Local Politics

I tend to stay away from politics in my work and writing but there is an issue that is very important to the care of our pets.  Governor Cuomo has proposed tuition relief (actually free tuition for qualified students) at public universities and colleges.  Why do I care?  I know, my kids are out of school, no personal benefit to me.  Wrongo!

The staff that takes care of your pets at Crawford Dog and Cat Hospital is composed of a dedicated group of trained individuals.  Some, like receptionists and assistants have been trained on the job, over many years with us. Others, like the doctors and technicians have formal educations and are licensed by the state.  We currently have two licensed technicians on staff, Kim Green and Ellie Abrams.  these two are responsible for all nursing care, in house diagnostics, (lab work and radiographs), surgical prep, anesthesia, you name it they do it.  The state requires a t last an associates degree and then they need to pass an examination.  Associate degrees are offered locally at SUNY Farmingdale, LaGuardia College, and Delhi.  We are fortunate to have these two on our staff, but there is a shortage of qualified technicians here in New York.  Tuition assistance would help individuals that want to pursue a career in veterinary medicine to get a leg up without becoming swamped in student loan debt.

So, when this issue comes to the forefront, think of your pets and the care they deserve and support tuition assistance at our public colleges and universities.

Preventing Infectious Kidney Failure

In the past few months I've seen two heartbreaking cases of dogs that were diagnosed with acute renal failure that probably could have been prevented.  But before we talk about failing kidneys, let's talk about what healthy kidneys do for our pets. (and us for that matter).

The major functions of the kidneys is to filter waste products of the blood into the urine, maintain a state of homeostasis (constant state in the body), and stimulate red blood cell production.  There are other hormonal functions but let's stick to the biggies here.  When we do a blood test and tell you that your pet's kidney function is good, we are actually measuring the levels of Urea Nitrogen and Creatinine (two toxic by products of protein metabolism).  these levels will be maintained within a narrow normal range until about 75% of the filtering units  (glomeruli) in the kidneys are damage.  Kidney function can also be evaluated by measuring the concentration of the urine as well as looking for things in the urine that shouldn't be there, such as protein and cells. When the filtering units are damaged, the waste products build up and the condition is called azotemia, or uremia.  hen the tubules ( different part of the kidneys) are damaged, we will see dilute urine or cast like structures in the urine.  Leaking membranes in the glomeruli may allow the filtering of wast products but facilitate the leakage of protein into the urine.  When caught early, the progressive nature of renal disease can often be mitigated.  However, once the glomeruli are damaged, they are gone, and no new ones will replace them.

We had a dog present to the clinic a few months ago.  It lived in Nassau county, never went out east, mostly lived in the yard in a suburban environment that was not particularly wooded.  This labrador was not feeling well and when blood work was performed, it was in azotemic (elevated BUN/Creatinine) renal failure with severe levels of protein in the urine.  It was also positive for exposure to Lyme disease.  The owners had not vaccinated it against Lyme disease because they did not think it was at risk for exposure.  Indeed it was at low risk based on life style assessment, but no dog on Long Island is at no risk.  They also were not using any flea or tick control.  Lyme nephritis is a kidney disease caused by the body's reaction to Borrelia burgdorferi, the bacteria that causes Lyme disease.  (Note Lyme not Lyme's).  Unfortunately for this dog, once the kidneys are involved, the prognosis is guarded.  In fact, this dog did not make it and was put to sleep after a week in the hospital receiving intensive care.  While we do not see a lot of dogs in our practice that are ill with Lyme disease, we do see many that are exposed to the bacteria and therefore at risk.  This is why we recommend testing every dog every year for heartworm and tick borne diseases.  we also recommend tick control for all dogs.

