The past week has been rough for me. I found out that two good buddies of mine have malignant cancer. To make matters worse, the cancers hav...
One of my favorite people sent me an article from aolnews.com, titled "Letting Sleeping Dogs Lie in Your Bed Can Kill You" . The ...
As the owner of a fairly large (4 DVMs, 35 support staff) suburban veterinary practice in the year 2013, I occasionally get complaints from ...
This is going to be more of a "rant" than a blog. So, sorry, but here goes... My daughter went to her dermatologist this morning....
I have to say, I really love my job. It is a rare day that someone doesn't tell me they've wanted to be a veterinarian at some point...
Friday, November 22, 2013
The good news is that a single seizure is rarely as serious as it appears. They usually last no more than a couple of minutes (although they seem to last forever), and after some recovery time, the dog returns to normal. As with most medical problems, there are some exceptions.
Some dogs who have a seizure, only have a single one, and then are fine. For this reason, I usually do not do a full work-up on a young adult dog who has had a single seizure, has no other symptoms, and has a normal physical exam. However, if a dog is less than a year old, older than five years old, has other symptoms, or has had more than one seizure; that dog will need a full work-up.
By far, the most common cause of seizures is a disease called Idiopathic Epilepsy. Epilepsy usually first appears in dogs between the ages of one and five. There is no known cause, but certain breeds seem to be predisposed. There is no test for epilepsy, so the diagnosis is made by ruling out other causes of seizures. So, what are some other causes of seizures? The list is long, but includes: head trauma, toxins, metabolic disorders (low blood sugar, kidney disease, liver disease), congenital brain disorders (such as hydrocephalus), cancer, meningitis, heart disease, and "stroke." My typical work-up for a seizure dog includes an ECG, CBC, blood chemistries, blood pressure, and a thyroid test. If these tests are all normal, but the dog is showing other neurologic symptoms or is not responding to treatment, I refer the dog to a specialist who can do more advanced testing such as CT scan or MRI.
My first choice anti-seizure drug for epileptics is phenobarbital. Phenobarbital is very effective in most cases and is fairly inexpensive (the dog will be on medication for life). There are potential side-effects of phenobarbital which include transient sedation, increased appetite, and most significantly - liver toxicity. The liver problem is uncommon, but we closely monitor liver values on our patients who take phenobarbital. For those patients whose seizures are not adequately controlled with phenobarbital, I usually add potassium bromide. When combined with phenobarbital, potassium bromide is a very effective anti-seizure drug, and is also fairly inexpensive. Dogs on potassium bromide have an increased risk for pancreatitis.
There are newer anti-seizure drugs on the market, which are significantly more expensive. However, these drugs tend to have fewer side-effects, and are sometimes effective in patients not responding to (or who are having side-effects from), phenobarbital or potassium bromide.
A recent study showed that the sooner an epileptic dog is put on medication, the better the medication will work, and lower doses will be needed. Historically, veterinarians (including myself) tended to not start anti-seizure drugs until the patient was having seizures with unacceptable frequency ("unacceptable" was based on the owner's tolerance, but I often would suggest that more than every two months was "unacceptable.") Since the newer information has come out, I strongly urge that my epileptic patients start medication after the second seizure. Being able to use lower doses of anti-seizure drugs (lower-doses = less chance for side-effects) with better results is definitely in the best interest of the patient!
Thursday, September 26, 2013
The only thing I would add is that she mentions that she has the potential to spend more for her vet visits than on her family's healthcare in a year. This conveniently overlooks the THOUSANDS of dollars that she or her employers are spending annually on health insurance, which then pays most of their medical bills. I've seen my health insurance premiums, and I've seen the medical bills before insurance. No one can reasonably assert that veterinary care is anywhere close to the cost of human health care. I assure you, no one at my practice (including me) is getting rich. And by the way, I'm not complaining: I make a good living, and I don't mean to suggest that veterinary care should cost as much as human health care.
Wednesday, September 11, 2013
Except, it often isn't as bad as it looks. I just described to you the symptoms that animals with vestibular disease often present with. Vestibular disease is a generic term which simply means there is a problem with the pet's equilibrium. The problem can be located in the inner ear, or more often in the brain. What the pet is experiencing is akin to someone spinning us around at a high rate of speed and then asking us to walk across the room. We will stumble, stagger, and maybe even vomit if we were spinning fast enough.
