or ear problems (often extensions of skin problems, and I will discuss ear problems in more detail in a future post). 

The personal hygiene problems are worst for long-haired pets.  If you have lots of fringe around your mouth, food and saliva can lodge there and cause odor problems.  Long hair around your hiney needs to be kept trimmed.  Otherwise, the first soft stool hangs up and starts a "snowballing" effect.  It's hard to stay clean if you go to the bathroom with your pants on.  Dogs with deep skin folds also have odor problems with yeast and bacteria growing in the valleys.  This would include the English Bulldogs, the Chinese Shar-Pei, any "smashed face" bug-eyed dog, and some obese dogs.  Spaniels sometimes have folds in their lower lips that catch food and saliva.  You need to keep the folds clean. In some extreme cases, plastic surgery may be needed to eliminate the offending creases.

We have discussed basic dental care in previous posts.  The gunk in a diseased mouth stinks, and if you have an itchy dog, they will be spreading that goo on their skin wherever they chew themselves. Sweet.

Really itchy dogs (or pruritic dogs, as we scientists would say) are usually stinky if the problem is long-term.   The really itchy dog chews and scratches himself constantly.  This traumatizes his skin.  Often you can see sore places where he has actually broken the skin in an attempt to relieve his itching.  The skin attempts a protective response when continually assaulted in this fashion.  Most of us are familiar with the formation of calluses in skin areas that take a lot of wear and tear.  In dogs, the constant scratching does some other things as well.  It speeds up the process of new skin formation and maturation, though this is not particularly helpful. When you shortcut a 3-week process, the results are not as good as if you "did it right".  That's why the skin begins to flake: it's just not built as well as it should be.  Another thing that happens is that the oil glands in the skin get over-active.  This is a fatty secretion, and when produced in excessive amounts, it gets rancid pretty quickly.    This rancid odor will therefore develop with many chronically itchy dogs, no matter what the underlying cause for their problem.  Thus, dogs with yeast infections, bacterial infections, mange mites, allergies or contact sensitivity all "smell mangey".  Give them a bath and they will be stinking again in very short order. Their skin continues to crank out the grease, which goes rancid in a hurry.  The technical name for this situation is seborrhea. 

Medicated shampoos (benzoyl peroxide, colloidal sulfur, coal tars) will help abate the excessive flaking and greasiness, but you must find the underlying cause and treat that.  The stinkiness would not be happening if the itchiness were not happening.

Acceptable Stinky Dog Treatment Plan:

1. Find the source of odor:  mouth, ears, hiney, skin or combination thereof

2. Find the underlying causes and treat all of them. 

Unacceptable Stinky Dog Treatment Plan: throw dog outside.

January 02, 2007

Anal Sac Problems

Warning: This post describes disgusting bodily functions.

When I was starting veterinary school, I visualized myself as "the boy-wonder equine surgeon".  I really thought that I'd be doing nothing but horse-work.   Not only do horses not have anal sacs, at that time I wasn't aware that these particular disgusting anatomical structures even existed.  Had I known how much of my life would be involved with anal sacs, I might well have made a different career choice.

Sometimes people call them "anal glands" instead of "anal sacs".  I believe this may be to avoid the aural confusion between "anal sacs" and "anal sex". Believe me, that is not nearly as funny as you think it is when it really happens in the exam room.

Dogbutt2_ Dogs and cats both have these things.  The actual anal glands are very tiny and surround the anus.  Their secretions accumulate in the anal sacs.  At the end of each bowel movement, the animal gives things one last squeeze and this empties a few drops from the sac. They fall freely and land on top of the waste-pile.  The pheromones (hormone-like chemicals) act as a scent territorial marker.

In skunks and ferrets, the anal sacs become more specialized as the main musk glands.  The skunk has a special expelling mechanism.  In dogs and cats, they don't generally squirt the stuff across the room.  The exception would be the large and frightened German Shepherd (aka "anal glands with teeth").  Any dog or cat experiencing an extreme "butt-pucker" moment (like... looking at me) may squirt the secretion onto the floor. The volume is more impressive when the Shepherd lets go.

The more common problem is the dog who doesn't spontaneously expel his anal sacs.  This is most common in dogs with generally poor muscle tone: very small dogs, very old dogs, and very fat dogs.  When the sacs don't empty, the secretion accumulates.  This stretches the sacs, which creates pressure, which creates discomfort.  That's why these dogs scoot around on their butts. They are trying to empty the sacs and relieve that discomfort.  This (NOT worms) is the most common cause of butt-scooting.  In order to relieve the dog's discomfort, a groomer or veterinary technician (OR a veterinarian, like me) empties the sacs by squeezing.    If the dog is very fat, this may require a rectal examination to complete.  Sometimes the secretion gets thicker and harder over time, making it harder to empty.  Alas, this is a very common problem.

Analsacsbad_2_ Worst case scenario is rupture of the sac.  This is a painful and nasty mess, but is generally salvageable.   Conservative care with warm compresses and antibiotics is often all that is required.

Dogs who have continual or recurring problems can have the sacs surgically removed.  They are not a necessary structure, as their only purpose is to provide a scent territorial marker.  Our pets have their territories marked by the fences and sidewalks.  They can get along without these sacs.

One thing I failed to mention: this stuff stinks powerfully, much worse than mere feces.  A few drops are supposed to last weeks outside.  When the dog succeeds in squeezing a little out by scooting, it gets smeared on his hiney and you can smell him a mile away.  When it all gets emptied in one spot, it is mighty stinky.  Just washing doesn't fix it up.  You've got to add some odor neutralizer, something a little like this: Buttsofresh_1