VETBLOG

Bacterial or infective endocarditis in a Pointer (endocardite infectieuse chez un Pointer)

2011-11-21T23:25:00.005-05:00

A relatively rare diagnosis in veterinary medicine is one of infective or bacterial endocarditis. This occurs when bacteria enter the blood from either a wound or other focus of infection and attach to the inside of the heart, often on a valve. This causes lesions called "vegetations" as they appear to be plant- or moss-like growths made up of a colony of bacteria. Bacteria in the blood are more susceptible to "sticking" to a damaged or leaky valve.
My case involved a 7 year-old male, intact (not neutered) male Pointer. Now "Max" is not your typical family pet. Oh no, Max is truly his owner's sidekick. Max is a working dog, spending most of his time outdoors with his old-fashioned, old school, European, owner. They both spend time exercising outdoors, in the woods, especially during winter hunting season. The septuagenerian brought his dog in to see me when the dog starting slowing down and essentially stopped eating: two things this pet owner had never experienced with his uber-fit canine.
Examination findings included a fever, a 7% drop in weight over one to two months, lethargy, and a grade 4 heart murmur that I had not heard on previous examinations. His prostate was normal (this is important to note as a common cause for fever in an older intact male dog is prostatitis). The (acquired) heart murmur and fever were highly suspicious for endocarditis. Bloodwork on this dog showed a very high white blood cell count of about 37 thousand, and many young neutrophils, called band cells or bands, were seen on his blood smear (called a left shift). A left shift occurs when the bone marrow releases young white blood cells in an effort to stave off an infection. A cardiac ultrasound, called an echocardiogram, showed moderate mitral valve insufficiency and some "clubbing" of one of the mitral valves. These sonographic findings support the diagnosis of, but are not specific for, bacterial endocarditis.
Blood was collected in a special blood culture medium and sent to the lab for microbiology and a culture and sensitivity. This was an effort to isolate the offending bacteria in the blood, which, if positive, would allow me to choose the most appropriate antibiotic for his treatment. These results would take a little less than a week to return. Pending these results, I started the dog on a few injectable antibiotics and iv fluids. The following morning, his fever was gone, he had started eating, and his owner reported the dog pulling him on his leash, as was normal for this dog! The blood culture grew E. coli, a common bacterium, which was sensitive to all antibiotics on the antibiogram. This positive blood culture had been the real clincher in the diagnosis. It's not often we have to do blood cultures but it makes for an interesting case.
Max is now receiving medication for his heart and a two-month course of antibiotics. He continues to improve day after day and his owner (and I) couldn't be happier.
What's interesting in this case is that the owner reported that about one month prior to Max's illness, he had suffered a laceration or rash on his skin (likely from running in the bush). This just might have been the source of the dog's bacterial endocarditis.

Vegetative bacterial lesions on the inside of a cow's heart. Gross.

Park worm

2011-10-15T17:56:00.005-04:00

Park worm is a parasitic disease caused by Spirocerca lupi. Having learned about this parasite in vet school over a decade ago, I have not heard about it until just recently, when I was in Israel for three weeks. Pet owners had their dogs on park worm prevention, not heartworm prevention (though heartworm exists in Israel, park worm is much more common/endemic).
Not many of us have to worry about this parasite as it is found mainly in very warm countries. Park worm, or Spirocerca lupi, is a worm that is transmitted to dogs and cats (wild dogs and cats included) when these animals eat a (dung) beetle. The beetles carry the larval stages of this worm, which mature after the dog or cat eats the beetle. After migrating from the stomach to the esophagus in some convoluted way, a wall of tissue granuloma forms around the worm, causing a nodule to form in the esophagus. Yes, totally gross (yet interesting: how does such a thing even evolve??). Affected animals show symptoms from weight loss, to fever, to vomiting, to regurgitation. In some cases, the granuloma is transformed into a malignant tumor, a process that is poorly understood by researchers. This is no benign disease!
In areas where the disease exists, dogs are on park worm prevention.

Endoscopic view of the esophagus of a dog with four granulomas (#1 looks like a tumor), each one containing a Spirocerca lupi worm.

Can you believe that Spirocerca lupi can cause swollen limbs, called hypertrophic osteopathy? In fact many diseases in the thorax/chest can cause this syndrome (like heartworm, park worm, and cancer, to name a few).

Herpes in cats...

2011-08-03T22:07:00.005-04:00

is not a sexually transmitted disease. In cats (even wild cats), feline herpesvirus type 1 is one causative agent of feline upper respiratory infection complex. It causes rhinotracheitis (infection/inflammation in the nasal cavities and upper airway). The virus can also infect various structures of the eye, in some cases causing severe and debilitating disease. It can also cause severe skin lesions and complicate pregnancy by affecting the reproductive tract. It is assumed that the prevalence of the virus in the feline population is quite high, but not all cats have the virus. Many are asymptomatic carriers, showing no signs of respiratory or ocular problems. Feline herpesvirus infection is highly contagious, making individuals in catteries, kennels, pet shops, and other high cat-concentrated areas, highly susceptible to the virus. Kittens and unvaccinated cats are highly susceptible to acquiring clinical symptoms, sometimes severe. I personally had one feline patient under my care die of a severe upper respiratory infection, presumably from herpes, but this was not confirmed with testing.
Veterinarians often see cats for sneezing, many having just been acquired from a shelter or store. Most, if not nearly all, of these cats have herpes. Other viruses and various bacteria also cause upper respiratory infections in cats. Antibiotics are not indicated in most cases, despite their use. Secondary bacterial infections can accompany a viral infection, often manifested by a purulent (presence of pus) nasal and/or ocular discharge. These should be treated with antibiotics. L-lysine, an amino acid, has been advocated for the treatment of herpesvirus in cats. Humans with cold sores often take L-lysine, which decreases the severity and duration of the cold sore. In cats with herpes, this may also hold true, though some researchers are questioning its use. More recently, topical (for eyes) and oral anti-viral agents are being advocated to treat herpesvirus in cats. Remember, in humans and cats, the herpesvirus sits latent in specific parts of the nerves, "coming out" and causing symptoms during times of stress, immunosuppression, when on steroids, etc. Like with shingles, cats with clinical signs of herpes often benefit enormously from anti-viral agents such as famciclovir or ganciclovir. Testing is often unnecessary, however I have recently been running more and more feline upper respiratory panels in cats, which I personally have found helps me treat these cats more specifically, as well as more effectively.

I don't think this photo was photoshopped (photo from iknow2.net).

"It's okay..."

