Category: General

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Shipboard Surgery

I wrote the following article several years ago for publication in a sailing publication – just never got around to submitting it! I lost it when my site went down and I just found it again. I think it’s an interesting story for the cruising pet owner.

Dollar Gets a Nip and a Tuck – Shipboard Style

BEYOND THE REACH OF TODAY’S SOPHISTICATED VETERINARY FACILITIES , A DOG UNDERGOES SOME ‘MEATBALL SURGERY’ AND COMES THROUGH WITH FLYING COLORS

    It’s 0830 and I’m arriving aboard ‘Sanctuary,’ a 56 foot Ted Brewer ketch anchored in Puerto Blanco,  commonly known as Luperón harbor, in the Dominican Republic. ‘Sanctuary’ is anchored along with our boat, ‘Fidelis,’ and over a hundred other cruising boats spending hurricane season in the protection of one of the best hurricane holes to be found in the Caribbean basin.

Dollar before his surgery.

    Yesterday we checked over our patient and decided there was no point in putting off this surgery any longer. After a few visits ‘Dollar,’ the six year old Dalmatian dog belonging to Amanda and Caroline, has become much more receptive to my attention and is actually eager to see me today. No signs of nervousness and no more growling. That’s a good thing, since today he goes ‘under the knife.’ 

     A physical examination a few days ago revealed a skin tumor low on Dollar’s chest, between the front legs. That alone, his owners can afford to just keep an eye on; however, he also has an aural hematoma, a squishy pocket of fluid on the surface of the ear, which they have since been monitoring, and the consensus is that, if anything, it is getting larger. Either of these problems by itself might warrant a ‘wait and watch’ approach, but the two together suggest that we should probably address this situation now, before either one progresses any further, especially in view of the fact that his owners will soon be leaving him under the care of a boat sitter and flying out for a month

The aural hematoma — you can see the puffy area just in from the near edge of the ear.

SIDEBAR:    An aural hematoma is essentially a large pocket of blood, which collects between the skin and the cartilage of the earflap. Usually it occurs as a result of self-induced trauma from scratching at the head, often triggered by an ear infection or fleas, or as a result of shaking the head and knocking the ear flap against a metal buckle or D-ring on the collar or against a hard object in the environment. 

    I have already discussed the alternatives with Dollar’s keepers. They are not eager to entrust his care to an unknown doctor with limited facilities. 

    Ideally this sort of procedure, even though quite minor, should be done in a veterinary hospital with gas anesthesia, monitoring equipment, and an overnight hospitalization. Here in the Dominican Republic, gas anesthesia, let alone any type of sophisticated monitoring device, is almost unheard of at veterinary facilities, and the trip from rural Luperón to the nearest veterinary facilities in Puerto Plata or Santiago requires a long ride of more than forty miles, either by multiple gua-guas (the local mass transportation, where commonly upwards of fifteen to twenty passengers literally pile into a small minivan to get where they are going) or an expensive taxi ride. 

    I have explained to the ladies that frankly I cannot see much of an advantage to subjecting Dollar to that kind of trauma for what amounts to little or no increase in safety. In addition, if there are any complications following the surgery, not uncommon with an aural hematoma repair, his post-op care will fall under my hands here in the harbor. And, as is common among surgeons, if I have to do any aftercare I’d prefer to clean up my own mess rather than someone else’s. As a result, it was their preference to go ahead and do this here in the harbor aboard ‘Sanctuary.’ 

    A cursory look at Dollar’s ears doesn’t reveal any infection, and I have found no evidence of fleas, so I am suspicious that he probably whapped the ear on a stanchion or a lifeline or any of a multitude of other solid shipboard objects. The excessive head shaking that has developed since the swelling arose is simply a result of the unusual sensation of the heavier ear flap, and each subsequent shake of the head disturbs the swelling, leading to more bleeding into the pocket and further enlargement. With repeated head shaking the swelling could literally become the size of a tennis ball. Eventually, striking that swollen mass against a hard or sharp surface could then rupture the oversized blood blister, creating a huge mess and an invitation to serious infection. Thus our decision to operate. While we are at it, we will also remove the small chest tumor. 

Dollar in the on-deck “surgery suite.”

    On the stern deck of ‘Sanctuary,’ I administer intravenously a heavy dose of sedative and an immobilizing agent, which is essentially the same anesthetic protocol that would have been used by any of the local veterinarians, and Dollar drifts off into a deep sleep. I use a local anesthetic around the chest tumor, prepare the site for surgery, and we promptly dispense with that. 

     We then shave the earflap and prepare that site. A large S-shaped incision of the skin on the inner surface of the ear allows complete drainage of the fluid pocket, and I then place a number of sutures through the earflap in an effort to close the space and prevent it from filling again. While I have Dollar immobilized, a closer examination of the ear canals confirms my previous impression that the ears look clean and healthy and that this was probably caused by an incidental smack on some piece of boat hardware. Finally, we place a wrap snugly around the head and put in place the Elizabethan collar that Amanda has already made on her sewing machine from a spare piece of isinglass (vinyl glass used in fabric enclosures) that she had aboard. 

Dollar with his homemade Elizabethan collar in place.