The second dog presented two weeks ago with a rapidly worsening, acute renal injury.  This young German Shepherd Dog was losing weight, not eating, and had decreased energy, His blood work showed a worsening azotemia, increased levels of protein in a dilute urine, and he tested positive for leptospirosis, a bacterial disease.  Leptospirosis is spread by the urine of infected animals, in our area, dogs, raccoons, mice and rats.  While usually more common in the summer, it is obviously around all year here on Long Island.  It's prevention is complicated by the fact that there are many serovars (types of Lepto bacteria), and the vaccination only covers the 4 most common and virulent.  Many clients are reluctant to vaccinate because they have read that the vaccine causes reactions, or is dangerous.  The truth is that while vaccine reactions do occur, most often, they are similar to the type of reaction we get when we get a flu vaccine or a tetanus shot. And while we hate our dogs to have any reaction, it is better than renal failure.  Lepto is also contagious to people so having a dog that is unknowingly shedding this bacteria in the urine puts all of us at risk.  This puppy (he is only 2 1/2 years old) is still undergoing treatment with antibiotics and Intravenous fluids.  It looks like he may make it but will most likely have permanent damage to it's kidneys.

We have to remember that there are many diseases that can affect our pets (and sometimes us).  prevention is always better than treatment.  While vaccination is not always a completely benign procedure, modern vaccine science has come a long way in our fight to protect our pets from infectious diseases.

The Two Sides of Bread

I'm going to digress from my trending posts on things clients say and move onto things dogs eat.  It has been an interesting (translates to busy) pre holiday season which explains the missed posts.  We had two cases come in, both dogs that had eaten something that they shouldn't have.  The cases are different, but there is a common thread that I thought everyone might appreciate.

Here is doggy number one.  Just for a radiography review.  The head is on the left, the spine is at the top.  Air is black (see outside of the dog and the lungs on the left side surrounding the grey heart).  Muscle and soft tissue are grey.  And metal would be white.  That's right, look at all that metal in the stomach and intestines.  Not supposed to be there.  The truth is that this pup had been dining on antenna wire as it came out of the wall to where the TV used to be pre cable.  The bad news is that this pup was vomiting off and on and I was worried about the wire penetrating the intestines and causing an infection. Or, the mass on the left getting stuck in the stomach and causing a blockage.  Unfortunately, surgery would be a challenge because we would need to remove all of the wires to eliminate the danger of perforation and peritonitis.  Also unfortunately, the dog had done something similar last year and the owners were tapped out financially from that surgery. Fortunately, this was a soft braided wire and not a stiff, sharp coaxial cable sort of wire.  Although we advised referral due to the possible complications of surgery, the owner declined and we were force to treat this case medically.  A meal of bread, a strong anti emetic to induce vomiting, and an enema and laxatives to move the whole mess through, and everyone was happy within 24 hours.

Ah bread, the staff of life.  Savior of dogs.  Except when it isn't baked.  Raw dough is a real problem.  Why might you ask?  I know I love to nibble on dough when I am baking.  Well, next time you're nibbling, think of what is going on in the dough.  Yeast, water, carbohydrates...  The mixture yields what?

Now remember the radiology lesson.  This dog is positioned the same way.  Less of the lungs are in the picture towards the left.  Less metal wire too.  But look at all that gas in the intestines.  Right, the dough (an entire bowl of doughnut dough) is rising in this dog's intestines.  The carbon dioxide from the yeast is making the intestines distended with gas.  Oh, and that's not all.  Beer lovers will know that carbon dioxide is not the only product of yeast and grain.  That's right, this dog was as drunk as a skunk.  We tried to get her to vomit up the dough, but most of it was out of the stomach.  So, IV fluids and supportive care was all we had to offer.  This case was this weekend, so it isn't over yet, but so far things seem to be coming out OK.

Keep these stories in mind for the rest of the holiday season.  Dog food for dogs, cat food for cats, raw dough for, well really no one and wire for electricians.

Happy New Year.

Things Clients Say, Part 2

Friday is here again and the Turkey coma is almost passed.  Actually, I will be having daily turkey comas for a couple more days.  Anyway, I wanted to share another client misconception.  It's the "Hey Doc, he's a little stiff on the stairs but I don't think he's in pain because he doesn't cry", misconception.

