Update On Hospice PatientMarch 16, 2012 For those of you following my blog, you know that my 14-year-old Somali cat is currently in hospice care for suspected infiltrative GI lymphoma. We were given a rainbow of hope when we started Prednisolone, even though it upset me to move to the “last step” in her treatment. In other words, the Pred is the last thing we can do to help her. I knew this, so starting it seems like the end. But she rebounded so nicely, started putting weight back on and grooming herself more. Then we fell under the delusion that maybe she isn’t sick after all? My friend the hospice nurse said this was normal, families begin to feel like maybe the end isn’t coming, because the animal responds so well to the treatment. Yet she warns, it’s just that the palliative care we are giving her is working, for now. In practice, we often have families who cling to the last little bit of hope. Sometimes it borders on denial, and it’s difficult to make them understand that their pet is suffering. This is particularly true because most people don’t understand how a pet demonstrates …
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Cats From Hell?March 12, 2012 So are any of you watching the show My Cat From Hell on Animal Planet? What a show! At first I was skeptical; who is this Jackson Galaxy dude, what kind of name is that, why does he shape his facial hair like he does, why does he carry his cat equipment in a guitar case, and most importantly, what credentials does he have that makes him a cat behaviorist? Being a cat person myself, I couldn’t help but watch a few episodes to see what happens…and now they are set up to record on my DVR! From what I can tell, he learned cat behavior by working with shelter cats who were trying to get rehomed. I’m not sure if he has any true credentials in cat behavior, but I tell you, he knows his stuff. They show some of the nastiest cats I’ve ever seen. They lunge at the people in the house, they terrorize each other when there are multiples, they pee in the sink and on the carpet, and one even climbed a trellis out on the back patio, opened the neighbor’s screen door, and stalks her at her own house! What is …
A Tetraplegic Recovers Without SurgeryMarch 6, 2012 Kelvin, a 50 pound, 4-year-old female spayed Husky mix was in bad shape. She presented with progressive weakness in all four limbs. Her recent history included a mild bout of diarrhea, which was (still) treated with 500 mg metronidazole BID. The day the dog was referred for an MRI, she was unable to walk on all four limbs. There was no obvious cervical spinal pain and she was tetraparetic (i.e. weak and unable to stand or walk). She appeared tense all over her body and “nervous” or “stressed out.” Blood work was unremarkable. The rest of the physical exam, including heart auscultation, was normal, except for obesity (body condition score of 5/5). A cervical spinal MRI was performed. The radiologist, who read the pictures in real time, deemed the scan normal. Therefore, an MRI of the brain was performed. It was normal, as well. The dog was referred to an internist. The diagnosis was central vestibular disease due to… metronidazole toxicity. Full disclosure: This patient was not mine, but I thought it was an interesting case that was well worth a quick review of metronidazole toxicity to avoid “getting caught.” The important thing to …
Cracking Fevers Of Unknown OriginFebruary 13, 2012 Fever can indicate infectious, inflammatory, immune-mediated or neoplastic disease. Typically, a physical examination and medical history lead a practitioner to a fever’s cause. Or the fever resolves serendipitously or in response to antibiotic therapy. But in some cases, the underlying cause of the fever is not readily apparent. These patients are said to have a fever of unknown origin (FUO). In 1961, the acronym FUO was coined by medical doctors Robert Petersdorf and Paul Beeson and defined as a temperature greater than 101 degrees Fahrenheit on several occasions, illness for more than three weeks and failure to reach a diagnosis despite one week of inpatient investigation. According to the Merck Veterinary Manual and veterinary specialists, this syndrome has no recognized definition in veterinary medicine, making its prevalence difficult to determine. “FUO is common in both species [canine and feline], although underlying causes can be quite different,” says Craig Webb, DVM, Dipl. ACVIM, Ph.D., MS. “Unfortunately, these cases often require that we try to rule out almost everything,” continues Webb, an associate professor of internal medicine at Colorado State University’s College of Veterinary Medicine and Biomedical Sciences. “So after the history and physical examination we …
The Bossy Cat And Owner-Directed AggressionFebruary 8, 2012 Owner-directed aggression in dogs has been written and talked about at length, but feline owner-directed aggression has received less attention. In dogs, “conflict aggression” has replaced “dominance aggression” as a more accurate description of the behavior’s motivation. The change occurred because pundits no longer accept the premise that the relationship between dogs and their owners is governed by pack mentality, as neither dogs in the wild nor, as it turns out, wolves seem to organize themselves along these lines. With this in mind, it seems ludicrous to discuss dominance or status-related aggression in cats, as they do not organize themselves into packs and should have no biological drive to establish themselves in any kind of order. But is it so ludicrous to consider that there may sometimes be a particularly bossy cat that calls the shots with others in a household? I think not. One social arrangement of cats has been described as a “despotic hierarchy,” a system in which one cat assumes control over all others who, barring the odd pariah, live peaceably as subordinates. Another more fluid, social situation between house cats involves a sort of time share arrangement in which one cat may …
