Thursday, August 28, 2014

Frank update

I have put off writing this blog because I didn’t want to jinx anything, but after almost two months I think I am safe saying that Frank is 100% back to normal!  In my post from May 7th I reported that he was on the mend but he really wasn’t back to doing all his normal Frank activities.  After several weeks on Prednisone it was in mid-June I accepted that he still wasn’t himself and decided to move forward with an MRI to make sure there was nothing else going on. 

We headed out to Animal Scan in Virginia and under the exceptional guidance of neurologist extraordinaire Dr. Lauren Talrico, Frank had his MRI.  We found that he had some very mild changes in his spinal cord consistent with intervertebral disk disease (IVDD) and Wobbler’s syndrome.  Dr. Talrico believes that both of these changes are causing him pain in addition to the meningitis that he was initially diagnosed with.  Poor Frank!


Frank helping Dr. Talrico read his MRI

IVDD is a condition in which one or more of the cushions that exists between each vertebra comes into contact with the spinal cord causing an array of clinical signs.  These can range from irritation that results in pain to compression that can lead to weakness and paralysis.  Wobbler’s syndrome is a collection of abnormalities that occur in the cervical spine (neck) that affect how the vertebrae line up with one another.  This is turn can also result in neck pain and spinal cord compression.

Thankfully Frank’s condition was not severe enough to require surgery so we started pain management with pregabalin (also know as Lyrica) and physical therapy.  Unfortunately the underwater treadmill is not yet up and running at Friendship but our wonderful physical therapist Janay gave me several exercises to work on at home with Frank.  One of these exercises was cavaletti work - you can see in the video below how much he enjoys it!

video


I am incredibly relieved and delighted that Frank appears to be pain free off all his medications and is now back to his usual antics.  What has been the most surprising to me is how this situation crept up on us.  For several weeks before we noticed he clearly wasn’t feeling well that he had stopped doing many of his usual adorable Frank activities.  He had all but stopped picking toys up and asking us to play with him.  He would no longer body check my husband to get out the back door so he could accompany him to take out the trash and run around outside.  He used to wrestle with Poppy every day, often times so loud you couldn’t hear the television over their play growling.  For the last few months that he has been back to normal all of these behaviors have returned and I can’t believe that I didn’t pick up that something was off earlier. 


Happy after a swim at the beach


We will always have to keep an extra close eye on his behavior in case one of his three conditions flair up again.  He will never receive another vaccine as this can cause his meningitis to come out of remission.  He can’t roughhouse anymore and we need to continue his physical therapy long term to maintain his muscle conditioning.  Once the underwater treadmill is installed he will be first in line for therapy sessions.  Friendship will also be offering acupuncture soon and this is an excellent therapeutic option for Frank.  I am incredibly thankful that Frank has responded so well to treatment and is back to being his normal, wonderful, lovable self!

Tuesday, August 19, 2014

The Key to a Happier, Healthier Pet: Annual Vet Checkups

Want to know why veterinarians are always reminding you about annual checkups? Because they are one of the easiest things you can do to help keep your cat or dog happy and healthy for many years to come. Unfortunately, it's also something that can easily be forgotten or pushed off for another time.

In fact, according to a recent petMD poll nearly 2 in 10 pet owners hadn't visited their vet for a routine checkup in the past year. Take it from a veterinarian — that's a big deal!

Missing Just One Annual Exam Can Still Be HUGE


The reason the standard recommendation for cats and dogs to visit the veterinarian once a year for a checkup is because missing even one yearly exam for your pet is roughly equivalent to you, a human, not seeing a doctor for five years! These wellness checkups not only allow us to catch certain diseases at their onset, which can prevent them from getting worse, but they also potentially save you money in the long run. That's a definite win-win situation.

Dental disease in both cats and dogs is the perfect example of this.  During your pet’s annual exam your veterinarian will assess their degree of dental disease and recommend yearly dental cleanings. 


Sherman, a 6-year-old Yorkie-Chihuahua mix, came to me for his initial exam shortly after being adopted by his new family at 3 years old. He had moderate tartar with minimal gingivitis, but I didn't notice any obviously diseased teeth. Nevertheless, given the heavy tartar and stinky breath, I recommended a dental cleaning and oral exam to be performed under general anesthesia.