    I have previously explained to Amanda and Caroline that postoperative care and restriction of activity is the most important part of this surgery and is likely to make the difference between success and failure. I prefer to leave the sutures in an aural hematoma repair considerably longer than the usual seven to ten days allotted for most other surgeries; and I allow a good three to four weeks before proclaiming this particular surgery a success, as disruption of the healing process by excessive activity or by shaking of the head can easily occur. We will be sorely tested here, as Amanda and Caroline will be leaving in ten days and while they are away Dollar will be under the care of a resident harbor boat sitter who will be responsible for ensuring his well being. I will also be checking in periodically.

    Within a matter of two or three days after the surgery, it is evident that Dollar is behaving himself admirably – the model patient! He is tolerating his head wrap and his Elizabethan collar with commendable patience. Amanda and Caroline are following my instructions to the letter. Removal of the wrap reveals that the ear is healing nicely, and the prognosis for a cosmetically attractive result is improving. By the time his owners are ready to leave on their trip, we have removed the sutures from the tumor site on the chest, and Dollar has recovered to such an extent that I am actually willing to let them leave with a clear conscience – I go out on a limb and pronounce his ear surgery a complete success.

    I strongly recommend to the boat-dog-sitter that, to assure everyone that any possible reinjury of the ear is not his fault, Dollar should continue to wear the protective collar until his owners return. If there should happen to be any relapse, let it be on their watch. He gets along great with Dollar and he enthusiastically agrees. 

    A week or so after Amanda and Caroline leave, I feel comfortable doing the final suture removal from the ear, and, with firm instructions to limit activity and watch for excessive head shaking for the next day or so, I renew my concern that the E-collar be worn. A couple of follow-up check-ups, and he’s hanging in there fine. The ear looks better than usual for having undergone this type of surgery. By the time the ladies return from their trip, Dollar is a picture of cooperation, proudly wearing his E-collar, and with a completely healed, good-as-new earflap. Over the next few days, in order to acclimate to the new sensation of not wearing the protective collar, it is removed for increasing periods of time until Dollar has readjusted and returned to the normal shipboard routine.

    This is simply an example that, given a good patient and pet-owners who are willing to follow doctor’s directions to the letter, out here, even under less than optimum circumstances, a pet health problem can end with a rousing success. Happy sails to all the cruising pets and pet owners out there!

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The Newest Flea Technology

New Flea and Tick Products that Work!

Anybody who has heard me talk flea products or read my recommendations for the past ten years or longer is aware that I have been reluctant to depart from my traditional recommendations of Advantage and Frontline simply because there has not been anything in the way of flea products that rival them in both safety and efficacy. Admittedly, for several years now they haven’t been near as effective as they once were. Fleas are quick to make the adjustment to new poisons and these were no exception. However the tradeoff for many of the newer products since that time has been in the area of safety. Many newer products have worked reasonably well, and that’s all they have had to do in recent years to outdo Advantage and Frontline — just a reasonable job — but really nothing has rivaled those two weapons as far as safety is concerned.

Well, after all that time, it seems we have a new class of product that is looking attractive. Isoxazolines are showing significant promise and I attended a presentation at a recent conference on the product Bravecto (fluralaner). Bravecto is available in both a cat version and a dog version. The dog version is an oral chewable tablet that is to be given to dogs at 12 week intervals. The cat version is a topical spot-on type of treatment that is to be applied once every 12 weeks.  (For certain tick applications this interval can be shortened to once every 8 weeks) The report that I heard was very impressive. 

The study was done here in Florida where the fleas have seen and done it all. Nothing works very well here, yet the results were nothing short of remarkable. The researchers went into a number of households where there was no existing flea control and, after performing their flea counts for study purposes, treated all of the dogs and cats in the household. They then followed up with visits to the homes where they repeatedly did flea counts to monitor the flea population and by the end of the 3-month period the flea population had been eliminated within the household. Counts were at zero! All animals were flea-free with only a single treatment. They did not do any environmental treatments, nothing else. Although the results are amazing we must keep in mind that this product is still pretty new and the fleas haven’t yet had the opportunity to adjust, but the implications of the study are pretty impressive for the near future.

If you combined their methods with a reasonable environmental treatment program, this study suggests that you should be able to maintain an effective control program by treating only once every 3 months. Not only that, but if you maintain a closed population, no pets going outdoors, it is not unreasonable to presume that you could discontinue treating after only a few treatments and still maintain control. 

There are a number of other isoxazoline products on the market. The identifying suffix on the generic name is the –laner ending on the product name. So far the other brand names that I can site are Simparica, Credelio, and Nexgard. I don’t have any details on those products but they are all probably worth a look. That’s the good news.

Now the not-so-good. As with any drug or insecticidal product there is always a downside. These products are too new yet for a lot of data to be available, but there may be some possible increase in seizure activity and/or some neurologic symptoms that could be seen in some patients. Now lots of these products are already out there and the numbers at this point are still not impressive but in all likelihood there is some substance to the reports. We really should not be surprised. Seizure and neurologic issues are not rare with insecticidal products in general. Another issue which I feel is probably of greater concern, is the possible interaction with ivermectin in collies, shelties, and other breeds that carry the ABCB1 genetic variant which predisposes these individuals to various drug sensitivities, including ivermectin. Combining isoxazolines with ivermectin in these breeds is a bad idea, and there are suggestions from some ophthalmologists that it may be a good idea to avoid isoxazolines altogether in these individuals due to some possible reports of vision impairment. The jury is still out on this. I would probably play it safe and avoid these insecticides if I owned an abnormally sensitive dog. Here is one of those potential issues where the product is not the problem, but rather it’s the patient.

