Tuesday, March 30, 2010

Coughing Huey

Huey’s owners arrived home from their vacation in The Bahamas happy, relaxed and rejuvenated. They rushed directly to the kennel to pick up their black Labrador retriever Huey who then proceeded to do nothing but cough from the moment he jumped into the car. If you are a dog owner I’m sure this sounds all too familiar.

After a long night during which no one in the house slept very well, Huey’s owners brought him to Friendship. He was quickly diagnosed with kennel cough, which is a collective term for a highly contagious group of viruses and bacteria that cause irritation in the upper respiratory tract. Symptoms include coughing, sneezing, watery eyes, nasal discharge, lethargy, decreased appetite and fever.

Although Huey had a nasty cough with frequent sneezing, he did not have a fever and was otherwise eating and acting like himself. I prescribed a cough suppressant and advised his owners to give him steam baths at home to help soothe his airways. The cough suppressant would allow Huey to rest, thus preventing his immune system from becoming stressed, which in turn could lead to a secondary bacterial infection.

The infection would most likely resolve without treatment, although Huey's cough might last for 7-10 days. I instructed his owners to watch him closely for lethargy, decreased appetite, a yellow/green discharge from the nose, or a fever greater than 103 degrees. These are signs of a secondary bacterial infection which would need to be treated with antibiotics.

Huey’s owners asked me about starting antibiotics immediately, but I explained that Bordetella (the bacteria most commonly associated with kennel cough) is not very responsive to antibiotics. In addition, most of the other infectious agents that cause kennel cough are viral, and therefore cannot be treated with antibiotics.

Since Huey had previously been vaccinated for kennel cough, his owners wondered how he could have contracted it. I told them that the kennel cough vaccine does not actually prevent the disease. Instead, it helps boost the immune system to decrease clinical signs and probably prevented Huey from getting even sicker.

The worst part for Huey was that since kennel cough is highly contagious, he wouldn’t be able go to the dog park or doggie day care until 7-10 days after his cough had fully resolved. His owners called a few days later to report he was doing great and they were happy we held off on the antibiotics.

Wednesday, March 24, 2010

Exciting news!

This is a big week for Friendship Tails filled with bittersweet memories, celebrations, and an exciting announcement.

A year ago today, which also happens to be my birthday, I lost my beloved dog Westin to cancer. She was my constant companion and best friend; my life would be very different had she not been by my side for the last thirteen years. It seemed unnecessarily tragic that she passed on my actual birthday but on further reflection I am thankful to have a meaningful date to remind me of how lucky I am to have shared a part of my life with her. I think of Westin often and will never forget the joy and comfort she gave to me.

This Saturday we celebrate the one year anniversary of Friendship Tails. We are having a party to commemorate the event as well as raise money for Fashion for Paws benefiting the Washington Humane Society. I find it pretty amazing that I have been at this for over a year already and with the following announcement it seems there are only more exciting things to come.

With the help of Queen Anne's County Public Television and the fabulous Andrea Hearn I am thrilled to reveal Friendship Tails - The Show. We will be posting segments here and on YouTube which are filled with even more tips on how to provide your pet with the very best care for a long and healthy life together. Here is the very first one - I hope you enjoy it!

Friday, March 19, 2010

Fox 5 story

Click here for the EPA spot-on story seen on Fox 5

The EPA and fears about "spot-on" preventatives

I will be on Fox 5 today to discuss the EPA’s announcement earlier this week regarding a “sharp spike” in the number of adverse events associated with the use of topical flea and tick preventatives. Understandably this has pet owners concerned and wondering if they should continue to apply these medications to their dogs and cats (the short answer is YES).

In the 29,000 reported events that the EPA reviewed about 97% of reactions were mild to moderate with side effects consisting of local skin irritation, transient lethargy or vomiting. The majority of these reactions were due to use of an over the counter product by brands like Hartz or Sargeants. I personally have never seen a severe adverse reaction to products prescribed by veterinarians like Frontline, Revolution or Advantage Multi.

I have seen severe reactions to these over the counter substitutes which include pyrethroids in their formulations. Cats in particular are very sensitive to pyrethroid pesticides and even given at appropriate doses can result in neurologic disease which is usually fatal if left untreated. Hartz actually has pulled its cat product off the market after several adverse effects resulting in death were reported.