We were shocked to discover during the cleaning that Sherman had severe dental disease and needed to have 13 teeth extracted. That's the funny thing about dental disease — things may not look so bad on the surface, but once you start poking under the gumline the disease may be running rampant and unchecked.

Fortunately, Sherman felt like a new dog after having all of his painful and diseased teeth removed. He now gets annual dental cleanings to minimize bacteria buildup on his teeth and monitor for new disease under the gumline. We also started him on a dental diet to help keep tartar to a minimum to maintain his healthy new smile.

Vet Checkups are Even More Important in Your Pet's Senior Years


Veterinarians often recommend senior dogs and cats undergo yearly baseline bloodwork in order to screen for metabolic abnormalities. Elevations in your pet's liver or kidney values, for example, can indicate one of these organs is compromised and needs to be addressed. Senior cats often have issues with kidney function as they age.

Take Charlie, a 12-year-old kitty that is a patient of mine. During his annual exam Charlie's owner reported that he was doing well at home but perhaps drinking just a bit more than usual. Charlie's physical exam was unremarkable overall, but he had lost just a touch of weight compared to the year prior.

We submitted a chemistry panel, complete blood cell count, thyroid level and urinalysis. This is the standard baseline that I check on all senior cats. The urinalysis is essential to alerting us to diminished kidney function and increased thyroid levels, which are often to blame for weight loss in cats. In Charlie’s case he had dilute urine and very mild elevations in his kidney values on the chemistry panel, an indication that his kidneys were not working well and confirmation he had chronic kidney disease (CKD). 

Had Charlie not come in for an annual exam, the CKD would have gone unmanaged and further complicated his health. Fortunately for Charlie and other cats with CKD, the quality of life can be improved when steps to maintain kidney function are implemented—therapeutic kidney-friendly diet and increased water intake, to name a couple of changes. Charlie's annual exams were also bumped up to every six months so that we could
closely monitor his blood work and blood pressure for unusual changes.

Annual Exams: A Great Way to Answer Your Pet Health, Too


I could write story after story about patients of mine that greatly benefited from a yearly checkup. But these appointments are also the best time to discuss with your veterinarian any concerns you have regarding your pet’s health. It can be something as subtle as tips to help your dog lose a few pounds; which supplements are best for preventing joint disease or diet suggestion to help senior pets ward off dementia. 

By working with your veterinarian during annual wellness checkups, your pet can better stay happy and healthy…so you can love them longer!

Wednesday, June 25, 2014

Amelia's Kittens

Friendship was very proud to send eleven of our team members off to veterinary school last fall.  Below is a report from Amelia who was the indispensable assistant to our Chief of Primary Care, Dr. Kuehn.  We all miss Amelia very much (especially Dr. Kuehn!) but it certainly sounds like she is making the most of vet school - Enjoy!

Kittens are very fragile creatures. They are born unable to see, hear, or eliminate on their own. When orphaned or separated from their mothers prematurely, they require very involved care. At many shelters, kittens prematurely separated from their mothers are not prioritized and may even be euthanized because of the intensive care they need and the number of older cats also looking for homes. When I began veterinary school this past fall, I became involved with a club called the Orphan Kitten Project, which fosters these babies while they are so helpless (requiring bottle feedings every two hours at first), until they are old enough to be adopted.
When I received the carrier containing my first two foster kittens, I wasn’t really sure what to expect. These little guys only weighed 10 ounces and fit into the palm of my hand. I had never seen kittens so small. They looked like little aliens. The woman who kept them for a few days before me described one of them as “feisty and demanding;” I wondered vaguely if they were giving me an evil kitten. But after a day of caring for them, I was completely hooked. Watching them grow was incredibly rewarding; each day they accomplished new feats that were impossible for them only the day before (climbing over baby gates, climbing up my entire body to sit on my shoulder, leaping onto anything really).
A few days later, one of my kittens got really sick. She began to vomit suddenly and then went completely limp, like a rag doll. Feeling the profundity of my ineptitude and lack of experience weighing heavily, I decided to rush to the nearest emergency hospital. When kittens are so small, they can crash very quickly and there’s often nothing anybody can do. The technicians quickly took her to the treatment room. Unfortunately, there were many animals that arrived in emergent situations at the hospital that night, and we had to wait in the exam room for several hours, while the veterinarian came in and out three or four times. She offered a plethora of diagnostic tests and treatment options, all of which I have heard explained to clients many times (as a prior veterinary assistant at Friendship Hospital for Animals). Even though everything was incredibly familiar, it was overwhelming to decide what to do for her. On one side, I had my boyfriend muttering at me not to spend any money on a kitten I don’t even own. On the other side, I had a near-death kitten trusted to my care, and felt devastated at the thought of not doing everything I could for her. Even though I knew she was receiving excellent care at the hospital, I wondered if she was cold or lonely in the treatment room.