As I have said so many times before, no product is 100% safe. If it were, it wouldn’t do anything. But for the most part I think for the vast majority of individuals these products are relatively safe and worthy of consideration in the battle against fleas. Remember, fleas offer a much more concrete, widespread, across-the-board threat to your pet’s health than do these insecticides. There are a lot of folks out there who still consider fleas to be a “natural” part of owning pets and for those people any effort at flea control beyond the fantasy world of garlic and brewer’s yeast is considered “dangerous.”  While they live in denial in their fairytale world, their miserable, bald, scabby, scratching pets (not to mention having a house full of fleas) are perfectly acceptable to them in a world where we have the means to eliminate that suffering. I’m sorry but I don’t agree. Give these new products some serious consideration, but watch closely for any possible signs of trouble.

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Euthanasia

Euthanasia

Most pet owners hope they will never have to face the decision to put a beloved pet to sleep. As difficult as it might be to think about, it is not likely that your pet is going to live forever. And the odds really do not favor her living to a ripe old age and quietly drifting off to sleep and not waking up, like most pet owners envision. Unfortunately most geriatric pets fade away relatively slowly and go downhill in a painstakingly long, drawn out death spiral. As the end slowly approaches there comes a time when the decision stares you in the face. Should I or shouldn’t I? Is it time yet? It’s at this particular juncture that I often see clients who are searching for the answer to these questions. Remember, this may be a difficult topic to face, difficult to even think about for some, but for most pet-owners it’s likely to be a part of your future.

Over the years I have found that in nearly every case the pet owner already knows the answers to the above questions. In my opinion, a person does not spend ten or fifteen or more years living with a companion who has been the light of his or her life, and make this kind of life and death decision without giving it ample consideration. I tell the pet owner the truth: no veterinarian knows better than you do. We perform a physical evaluation of the patient and we see the pet for a few minutes in a totally foreign, hostile environment where the adrenalin is flowing and the pet is as far from “normal” as it is likely to be. You are the one actually living with the patient for the other 23 ½ hours a day. Who do you think has the greater understanding of the situation?

I try to not insert myself into these cases. I do not inquire about further treatment, and I do not insult the owner by pretending that I know more about their pet and what they have been going through than they do. I have always maintained that when it comes to elderly pets and the end of life decisions involved, the owner has the greatest understanding and the most intimate knowledge of that pet and of what they themselves can deal with. They know what needs to be done. It’s not my job to second-guess, and I certainly have no business questioning their motives or their timing. End of life decisions are always difficult for everybody concerned. There is no point in offering suggestions that may raise doubts after someone has taken hours, days, or weeks screwing up their courage to finally do it. 

I am appalled by veterinarians who, facing a client who has wrestled with the decision of when to euthanize, feel that they have to throw out one more treatment just to prolong the end by another week or another month, rather than be supportive of a decision that has been carefully considered. All the owner wants is to feel support for their decision so that they can say good-bye without guilt. Sure, there is always one more treatment out there, but that’s not what the owner is seeking at this point.

I have rarely if ever encountered a pet owner who was guilty of putting down the aging and failing family pet too soon. I’m not talking here about young pets that are having temporary health problems. I’m talking about the terminally ill or geriatric end stage patient. If you are one of those who does not believe in euthanasia and prefers to hospice your pet, that’s fine.  Hospice is not something that I recommend to anyone unless they specifically express such concerns. Not everybody wants to watch the pet that they have loved and cared for for years, waste away and suffer a prolonged, agonizing death. The decision is yours and procrastinating does not make it any easier.

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Spay Your Dog!

Pyometra – Get your dog spayed

Here I am on my soapbox again. If you own an unspayed female dog, read on.

A three-year-old female dog was recently presented to me, flat out and unresponsive. According to the owner she had been “in heat” for the past two months and, although she had slowed down and lost her appetite, she was doing fine until yesterday. We immediately admitted her, placed an IV catheter and started fluids, and began a diagnostic blood workup. However, in spite of our attempts, within an hour of her arrival she went into respiratory and cardiac arrest and died with no response to our efforts at resuscitation. 