Here's the deal, if your dog is stiff, slow to rise, or limping (even if it is a subtle limp), he is in pain.  (I've picked the male gender for this patient because we tend to be worse about this particular oversight than female owners.  Don't know why, just an observation)

Think about it.  When was the last time you had a limp?  Why were you limping?  I bet it was because your leg hurt.  The same goes for when you have a tough time on the stairs, or can't get up off of the ground after playing with a grandchild, the challenge is due to pain in a joint or your back.  The pain is real and can be debilitating.

Dogs and cats give us subtle (and sometimes not so subtle) signs of pain and discomfort.  Abnormal movement, decreased activity, missed jumps, you get the picture.  While these changes are often seen more frequently in older pets, they are not normal and the pain will decrease the quality of life.  If you notice these changes or anything similar, it is important to have a complete orthopedic examination at the veterinarian.  At that time, the doctor may recommend radiographs to determine the exact nature of the problem and the source of the pain.  Then, and only then, can a safe and effective treatment plan be formulated.

We use a multi modal approach to the management of chronic orthopedic pain in our patients.  Diet, supplements, medications, laser therapy, joint injections, and stem cell therapy are just some of the weapons in our battle against chronic pain in pets.

If your dog is limping, or if your cat can't jump on the counter or make it into the litter box anymore, give your vet a call and get to the bottom of the problem and relieve your pet's pain.

Things That Clients Say Because they Don't Understand, Part 1

Reflecting back on the week, I thought that I would share a few of the things that clients have told me about their pets that show just how far we have to go with education.  I want to start off, continuing on the theme of last weeks dental post.  An oral examination, including the mouth, pharynx, teeth and gums, is part of our regular wellness exams.  This past week, I had the opportunity to flip up a dog's lip and show the owner the accumulation of tarter that was caked on the outer surface of all of her dog's teeth.  It was at this point where she asked, "Why does he have tarter, he just had his teeth cleaned last year?"

A couple of points here.  Checking the records I noticed that it was closer to 18 months ago that the teeth were last cleaned.  But we all suffer from distortions of time passage, why I am pretty sure that I am still in my early forties.  Be that as it may, when it comes to dental health maintenance, our pets are similar to us in many ways. Some have excellent dental health with minimal intervention.  Others need to have work done on a regular basis.  As owners, we know that we brush our teeth twice a day. (or we should).  Still, we need to have our teeth cleaned at least once a year.  Very few pet owners ever brush their pet's teeth.  So why is it surprising that they need their teeth cleaned annually?

The truth is, proper dental care, along with good nutrition, and appropriate rational vaccination is one of the three most important things that we can do to improve the quality and longevity of our pet's lives.  I cleaned my Cookie's teeth every year for 15 years, until underlying health problems such as cancer and heart disease made the procedure more risky.  I attribute her long, basically healthy life to her good oral health.  It is important for your pets as well.

While we recognize that dental care can be expensive, routine cleanings are less expensive than the major dental work we have to do when teeth are diseased.  However, when even routine care is budget busting, we have several payment options for qualified clients.  Most are easier and less expensive to qualify for than you would expect.

So when your veterinarian tells you that your pet needs his or her teeth taken care of it does not matter when they were last treated, they need to be treated again.  Let's work to keep those pearly whites pearly white and that breath fresh.

Dentistry

Well, after a couple of hiccups and false starts, we are back up and running in our dentistry department.  That's a good thing because there have been several published epidemiology studies indicating that 80% of pets over three years of age have some form of dental disease.  In fact, the American College of Veterinary Dentists state that periodontal disease is the most common disease in older pets; and, it is preventable.

We are not talking about intervening in sewer mouth disasters. You know the dog that you can smell coming into the room because his breath belies the rotting infection that used to be his gums.  This guy will only benefit from having all or at least most of his teeth extracted under general anesthesia and the infection treated with a long course of antibiotics.