2011-05-06T16:52:00.004-04:00

"It's okay" is a phrase I hear all the time in the waiting and consultation rooms. It is a phrase that should never, ever, be uttered to a dog. Our reaction to our dogs' fears and anxieties, however, is entirely understandable. We immediately want to extricate the fear reaction by telling our dogs that "everything is okay." But it's not. You are simply rewarding a dog for negative or unwanted behaviour, invariably telling the dog that it's okay to be fearful of loud noises, to be fearful at the vet, fearful of a stranger, to growl or bite the vet, to walk across the street, to bite the hand that feeds him. You are reinforcing a negative behaviour.
I tell clients that it's entirely natural to say "it's okay," as we are the dogs' caregivers, we love our pets. It's natural, but it's not okay.
Redirecting a fearful response is far healthier for the pet and will stick long-term. You can do this by using the dog's favourite treat (literally: something the dog loves to snack on). When your dog is exhibiting fear or anxiety and you find yourself starting to utter "it's okay," bite your tongue (often literally), and have the dog perform a simple command like "sit" or "stay" or "heel" and reward them immediately for having completed the task. This redirects the behaviour away from a fearful one and rewards the dog, rendering the entire experience a positive and beneficial one.

This is never okay!

Too many pet foods, too little time...

2011-04-19T18:54:00.006-04:00

Where to begin? All commercially-available pet foods have one thing in common: their manufacturers want you to feed their food to your pet. Quality, like any product on the market, is highly variable. You can probably buy a 60-pound bag of questionable-quality dog food for $30, but I wouldn't go for the cheapest. Conversely, I don't subscribe to the notion that pet foods require "human-grade," "holistic," or "organic" ingredients. Pets are not humans - these are highly effective marketing ploys. Don't fall for them (THE SAME MARKETING IS USED ON US TO BUY OUR FOOD!) That said, many moderately-priced pet foods are indeed high-quality pet foods (because of their ingredients and not for what's written on the bag).
MYTH: By-products are unhealthy for pets.
TRUTH: There is nothing inherently wrong with the use of animal by-products in pet foods. Quite the contrary in fact. Many humans eat animal by-products: sweetbreads, tongue, liver, kidney,... pretty gross to many of us but not necessarily any less healthy (or less morally acceptable) than eating the muscle (steak, pork chop, chicken breast) of any slaughtered animal. That a pet food contains by products doesn't and shouldn't imply that it was made with ground up leather shoes and raccoons.
MYTH: Wheat and corn are bad for pets.
TRUTH: Wheat and especially corn are great sources of energy for both dogs and cats. Some dogs, especially those fit canine athletes out there, require huge amounts of energy for their level of activity. Cats are a totally different story. Because they are obligate carnivores, their level of carbs should be kept to a minimum, ideally less than 6 per cent. Kibble will have a higher percentage of carbs and many cats will have no problem eating these. Carbs are required to make gravy so I advise cat owners not to feed their cats canned foods containing gravy.
While cats and dogs can become allergic to wheat and corn, there is nothing inherently allergenic in wheat and corn. Not any more than chicken, beef, potato, or other protein and carbohydrate sources. Just because you have celiac disease (wheat/gluten allergy), doesn't mean your pet has it or will develop it.
MYTH: Food made with lamb is hypoallergenic.
FALSE: Before lamb became ubiquitous in pet foods, lamb was hypoallergenic. Not anymore. A dog or cat can become sensitized to virtually any ingredient in their diet and develop a food allergy. A true hypoallergenic diet contains ingredients that the pet has never swallowed in its lifetime. That could be pork, catfish, sweet potato, barley, oatmeal, ostrich, horse, kangaroo, and rutabaga (list not complete).
Diet should be tailored to the individual, just like in humans. A 4 yr-old, Jack Russell terrier, that is active, with an excellent body condition (not fat), with an iron constitution may thrive on a plethora of pet foods out there. A 10 yr-old, obese, severely arthritic, Labrador Retriever, with a sensitive stomach, would get something different: she'd benefit from a low-calorie, high-fiber, easily digestible, combination of high-quality kibble and/or canned food(quantity measured to the last calorie).
Have your vet help you choose the diet that is best suited for your pet. By the way, calorie-counting works!
Lots to write about so stay tuned for more on pet foods...

Food allergies

2011-02-05T18:45:00.007-05:00

I've blogged many times on allergies in dogs and cats. The two main categories of allergies in companion animals are atopy (environmental allergies) and adverse food reactions (food allergies).
Symptoms of both can be very similar, which include chronic otitis (ear infections), itchiness of the ears, face, paws, belly, etc., non-itchy or itchy infections along the entire dorsal neck and back and other dermatological manifestations. Most (but not all) pets with food allergies are ITCHY.
Some (but not all) dogs and cats with a food allergy, will have gastro-intestinal symptoms such as vomiting, diarrhea, and flatulence.
In dogs, the ingredients most commonly responsible for food allergies include chicken, beef, dairy, lamb, eggs, wheat, less often corn and soy. In cats, fish, beef, and dairy are big ones.
What is so important to understand is that any food can eventually become an allergen in any pet, it just takes time to develop an immune response to the offending food.
Pets that present with allergy symptoms at either a very young age or a very old age are more likely to have a food allergy than an environmental one (though this is not set in stone).
Some laboratories run diagnostic tests that look for specific antibodies (called IgEs) against different antigens found in food, however dermatologists have taught us that these tests are far from accurate. These serum IgE blood tests are far more accurate against environmental allergens (like dust mites, grasses, trees, etc). The only way to find out if your pet has a food allergy is to try a limited-antigen diet, or a novel diet (containing ingredients that the pet has NEVER before consumed in its lifetime) for a total of 10-12 weeks, with no cheating! Do not choose these foods on your own, but rather have your vet help you choose. In my experience, pet owners often have the right idea by changing foods, but invariably never choose the appropriate ones to rule out food allergies.
And don't run for organic-shmorganic foods. A cat allergic to beef will also be allergic to beef in a bag of food that costs a thousand bucks!
If you suspect food allergies in your pet, talk to your vet about it.

A cat with a food allergy. Photo taken from: www.leicesterskinvet.com

Dressing dogs up... take 2

2011-01-18T10:57:00.003-05:00

I've posted in the past about how much I dislike (nay, detest) the current trend of dressing our dogs up. Cesar Millan would have a cow if he saw a Rhodesian Ridgeback in a trendy famous-label sweatsuit. Cesar Millan, however, lives in Los Angeles, not a cold, Canadian city where winter gusts of -20 Celsius are commonplace. While there are 400 plus breeds of Canis lupus familiaris, the variation in breeds is astounding. A Jack Russell Terrier, weighing about 20-30 pounds, is a far cry from a 140 pound Alaskan Malamute. Take a look at both of 'em. Which one needs the coat? Over generations and generations, the former lost its size, its coat, its ability to live in a freezing climate. The latter is literally at home surrounded by ice and snow. Smaller animals also have a GREATER surface area to volume ratio. This is important because they lose heat faster when it's cold outside (and conversely heat up quicker when it is hot outside). So, when required, these dogs should be wearing a sweater, boots, sweatsuits, or whatever is needed to prevent them from freezing.
There is no specific temperature at which I would say, "You must cover up your dogs." We all know our pets very well. Have common sense, know how to recognize the earliest signals of frost-bite or hypothermia (head shaking, shivering, limping, lifting up a paw, etc), and if it's that cold outside, take your dog for a 5-minute pee/poop, followed by hot tea and cuddling with your pooch back in your warm house.

