When The World Gets Crooked

It won't happen to too many pets, but if it happens to yours, it will have you thinking that it's finally time to "put her to sleep." Your dog (or cat) will suddenly (as within a few hours) become extremely disoriented - probably to the point where she is running into things and falling over. There's a good chance she'll vomit, and for sure she will refuse to eat. You may or may not notice that her head is tilted, and her eyes are doing crazy things! You will see these symptoms and fear the worst. And who can blame you? This almost always happens to older pets: the ones that we are waiting and fearing something terrible is going to happen to anyway. And this certainly is something terrible.

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.

Aspirin in Pets - Bad Idea

Last night I had a patient who was in a really bad way. He had a serious arthritic condition which had gotten progressively worse over the past several months to the point where the dog could no longer stand on his back legs. In an effort to help, someone in the house had given the dog aspirin. Ugh. 

First of all, I could have done a whole lot more for this poor dog had he been brought to me months ago. Arthritis is a relentlessly progressive condition in dogs, and once it occurs, arthritic destruction of cartilage and remodeling of bone cannot be reversed. However, the progression of the disease and the pain that accompanies it can be dramatically reduced in most cases IF TREATED EARLY. Okay, that's not the topic of this blog, so...about that aspirin...

Aspirin in dogs is an effective pain-reliever at the proper dose. In fact, I would prescribe it for some of my patients 20-25 years ago. You can still buy "doggie aspirin" with the dose listed on the bottle. But unfortunately, aspirin has a very high potential to cause more problems than it helps. The number-one risk is gastric ulceration, which can cause death from hemorrhage or stomach perforation. I have seen it happen. Aspirin can also cause kidney failure, especially in older pets (which are the ones most likely to receive it).

Now we have newer drugs which are similar to aspirin, but much safer and more effective. These drugs can also cause serious side-effects, but their risk-profile is muuuuuch safer! The problem is, if our patient has been given aspirin for any recent length of time, it changes the dog's ability to handle the safer drugs. What this means is, if you give your dog more than one dose of aspirin before bringing him to see me, you have effectively tied my hands from giving him something much better and safer. 

Dogs who have received previous aspirin therapy should go through a 5-7 day "washout" period of no medication, before we can give the good stuff. During this time, the dog has to suffer with the pain that we could be treating had the dog not been given aspirin. 

As a side-note, aspirin is quite toxic in cats, except at super-low doses and prolonged intervals. Never give aspirin (or Tylenol) to a cat without specific instructions from a veterinarian. You know what? Let's just not give any medication to our pets without first checking with the vet. DVMs know what is safe, and at what dose. Use us! That's what we're here for.

The Difficult Decision

Five minutes ago, I ended the life of an older, but not "ancient" cat on a soft towel in a quiet room in the back of my office. She went to sleep peacefully and painlessly. This cat belonged to some nice folks that my family has been acquaintances with for a long time. The husband spoke to me yesterday about their cat. I was not at work, and we had been talking about something else (probably sports), when he abruptly mentioned that his cat had started urinating and vomiting all over the house. She had ruined several pieces of furniture as well as the carpet in the basement. He said, "I think it's time to put her down, don't you?"

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.

Tularemia - An Emerging Threat To Cats and People

This just in from the Illinois State Veterinary Medical Association:

Cats Test Positive for Tularemia

Champaign-Urbana Public Health District Encourages Citizens to Keep Cats Indoors to Help Minimize Tularemia

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).

Cats may prey on rabbits and rodents and become infected or they may become infected through tick exposure. Cats may develop a variety of symptoms including high fever, mouth ulcers, depression, enlarged lymph nodes and behavioral changes including not eating. Persons whose cats have contact with the outdoors should take their pet into the veterinarian if they should develop these symptoms.

People may also contract tularemia developing sudden fever, chills, headaches, diarrhea, joint pain, muscle aches, cough and weakness. People can become infected by handling pets or wild animals with tularemia, being bitten by ticks or by inhaling the organism. If you develop symptoms of tularemia see your health care provider.

To reduce the chances that your cat will become infected:

• Do not allow your cat to hunt outdoors
• 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

If you have questions about tularemia in humans, please contact Rachella Thompson, Communicable Disease Investigator, with CUPHD at (217) 531-5361 or your health care provider. If you are a cat owner or have questions about tularemia in animals, please contact your veterinarian. Visit http://www.bt.cdc.gov/agent/tularemia/facts.asp orhttp://www.avma.org/public_health/biosecurity/tularemia_facts.asp for additional information.

Note from Dr Hall: There is no vaccine for Tularemia!

Laser Therapy -- The Latest and Greatest

After years of research, conferences, and opinion-gathering, we finally took the plunge and purchased a therapeutic laser for our veterinary hospital. Normally equipment purchase decisions are not so agonizing, but therapeutic lasers are so new in veterinary medicine that there aren't a lot of published, refereed  studies to prove (or refute) their efficacy. We take considerable pride at our hospital in the fact that we practice "evidence-based" medicine, which basically means that the medications and other therapies we recommend have been proven effective (usually in university studies). Therapeutic laser is really not an evidence-based therapy. Yet.

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.

Pain Control as an Option? Really?

I'm going to share an "industry" secret with you. We price-shop our competition. All veterinary hospitals/clinics do this as a way to make sure our prices are in line. We have to do this by calling other veterinary clinics and pretending to be a price-shopping client. Anti-trust laws prevent us from having honest discussions with our competition about what they/we charge, so we all have to be clandestine.

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.

I Bet You Don't Take Your Cat To The Vet

Admit it. You have a cat that I, your veterinarian, don't even know about. I have been taking care of your dogs for many years now, so we know each other pretty well. But you never mention that cat. I know what you're thinking. "Why should we talk about the cat? He seems healthy enough, never goes outside, and besides, he HATES car rides and new situations."

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.   :-)