So what happened? Why did this young dog get so sick and why did she die? The simple answer is: because the dog never got spayed. She was suffering from a condition called pyometra. It is the result of a hormone problem within the reproductive system. It often appears to start with an apparently normal heat cycle that has gone awry. In a nutshell, the dog goes into heat, the hormones within the ovaries and brain that control the heat cycle get out of control, and there is a collection of pus, sometimes due to infection and sometimes not, within the uterus. If the cervix closes down, the pus has nowhere to go so it accumulates within the uterus and the uterus enlarges. As the uterus distends, sometimes the body is fooled into thinking it is pregnant and all of the mechanisms of pregnancy kick in. When the time finally comes for the anticipated “birth” of the puppies or kittens, the cervix opens up and, to the owner’s surprise, instead of puppies or kittens the accumulated pus is discharged. While this pus is collecting within the uterus, the patient is susceptible to a number of potential complications such as septicemia (blood poisoning), kidney damage, or infection of other organs. The dog that we hospitalized was suffering from severe septic shock and her condition was just too advanced when we got to it. The “two months” of being “in heat” described by the owner was probably, mostly if not all, the draining of this pus discharge from the infected uterus, and the dog’s body was continuously exposed to that infection during most of that period. Sometimes in these cases when we dig deeper the owner will mention that the dog has had a history of irregular or nonexistent heat cycles. The hormones have been messed up for ages.

There was no reason for this young dog to have died. It was entirely avoidable. The simple act of getting her surgically spayed early in her life would have saved her life. We see this scenario and variations of it far too often. The unspayed dog (or sometimes even a cat) has been in heat recently and starts acting a little “off.” Sometimes we’re lucky to have even that much to go on. There may be no visible signs at all. In some cases the dog starts to leak small (or occasionally large) amounts of dark, bloody fluid from the vaginal canal. This bloody discharge leads the owner to think that she is still (or back) in heat. At times, when the condition mimics pregnancy and the dog’s belly swells up, the owner will present the dog as a “pregnant” dog that has been acting sick. There may even be milk present in the mammary glands. Fortunately, most of the time these pyometra dogs don’t die. But they often still end up requiring a costly emergency lifesaving surgical procedure that could have and should have been avoided by simply taking routine preventative action. Although the end result of the surgery is the same as a routine spay, the procedure itself is far more involved and far more critical – translate that to far more expensive – than a routine preventative spay. And, although this patient that I couldn’t save was only three years old, keep in mind that usually these pyometra cases are seen in much older pets – sometimes ten years of age or older. That makes the decision to spend often a thousand dollars or more to save her life that much more daunting. The risk is greater, the cost is greater, for those who are looking at a cost-benefit comparison the expected remaining lifespan is less – there’s a lot on the line. Why not avoid the entire scenario? 

The bottom line is that there are much more significant reasons to get your pet spayed at an early age than simply prevention of unwanted puppies or kittens. Pyometra, along with ovarian and uterine cancer and other uterine and ovarian pathologies, can be entirely eliminated as potential health issues in the spayed pet. If you have chosen not to spay your pet, watch for irregular or nonexistent heat cycles. Take it as a warning sign that something bad may be looming.

So next time your veterinarian talks about getting your dog or cat spayed, or you see or hear one of those ads to “Help Avoid Unwanted Puppies and Kittens – Spay or Neuter Your Pet”, instead of “help avoid unwanted puppies and kittens…” think “Help Save Your Pet’s Life, Help Avoid a Very Expensive and Dangerous Health Problem.” Get your pet spayed.

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Limited Budget?

Owning a Pet on a Limited Budget

It is a sad fact of life in our society that medical care is a costly commodity and, unfortunately, veterinary care for our pets is not an exception to that rule. We may have an ‘Affordable Health Care Act’ (if indeed you happen to feel that Obamacare has actually made health care ‘affordable’ for anyone) for us, but don’t hold your breath waiting for government assisted health care for your pet. Therefore, for those who must live life with limited financial resources, planning in advance is the key. A rainy day fund is a must if you are ever faced with a serious and immediate veterinary emergency. 

If you don’t have a regular veterinarian, find one. Take your pet in and get a routine annual checkup and vaccinations. If finances are limited you might inquire about vaccinating your pet once every three years instead of annually. You should lose little in the way of disease protection by vaccinating every third year, yet will save some money. Monthly heartworm and parasite prevention medication can be a lifesaver over the long run. Don’t cheap out cutting corners that will end up costing more down the road. Visiting the same full-service veterinary hospital for all of your veterinary care needs will make you one of their “regular” clients and might help if at some point you need emergency treatment. They may be more willing to help finance an emergency veterinary visit if you are not walking in off the street as a total stranger. 

Have a functioning credit card and keep your payments current. After-hours veterinary emergency hospitals do not offer credit. This is a simple fact of life. Unfortunately a veterinary emergency is only an emergency for the pet owner until the pet goes home. If the bill isn’t paid before the pet goes home, it’s not likely that it ever will be, and emergency clinics live by that rule. An after hours emergency clinic is not a free clinic, and emergency veterinarians are in the business of providing veterinary care for your pet, not financial services. So, no credit! That means that when you have an emergency with your pet, you actually have TWO emergencies, both equally important. One is to get your pet to the emergency clinic ASAP where the experts can deal with the problem; but just as important is the other factor: coming up with the money to pay for it. Before leaving for the ER, get some money. Call friends, call neighbors, call family, or go to the local cash advance facility. Don’t waste valuable time standing in the lobby of the E-clinic arguing about how the money is more important to them than your pet’s welfare. The onus is one you. Find a friend with a credit card to go with you and make an agreement with him/her to pay whatever it costs. If you can’t provide a substantial payment, it’s very possible your pet will not get anything more than just bare minimum treatment. If you expect to get more than minimal treatment you will need more than minimal funds. It’s that simple.