Believe it or not, I think this is totally acceptable (but only in the winter!).

Pica

2010-11-19T20:19:00.005-05:00

Pica is a medical condition veterinarians sometimes encounter in practice. Pica comes from the latin word for magpie, a bird with a reputation for eating almost anything. Pica is considered a symptom of disease (like vomiting or fever, for example), not a disease per se. Pica can be exhibited by dogs and cats suffering from a plethora of medical conditions, from gastrointestinal parasites, to anemia, to liver disease, to cancer. While most humans who exhibit pica have serious mental illness (OCD, schizophrenia, etc), dog and cats almost invariably have a physical condition, often a lack of a dietary requirement or nutrient of some kind, or any disease that results in a loss of nutrients from the body. Anemia (absolute decrease in red blood cells and hemoglobin) is a very common cause of pica. Anemia, like pica, is not a disease but a reflection of disease. Many, many diseases result in anemia: gastrointestinal parasites (especially hookworm infestations), iron-deficiency, auto-immune diseases, blood parasites, hemorrhage of any kind (especially GI ulceration), and cancer. All of these conditions, and others, can result in pica.
Patients with liver shunts (essentially, blood from the intestine doesn't go to liver but bypasses it) sometimes exhibit pica. In a nutshell, the animal is trying to make up for what cannot be produced by the liver, since the liver is not receiving nutrients from the gut.
One very recent case I saw involved a cat with true red blood cell aplasia, a rare auto-immune disorder where the immune system destroys the red blood cell precursors in the bone marrow. This cat swallowed a few shoe laces and elastic bands - you really had to see it to believe it. The objects in the poor cat's stomach were the least of his problems.
Now, can magpies suffer from pica?

X-ray from a mentally ill man with pica. The large white area on the radiograph is a collection of hundreds of coins, needles and other objects not typically eaten by healthy men. The whole story here.

A vet's job

2010-10-11T23:36:00.002-04:00

While a vet's job is dedicated to treating disease, it not always possible to do so. We have taken oaths to alleviate the suffering of animals. This is why it is incumbent upon veterinarians to help owners make a decision to euthanize their pet. Nay, to recommend that a pet be put to sleep.
If a dog has cancer, for example, it would be my recommendation to find out what that tumor is, where it is, the possibility of surgical resection, the repercussions of surgery, the chances of recurrence, and the presence of metastasis (spread).
If I find out that a tumor has littered the poor pet's body with metastases, it would not be my recommendation to send that dog for surgery or chemo. Call me old-fashioned. The pet's, and let's not forget, the owner's suffering following the diagnosis would far likely be greater than the quality and quantity of life that that pet would have in the weeks afterward (if surgery, chemo, etc, were done). Of course the patient's well-being comes first, but does the owner's well-being and suffering not count, too?
My views in this matter are not set in stone. Pet owners must be given their options - these decisions are ultimately up to them. Veterinary oncology has come a very long way and, very importantly, pets do not typically suffer through chemo in the same way that human patients do.
That said, part of my job is helping pet owners through these very trying times. I was issued the degree, I have a strong opinion on the matter, and I feel it is incumbent on me to help pet owners make the best decision. Very often, and especially in the aforementioned case, the best decision is saying goodbye.

Fat pets

2010-10-04T23:09:00.003-04:00

We are aware of the negative health consequences in humans, so why is it ok for our pets to be overweight? That's correct: it's not.
We don't see overweight animals in the wild, only in captivity (our captivity). A fat cat or dog would be lunch to predators in the wild.
I impart a huge amount of importance to weight loss in obese pets. Pets that are overweight have a much higher incidence of diabetes mellitus, cardio-pulmonary disease, arthritis (at least clinically affected with arthritis), and even skin issues (fat pets can't groom themselves properly).
Based on ideal weight, vets can calculate (or simpler: find a table in a book) a pet's daily energy requirements.
For example, a dog's RESTING ENERGY REQUIREMENTS (RER, the energy expended while the dog is at rest) is calculated in this manner: (30 mutiplied by body weight in kilograms) + 70.
This would equal the RER in kilocalories (kcal) per day.
A few examples: If your dog should lose weight, the RER is multiplied by 0.8-1.
A neutered dog would consume 1.6 times RER.
A working dog should consume 2-5 times RER, depending of course, on the type of work (a dog sitting at a computer desk all day doesn't require that many calories).
Talk to your vet about counting calories for your pet.

Over 50% of the pet population is consider overweight, a large percentage of those obese.

More on allergies in dogs and cats

2010-09-14T18:13:00.003-04:00

So sorry folks for not posting in a while. Was in Paris three weeks ago, and climbing in a beautiful provincial park last week - almost froze (see above).
Here in Toronto, Ontario, and the surroundings, dogs and cats have literally erupted with seasonal allergy symptoms over the last few weeks, while many others started scratching in the spring or summer. Some are mild but most are quite severe. These dogs and cats are being presented with severe itchiness involving the face, the ears, and most frequently the paws. Itchiness can essentially involve any part the pet's body. Neuroses (obsessive compulsive disorders) very rarely cause these symptoms. It is likely your dog is not neurotic but rather allergic if he/she is experiencing these signs. So be on the lookout for ANY itching involving ANY part of the body, especially the ears, paws, and face. Allergic dogs and cats must receive antihistamines (or immunosuppressants or steroids if the former don't work) to relieve these often-suffering dogs and cats.

Horner's syndrome, revisited, again

2010-08-13T10:27:00.006-04:00

By far, this topic has received the most attention and comments on this blog. Many, if not most, cases of Horner's syndrome are idiopathic, meaning that no discernible causes can be found. Again, Horner's syndrome is not a disease per se, but rather a constellation of clinical signs that make up the syndrome: ptosis (or drooping eyelid), enophthalmos (or sinking in of the eyeball), miosis (constricted pupil), and prolapsed nictitans (presence of 3rd eyelid covering the eyeball more than usual).
When this young Cocker Spaniel was presented to me yesterday for an eye infection, she exhibited all signs of Horner's mentioned above. By default, because she's a Cocker Spaniel, I had a good look deep into her ear canal and lo and behold she had pretty convincing evidence of an ear infection, a ruptured ear drum, and likely a middle ear infection. X-rays of her middle ears were iffy, as they often are (CT is better for these little structures). We sedated her, flushed her ears with saline, cultured the "gunk", and sent her home on topical and oral antibiotics, and analgesics.
In this case, otitis media (an infection of the middle ear) is the likely culprit causing Horner's syndrome.