Fortunately, kittens can recover almost as quickly as they become sick. My little baby was back to her normal, rambunctious nature within a few days. Being a client rather than an employee at a veterinary hospital in an emergency situation taught me the most valuable lesson I have learned in vet school so far: as a veterinarian, regardless of how many times you have seen a particular situation or disease, every single patient is completely unique. Likely, it is the first time the client (owner of this patient) has experienced anything like this situation. While these realizations may seem obvious, they are vital lessons that should be kept at the forefront of a veterinarian’s minds every day. With this knowledge, a veterinarian can provide guidance to clients in a truly compassionate and understanding manner, and I hope to be able to do the same.

Wednesday, June 18, 2014

Introducing Nexgard!

There is a new oral flea and tick product on the market and we are all very excited about it here at Friendship.  Nexgard is a monthly chew that protects dogs against fleas and ticks.  It is absorbed into the blood stream and kills parasites when they bite your dog and begin a blood meal.  Due to this mechanism of action you may still find dead ticks attached to your dog, the fleas probably just fall right off (Ick!). 

Like Frontline it does not offer any repellant protection, the bug has to feed before it can be killed.  Unlike Frontline you don’t have to deal with the greasy spot they get on their fur after application or worry about how bathing and swimming will affect protection. We will not be selling Frontline Plus anymore but you can still find it online and at retail stores if that continues to be your product of choice.

If you are interested in a product with repellant properties we also carry the Seresto collar for dogs and cats.  This is worn all the time and lasts for five to eight months depending on how often your pet is bathed or enjoys a swim.  My only complaint with this product is that I find the collar itself a bit unsightly on shorthaired dogs.  This is a fairly superficial reason and should not detract you from considering it, especially if you have a hard time remembering to give the chew monthly.


 
For parasite protection of kitties we will continue to sell Advantage Multi topical spot-on treatment that protects against heartworm, fleas, ear mites, roundworms and hookworms.  I feel this or Revolution (we do not sell this particular product) are the best choices for cats because they provide heartworm prevention.  Dogs of course get their monthly heartworm prevention in the form of monthly Heartgard chews.


The products we sell at Friendship are a small subset of the multitude of monthly preventive products out there.  If you have questions about any product in particular please don’t hesitate to discuss them with your veterinarian.  I hope this helps you muddle through the options available for purchase at the hospital.

Wednesday, May 7, 2014

Frank's Big Scare


I apologize that it has been awhile since my last post, April was a crazy month and I am still recovering from it.  The 8th Annual Fashion forPaws Runway Show was on April 12th and it was a huge success.  The event raised over $425,000 that will directly provide care and medical attention for the 43,000 animals that the Washington Humane Society cares for each year.  Frank was a star of course and I was honored to speak at the event this year as Executive Committee Chair.

Our delight in the Fashion for Paws afterglow was put out quickly when Frank became sick a few days after the event.  I first noticed that he was eating a bit slower than usual and he seemed tired out on our walks.  When he didn’t get up for his treat one morning I knew something was really wrong and we rushed him right into Friendship.

Dr. Calabro who is one of Friendship’s two amazing critical care specialists examined Frank and found him to have a low grade fever and back pain.  Screening bloodwork was submitted and he was started on intravenous fluids and pain medication.  Friendship’s radiologist Dr. Hankin performed radiographs and an abdominal ultrasound to rule out an infection of the vertebrae called discospondolytits as well as look for any additional underlying abnormalities.  Thankfully these were all normal.  We also submitted tick titers to make sure this wasn’t from an infectious cause such as Lyme disease or Ehrlichiosis. 