Here are some steps that you can take to put yourself in a more favorable position should your pet need emergency pet care:

Save money and put away a rainy day fund of $1000 or more. That may sound like a lot of money, but most emergency situations tend to be costly; this amount should at least allow you to get started with some significant diagnostics and care while you scramble around to get more. If you have multiple pets, remember, these potential expenses and problems are multiplied by the number of pets.

Next time you’re thinking about a new video game, a trip to the beach or the amusement park, a new tattoo or another piercing, or some other expense, ask yourself how much more practical would it be to have that money put away for a pet emergency?

Set up a Care Credit account. You can do this yourself online. Go to www.carecredit.com and fill out an application. If you have a job and have any kind of reasonable credit rating, you may qualify for anywhere from a few hundred dollars to a couple thousand or more. Care creditis accepted at most veterinary hospitals and emergency centers and also is accepted by some human physicians and many human dentists. Don’t waste your line of credit on routine things. If you do, it won’t be there when you eventually need it. If you have crappy credit, they won’t touch you and you’re back to plan B – building your own pet emergency fund.

If you are thinking about pet insurance or one of those veterinary health care plans offered by the big corporate veterinary groups, consider the following. Most veterinary health insurance plans have limits and only make a token payment toward whatever the problem might be. You’ll be left owing the bulk of any significant expense. Not only that, but in all likelihood you will be required to pay the entire veterinary bill in advance before you are eventually reimbursed by the insurance plan for whatever paltry amount they elect to pay. If your coverage is through a veterinary hospital plan, generally those plans only provide a minimal discount on anything other than routine preventive care. And the plan is only good at their clinic during their office hours. You should realize up front that with corporate owned hospitals most significant health care expenses are generally overpriced enough to allow for the “discounts” you get, and, like most insurance programs, over the long haul you end up throwing away a lot of money. Don’t get sucked in. Don’t get screwed. Take the equivalent amount of money and put it away each month or each week into your pet care fund and you will likely come out way ahead.

If you are spending premium dollars on pet food, STOP! In all likelihood, any extra money that you are spending on a special overpriced pet food is a waste if it is taken away from your pet’s emergency welfare fund. If finances are tight, step down to something cheaper and put away the money you save into your pet health care fund. The nutritional difference between feeding something like Ol’ Roy and a “premium” food like Science Diet or Iams is negligible. For the most part, the pet food industry is a huge scam. Before you spend your hard-earned cash on overpriced pet food, try to be certain that you’re actually getting something that is really better than the cheaper brands. You may do well to feed the cheapest stuff you can get until you have your rainy day fund saved up. Then do your pet food research. You can visit dogfoodscoop.com or dogfoodanalysis.com. for information. They have done the research to help you tell the good from the bad. Most commercial pet food is pretty much garbage anyway – so why pay more than you need to? If your pet doesn’t do as well on a cheaper food (yes, some pets do actually do better on a more expensive food), then go back to the more expensive stuff. You can at least cut your cost in half sometimes by mixing a bag of the really cheap stuff with a bag of the more expensive stuff and save money that way. Then once you have saved up your emergency fund, go to a better food. You are what you eat – and so is your pet.

Likewise, don’t waste your money and risk your pet’s health by feeding nasty processed pet food treats. Boxed and packaged junk like Pup-Peroni, Begginstrips, and other pet snacks belong in the trash, not in your pet, and are likely to lead to health problems, not the least of which is obesity. Just because pet treats are labeled with “natural,” “organic,” “homemade,” “premium,” or some other marketing ploy, it doesn’t mean they are good for your pet. Avoid these kinds of treats and, above all, do not allow these sorts of treats to become a part of your pet’s routine.

Last, but certainly not least, avoid anythingChinese. There are simply too many unresolved issues with Chinese imports.

Get yourself ready! Don’t put yourself in that unfortunate situation of finding yourself facing an emergency and having to choose euthanasia for your pet because you have left yourself financially unprepared.

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Topical Flea Products

A few words about spot-on topical flea products that you should be aware of.  In our after-hours emergency hospital we routinely see a few cases each month of cats that have been unintentionally poisoned by their owners.

Do not use any product on your cat that is labeled for use in dogs only.  “For Use in Dogs Only” and “Do Not Use in Cats” are a less offensive way of telling you that the product may kill your cat. Manufacturers are evidently more concerned with offending buyers’ sensibilities than with providing an effective warning. Don’t take a chance with any of these insecticides. Most of the time the offending ingredient is a type of synthetic pyrethrin. Advantage  is safe to use on your cat. Advantixis not. Although the flea-killing component is the same in both products, Advantixcontains a separate synthetic pyrethrin that is intended to provide additional protection against ticks. That ingredient is harmful and potentially deadly to cats. ALWAYS READ THE LABEL THOROUGHLY.

Do not use any product on your cat that is labeled for use in dogs only.  “For Use in Dogs Only” and “Do Not Use in Cats” are a less offensive way of telling you that the product may kill your cat.