Not the Cocker Spaniel in question! The affected eye is evident.

"Holistic"

2010-07-14T22:19:00.004-04:00

Merriam-Webster describes "holistic" as the following: relating to or concerned with wholes or with complete systems rather than with the analysis of, treatment of, or dissection into parts; holistic medicine attempts to treat both the mind and the body; holistic ecology views humans and the environment as a single system.
Many pet-food companies have jumped, nay, leapt, on the "holistic" band-wagon, and pet owners cannot get enough of them. Based on my experience, most pet owners do not have a good (or any) understanding of what "holistic" is. That their pets are eating some sort of "holistic" diet is the only thing that many pet owners care about, but don't really understand why.
Example: if I am using an holistic approach to treating osteoarthritis, I would be giving NSAIDS for pain and inflammation, Cartrophen injections to maintain healthy cartilage and joint fluid, omega fatty acids as an adjunct to anti-inflammatories, weight loss to reduce strain and stress on joints, exercise and physical rehabilitation to prevent muscle atrophy and strengthen bones, muscles, ligaments, tendons, etc, and possibly tramadol or gabapentin for pain or concurrent neuropathic pain. This is an holistic approach to treating osteoarthritis. The use of the word holistic to describe pet foods irks me, as much as the word "organic" and "natural." Rocks, twigs, and chicken bones are all "natural," but I don't want your pet eating these things, savvy? Organic foods are those limiting or excluding synthetic ingredients. I will sooner recommend a non-organic food that has undergone studies in animals before recommending an organic pet food having undergone none.
In all fairness, many of these holistic foods seem perfectly balanced, are recognized by the Association of American Plant Food Conrol Officials (AAPFCO), and whose quality of ingredients make me wonder why human beings are not eating half as well as our pets and livestock.
Ultimately, we should be reading pet food labels as if we're eating these foods ourselves. Be curious, ask questions, confirm mysterious ingredients with your veterinarian and don't buy into the hype of "holistic" or "organic" foods unless the proof is in the pudding, or rather in the pet food.

and

both genuinely organic... but don't feed to your pets.

Familiar species?

2010-06-16T09:57:00.008-04:00

This lateral radiograph is of my chest. It's a lateral view that was rotated to look like I'm a quadriped. It is eerily similar to those lateral views of cats and dogs, which vets see virtually every day. But these are mine.
Chest x-rays were taken a few days ago at the ER, as I've been quite ill. I don't have pneumonia, just a severe, viral bronchitis and sinusitis, that is now more irritating than it is painful.
I was actually panick-stricken that I would see a nodule on the chest rads, or pneumonia, both easily identifiable for someone with basic skills in reading films. Neither I nor the physicians saw anything abnormal. How these chest rads rendered me mortal! How I realized that the course of my life would have been altered had even just a small blip been seen on these chest x-rays!
What these x-rays have done is smartly knocked me down a peg. Not only that, but raised the bar on those pets whom I treat every day.

This is another view taken of my chest. How could the physicians have missed this? Click on image to enlarge it.

Ringworm in a shelter

2010-06-07T19:47:00.009-04:00

While the dust has already settled somewhat on this matter, I would like to dig it up and comment on it. In early May last month, an Ontario SPCA shelter, north of Toronto, had to deal with an outbreak of dermatophytosis, or ringworm, affecting about 350 animals. The original decision to euthanize all animals in the shelter was amended to have many of these animals taken in by local clinics to have them treated (thankfully).
Ringworm is a fungal disease of dogs, cats, and many other mammals, which can be transmitted to humans coming in close contact with infected animals. There are no worms in ringworm, named for a classic round lesion in people with a raised perimeter, giving the appearance of a worm under the skin. No worms in ringworm. The disease is not fatal but can cause severe hair loss and skin disease that can often look horrific. But it's not fatal.
The outbreak was blamed on human error, which lead to the dismissal of a manager there.

Here's my take: ringworm can look like a great number of other skin disease: scabies, a severe bacterial or viral skin infection, allergic skin diseases, endocrine diseases (such as hypothyroid or steroid dermatopathy), paraneoplastic syndromes, etc, etc, etc. In addition, cats and dogs can be asymptomatic carriers of ringworm, posing a risk to other animals and humans handling them. It is my suspicion (though I don't know for certain) that asymptomatic cats and dogs entering the shelter are not tested for ringworm, whose diagnostic tests requiring typically 2-3 weeks. Remember, this is a shelter, filled with rescued animals, not a single animal living the "good life," in some downtown loft. The responsibility of the OSPCA workers is to take in animals and treat them, if possible. There is no guarantee that any animal entering the OSPCA will be successfully treated, especially if it has a disease (even a curable one) requiring a lengthy and impracticable treatment, for a shelter.
While the decision to euthanize many animals sparked outrage and condemnation, in no way should the OSPCA employees be vilified for, or charged with, cruelty to animals. Shelter medicine deals with a population, not the individual animal. As sad as it is to put a dog or cat down because of ringworm, the greater picture dictates that the culling of some animals will allow a more expeditious return to a normal shelter environment, allowing anew the entry and treatment of pets requiring the OSPCA's services.

Classic lesion in a person: not hard to recognize.

Ringworm in a cat: not so classic.

What I have a huge problem with: the nutjobs who staged protests against the OSPCA, dressing their dogs up in black, who brought their children to a mock funeral (abounding with small coffins!) for the animals euthanized. This isn't normal human behaviour.

Meningitis in a dog

2010-05-02T18:20:00.004-04:00

Meningitis is a life-threatening disease involving inflammation of the layers that protect the brain and spinal cord. I treated my first case of meningitis in a nine-month-old chocolate labrador retriever that was presented to me a few days ago (day one) for inappetence and lethargy, that's it. Being a labrador with a history of having eaten six rawhides in the few days preceding the visit, I treated her symptomatically for stomach upset. The following day (day two), her symptoms were much more specific. She had a stiffed gait and would not dare budge her neck or allow me to manipulate her head. Her temperature was normal.
I got on the phone with a nearby board-certified veterinary neurologist and said to her, "I'm pretty sure I have a dog with either meningitis or an acute disc prolapse."
"She probably too young for a disc," she told me, "she has meningitis." After discussing with the owner the likely diagnosis and quote for a referral for a CSF-tap (an important analysis of the fluid surrounding the brain and spinal cord), the owner elected to have me treat the dog and declined the referral due to its high cost. The neurologist gave specific doses for steroids (dexamethasone) and antibiotics should the owner not be able to make the referral.
The dog responded within four hours of treatment, and walked out of the clinic with much more ease than when she was presented to me. She continues to improve.
The dog likely has steroid-responsive meningitis, or auto-immune meningitis, where the body produces antibodies against its own tissues and this produces a massive inflammatory response. It is unknown why this occurs. Antibiotics were used in this case because a CSF-tap was not performed, making bacterial meningitis a possibility as well.
Meningitis can occur because of viruses, bacteria, fungi, and parasites, as well as different types of steroid-responsive meningitides (the plural of meningitis), as discussed above. Pugs get their own type of meningitis, called granulomatous meningo-encephalitis (or GME), for which steroids are used in its treatment. There are other breed-specific types of the disease.

