Thursday, August 27, 2009

A Case of Pneumonia -- In a Season of Canine Influenza Fears

Early last week, Poppy developed some mild coughing and sneezing. I assumed she had picked up some form of “kennel cough” along the way. Kennel cough is a term that refers to a collection of bacteria and viruses--including canine influenza--that cause mild upper respiratory signs such as coughing, sneezing, lethargy, decreased appetite, and fever. These signs are usually mild and resolve on their own without treatment.

Pneumonia Develops

Sure enough, Poppy’s symptoms resolved but a few days later, my 4-year-old Chihuahua mix Lilly developed similar signs. Unlike Poppy, Lilly started to get worse and developed a thick, green nasal discharge. I started oral antibiotics but the next day she was extremely lethargic and wouldn’t eat. Due to these symptoms, mild dehydration and her reluctance to eat I admitted Lilly to the hospital for intravenous fluids and medications. While she was there I took chest x-rays which revealed her upper respiratory infection had progressed to pneumonia.

After twenty four hours Lilly was looking much brighter and I decided to bring her home for further care. The next day she was depressed again but still eating and not having any respiratory difficulty. I started another antibiotic and a medication called Mucomyst which helps break up congestion and acts as an anti-oxidant to protect her lung tissue. I also began what Lilly now considers torture: steam baths to help clear out her airways. This is accomplished by closing her in the bathroom and letting the hot water from the shower fill the room with steam.

About one day after starting the new medications, Lilly seems a little brighter and is eating well but is still not acting like herself. If she continues to be depressed I will bring her back into the hospital and take follow-up chest x-rays to assess the progression of her pneumonia. I am keeping an extremely close eye on her progress and will continue to treat aggressively.

Caused by Canine Influenza?

With all the recent hype about canine influenza, it’s natural to wonder if this was the initial infection behind Lilly’s upper respiratory signs, which in turn progressed to pneumonia.

The answer is… maybe. Lilly’s original infection could have been canine influenza, Bordetella, parainfluenza or any of the many unnamed viruses lurking about the dog world.

Believe it or not, I won’t be testing Lilly for canine influenza. For one thing, although the technology* is available, the test results take about three weeks to get back. More importantly, though, there is nothing the test could reveal that will affect how I proceed with Lilly’s treatment. My main goal now is to treat Lilly’s pneumonia symptoms and help her regain her health – and it won’t make any difference whether or not her condition was originally caused by canine influenza.
I say this to remind pet owners not to panic about canine influenza. Even if your dog does come down with it, in the vast majority of cases it will resolve itself with a minimum of treatment. Should a more serious infection develop, like pneumonia, your veterinarian is ready to treat this – no matter whether the root cause is canine influenza, Bordetella, or another virus.

* Cornell University offers a paired serology test that is known as the gold standard for diagnosis of canine influenza. The kennel in Fairfax with the alleged canine flu outbreak did NOT use this test.

Tuesday, August 25, 2009

The facts about canine influenza

Last week, a kennel in Fairfax was closed due to a suspected outbreak of canine influenza. Due to the heavy media coverage, we have received quite a few calls from concerned pet owners.

Given all the scary publicity about canine influenza, I would like to make a few things clear.

Don’t Panic!
It is extremely unlikely that a healthy, adult, pet dog will develop the severe and deadly form of the canine influenza virus.

Overall, canine influenza is no more a threat to your dog than an infection from Bordetella (the bacteria associated with “kennel cough”). While it’s true that about 80% of all dogs exposed to the virus will become infected, the vast majority of these experience mild symptoms similiar to a human head cold which resolve with simple supportive care. About 20% of those dogs exposed will clear the infection without any signs of illness.

Infected dogs may develop such clinical signs as coughing, sneezing, lethargy, decreased appetite, fever and a runny nose.

Often mild symptoms such as coughing and sneezing can resolve themselves after just a few days. If treatment is warranted, then supportive care consisting of antibiotics and possibly intravenous fluids would be indicated. A very small percentage of dogs can develop pneumonia, which requires more aggressive therapy.

At-risk canine populations

Shelter dogs and racing greyhounds are at a greater risk of contracting the severe form of canine influenza, due to the close proximity of their crates and the increased stress levels these dogs experience. As with human flu, the very young or very old are also at increased risk. Again, it is rare that a healthy, adult, pet dog will develop the severe form of this virus.

