Tuesday, July 28, 2009


We all know that our pets have huge hearts filled with unconditional love--but what does it mean when your veterinarian tells you your pet has a heart murmur?

It could mean nothing or it could indicate that there is heart disease present. The only way to know is with an ultrasound of the heart called an echocardiogram. This procedure takes around 30 minutes and is done by a board certified cardiologist. Usually sedation is not necessary and you are with your pet the entire time. The doctor will image the heart and see if there is disease present such as thickening of the heart wall or abnormalities with the valves.

I often have people ask me “even if there is something wrong what are we going to do about it anyway?” While heart surgery is not commonly performed on animals, we can treat with medications that will help the heart work better and prolong your pet’s quality of life. On Wednesdays at Friendship we have Dr. Braz-Ruivo seeing appointments; he is not only a delight to work with but also an excellent cardiologist. If you would like to schedule an appointment please call (301) 809-8800.

Thursday, July 23, 2009

The dreaded e-collar

One of the most universally hated recommendations by veterinarians is that their client’s pet wears an Elizabethan collar, also known as “that lampshade thing”. I was discussing post-spay care with a client on Tuesday and she asked me if I thought it was realistic to expect her puppy to wear the collar for the necessary 10-14 days following the surgery. I replied with a very assertive “yes” and explained what can happen if the puppy is allowed to lick at her incision.

If a dog or cat is constantly licking at a surgery site this will cause the incision to open and become infected. Treatment consists of a course of expensive antibiotics, twice daily warm compresses, multiple recheck appointments, prolonged e-collar use and possibly surgery to remove the infected tissue and repair the incision. The simple act of using an e-collar saves the owner money and spares their pet unnecessary discomfort.

I understand my clients’ disdain of e-collar use but it was not until I performed Poppy’s spay surgery on Tuesday that I truly appreciated what I was asking them to endure. Poppy is usually somewhat of a disaster around the house but with the addition of the e-collar she has been upgraded to a level 5 hurricane. In the past 24 hours she has flipped over multiple water bowls (full of course), scraped my arms and legs to shreds, figured out a way to trap the cats between the e-collar and the floor so she can “play” with them and sent Sparkle and Lilly into hiding under the bed.

As tempting as it is to just take the e-collar off and do my best to keep an eye on her, I have seen too many complications arise from this. I know that if I can tough it out for eight (yes, I’m counting) more days then I will be done with it. The good news is wearing the e-collar hasn’t slowed Poppy down one bit, the bad news is I am having a very hard time keeping her quiet so her incision can heal properly.

Tuesday, July 21, 2009

Annual exams are a necessity

Recently I saw a lovely 9 year-old cat named Mittens for his yearly exam. His owners report he has been doing great, except vomiting more than usual. Mittens was a handsome cat but physical exam revealed a heart murmur and dental disease. I recommended that we do pre-anesthestic blood work for the dental and see if there were any indications as to why he was vomiting. I also advised the owner to see a cardiologist to have the heart murmur evaluated before anesthesia for the dental cleaning.

Mittens blood work revealed very mild kidney disease which is an all too common finding in middle-aged to senior kitties. Though we are not yet able to prevent kidney disease, the earlier we detect it, the better chance we have of managing it, which is why we strongly suggest that all senior cats get blood work as part of their regular wellness exams. Clinical signs to look for are decreased appetite, vomiting, weight loss and increased thirst and urination.

At 9 years old Mittens has just entered into the realm of senior cat-hood but he was found to have three very serious but also manageable diseases. Given his heart murmur and kidney issues cleaning his teeth is now even more important. In a healthy animal (people too) every time you eat bacteria are released into the blood stream. With diseased teeth the amount of circulating bacteria increases, these bugs then lodge in the heart, kidneys and liver. Thus as a veterinarian I don't want Mitten's dental disease to make his heart and kidney disease worse. Isn't it amazing how everything is connected?

I feel this is a great example of why annual exams are so important. All of Mittens issues are at the very beginning stages and with proper management we can keep him as healthy and happy as possible.

Tuesday, July 14, 2009

Road Trip

The dogs and I have just returned from a trip up the east coast with stops in New York, Connecticut, Maine and Massachusetts. The trip was wonderful: full of new adventures and visits with old friends but we are very happy to be home with the kitties. I got to spend a lot of time with the dogs and was able to introduce Poppy to the beach which she enjoyed. Sparkle has always loved swimming and I was hoping that Poppy would follow but it took my swimming in the freezing cold water to get her all the way in.

I thought I would post a few pointers for taking your dogs on driving trips. The most important thing is to be extremely cautious when leaving your dog in the car for any length of time. Temperatures inside a car on even a mild day can quickly rise to dangerous levels resulting in heat stroke. You should also offer your pup water frequently during the trip to prevent any dehydration. Luckily my dogs do not have any issues with motion sickness but this is a frequent occurrence. Meclizine (Bonine) is an over the counter medication for motion sickness that is similar to dimenhydrinate (Dramamine) but causes less sedation. If you are taking a long trip and you know your dog is going to be sick ask your veterinarian about oral, prescription anti-nausea medications like Cerenia. Often anxiety or excitability can be a problem, there are also medications your veterinarian can prescribe that may help with this. Speaking with your veterinarian and planning ahead are an ideal combination for a safe drive that both you and your dog can enjoy.

Thursday, July 9, 2009

Vomiting Kitty

A few weeks ago, I noticed that one of my cats had begun vomiting at least one a day. After a couple of days of observation--and one morning of being woken up to the sound of vomiting--I determined that it was my cat Breaker.

All cat people know that cats vomit from time to time, and there are about a million things that can cause it. But when a kitty starts vomiting more than once a week, it warrants further investigation. I started by giving Pepcid AC to Breaker once a day, to help settle his stomach by decreasing the amount of stomach acid produced. Unfortunately, despite the Pepcid, I continued to find frequent piles of kitty puke around the house.