Being a good dog for his IV fluids
His bloodwork came back with a slightly elevated white blood cell count indicating systemic inflammation.  Additionally his platelet count was low; platelets are the blood cells that are responsible for clotting blood.  The decreased platelets could be from an infection destroying his platelets or again systemic inflammation.  We added doxycycline to his treatment and he spent the night in the hospital.  If his symptoms were due to a tick borne infection it should resolve quickly on the doxycycline.

The next day his fever had come down a bit, he was eating well and seemed to be feeling better so we took him home.  Over the next day he was fine but still acting very quiet and not himself.  I brought him back to the hospital about 36 hours after discharge to have his bloodwork rechecked.  Friendship’s other criticalist, Dr. Gonzales took a look at him and found that in addition to back pain he was now painful in his neck and multiple joints.  The follow up bloodwork showed that his platelets had not improved at all and his white cell cont was now higher.

At this point my husband and I were beside ourselves worrying. Frank is only 4 years old, how could he get this sick so quickly and how could we not know what was wrong with him.  Our next step was to have Friendship’s orthopedic surgeon Dr. Glassman evaluate his joint pain and take samples of joint fluid to see if there was evidence of infection or inflammation in his joints.  Frank had to be sedated for the joint tap procedures, as it is painful to enter the joint and collect the samples.  Analysis of the joint fluid did not show any abnormalities so we returned to looking at his neck and back pain as the primary problem.

Waiting in Dr. Talrico's exam room
The next day we headed out to Southpaws for a neurology consult with the amazing Dr. Talrico.  The very first day Frank was sick Dr. Calabro discussed his case with Dr. Talrico who thought it sounded like a textbook case of Steroid-Responsive Meningitis-Arteritis (SRMA). The cause of SRMA is unknown but it is auto-immune in origin meaning that for some reason the body creates inflammatory cells that attack the central nervous system.  After a complete neurologic exam Dr. Talrico recommended a CSF tap that would hopefully confirm her suspicion of SRMA.  For this Frank was put under general anesthesia and a needed was passed between the vertebrae in his neck to collect the fluid that surrounds his spinal cord.  He recovered well from the procedure and we headed home to wait for the analysis of the spinal fluid.

Here is where medicine can get frustrating; the results from the CSF tap were suggestive of SRMA but not definitive.  Unfortunately we can do all the testing in world and still not have an exact answer of what is causing the problem.  In this situation it is critical to work with a doctor that you trust and has experience with the suspected disease process.  Veterinary medicine is often a puzzle; you have to take the history, exam findings, test results and response to treatment and piece them all together to get an answer.

 Dr. Talrico felt given his clinical signs and the results from all of his testing that we caught the disease very early in its progress.  This was actually good news because it meant with aggressive treatment Frank has a much better prognosis for complete remission with no future relapses.  We started steroids that day and within a few days he was feeling much better and his platelet count was almost back up to normal.

This is not a disease he will ever be cured of and it always has to be in the back of our minds as he can relapse at any time.  Frank cannot ever be vaccinated again as this could over-stimulate his immune system resulting in a relapse.  I am most worried about not being able to vaccinate him against leptospirosis.  I can monitor his immune protection against rabies, distemper and parvo viruses with titers but not with leptospirosis.

My family is so thankful for all the amazing care Frank received during this ordeal and that he is back to his normal crazy/loving/adorable/playful self.  Drs. Calabro, Gonzales, Galssman, Romsland, Hankin and Talrico are brilliant veterinarians and dedicated themselves to helping me figure out what was going on with Frank.  All of the technicians that took care of him while he was in the hospital were gentle and caring.  I am lucky to count all of these wonderful people as my friends and am grateful for Friendship and the excellent care that is available to all of us here in DC.  So go home tonight and give your pets a big hug and a kiss, each day we have with them is truly a gift that should be treasured.

He has a new haircut to even out all his shaved areas and is feeling much better!



Monday, March 31, 2014

Weight loss success for Toby!

Losing weight is hard.  It is hard for us and it's really hard for our pets. Given that fact, I am very excited to report a weight loss success story! Toby is a 3-year-old Greater Swiss Mountain dog that I have been seeing since she was a tiny puppy.  Last spring at her annual exam Toby’s owner and I discussed that she had gained quite a bit of weight over the winter.  She was weighing in at 129 pounds and on physical exam she was quite chunky.  She was eating an adult formulation of dry food at the correct amount for her body weight.  We decided to switch her to a light formula and increase her activity.