In its severe form, canine influenza is characterized by a rapid onset of hemorrhagic pneumonia with high fevers, difficulty breathing and coughing up blood. In these cases death can occur within four to six hours of presentation.

Scary as this sounds, it’s important to remember that, even in these very high-risk populations, the mortality rate is only 5-8%. That means that almost all dogs affected do recover with treatment.

Steps for prevention

You can help protect your dog with these simple preventive steps:
· At the dog park or doggie day care, avoid any contact with dogs that are coughing and sneezing.
· Keep a watchful eye out: If your dog starts coughing or sneezing and acting lethargic, see your veterinarian to discuss diagnostic and treatment options.
· If your dog shows any of these upper respiratory signs, limit your dog’s socializing -- steer clear of the dog park and doggie day care until these symptoms are gone.

Although a vaccine is available, Friendship does not recommend or carry it. There are multiple reasons for this:

· Though initial clinical trials showed the vaccine to be safe, the number of dogs tested was relatively small (only 746). As with many other medications, we do not know the full potential for reactions or complications until the vaccine is used in much larger number in the general population.

· The vaccine cannot prevent your pet from becoming infected if exposed to the virus. Instead the vaccine will only reduce the severity of clinical signs.

Given these facts, we do not recommend that all dogs get vaccinated for a disease that, for the great majority of pet dogs, is mild and does not cause a life-threatening illness.

Thursday, August 20, 2009

Monday, August 17, 2009

Successful fundraiser for Trooper

Trooper’s fundraiser was a huge success on Sunday. Apart from raising over $4000 for her medical expenses I think the community really appreciated having a place to go so they could show their support. Thank you to everyone who stopped by, we hope you had a great time!

Three Trooper fans show their support with face painting

The table with all of our wonderful raffel items

Trooper’s wounds continue the slow healing process. She has daily sedated bandage changes where the wounds are cleaned and a fresh bandage is placed. Last week we removed a large amount of dead tissue that was causing the discharge from her right eye seen in her first TV interviews. It was a little nerve racking to remove so much tissue from her face where there isn’t a lot of extra skin to work with, but it had to be done.

She has responded very well, the wounds are clean and appear to be free of infection. Once we are certain the wounds are ready we will close the skin and hope for the best. At this point she still has her right eye but both the upper and lower eyelids were involved and a large amount of tissue was removed. If the skin around her eye contracts too much when it heals she would be unable to blink which would necessitate removing the eye. Again we are taking everything one day at a time and so far we are pleased with her progress.

Friday, August 14, 2009

Trooper's fight continues

Trooper's story has struck a cord with the community and it seems like the country as well with news stories popping up coast to coast. To date, thousands of dollars in donations have been given to the Washington Humane Society (WHS). In addition to the generous discount on services that Friendship provides for all WHS patients, we are also contributing a portion of our Brudder Sullivan Fund to Trooper’s medical expenses. Every time a beloved cat or dog is euthanized at Friendship the hospital makes a donation in that animal’s name to our Brudder Sullivan Fund. We have set aside the thousands of dollars in contributions from July and August for Trooper’s care.

In addition, this Sunday we will be hosting a fundraising event at Friendship with all proceeds going to help Trooper. We will have a get-well card that you can sign for Trooper, a raffle, food, lemonade, and face painting. Friendship and WHS staff will be there to answer any questions you might have regarding Trooper or your own pet. You can even meet Officer Eve Russell who found Trooper and rushed her to Friendship for immediate care.

If you are interested in communicating about Trooper’s harrowing ordeal you can visit Friendship’s message board to chat with other concerned dog lovers.

Please come by and see us this Sunday!
4105 Brandywine Street NW
Washington, DC 20007

Monday, August 10, 2009

Trooper's Story

Humane Law Enforcement Officer Eve Russell brought a young pit bull into Friendship after responding to a call in Southeast DC on Friday afternoon. A resident of an apartment building was throwing her trash into a dumpster when she noticed a dog's head sticking out of a bag. The Washington Humane Society was immediately notified and Officer Russell arrived to investigate.

She found an approximately two year old dog covered in dirt and blood that had been duct taped in a black trash bag and thrown in the dumpster. Officer Russell was able to pull the dog out and quickly freed her from the garbage bag. She realized what critical condition the dog was in and rushed her to Friendship for emergency care. She was named Trooper by Officer Russell during admission to the hospital.