Many over-the-counter topical flea products contain ingredients that are toxic to cats. READ THE LABEL. If it says “For Dogs Only” or “Do Not Use on Cats,” then don’t even think about putting it on your cat. Pet-owners often have a cat and a dog in the same household and inadvertently apply the dog product to the cat. Once again, READ THE LABEL before you apply it! Make sure you are using the right stuff.  Some owners try to save money by buying one product and applying it to the dog and then applying just a tiny amount to the cat. Don’t do it! Trying to save a couple bucks may end up costing you hundreds. One other thing, if you apply your dog product to your dog and your cat likes to groom the dog, you should be prepared for a problem when the cat licks the dog. It’s a good idea to separate the cat from the dog for several hours after applying a flea product to your dog, just to be safe.

If you should happen to screw up and accidentally use a “dog only” product on your cat, you should immediately bathe the application site with some Dawn (or similar) dishwashing detergent. Apply the detergent to the application site, lather it up well, and rinse thoroughly; then repeat and blow dry when done. Then get to your veterinarian before any symptoms are visible. Symptoms are generally neurologic. Tremors are the first thing usually seen. It may progress to stumbling and an inability to stand up and possibly even seizures. Prolonged seizures or tremors may result in hyperthermia, which can lead to permanent brain damage. In really severe cases a cat can die. In most cases the symptoms will gradually subside over 24 hours or so but don’t take the risk. Get to your veterinarian as quickly as possible for proper symptomatic treatment.

Occasionally symptoms similar to those seen in cats can be seen in dogs that are unusually sensitive. In that case, treatment should be similar to an affected cat, bathe it and get to the vet right away. Prompt attention and treatment lessens the likelihood of any serious injury.

Because of continuing increasing resistance to insecticides in the flea population, older, established products are becoming less effective at flea control, and new products are continuously coming onto the market. The older extremely safe products like Advantageand Frontlineare becoming less effective and therefore less popular among both veterinarians and pet-owners. In an effort to find new things that work, the ongoing parade of new products, both veterinarian-only and OTC type products, increases the likelihood of your encountering a less familiar product or of using something that has had less than extensive testing and marketing trials. Buyer beware. 

There are some new, up-and-coming veterinary topical and systemic flea products. I need a little bit of time to evaluate them before I get back to you, but hold tight. I can see some improvements on the way.

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Seizures


One of the more common after-hours emergency presentations that we see is the dog that has unexpectedly experienced a seizure. The excited owner calls us in a panic and loads the dog into the car and brings it in for us to evaluate. Usually, by the time it gets to our clinic the seizure is over and the dog is back to normal, or is in the process of slowly returning to normal. I examine the pet and usually find no problems on the physical. We generally offer a diagnostic workup, which includes a complete blood count, blood chemistry evaluation, and fecal exam all of which the owner may or may not choose to pursue.  We also offer them the opportunity to hospitalize the pet overnight for observation, which most decline. At that point it’s time for the seizure discussion. It goes pretty much as follows:

Seizures can be caused by a variety of factors including trauma (such as a blow to the head), poisoning, an infection involving the nervous system, a brain tumor, various organ diseases and metabolic conditions such as liver disease, hypoglycemia, hypoxia, and so forth. There can be congenital and hereditary causes also. Most commonly we are unable to find a specific inciting cause for the seizure activity and those seizures are usually considered to fall into the category of idiopathic epilepsy. Epilepsy is quite common in dogs and usually first appears somewhere around one to five years of age. Seizures that have their initial onset later in life, say at ten or twelve years of age, are often caused by the gradual development of a brain tumor, while seizures that occur in the very young dog may be due to congenital liver disease. However, all of these statements are just broad generalizations.

Remember, no medication is completely safe. If it were, it wouldn’t do anything.

When describing the mechanics of a seizure, I loosely compare a seizure to an itch on our skin; only the irritation in this case is within the neural pathways of the brain. When our skin has an itch, we address it by scratching and the itch goes away. The seizure is a similar response on the part of the brain to address an irritated focus within the brain’s tissue. The brain is scratching its neurological itch. Just like with an itch on our skin, when we scratch it, the itch settles down and permanently or temporarily goes away. Similarly, after a seizure the irritated focus in the brain quiets down and permanently or temporarily resolves. In most cases no harm is done. Occasionally however, if the skin is scratched excessively or violently, it can be damaged. With a seizure, on occasion the seizure may be more severe or longer lasting and damage to the brain can occur. 

Just because your pet has had a seizure does not mean that the outlook is bleak. It does mean that you are likely to see another seizure at some point, but not necessarily any time soon. I once owned a dog years ago, a Basset Hound named Samwise, who had a seizure. I was walking him one day on his leash when he fell over, lost consciousness, and went into a generalized tonic-clonic seizure (what would be described as a grand malseizure, in human terms) that lasted for about a minute or so. He recovered after a brief rest, got up, and walked away and was fine. This event happened when he was about two years of age and he lived to be over ten years of age and never had another seizure. So, just because you have seen a seizure, does not mean that there will necessarily be more. It just means that your pet has a greater likelihood of having additional seizures in the future compared to a dog that has not had one.

There are three phases to a seizure. The pre-ictal or prodromal phase may or may not be evident. It is a behavior that is recognizable as one that occurs prior to the onset of the seizure itself. In human epileptics it is often referred to as an aura. 