The EPA's data included the difference in reactions between over the counter and veterinary products when used inappropriately. It was found that an over the counter spot-on like Hartz used on the wrong species caused severe reaction or death 24% of the time compared to 4% when a veterinary product was used. This is usually seen when a dog product is applied to a cat.

Pet owners should continue to use the flea and tick preventatives prescribed by their veterinarians. Owners also need to be sure that they are using the correct dose for their pet’s body weight and NEVER apply a dog product to a cat. The risk of flea infestation, flea allergic dermatitis, tapeworms and tick borne diseases such as Lyme disease or Rocky Mountain Spotted Fever are a much greater threat than the rare and mild reaction that could occur with a product like Frontline.

As for the EPA press release let me first stress that there has been no confirmation that the topical flea and tick products definitively caused the adverse events. If a product was in use during any adverse reaction by a pet, it must be reported whether or not the product caused the reaction. As far as the overall numbers and the "spike" seen by the EPA all reactions are treated the same; there is no difference between a mild skin irritation and a much more serious reaction.

Companies who make these products are required by law to submit information about adverse events to the EPA. However, the companies can choose which events to report. Merial the company that makes Frontline voluntarily reports every adverse reaction that consumers or veterinarians report to them, no matter how small. It is unknown whether all pharmaceutical companies adhere to this same level of diligence.

While Frontline was listed among the seven products named in the EPA announcement, consider that thousands of veterinarians have dispensed millions of doses of Frontline since its introduction in 1996. Adverse events reported with Frontline are rare and most often minor. It is interesting that while Merial is extraordinarily diligent in reporting every adverse reaction reported, their records do not indicate any increase in adverse events associated with Frontline.

Since the Frontline product has not changed since its inception, veterinarians and pet owners should feel safe and comfortable using it to provide the highest level of flea and tick protection. The rarely seen but potential side effects pet owners might notice include minor skin irritation, transient lethargy, or vomiting with the use of Frontline.

Tuesday, March 16, 2010

Leptospirosis Awareness

With the warm weather and rainy days ahead you should be aware of a relatively unknown and quite nasty bacterial disease called Leptospirosis. We do have a vaccine to protect against Lepto but it is not considered a "core" vaccine and many dog owners are unaware of it's existence.

Lepto is a bacteria transmitted via the urine of an infected animal, most commonly wildlife such as rats, opossums and raccoons. These animals urinate in standing water or moist soil where the Lepto bacteria replicate and can live for quite some time. Your dog then comes along and either drinks the contaminated water or steps in the puddle, which allows the bacteria to enter the blood stream through a cut in the skin or through mucus membranes such as eyes, mouth, or nose. People can become infected with Lepto either through contaminated water or via contact with the urine of an infected animal.

Though Lepto can be treated with antibiotics, if the infection is not caught early enough it can permanently damage the kidneys and/or liver, resulting in organ failure. Clinical signs include non-specific flu-like symptoms such as fever, lethargy, decreased appetite, vomiting, and diarrhea. With aggressive therapy consisting of intravenous fluids and antibiotics, dogs usually recover. But in some cases, the disease is too advanced by the time we catch it and ends up being fatal.

Wondering if your dog should be vaccinated? Talk with your veterinarian. Dogs of any age can be given the Lepto vaccine. Bear in mind, that though the vaccination protects against the four most common strains of Lepto, a vaccinated pet can still be infected with one of the many other strains of the bacteria. And, as with all vaccines, there is the risk of a vaccine reaction, something you’ll want to discuss with your veterinarian as well.
I strongly recommend the Lepto vaccine for all my canine patients, and my own dogs are vaccinated, too. I frequently take my dogs to the park and trails in my neighborhood, and feel much more comfortable knowing that I’ve done everything I can to protect them

Thursday, March 11, 2010

The Polite Puppy

Spring is finally here and with the warmer weather comes a parade of new puppies and kittens into the hospital. I am excited to announce the creation of The Polite Puppy - manners and wellness care class. Friendship and Happy Paws have paired up to offer a complementary class to all new puppy owners. On the last Sunday of every month I will be holding a class at Happy Paws to discuss basic commands puppies should know and the concept of behavior modification training. In addition we will discuss recommendations for vaccines, nutrition, toys, products and tips to promote life-long health of your new puppy.
The Polite Puppy kicks off on Sunday, April 25th at 3 pm. Class will be held at Happy Paws located at 4904 Wisconsin Avenue. Please email politepuppy@friendshiphospital.com if you are interested in signing up.