Upon arrival at Friendship we found her to be in shock, severely dehydrated and in a lot of pain. We started intravenous fluids and quickly administered pain medication. She suffered from multiple puncture wounds around her neck, head, and muzzle. Her most severe injury came from a large, very deep gash over her right eye that extended to the bone.

Once she was stable we sedated her to begin to fully assess her wounds and start treatment. The laceration above her eye was closed with multiple sutures as was a tear in her lip. The remainder of the abrasions were clipped and cleaned. She was started on antibiotics and anti-inflammatories.

The next day Trooper was comfortable and eating very well. She continued to do well until Sunday evening when she spiked a fever and became lethargic. We added in another antibiotic to assess infection and are monitoring her very closely. She has such a severe amount of swelling around her right eye and muzzle her skin is starting to slough off.

All we can do now for Trooper is continue to monitor, treating with aggressive antibiotics and pain management. Despite everything she has been through she remains comfortable and continues to eat. You can view the links posted above for more coverage on Trooper.

The Washington Humane Society is offering a $1500 reward for anyone who has information leading to an arrest of the individuals who did this to Trooper.

Thursday, August 6, 2009

Channey's angry pancreas

Channey is a chubby, 11-year-old Jack Russell terrier who presented for sudden onset vomiting, anorexia and bloody diarrhea. Prior to these symptoms, her owners did not notice anything out of the ordinary, although they did mention that they had given her a large steak bone from their dinner the night before.

On physical exam Channey was very quiet, dehydrated, had a mild fever and was painful on palpation of her abdomen. My immediate thought was that Channy’s condition was caused by pancreatitis, a fairly common diagnosis or suspected cause of vomiting and diarrhea that many people do not know much about.

Pancreatitis is an inflammation of the pancreas, a gland that lives in close contact with the stomach, liver and small and large intestines. Its major function is to secrete enzymes that help digest nutrients in the small intestine.

\Pancreatitis occurs when a breakdown causes the digestive enzymes to come into contact with the pancreatic tissue. This results in a large amount of inflammation that extends to the surrounding organs and, in severe cases, through the entire body. The most severe cases of acute pancreatitis can result in death, although this is uncommon. We are not sure what causes pancreatitis, but there are many suspected causes, with pet obesity and ingesting a very fatty meal being at the top of the list.

My first step was to order x-rays, to find out if we could see what was causing the abdominal pain. Despite Channey’s recent steak-bone snack, I wasn’t expecting to see any bone fragments remaining, as these are usually digested very quickly. Still, I wanted to rule out any other abnormalities and make sure Channey’s small intestines had not formed a pattern consistent with obstruction. The x-rays were unremarkable which made me even more suspicious of pancreatitis.

Next, I submitted bloodwork and admitted Channey for supportive care. While I waited for Friendship’s lab to run her bloodwork, I checked a cPL snap test that specifically checks for one of the enzymes produced by the pancreas. Channey’s test was positive, confirming my diagnosis of pancreatitis. (Interestingly, this test is often negative, even in cases when I believe the dog still has pancreatitis. Yet another example of how important it is to look at how the patient is doing rather than rely solely on testing.)

I checked Channey’s bloodwork to assess the severity of her condition. She had a high white cell count consistent with inflammation and a high red cell count along with mild electrolyte abnormalities indicating she was most likely dehydrated. Fortunately, she did not have any elevations in her liver values, which can be another common finding with pancreatitis.

There is no specific treatment for pancreatitis - instead we try to alleviate the symptoms and make the patient more comfortable. We started Channey on intravenous fluid therapy to re-hydrate her and antibiotics to help with the diarrhea. Pancreatitis itself is not infectious but severe diarrhea can lead to secondary bacterial infections. To help keep her comfortable, we gave her pain medication along with anti-nausea medications. She was not offered food for twenty-four hours to allow her gastrointestinal tract time to rest and the inflammation to decrease.

Channey was in the hospital for about two and a half days before she began to improve. She started eating the small amounts of bland diet we offered her and was able to keep it down. By the fourth day we had transitioned her to oral medications, she was eating well without vomiting and appeared one hundred percent more comfortable. She went home with suggestions for weight loss and strict instructions to avoid any fatty foods.