Interesting case, but I'd rather treat an ear infection than meningitis given the much better prognosis with the former.

Collecting cerebrospinal fluid from a dog requires practice and technical skill.

Mourning in dogs

2010-04-12T23:41:00.005-04:00

A wonderful eleven year-old Shih Tzu, owned by a very close family member, was struck recently by a car and killed. She left behind a mourning human couple and a lovely canine companion.
Her owner was reasonably, and rightfully concerned about how the living dog would fare after her companion's death. "I don't know," I replied honestly. "We'll have to see."
After more than three weeks since the accident, the surviving Shih Tzu has shown absolutely not a shred of evidence that she is missing her departed canine companion. It's paradoxically sad to report that she continues to thrive in the other's absence (obviously we don't want her to suffer, we just want or expect her to be "missing" the other dog).
Certainly, this is not the case for every dog who suffers the loss of a companion. According to a study done by the SPCA in the late nineties, nearly seventy percent of dogs manifest symptoms in cases like this: inappetence and lethargy are the most common. Are these dogs reacting to a change in their routine or are they literally depressed? I hate to anthropomorphosize but such prolonged symptoms in a person would be consistent with depression.
Wolves, our beloved pets' ancestors, mourn the loss of other wolves in many ways, such as vocalizing, refusing to eat, and futile searches for the deceased (I tried to find more on mourning in wolves but alas could not, so feel free to chime in, experts).
This post was introduced with direct, anecdotal evidence that not all dogs will mourn the loss of a companion. The status of both dogs must surely be taken into account, given that the surviving dog's status may change after the death of a companion. The consequent behavior of the owner(s) who lost the pet will also affect the behavior of the surviving dog.
I'd love to hear your personal stories.

Used with permission, taken from Beverley and Pack's photostream on Flickr.

Whoa, this is interesting:

2010-04-03T17:45:00.011-04:00

A recent study by Ottawa researchers showed that people who live alone and have a dog do not feel less lonely than those without dogs. This contradicts a long-held myth that our canine companions offer an escape from our solitude. People with dogs and a lack of a good social circle did not feel less lonely than those living similarly and without a canine friend. You can read the entire article HERE but I just had to quote a paragraph from the Montreal Gazette article:

People with limited community connections, for example, were more likely to humanize their dog - and those who engaged in this type of anthropomorphism were more depressed, visited the doctor more often and took more medications. Pychyl [author of the study] suggests this is because people who treat their pets like family will go out of their way to nurture the relationship, often at the expense of their personal lives.

This undermines the notion that lonely or depressed people should have dogs. The greater picture is a need for us to connect with those around us of the same species: Homo sapiens. Anthropomorphic behaviour includes, but not limited to: walking dogs in strollers, calling our pets "little people" or our "children," and yoga for dogs, to name just a few. Anthropomorphic behaviour is dangerous: for the dogs, for the cats in crazy-cat-lady-homes, and for us (including the crazy cat lady). They'll be no political correctness here.

Psychological health and a strong feeling of community must involve, at least in great part, playing this game.

Dogs don't think like us

2010-03-25T21:59:00.006-04:00

Humans think. We rationalize, we remember, we anticipate, we cry, we stress over our past and our future. Dogs and cats are hardwired to respond in the moment. A hungry cat will eat, a stressed-out cat will bite your head off, a territorial dog will bark or bite, a calm and submissive dog will roll onto her back and let you rub her belly.

The reason for this post is simply to ensure we understand that much of what's going on in a pet's head at any moment is fleeting. To illustrate this further: just the other day, a very friendly dog that was delighted to meet me would've taken my arm off while I performed an orthopedic exam on him if it weren't for his muzzle (which his owner insisted I use). Not a nanosecond after removing the muzzle, he devoured a treat and licked my face until I was drenched. His aggressive behaviour towards me was intimately tied with fear... in that moment.

On a similar token, a sick dog or cat will not show behavioral or physical symptoms "out of spite." As smart as we think our pets are, their behavior is much more organic, much more ingrained, and exponentially less conniving than we think. The genes of our pets are constantly firing in massive neon letters, "DO NOT SHOW YOUR ILLNESS TO ANYONE," as they were millenia ago, long before domestication (incidentally, cats are the worst in this regard, rarely showing signs of marked illness until they are deathly ill). If your cat or dog is showing any signs of illness, they are not trying to trick you, annoy you passive aggressively, or trying to be devious with recalcitrant spite. A cat doesn't urinate on your rug from jealousy, and a dog wouldn't hold back his appetite for more attention. They need to see a doctor...

...or this guy.

Addendum: take 2

2010-03-19T00:31:00.005-04:00

See previous two posts for details. The histopathology results came in on the cat on which I performed the necropsy. Shockingly, this cat had a metastatic carcinoma of the intestine. A clot was indeed found, however it was intimately associated with this intestinal tumor. The tumor likely acutely bled, leading to the formation of a clot, which led to the ischemic event (lack of oxygen) that resulted in the hemorrhagic necrosis of the intestine (see photo in previous post). The clot had absolutely nothing to do with heart disease as the heart was normal. An incidental finding was chronic pancreatitis. A specific laboratory test for feline pancreatitis, which was done when the cat was alive, came back normal.
We certainly learned something from this case.

Such cases are almost as rare as this (addendum: I switched the photo from zebras to this - way cuter).

Addendum: I did find out

2010-03-12T09:58:00.003-05:00

The client whose cat died (discussed in the previous post) requested a necropsy (called an autopsy in human medicine) a day after the cat passed, which I performed.
Dr. Vassey, who left a comment below, most likely got it right: the cat likely died from an infarct (thrombus/clot) that acutely became lodged in a blood vessel supplying the intestine. Without normal blood flow, and therefore oxygen, the intestine literally "died."
The cat's entire intestine was grossly hemorrhagic and necrotic, while other abdominal organs were spared this pathology. I found a massive clot in a blood vessel feeding a portion of the intestine, which I submitted for histopathology, along with the cat's heart, portions of liver, lung, and intestine.
Unfortunately, it was grave news for this kitty from the get-go.

While not the cat in question, this is exactly what I found.