The various causes of vestibular disease in pets are still pretty mysterious to us. The most common maladies are "old dog vestibular disease" and "feline vestibular disease." The bad news is that we don't know what causes either one of these syndromes. The current thinking is that they are some form of vascular accident (think "stroke"). The happy news is that the prognosis is usually pretty good. Usually time, antivertigo drugs, and maybe some steroids work wonders for these patients.
Vestibular symptoms can less-often be caused by inner ear infections, trauma, or tumors. The prognosis varies in these cases.
My typical workup for a dog or cat with vestibular symptoms is to check the blood pressure (hypertension makes me suspicious of a vascular accident), and thyroid levels (hypothyroid dogs seem to be at increased risk for neurologic problems). I also do a thorough physical exam with special emphasis on the ears. The typical patient will improve over the next 2-4 weeks. If there is no improvement, I will do a more complete blood workup and skull radiographs to look for changes deep in the ear canals. If these tests are normal (which they usually are) and my patient isn't improving, the prognosis is less favorable and I am sending her to a veterinary neurologist for a second opinion and possible MRI.
I am happy to say that in my personal experience, about 80% of these pets do remarkably well, and the owners are REALLY glad I talked them out of euthanasia.
Thursday, August 29, 2013
Monday, August 12, 2013
I never quite know how to respond to those situations, because you see, we had not seen his cat in two years. I assumed that since he hadn't brought her for an exam (and possible testing), that he really wasn't interested in trying to find out why she was vomiting and urinating all over. He was really just wanting me to "sign off" on a decision that had already been made. The cat had originally belonged to his son, who had long since moved away.
I'm not judging him. There are often mitigating factors when people decide that it's best to end the life of a pet. We usually are not privy to these circumstances. I believe that sometimes the person making the decision isn't even aware of some of the psychological "baggage" that is influencing their choice. The gentleman in my story is an intelligent guy. He is smart enough to know that maybe I could have done something medically that would have helped his cat. He's also smart enough to know that it might have been expensive, unrewarding (ie ineffective), or labor-intensive (have you ever tried sticking pills down a cat every day?)
So he probably had his reasons for not seeking my medical assistance, but instead my reassurance that they were making the "right" decision. Was it the "right" decision? I am humble enough to admit that I don't know. There are simply too many factors that I am unaware of.
I do know this: His is a good family, and although the cat might not be high on their priority list, I think they provided a comfortable home for her. I also know that humane euthanasia results in no suffering for the pet. I was there to make sure she left this world in a painless manner (which is better than many of us will have.) For reasons of their own, they chose euthanasia over exploring medical options. It's not the decision I would have made, but that doesn't make it wrong.
Tuesday, June 11, 2013
Champaign, IL – The Champaign-Urbana Public Health District (CUPHD) is encouraging area residents to keep cats indoors to reduce the likelihood of contracting tularemia. The Champaign-Urbana Public Health District has identified two additional cats positive for tularemia in Champaign-Urbana. Previously, five cats were diagnosed with tularemia at the University of Illinois, College of Veterinary Medicine; one cat from Champaign and one from Urbana; and three cats from two households in Savoy. Tularemia is caused by the bacterium Francisella tularensis found in animals (especially rodents, rabbits and hares).
• Consult with your veterinarian to make sure your cat is protected from tick bites
• Report any unexplained large die-offs of rodents or rabbits to your local animal control. • To reduce the chance that you or your family members will become infected:
• Wear tick protection when outdoors
• Do not mow over sick or dead animals
• Do not handle wild animals
• Cook wild game meat thoroughly before eating and use gloves when handling the animal and preparing the meat for cooking
• Take any pet with symptoms of tularemia to the veterinarian
Tuesday, May 21, 2013
The majority of veterinarians I have talked to over the past couple of years who use laser therapy could not say enough good things about it. I have attended laser therapy lectures at major veterinary conferences and been impressed by the tremendous upside and the lack of an actual downside. Once we decided to purchase a laser, we opted to go with the one we felt was clearly superior to all the others, and that was an MLS unit. This unit uses two different wavelengths simultaneously to control pain and inflammation. There is no heat generated (thus the sometimes-used term "cold laser"), and no discomfort to the pet.
The great news is the results we have seen in the few weeks since we started using the laser. The most obvious benefit can be seen in patients with traumatic wounds. We are witnessing a speed of wound healing which has absolutely amazed all of us. There are pictures posted on our Facebook page which show this. But we are also seeing it's benefits for cats with bladder problems, joint pain, post-surgical pain and inflammation, abscesses, and spinal problems. I will say that there have been some cases that have responded less dramatically than others, but I have found that to be true of any treatment modality I have ever used. There is no such thing as one therapy that works better than all others in every situation.