With Thyroid Replacement, Consistency MattersJanuary 30, 2012 Everyone is aware of the economic challenges facing veterinary practices today: Visits to the veterinarian are down, and clients are getting concerned about some pet care costs. Some are even selecting alternate resources, including online pharmacies, and requesting prescriptions to have medications filled at human pharmacies at a lower cost. Practice managers or buyers might try to economize by going for the least expensive option when purchasing medications to stock for the clinic pharmacy, to help offset some of these concerns. Medically speaking, if veterinarians are dispensing human generic products in certain categories, there may not be a big difference in the actual product, but this is not the case for every prescription. Educate your staff and clients about when quality and consistency count, such as with thyroid replacement therapy. Overall, some aspects of hypothyroidism in dogs are fairly straightforward and simple. Most cases arise from irreversible acquired thyroid gland disease, due to either immune-mediated lymphoid thyroiditis (a heritable trait) or idiopathic follicular atrophy (normal thyroid tissue is replaced by connective and adipose tissue). In the immune-mediated form, there is a chronic, progressive lymphocytic destruction of the thyroid gland with a slow onset. Auto antibodies …
Considerations For Canine Rehab ProtocolsJanuary 30, 2012 The young and burgeoning field of canine rehabilitation is changing the way dogs recover from injury and surgery, with rehabilitation centers springing up across the country. The outmoded approaches of yesteryear, wherein animals were kept inactive through cage confinement or unmitigated pain, are disappearing in favor of more enlightened approaches adopted in human rehabilitation decades ago. Veterinarians now look for more than just a good surgical outcome, seeking earlier return of neuromuscular control and function through active engagement of both the patient and client. Rehabilitation procedures typically practiced on dogs include underwater or land-based treadmill exercise, passive range of motion and stretching movements, electrical stimulation, therapeutic ultrasound, proprioceptive training techniques, massage or other manual therapy maneuvers, swimming and more, depending on the inclinations and training of available therapists. What Studies Show Although evidence is emerging in both human and veterinary physical therapy, human physical therapists and canine rehabilitators alike readily acknowledge the dearth of high-quality, randomized, controlled and sufficiently powered trials, individually evaluating each component of a multifaceted rehab protocol. Such studies would lend insight into the relative value of each modality and provide answers to persistent questions concerning rehabilitation. For example, some studies …
The Epulis: What’s In A Name?January 25, 2012 Practitioners and technicians in general practice are on the front line of diagnosis. Early detection of oral tumors improves outcome. Gingival masses may result from neoplastic, hyperplastic, inflammatory or infectious causes. Any mass arising from the gingiva may be correctly referred to as an “epulis” (plural is “epulides”). However, the term “epulis” has been adapted in veterinary nomenclature to describe specific gingival tumors arising from periodontal ligament cells, including acanthomatous, fibromatous and ossifying epulides. In recent years, the nomenclature for these odontogenic tumors has changed. Fibromatous and ossifying epulides are now often referred to under the same heading of “peripheral odontogenic fibromas.” Based on histological appearance, acanthomatous epulis is now referred to as “canine acanthomatous ameloblastoma.” This article describes a clinically rational approach to gingival masses noted during conscious oral examination. 1. Start with a thorough oral examination On conscious oral examination, look for clues of whether the gingival mass is neoplastic, hyperplastic, benign or malignant. Is it well-circumscribed? Is there evidence of mobile or displaced teeth in the area? Mobile teeth are more commonly seen with malignant neoplasms due to aggressive root resorption, whereas benign neoplasms cause slow movement of teeth …
How To Test, Interpret Thyroid FunctionJanuary 16, 2012 Hypothyroidism is the most common endocrine disorder of dogs. More than 80 percent of cases result from autoimmune thyroiditis, the heritable autoimmune disease that progressively destroys the thyroid gland. Classical clinical signs of hypothyroidism only appear once more than 70 percent of the gland is destroyed. Accurate diagnosis may be difficult because thyroid dysfunction produces a wide range of clinical signs, many of which are subtle and mimic those of other causes. Hyperthyroidism is a common endocrine disorder of older cats. Diagnosis can be confounded by concurrent kidney, gastrointestinal and liver disease, as total T4 concentration can be suppressed into the normal reference range. To facilitate diagnosis of thyroid disorders, veterinarians need to routinely employ more complete thyroid profiles, and there is a need to balance affordability with accuracy. Testing Overview Total T4: Measures bound (> 99 percent) and unbound (< 1 percent) circulating T4. While T4 is the most widely used initial screening test for thyroid disorders, relying on this test alone is a primary reason for the misdiagnosis of canine and feline thyroid disorders. T4 concentration is affected by non-thyroidal illness (NTI) and certain medications (e.g. phenobarbital, corticosteroids and sulfonamides), …
One Clinician’s Experience With A New Treatment For Feline StomatitisJanuary 16, 2012 Feline stomatitis, the most painful oral disease in the feline, has many faces and names. It is the most misunderstood, frustrating and refractive of all feline oral conditions seen by the general practitioner as well as the oral specialist. It has been studied in detail by many researchers over the last 20 years and its etiology is still unknown. FS has been called lymphocytic plasmacytic stomatitis, gingivostomatitis, immune mediated feline refractory stomatitis and feline generalized oral inflammatory disease. The histopathology of oral biopsies in these cats evidences a predominance of plasma cells, lymphocytes and neutrophils. A polyclonal gammo-pathy is commonly noted. Pathology Noted The name is not as significant as the pain this disease causes. FS produces a chronic non-responsive generalized oral pain affecting the gingiva, mucosa, palate, lingual and sublingual area, the glosso-pharyngeal arches, the commissures and entire pharynx. Depending on the feline, all mentioned or site-specific pathology centers can be identified. Treatments Lacking The inflammation is progressive. There is no successful medical treatment. The inflammation can be hidden with glucocorticoids, immunosuppressants, herbs, gold salts, antibiotics, analgesics, vitamins, probiotics, local topical anesthetics, salicylate therapy, and multiple anti-inflammatory protocols. None is effective in the long term. …