Emergency

2010-03-09T17:19:00.002-05:00

A client showed up yesterday morning with her "crashing" six year-old cat. The cat was vocalizing, in severe pain, was markedly hypotensive (low blood pressure), and had pale gums. The elderly owner lives in an apartment, where there was no possibility of having been exposed to toxins, including rat poison, and no toxic plants which the cat could have ingested. She reported that the cat had vomited a few times the day before and that the vomitus contained blood and blood clots.
The cat was evidently in shock. We treated the cat for shock, provided judicious but important pain control for this poor, painful, kitty, and ran a whole slew of tests and x-rays. Nothing, Virtually nothing. The cat didn't have pancreatitis, which was my top differential. The cat passed away peacefully (she was nicely sedated with opiates) last night, which her owner knew was likely.
The owner declined to have a necropsy performed therefore I can only speculate as to the cause of the cat's death.
Obstruction? Intoxication? Intussusception?
I think it was the latter... but I'll never know.
I was not devastated with the outcome, considering the state the cat was in when she presented. Sad, yes, but not disappointed with our efforts.
I wish my condolences to her owner.

This is what I think happened to the poor kitty.

I just had to post this:

2010-03-01T00:21:00.004-05:00

Am I the only one who thinks that

and

are not disimilar?

Early exposure

2010-02-16T18:55:00.003-05:00

It is not uncommon for me to hear from a client, "I haven't taken him out yet." This refers to a puppy that hasn't been outside for the first 3-4 months of its life. It would be like having a newborn and taking her for her first stroll at six months of age.
Dogs need to be exposed to the outdoors, and all of its sounds and sights, at a very early age. In so doing, the risks of poor behavior (behavioral problems being the single greatest reason for which a pet is euthanized), is greatly reduced. Try to do this at 4, 5, 6 months of age, or older - forget about it: you'd be setting the dog up for a life of phobias and anxiety (devastating for both you and your pet).
A typical vaccine schedule for a dog is 8, 12, and 16 weeks. How do you ensure good behavior and protect the dog from infectious disease? The short answer: you don't. The risk of the dog acquiring fatal infectious disease is mitigated by the huge risks of your dog developing behavioral issues if she's not taken out early in life.
Have common sense: expose the puppy safely, to dogs whose owners you know, or are sure are vaccinated and not exhibiting symptoms (such as coughing, diarrhea,... you get the picture).
There is no excuse for the four-month-old puppy who cowers behind his owners upon
meeting another dog for the first time. At that age, it would be like running into this:

Lameness/limping in dogs and cats

2010-02-05T10:53:00.006-05:00

Lameness, or limping, is one reason a pet owner would seek a veterinary consultation. The causes are myriad, though some conditions are certainly over-represented.
A partial or complete tear of the cranial cruciate ligament (CCL), called the anterior cruciate ligament (or ACL) in humans, is one of the commonest clinical conditions seen in dogs with lameness involving a hindlimb.
The cranial cruciate ligament (from the Latin crux, meaning to cross) and the caudal cruciate ligament cross each other in the knee or stifle joint (see image below). Basically, they provide major stability to the joint. In humans, the ACL is often torn acutely from a injury. It is now thought the vast majority of CCL ruptures in dogs occur over time, from chronic instability, arthritis, injuries, or a combination of all of these. Partial tears are extremely common and essentially require the same surgical treatment, though long-term studies looking at orthotics/braces to prevent full CCL rupture in dogs with partial CCL ruptures have not been done (as far as I know).

Lameness in young, large-breed dogs, where the lameness "travels" from leg to leg, can often be attributed to panosteitis, a painful though relatively benign pathology of the bones - these dogs eventually grow out of it, the vast majority by a year of age.
Hip dysplasia, a genetically inherited disease of large breeds, is often diagnosed on the basis of pain attributed to the coxo-femoral joints (or hips), and radiographic evidence of this disease. It is treated surgically in younger dogs with severe disease and is managed with medication, mild-moderate exercise restriction, and rehabilitation in both surgical and non-surgical cases.

It must not be forgotten that neuropathies are often the source of limping in cats and dogs. This means that the cause is neurological, stemming from pathology of the central nervous system such as the spinal cord (e.g., intervertebral disc disease), or a peripheral neuropathy. See below for what a blown disc looks like - ouch.

Interverterbral disc disease is invariably associated with spinal pain, while acute unilateral lameness without spinal pain is commonly attributed to fibrocartilaginous embolism, a syndrome where a tiny fragment believed to be from a disc is caught in the tiny blood vessels of the spinal cord, and often causes severe lameness, though the prognosis of this syndrome in the vast majority of cases is actually very good!

Broken nails, splinters, abrasions, diseases of the nails and nailbeds, joint and muscle disorders, Lyme disease, and other infections, are other causes of lameness in dogs and cats.

Whatever the cause of lameness, in virtually all cases, the vet should be trotting the dog down a hallway or outside to evaluate the dog's gait. With a cat, the vet can omit the trotting.

Dog carts can be used for patients with severe hindlimb disabilities, though not this type of cart. Love, love, this photo.

More on allergies

2010-01-26T15:50:00.005-05:00

I think I passed out nearing the end of writing the last post. While I haven't documented it officially, about 25-40% (addendum: 50-60%) of my appointments are related to allergies. The dog with a chronic or recurrent otitis (ear infection): primary allergies. Chronic or recurrent pyoderma (skin infection): primary allergies. Chronic or recurrent client kvetching: primary allergies.
If symptoms are classic, and the pet responds favourably to antihistamines, a presumptive diagnosis of allergy can be made (though not a complete diagnosis). If a pet doesn't respond to antihistamines, allergic disease cannot be completely ruled out, as some dogs respond poorly, or not at all, to these medications. This often occurs in cases of food allergies and severe cases of atopic dermatitis.
Again, pets can be atopic or have a food allergy (to keep things simple). They can certainly also have both.
In cases of non-seasonal symptoms (itchy throughout the year), a food elimination trial is indicated. There are a few ways to do this. You can cook for your pet. In this case you must choose a novel source of protein and carbohydrate, i.e., something the pet has never consumed before. This could mean rabbit, horse, ostrich, kangaroo, and other things that completely gross me out. The source of carbohydrate is often either rice or potato. If you don't want the hassle of cooking the meat of these beasts, a prescription diet, made of hydrolyzed protein, can be tried for a minimum of 12 weeks. These foods include, but are not limited to, Purina HA, Medical HP, and Hill's z/d Ultra. Dogs with confirmed food allergies will respond to one of these diets in at least 75% of cases.
If the pet continues to itch after 3 months of a STRICT food-elimination trial, the dog or cat may have concurrent atopy or just atopy with no food allergy. Intradermal skin testing or serum allergy testing would be indicated in this case, with the aim to have the pet desensitized based on the results of the aforementioned tests (desensitization is essentially a process of vaccinating the patient, slowly however, with multiple and frequent injections, to slowly build up antibodies against the offending antigens).
If your dog or cat has chronic and/or recurrent skin problems, talk to your vet about allergic skin disease. Just be very patient as the diagnosis may take a while to elucidate, and the response to therapy may also require time and trials. Just keep the communication up with your vet because he/she needs to know what works, and what doesn't!
Remember, not only allergies cause itchy skin in dogs and cats.