The bottom line is that I am thrilled that we have the laser and that it has out-performed our expectations. Many of our staff have asked us to let them use it on themselves which I guess is the best testimony of all.
Monday, February 25, 2013
Anyway, as we were calling around last week to get price quotes for dental and surgical procedures, we discovered something that disturbs me very much. A small number of veterinarians consider pain medication and/or IV fluids optional. The absence of pain-controlling medication for an invasive surgical or dental procedure is, in my opinion, barbaric. Would anybody out there be willing to experience a hysterectomy, castration, or tooth extraction and wake up with nothing to help the pain? Really? If you were the patient, would you want your surgeon to make that an optional thing?
When I was in veterinary school in the '80s, pain control was not a point of major emphasis. We were taught that animals don't experience pain in the same way as humans, and that some degree of pain was helpful in preventing our patients from "over-doing" it after surgery. We now know that animals in pain are adept at hiding it, but they are hurting/suffering just as much as we would be under similar circumstances. We also know that effective pain control actually speeds healing. So there is a comfort benefit and a medical benefit.
Without going into a boring physiological description, I would like to briefly describe the purpose of IV fluids in an anesthesized patient. First of all, it gives the surgeon/anesthesist quick venous access in case of an anesthetic emergency, or even if the patient needs additional pain control under anesthesia. Secondly, it allows much greater regulation of blood pressure in these patients. We now know that most anesthesized patients experience a significant drop in blood pressure, which could result in organ damage that may not show up for weeks or months. Even though these patients may "wake up" from their procedure just fine, damage HAS been done. Only IV fluids and blood pressure monitoring can minimize this risk for the patient under general anesthesia.
For a veterinarian to skip, or make optional, these services, in order to offer a cheaper spay (or whatever), is unforgiveably irresponsible.
Monday, January 28, 2013
You are in good company. The overwhelming majority of American cat-owners do not take their cats for routine check-ups and vaccines. They all think like you do (we have survey results). It's understandable, but dead-wrong to not give your feline friend the same medical care as dogs get. I blame myself (and my colleagues) for your misinformation. Veterinarians do not do a good job of educating the public about why cats NEED regular veterinary care. So here I am, trying to help correct this oversight.
I'm going to start with the most important reason to take your cat to the vet every year. Cats are amazing at hiding signs of illness. I mean really gifted. More often than not, when we see a sick cat, we see a cat who is in real danger of dying from their disease. And the owners of these dying felines usually tell us that their cat has only been sick for a few days (and doesn't even seem too sick). Meanwhile, the weight loss, pale mucous membranes, heart murmur, jaundiced eyes, or disastrous lab results tell a different story. The owners simply never noticed the signs because the cat was too clever to give himself away.
You see, cats are not small dogs. If one of your cats lost 2 pounds (20-25% weight loss) over a 6-month period, would you notice? Or if one of your cats was drinking more or urinating more? What if one of your cats (assuming, like many cat owners, you have three or more) stopped eating, and was hiding more? How long before you notice? Well, you can bet that most cats are sick long before they start even showing these signs that you won't notice.
I can tell you with total confidence, that cats who get regular check-ups will have their diseases noticed much sooner, with less medication needed, and most-importantly, a better prognosis.
What about the fact that, unlike your dogs, your cats never go outside? This makes them less at-risk, right? Hmmm.... maybe so, but not much. Parasites, and disease carrying vectors will find their way into every home. Did you know that most commercial potting soil is contaminated with roundworm eggs? Also, indoor-only cats are actually at an increased risk (compared with indoor-outdoor cats) for certain diseases such as interstitial cystitis. The most important thing to think about here, though is this: staying inside will not protect your cats from diabetes, hyperthyroidism, chronic liver and kidney disease, asthma, etc....
Now, I know your cat hates to ride in the car, and hates new situations. My cats do too. However, we do have a special cat-friendly exam room just for him. We like cats here. We will be gentle. He will still get stressed out, but in all honesty, didn't your kids get stressed out at the doctor when they were little? But you still took them, because the alternative was very frightening. Your cat is in the same situation. I know you love him and want the best for him. You didn't know! Now you do. I will see you both soon. :-)