No, I am talking about the three pets that we treated today.  The first two were kitty cats, both come in regularly for dental examinations and treatments when indicated.  One had mild tarter, the other heavier tarter, but both had healthy looking gums.  Even more importantly, radiographs showed no disease under the gum line, no radiographic evidence of cavity like lesions or periodontal disease.

The third case was a dog, he had two fractured pre molars.  Once again, radiographs were valuable.  One tooth could be saved, the other had to be extracted.  All three pets were sent home with home care instructions and we hope that the owners will follow up with us as directed.  All in all, a good day in the mouths of our patients here at Crawford Dog and Cat Hospital.

Are Annual vaccines Necessary for My Cat?

The question doesn't get asked often, actually usually clients tell me, "My cat never goes out, she doesn't need any shots."  Of course, in their minds, the logical extension is that the cat never goes outside so it never needs to see the veterinarian.  Well, get ready for a shocker, I sort of agree.  Never thought that you would hear a veterinarian say that did you?



Here's may take on this topic.  All kittens need a series of injections to stimulate their immunity.  This initial series includes 2 or 3 FVRPC vaccines to stimulate the immune system against these potentially serious viral diseases.  According to the AAFP (American Association of Feline Practitioners), they should all be tested for FELV and FIV and then vaccinated against Feline Leukemia, and they should receive a rabies vaccine after they are 3 months old.  We recommend and use the Purevax recombinant DNA vaccine by Merial. All kittens should be boosted at 1 year of age with the FVRPC and Rabies (Felv not necessary if they are going to be indoor cats).  Then we recommend FVRPC vaccines every 3 years and rabies annually according to the label (and the law).  Notice that the only annual vaccine is the rabies. So, let's talk about that one first.  The truth is that the chances of your indoor cat contracting rabies is low.  It's not zero and I have a story that I would be glad to share with anyone that really wants to hear it that will illustrate a case that I had when I first started practice.  While the risk is low, the consequences are really serious.  Rabies is fatal.  Not sometimes, always.  It is contageous to all mammals, that means people as well as cats.  If your cat is not vaccinated and it bites someone, you could be forced to have your cat's brain removed and sent to the state lab for testing.  I don't write the laws, I just let you know what they are.  Vaccinate your cat for Rabies, it's the law and it's good rational medical advice.

Why the FeLV recommendations.  The AAFP recommends vaccinating kittens because their immune system is not mature, the test could be a false negative, they could have a latent (hidden) infection, and I can't tell you how many kittens come into my office with owner intentions of them never going outside ever again, only to find out one year later that they are spending time outdoors.  Once their lifestyle as an indoor cat is established and their immune system is cranked, they do not need boosters of this vaccine as long as they stay indoor cats.

The FVRPC is an excellent vaccine.  It stimulates an excellent immune response.  After a few triennial boosters, your indoor cat probably has enough immunity to protect it through the rest of it's life.  I still tend to be cautious and have always vaccinated my cats every three years.  Cat households tend to be fluid and new kittens come and go on a regular basis.  Many cats have chronic viral infections from when they were kittens and regular vaccination seems to keep these infections at bay. Plus, you can bring these viruses into the home and expose your indoor cat.  It just makes sense to me so I recommend it for my patients.

Now, just because your cat is at minimal risk for infectious disease doesn't mean that it doesn't need to be seen at least once a year by your veterinarian.  Cats are very good at hiding disease.  80% of cats over three years of age have dental disease, some times very painful dental disease.  1 in 3 cats will develop diseases such as hyperthyroidism, kidney disease, and heart disease before they are senior pets.  They won't tell you they don't feel well until it is too late for  you to do anything about it.  So, regular examinations, fecal tests for parasites (yes even indoor cats), urine tests for diabetes, infection, crystals, and inflammation of the bladder, and blood tests for evaluation of the endocrine (hormone) system and organs as well as complete blood counts to detect anemia and infections should be performed on a regular basis.  Don't ignore your cat.  Ask your vet about wellness screening and what you can do to help your indoor cat live to a ripe old age.