Toby came back in 6 months for a recheck and had only lost 2 pounds.  At this point we switched to Hill’s Prescription Metabolic food and enrolled her in the Hill’s Healthy Weight Protocol.  Hill’s created this online program with University of Tennessee to establish a better system for evaluating body fat in overweight animals.  The Metabolic diet was designed using nutrigenomics to affect gene expression by working with the animal’s metabolism for more effective weight loss.
Click on picture for full image

We started by taking a few measurements and plugging it into the online program which then told me that based on her breed, body measurements and weight Toby’s body fat index was 43% and her ideal weight was 90 pounds. Toby was allowed to eat 1 can and 31/4 cups dry Metabolic prescription food per day.  This was a lot more than the 2 cups daily she was allowed on the adult light food.  Her owner reported that she loved the food and we were off and running.


After eating the Hill’s Metabolic for 6 month I am thrilled to report that Toby is down to 112 pounds.  That is a loss of 15 pounds!  We are going to keep going and try to get down to about 100 pounds, which I think will be ideal for her.  Once she reaches her target weight we can continue feeding Metabolic and Toby get even more food each day to maintain her ideal weight.  I don’t know many dogs or people who would turn down that deal!


Thursday, March 27, 2014

Diabetes in cats - Izzy's story

Izzy is an 8-year-old kitty who came to see me because her owner noticed over the past month she had been drinking and urinating much more than normal. Overall she is a healthy, middle-aged cat with no previous medical issues. Her physical exam was unremarkable but she had lost a little over half a pound since her visit last year.  Additionally, a few months ago she had been given an injection of a steroid by a veterinarian at another hospital to help with a superficial skin infection.

There are many causes of increased thirst and urination, a condition technically called polydyspia and polyuria. We submitted blood and urine to look for underlying causes such as chronic kidney disease or a urinary tract infection.  Izzy’s results came back showing she had a significantly elevated blood glucose level and glucose in her urine. These two concurrent results are diagnostic for diabetes mellitus.  Other signs of diabetes in cats other than increased thirst and urination are weight loss, changes in liver function and hind limb weakness.

Diabetes in cats is similar to Type 2 diabetes in humans. The pancreas does not produce enough insulin in response to a meal resulting in elevated blood glucose levels. In addition, the insulin that is produced is not utilized correctly to process blood sugar.  The major cause of diabetes in cats is obesity, which is made worse by inactivity and excessive dietary carbohydrates.  In Izzy’s case she is not overweight but the steroid injection could have affected her ability to produce insulin resulting in diabetes.  It is unusual and unfortunate that she developed diabetes after just one steroid injection.



Once we had a diagnosis of diabetes, we needed to start Izzy on twice daily insulin injections and adjust her diet. After she had been on insulin for a week we performed a blood glucose curve to assess how she was responding to treatment. This means her owner checked her blood glucose with a machine called a glucometer, every four hours for a twelve-hour time span.  Izzy’s owner is amazing, she tackled both the daily and injections and at home curves with ease. 

We started Izzy on insulin and planned the first curve a week later.  This would give her body time to get used to the insulin and start balancing out her blood sugar.  Her first curve showed that the insulin barely changed her blood sugar at all so we gave just a touch more.  We have to be careful not to give too much insulin as this can cause her blood sugar to go to low (hypoglycemia) resulting in neurologic issues such as vomiting, decreased appetite, weakness, stumbling and seizures.  It took us about six weeks to get it right, after each blood glucose curve we would gradually increase the insulin and check a curve a week later.

Izzy is now a well-regulated diabetic, happily eating Hill’s Prescription M/D diet.  It is important to implement a diet change to help better manage diabetes in cats. Unlike people and dogs, cats are obligate carnivores. This affects how they process nutrients in many ways, one of which is that they are not well equipped to metabolize an excess of dietary carbohydrates. The M/D diet is high in protein and low in carbohydrates, specifically designed for diabetic kitties to help better regulate their blood sugar.


Diabetes is a difficult disease for pet owners, it is expensive to treat and requires a unique dedication to your pet.  Cats have a finicky pancreas and can develop complications from their diabetes without warning.  Owners like Izzy’s mom deserve recognition for all their hard work and devotion to their pet’s health.