The second phase is ictus, or the actual seizure itself. Seizures come in all shapes and sizes and a seizure in one individual may differ completely from those occurring in another dog. The seizure activity may be generalized involving the entire brain with loss of consciousness, and motor activity involving all of the muscles, or it may be partial and not involve the conscious brain and only some of the muscle groups may experience some moderate twitching. The pet may remain standing and just seem to be “gone” briefly before resuming normal activity. Regardless of the type, the nature of the seizure activity often has a tendency to be fairly consistent from one seizure to the next in any given patient. Over time the character of the seizure may change gradually but usually not dramatically from one seizure episode to the next. And usually a seizure doesn’t last any longer than a few seconds to a few minutes before it stops.

Finally, after the seizure is over, there is generally a period of recovery that we call the post-ictal phase. This period is characterized by disorientation, sometimes a noticeable behavior change, the pet may be unable to get up for a period of time, and often some stumbling and incoordination may be seen. It may last anywhere from a few minutes to several hours. If the seizure is not characterized by severe tonic-clonic activity (i.e. convulsions), sometimes the pet owner may have difficulty determining where the actual seizure ends and the post-ictal period begins. 

During a seizure, keep your hands away from the mouth. Don’t worry about your pet swallowing its tongue. Worry about possibly getting bitten if the mouth is chomping uncontrollably. If you are injured it reduces your ability to care for your pet properly. If it is a small dog, you can cradle it gently in your arms and gently and quietlytalk it down. Panic and excitement on your part may actually exacerbate the situation. Don’t cradle the dog on its back. Cradle it on its chest so that if it happens to vomit, it won’t aspirate. If you have a large dog, carefully pull her out into the center of the floor away from electrical cords, tables and chairs, or anything else that might present a hazard. You don’t want her getting wedged under a chair or knocking over a floorlamp. Keep your hands out of her mouth and gently pet her and try to quiet her down. The soothing sound of your voice and a soft touch may help bring her out of it. If your dog is one of those dogs that tend to become aggressive after a seizure (a rare occurrence but it can happen), use caution and keep children away until the aggressiveness has passed. The dog may not recognize you. Any time there is aggressive behavior you should consult with a veterinarian.

I recommend that you as the pet owner should start a log and keep a complete and accurate record of your pet’s seizure activity. Write down a physical description of the event: Which side was the dog lying on? Did s/he lose consciousness? Vomit? Have a bowel movement? Chomp the jaws and/or drool or foam? Paddle the legs? Which legs and did all four legs do the same thing or did different parts of the body do different things? Was it at night or while the dog was sleeping? Were there any unusual environmental factors, such as friends visiting, roadwork outside of your house, a thunderstorm or gunshots fired, a new pet in the vicinity or anything else that might possibly play a role? For the first visit to your veterinarian or a subsequent visit when there has been a noticeable change in seizure activity a brief video of the event might be worth taking along. But mostly these records are for your own use so that you can monitor any changes in the progression of the seizure activity.

Consider having a blood workup done. I don’t insist on it if the seizure is a mild one and has passed and there does not seem to be any immediate threat. However, if a subsequent seizure occurs I think it’s a good idea to check. We expect the blood workup to be essentially normal, but occasionally we get surprised. That is the purpose of diagnostic work. If an animal is not obviously sick, we expect the blood work to be pretty much normal, but occasionally we find something. I always put it this way: if we don’t look, we don’t know what we might be missing. Also, if we are considering any type of seizure control medication, a complete blood workup is essential prior to starting the medicine.

Should you put your pet on seizure medication? Most of the time, the answer to that question is NO. The purpose of seizure medication is to reduce the frequency of seizures down to an acceptable number. I generally aim for something less than about two or three a month. We don’t generally expect it to completely eliminate them. If we do not have a record (i.e. your log of the patient’s seizure activity) of how frequently the seizures are occurring, then we have no way of determining if the medication is effective. I have seen some patients come into my office for other issues, the owner mentions the dog is epileptic and is on seizure control medication. When I inquire when was the last time he had a seizure and the response is, “Three years ago.” I get a little suspicious. If the dog had a seizure and the owner panicked, and the veterinarian jumped in and started it on medication in order to quell the owner’s concerns, this patient may very well not need it. It might be a case like my dog that I mentioned earlier and the medication may really be totally unnecessary. Medicating a pet that doesn’t need it is just as bad as not medicating a pet that does. Although seizure medication is usually pretty safe, you should always remember, no medication is completely safe. If it were, it wouldn’t do anything.

Occasionally we’ll see a patient who has a very long, or very severe seizure as its first episode. Or that patient may have a cluster of several seizures in a short time or in a single day, kind of out of the blue. In these instances I will usually run a complete lab workup and start it on phenobarbital in an effort to settle things down and not risk another severe episode or cluster of seizures. Every case tends to be different and there are exceptions to every situation.

Very severe or prolonged seizures or a number of seizures over a relatively short period of time are a medical emergency. Don’t allow your pet to seizure for a prolonged period of time or exceptionally violently without getting medical attention. Prolonged or repeated convulsions cause an elevation of the body temperature and potentially serious hyperthermia, which itself can be deadly. Also the brain sometimes is more likely to be permanently injured by severe or repeated seizure episodes. Get to your vet or find the local ER.