They may be hypoallergenic.

Allergies

2010-01-24T23:39:00.005-05:00

I honestly don't remember how many times I've written about allergies in dogs and cats (seriously, I don't know if it's once, twice, or more, but I digress...).
At least a quarter of all patients I see have skin problems, the vast majority of them, allergies.
The white or cream-coloured dog trotting in the park with four stained paws (red-brown colour) elicits an easy spot-diagnosis: allergies.
If your dog or cat is constantly licking or munching on her paws, licking her forearms, scratching her armpits and or groin, shaking her head, scratching her ears, munching or licking her behind, or scratching any part of her outer anatomy, she has allergies.
The problem lies when a careful history is not taken. If you can imagine a pyramid, allergies in the vast majority of these cases figures at the top of it. These allergies cause variable itchiness, which in turn very often cause chronic skin and ear infections.
These infections will disappear with treatment, but unfortunately will invariably recur if the top of the pyramid is unknown. These dogs require antihistamines. Plain and simple. There's a whole gamut of them and often (but not always) one or more will work well.
Dogs and cats can be allergic to inhaled allergens (indoor or outdoor allergens), which will cause seasonal symptoms, while they can also have a food allergy (adverse food reaction), which will cause non-seasonal or year-round symptoms.
They can also have contact allergies (to perfumes, plastic, etc). Dogs and cats can also be allergic to traffic jams (oh, no, wait a minute, that's me).
Bottom line: dogs and cats with allergies have itchy skin, and that could mean anywhere on the body. More to come on allergies.

Dalmatian with a primary allergy and a secondary pyoderma (likely also has a dermal yeast infection but I can't tell from here - need the microscope for that one).

A sad case

2009-12-25T18:29:00.002-05:00

A young, two year-old cat presented to me in severe and acute respiratory distress, severely hypotensive (low blood pressure), and vomiting clear fluid. The cat's gums were extremely pale and his temperature was a freezing 34.5 degree C (94.1 degrees F), indicating that the cat's extremities were very poorly perfused (no/little blood flow). The owner brought the cat in immediately after hearing the cat suddenly screech. There were no toxins to which the cat was exposed.

On examination, the cat's veins were hair-thin, so tiny that it was difficult getting an iv catheter in one of them - but we did. After giving the poor gasping cat a tiny dose of a sedative to calm him down, I administered a shock dose of iv fluids, which was touchy, as chest x-rays indicated that the lungs were full of fluid (could be blood, infection, edema, whatever), but I had to get his blood pressure up.
A presumptive diagnosis of anaphylactic shock or pulmonary embolus was made (the latter very difficult to diagnose in animals and people ante-mortem). I administered oxygen, injections of dexamethasone, epinephrine, famotidine (an antihistamine/H2 blocker for all you meddies out there), and Benadryl). Epinephrine was repeated twice in the next two hours.
Within ten minutes, the cat improved clinically with this treatment. The fluid rate was dropped, an injection of a diuretic was then given to relieve the fluid in the lungs, all the while the cat had watery fluid coming up from his lungs and pouring out from his mouth and nasal cavities.
Soon afterward, the cat turned blue indicating hypoxemia (low blood saturation in oxygen), so we gave him a low dose of milk of amnesia (propofol), intubated the cat, and manually ventilated him for over two hours. Watery fluid continued to pour from his nose. His gums returned to a normal pink with us manually ventilating him, but every time we extubated him to seet how he would do alone, he turned blue - not good.
We continued to intubate and extubate him but he could not ventilate on his own.
I advised the owners that he would need mechanical ventilation but such therapy in the ICU at the referral practice would have cost thousands, which he understandably didn't have. We extubated the cat, his breathing became severely labored so we put him out of his suffering and humanely euthanized him.
One of my technicians broke down crying... we were all so upset. I like to think that our efforts were noble. As vets, though, we always question ourselves: "Was my diagnosis correct?" "Did I do something wrong?" "Could I have saved this kitty?"
Fudge, this case didn't end well... but we tried.

Not the cat in question, but a cat receiving oxygen therapy.

Coming out...

2009-12-16T14:58:00.005-05:00

...as depressed may be more difficult than coming out of the closet. As some of my regular readers may know, I have not posted very recently in many months, since the rupture of a long-term relationship. Since then, I have entered into a "circumstantial" depression, call it what you will...
Right now, I am actually on my way out of it.
My life from the outside is fully functional, I continue to work, and to love work. In fact, in all modesty I don't think I have ever been a more caring and empathetic veterinarian, and have never felt like such a good diagnostician.
A part of me is hiding, though. A significant part of me hides behind a very thick veil of diversions, activities, and (sometimes) feigning of happiness. Another part of me is truly happy, truly functional, truly "me."
My friends and family in whom I can confide have been nothing but supportive, loving, and caring, though there is only so much they can do. It goes without saying that I am also receiving professional help...
I am discovering that my true purpose is not to be someone's better half, though I must confide I don't always buy this. Then what is my true purpose? There must be something, someone, waiting for me, and for whom I am also waiting.
I have decided to "come out" so that perhaps others may realize they are not alone, that we are all human, and that through suffering we can achieve greatness.

Pet foods: where to begin?

2009-10-01T20:20:00.006-04:00

I've wanted to write on the topic of pet food for ages, but I didn't really know where to start. Frankly, there is such a huge variety of pet foods on the market today, it is impossible for me to know each of them in detail.
I am often asked, "What is the best food for my cat/dog/kitten/puppy?" That is the million-dollar question. What is the best food for our pets? Is it kibble? canned? what brands? raw food?
I don't have the scientific answer, sorry everyone. However, I do have some facts to share, which everyone should consider when choosing what to feed their pet.
Dogs are omnivorous, which means their gastro-intestinal tracts have evolved to digest meat and plant material. Wild dogs are mostly carnivorous but will also eat berries and plant material when available, though one study showed the latter did not exceed 1% of the material in their stomachs. Domestic dogs likely branched off from wild dogs about 100,000 years ago, though this date is highly controversial with hypotheses ranging from 12,000 to 140,000 years ago. I suspect it is closer to the latter, though I certainly have no proof of this. My point is that humans and canines co-evolved in symbiosis, with the humans benefiting from having canines as protection, while their canine counterparts adapted by taking scraps from humans, and with time, precluding the need for the group hunt.
We know from canine behaviour that dogs are quite the indiscriminate eaters, and will often eat things they are not supposed to, including non-food items. Therefore, just because a dog will eat a loaf of bread or your favourite pantyhose, does not mean it should be doing so. Domestic dogs are not wild dogs, but their biology is constrained by their relationship to them. This means that things like their eating habits and behaviour (amongst many other things), evolved from the eating habits and behaviour of wild dogs.
I apologize for my loquaciousness, but having said all of this, and with the knowledge that at least 50% of our companion dogs are obese, I think that dog foods should closely approximate those foods eaten by their ancestors: diets high in protein and low in carbohydrate (such as wheat, corn, etc), and balanced in vitamins and minerals (such as calcium and phosphorus). Protein contains less energy than carbohydrate and carbs are diabetogenic, more so than protein. Combine all of this with a strict calorie-counting diet, and our dogs would be in much better shape (i.e., not the shape of a coffee table).