It was time for some veterinary detective work: My first step was to run bloodwork to check for the most common cat ailments: kidney disease, hyperthyroidism and liver disease. I also submitted a feline heartworm test. The good news was that the bloodwork was unremarkable and Breaker tested negative for heartworm disease.

My next step was schedule an abdominal ultrasound to look for signs of pancreatitis, inflammatory bowel disease (IBD), and lymphoma. Luckily for Breaker, Friendship’s internist Dr. McConnell happens to be an absolute genius with this diagnostic test.

The ultrasound is non-invasive and, other than a little abdominal pressure, not painful. It allows us to view the internal architecture of the abdominal organs. Where x-rays show shapes and shadows, ultrasound lets us assess such things as the layers in the intestinal wall, and see if the gall bladder is distended or the bladder wall is thicker than it should be.

I was relieved to see that Breaker’s pancreas did not appear inflamed, his abdominal lymph nodes were normal sized and his intestinal wall looked just like it should. Because ultrasound is not one hundred percent diagnostic, I still didn’t have an exact answer as to why my poor kitty was vomiting. Still, it was good to know that pancreatitis, IBD, and lymphoma were much less likely.

To further rule out pancreatitis, we submitted a blood test to the vet school at Texas A&M to check Breaker’s pancreatic values. These turned out to be normal. At the same time, we decided to see if a change in diet would help. Success! I’m pleased to report that I switched Breaker to a prescription diet, and he hasn’t vomited once.

My plan now is to monitor him at home and continue with the new diet. If he starts vomiting again the next step would be endoscopy, which is the least invasive way to collect biopsy samples of the stomach and small intestine. This would then allow us to distinguish between inflammatory bowl disease and lymphoma. Let us hope for no more kitty vomit from Breaker.

Tuesday, July 7, 2009

Heartworm Prevention

Everyone knows how annoying those relentless mosquitoes are when you are trying to enjoy your yard or back porch. But these pests are more than just irritating – they can endanger your pet’s health by transmitting heartworm disease.

Heartworm disease is a parasitic infection transmitted when an infected mosquito bites your dog or cat. Monthly heartworm prevention is essential year round for both dogs and cats, even indoor kitties. In colder climates you could potentially discontinue preventative for the winter months but DC is not that climate. How often in DC do we have a few days of 50-60 degree weather in January? Those mosquitoes, fleas and ticks are just waiting to emerge and attack our dogs and cats. At Friendship we recommend giving both heartworm prevention and flea/tick prevention year round.

Prevention is key for both cats and dogs. There is NO treatment for heartworm in cats, and sudden death is a common result of heartworm infections. While it’s true that infected dogs can be treated, the treatment itself is very dangerous—and can even be fatal. Left untreated, heartworm disease will kill a dog.

Luckily, prevention is easy: just a pill or topical medication once a month. If only everything were that simple.

Thursday, July 2, 2009

Washingtonian Magazine

Poppy and I had our picture taken yesterday by a photographer for Washingtonian magazine. We will be in the August issue's monthly pet column. Poppy is very excited about this!

The Confusing Facts of Lyme Disease

I do not care for Lyme disease. Because the veterinary community does not yet fully understand how it affects dogs, diagnosis and treatment can be challenging. Plus, it’s a confusing disease, which can be tough for pet owners to understand. The best way to protect your dog from Lyme disease is through a combination of prevention and monitoring.

Prevention is your first essential step. Because Lyme disease is caused by a bacteria transmitted through deer tick bites (the tiny deer tick is pictured to the left), the best way to ward it off is with topical flea and tick preventatives like Frontline or Advantix. In a temperate climate like ours, these should be applied once a month, every month. (If you’re not already using one of these medications, come in and talk with us so you can get started). These also protect your dog against other tick borne infections such as Erlichia and Rocky Mountain Spotted Fever.

Although a Lyme disease vaccination is available, we do not recommend using it because there is no concrete evidence that it prevents the disease. Plus, some specialists believe that vaccinating an infected dog can make the disease worse.

Monitoring is equally important. Here at Friendship, we include a screening for Lyme disease in our canine patients’ yearly heartworm tests. This shows us whether or not a dog has been bitten by a tick carrying the bacteria. When a dog tests positive for Lyme disease, it does NOT indicate active infection only exposure. In Lyme endemic areas like DC, there are reports that up to 70%-90% of dogs will test positive. The good news is that the vast majority of the Lyme-positive dogs we see never develop clinical signs of the disease.

If the Lyme disease test is positive, your next step is to bring in a urine sample so we can test for Lyme nephritis, a serious and fatal complication involving the kidneys. This test, known as a urine protein creatinine ratio, looks for protein loss through the kidneys. If your dog’s urine has increased protein in it we will recommend treatment with oral antibiotics. In addition, we will also ask you to keep a sharp lookout for clinical signs such as lethargy, decreased appetite, fever and a lameness that shifts from leg to leg. If your dog displays any of these symptoms, we will ask you to schedule an appointment so we can discuss treatment. Based on the recommendations of the American College of Veterinary Internal Medicine, Friendship treats only those dogs that have abnormal urine tests and/or display one or more of the clinical signs of Lyme disease.

To sum up – when it comes to Lyme disease, the best medicine is a combination of prevention and monitoring. Keep on track with your dog’s monthly flea and tick preventative. Bring your dog in for a yearly heartworm screening, so we can test for Lyme disease. If your dog does test positive, don’t panic! Most dogs that test positive never display clinical signs of Lyme disease. Whatever happens, you can rest assured that we will work with you to keep your dog healthy and comfortable.