As mentioned earlier, most epileptic dogs do fine. Most of them have an occasional mild to moderate seizure, and yet live a long and healthy, relatively normal life without ever needing medication. The pet owner is often severely traumatized by the first seizure and perhaps the next couple after that, but usually once they have gotten over the initial shock and surprise of the situation, most owners adjust to the situation surprisingly well and it may even become routine.

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Pet Hoarding

Hoarding pets – rescue or incarceration? 

A television news article this week dealt with a woman whose house was raided by animal control authorities because neighbors had complained about the offensive odor emanating from the premises. When authorities entered the house they found over 100 cats living in this small tract type house, along with several dead cat bodies in the freezer, fecal material described as “two feet deep” on the floors, and cats suffering from various degrees of physical distress. The woman who kept the cats was apparently not living at the house and she told the police that the person or people who normally assisted with the care of her cats had recently been unable to help her. Needless to say, the cats were taken in by the local authorities and placed under the care of local humane groups to be hospitalized as needed and rehabilitated and then farmed out for placement with new homes. This particular incident happened in the Tampa Bay area but could just as easily have occurred pretty much anywhere.

Similar articles appear on the news a couple of times a year, usually dealing with cats but occasionally dogs, birds, horses, and even exotic zoo type animals are the victims, so the problem is out there. It just seems to be overlooked for a prolonged period before it is finally uncovered. Now – I’m no psychologist but the people who are guilty of this sort of behavior are, in my humble veterinary opinion, obviously a little over the edge. I’m sure their behavior probably began in a relatively normal way. A cat or two as pets or adopted from a shelter or off the street may well lead to a sense of self-satisfaction and the rush of feeling the part of the savior. That “high” derived from the sense of having saved these animals may well lead to an urge to repeat this feeling by “saving” more and more animals and each successive “rescue” leads to the need for another fix. In other words, not far into this behavior pattern the need for the rescuer to “save” another animal probably overcomes the actual need for the animal to be saved. No doubt, at some point the environment into which these pets are taken becomes much more detrimental to the well-being of the rescued animal than if it were simply left to its own devices in its natural environment, whether that’s the street, the forests and fields, or whatever. Rescue gradually turns into forced incarceration and an environment of squalor and disease develops.

Now I’m not talking here about the person who is hooked on cats and wants to have 10 or 12 cats but takes pleasure in providing those cats with plenty of personal attention, meticulous care, and proper food and medical attention. That situation is close to the edge but I think it falls short of the dangerous pet hoarder. (However, I have seen this situation turn into a serious abuse scenario simply by that loving and caring owner experiencing a major health problem and the cats suddenly being seriously neglected.) I’m not talking about a bunch of outdoor cats living at a particular address or about a dairy farm where often there are lots of cats who are kept around, fed a little cat food and a lot of surplus milk, in exchange for their services helping to keep the local rodent population in check. Sometimes any pet situation can appear marginal, and the ultimate determining factor should be the quality of the animals’ lives. I’m also not speaking here of legitimate pet rescue people who are out there rescuing strays and lost pets, keeping them temporarily, and fostering or adopting them out to homes with the intent of actually finding long term homes. Such an endeavor requires a boatload of money to keep it going, lots of volunteer labor, and a tremendous sacrifice in space, personal facilities, and private life. The dangerous situation arises when free-roaming cats and/or dogs are “rescued” and locked up in a building and/or in cages where they have no choice but to suffer and waste away at the whim of their captors. 

In my line of work I tend to meet up with the people who are caught in the middle ground and are frequently difficult for me to figure out. I think it sneaks up on these people, and one day it dawns on them that maybe things are getting out of hand – an animal is found dead and they didn’t even realize it was sick, or it never dawned on them that it hadn’t shown up to eat for the past several days. Hopefully this scenario serves as a wake-up call to the gradually evolving pet hoarder, but I just never get to know for sure. If this situation sounds familiar to you then maybe you have a problem. Back up and try to look at yourself objectively or ask a friend to be honest with you. Remember, anybody can fall into this category. I’ve seen veterinarians guilty of “compassion overload” who simply cannot turn down a pet in need, even if it is one that will obviously not be place-able or perhaps should be euthanized. Gradually the veterinary hospital is filled with strays and misfits, eventually to the detriment of the hospital’s medical facilities and care. And as a result you, the pet-owning client who trusts in your veterinarian’s good judgment, eventually become a victim of that doctor’s loss of vision.

Take a look at yourself and think about it. Do you have more pets than you can deal with? Can’t keep up with walking all the dogs or cleaning all the litter boxes? Veterinary care has become a thing of the past because you just can’t afford it any more with this many pets? Do you not have time to pick up and/or interact with each of the pets in your household? Do you have messes around the house that you just haven’t gotten around to cleaning up? Are you afraid to let company come over to visit because you don’t want them to see just how many cats you actually have? These are just a few of the warning signs of pet hoarding. Quality of life – for the animal, not for you – is the key. Remember, it’s not about giving yourself a good feeling; it’s about providing a proper, healthy environment for the pet.