Tuesday, March 9, 2010

What you need to know about anesthesia

Pet owners often become very nervous when I recommend a procedure that requires general anesthesia, be it a dental cleaning or removal of a mass. Though anesthesia can seem scary, at Friendship we make it as safe as possible. We take special care to ensure we are providing our patients the gold standard of care. I am very proud of our anesthetic protocols. If your pet needs surgery, but you're not able to come to Friendship, please use the following as a benchmark for state-of-the-art care. Before the procedure we perform a complete physical exam. We listen to the heart to make sure there is not a heart murmur or abnormal rhythm, and we listen to the lungs to make sure they are are clear. We also make sure that pre-anesthetic bloodwork has been done in the past three months. Bloodwork allows us to evaluate the liver and kidney values of the patient. It is important that these two organs are functioning well, because they are responsible for processing the anesthetic drugs. A complete blood cell count (CBC) is included to check for low platelets that could result in excessive bleeding; decreased red cells indicating anemia; and an increase white cell count which could indicate infection is present.

Once we have this information we design a customized anesthetic plan based on the overall health of the individual pet. If, for example, we discover a heart murmur during the physical exam, we will ask our in-house cardiologist to assess the patient's heart function. We then use this information to choose drugs that cause less cardiovascular depression. If we know the patient has kidney disease then we will support their kidney function with additional intravenous fluids before and after the procedure.

On the day of the procedure...

Before going into the nitty-gritty, I want to point out something that I think really shows the amazing level of care we provide at Friendship: throughout the entire operation -- from the very beginning all the way through recovery -- a highly trained technician monitors every aspect of the patient's signs. This technician literally stands next to the patient throughout the entire procedure, making sure that every parameter is exactly where it should be.

At the beginning of every surgery, the very first step is to place an intravenous catheter. This will be used later in the procedure for a number of crucial functions throughout the anesthetic process. Next we administer the “pre-meds” -- these usually include a sedative to calm the patient down and an opoid to get a jump-start on pain. Thanks to the pre-meds, we are able to drastically reduce the amount of gas anesthetic that is used. This is desirable because higher quantities of gas anesthesia may cause cardiovascular depression, in which the heart rate slows and blood pressure plummets, depriving organs of much of the blood they need.

Once the patient is fully sedated, we use the intravenous catheter we placed at the beginning of the procedure to administer powerful anesthetics called "induction drugs." These drugs completely relax the patient's throat, so that we are able to painlessly insert an endotracheal tube -- known for short as an ET tube (pictured above). We use the ET tube to administer gas anesthesia, and also to help keep the patient breathing freely.

With the ET tube in place, gas anesthesia is turned on and the patient is now officially under general anesthesia. As soon as the ET tube is placed, we begin tracking the patient's heart rate and blood oxygen levels using a device called a pluse-oximetry machine, which is placed on the patient's tongue. We also apply ECG leads to monitor the rhythm of the patient's heart. It is critical to monitor blood pressure constantly during anesthesia. This allows us to ensure that the patient's organs are receiving an adequate supply of blood. One of the many reasons IV fluids are administered during surgery is to maintain blood pressure.

Though there is always some risk when going under general anesthesia, here at Friendship we do everything we can to make it as safe as possible. Certainly, general anesthesia should be respected, but please don’t let fear keep you from moving forward with a procedure that will benefit your pet's health.

Tuesday, March 2, 2010

A must read

"Pets are our seat belts on the emotional roller coaster of life - they can be trusted, they keep us safe, and they sure do smooth out the ride." --Dr. Trout

I have just finished reading Tell me where it hurts by Dr. Nick Trout who is a surgeon at Angell Animal Medical Center in Boston. In this wonderful book he accurately and eloquently describes what it is to be a veterinarian. He highlights the amazing connections that people form with their pets and how we as veterinarians are dedicated to protect that bond.

Every pet owner should read this book!