Cats are obligate carnivores, plain and simple. Their diets should approximate the nutritional make-up of, say, the small rodents they eat. Throw a mouse into a blender and voilà: high-quality canned food! I know the comparison is quite macabre, but it's true.
Most diabetic cats fed a diet that is exclusively a high-protein CANNED diet, will have their insulin requirements decreased and often go into remission.
Personally and professionally, I believe that cats should be fed as much (high-quality) canned food as possible.

More on pet foods in the future...

Not funny, folks...

Psychological unhealth... in dogs

2009-09-20T19:18:00.004-04:00

Okay, okay, I'm giving in to the masses! A New Year, a new post...

It took me years as a practicing veterinarian to begin thinking about the psychological well-being of dogs. A healthy person is one who is free of disease: both physical and mental. A human patient suffering from general anxiety disorder, schizophrenia, or even a serious phobia, without cancer or diabetes, is still a sick patient, n'est-ce pas?
Therefore a dog who is hyperactive, untrained, phobic, or suffering from aggression (for example, fear aggression), is not a healthy dog. These conditions need to be recognized (the hardest part), discussed (the second hardest part), and treatment needs to be instituted.
How many vets recognize this? This is why the consultation starts in the waiting room. Veterinarians must recognize these issues immediately. The disservice is to let such patients go without having addressed the (sometimes easily) manifestations of poor doggy mental health. "Ok, he's now vaccinated, bloodwork is normal, no parasites..." Nope, not enough.
I want my patients to trot into the consultation room, be calm (to a realistic extent), sit when they're told to sit, and who obey their owners.
The dog who wants to take my face off will be given a poor bill of health as far as I'm concerned. That said, his prognosis is far from grave.

Depending on the context, this dog may require treatment.

It's been a month...

2009-08-29T12:32:00.003-04:00

... since I've posted. My sincere apologies. I'm afraid I was not being completely honest in my last post. The difficult time I have been going through was much greater than the euthanasia of my cat, Isaac. My seven-year relationship had just ended as well, sending me into a state of shock, confusion, and near-depression. Here I was thrown a massive obstacle, completely out of nowhere, knocking me completely off a course of apparent bliss. Only very recently have I rediscovered my path, or at least a path, on which I have began to walk.

It is only natural, normal, to take these things personally when they occur. My ego was smashed, sent flying into a wall by a gargantuan frying pan. -smack!-

Through thought and meditation, I have come to realize that I am still the same caring and warm person that I was before, and that the behaviour of one person on another does not negate or undermine the importance of another. We all have our paths: some converge and others diverge.

Though I cannot see it now, I suspect that Oz will be at the end of this yellow-brick road.

Stay tuned for less drama and more veterinary-related topics.

My apologies....

2009-07-21T10:37:00.005-04:00

... for not having posted for quite some time. Suffice it to say that I have been going through a very difficult personal period and that it has been extremely difficult to find the strength to do some of the things I enjoy most, like blogging and painting.
I will overcome this. This post is not to garner pity from anyone, but rather to express that, as all of us have experienced at some point, I am trying to overcome an unexpected curve ball that has recently been pitched at me.

This difficult period has been exacerbated by the recent euthanasia of my wonderful cat, Isaac, seen in the photo at the top of this page. I had been treating him for diabetes for about two years, and following a relatively recent additional diagnosis of acromegaly, it was evident his diabetes became uncontrolled. While he was not overtly suffering, his consumption of water had increased significantly and his voracious appetite, while I had previously written about it in my blog somewhat humorously, was really the only thing that was defining this cat. He lived to eat, would rarely leave his empty food bowl, and beg for food like a starving roadside village waif. His urine and stool were foul, reeking the house to a point where guests could not come over unless the house were fully aired out. The decision to euthanize him was based not only on condition, but on our suffering. Callous it may sound, but this is fact. While I could not predict exactly when, I knew that at some point he would start showing overt signs of suffering: he would develop ketoacidosis from uncontrolled diabetes, as well as the likelihood of starting to manifest neurological symptoms like behavioural changes and seizures secondary to acromegaly (caused by a pituitary tumor, which was spilling excessive growth hormone into his bloodstream). I was resolved it was his time, our time.
It was performed by me, peaceably, lovingly, painlessly, while he purred away in his owners' arms, knowing that they loved him as much as a human being can love anything.
Isaac was buried in a quiet corner of the backyard, with a large flagstone covering the earth over his grave, in which his body now lies still, while his spirit is meowing, hunting, and craving pizza somewhere above us.

Isaac, the cat: RIP 1995-2009

The veterinary consultation starts here:

2009-06-26T13:48:00.003-04:00

While veterinary consultations typically involve physical ailments and diseases, normal mental or psychological health is just as important in our canine companions. These things can and should be addressed by the veterinarian as soon as the client is greeted in the waiting or consultation room.
I feel this involves greeting the client and taking a brief period of time taking a history, while virtually ignoring the dog. The vet should deliberate approach the dog, while still ignoring it. This allows the dog to not feel like the focus of attention, reducing its anxiety and allowing it to remain calm. Should the dog cower behind the owner or stand up begging to be picked up, the owner should gently correct the dog and have it sit beside or just in front of him/her. Constant whining or attempts to get the owner's attention should be gently corrected. I feel that these steps are mandatory to ensure a successful and relatively pleasant visit to the veterinarian, and should be applied to every situation in which a pet is stressed or anxiety-laden when going somewhere (groomer, vet, boarding facility, etc.).
Small dogs are over-represented here not because they're "prone" to anxiety or fear, but because their owners think that this is the case. Nothing is further from the truth. In fact, they are easier to correct physically (and I'm not deathly afraid of getting mauled by them), making them great candidates to work on during their visit. Like Cesar Millan, the dog whisperer, I like to "train" the pet owners as well and I find them so wonderfully open to it!
I'll leave it up to professionals to deal with large, aggressive dogs, as I impart much importance to my fingers and other body parts. With these rarely-seen patients, we do the best we can.
Enjoy your next trip to the vet!

Does it get any better than this?!

Long days... and loving it.

2009-06-19T09:34:00.007-04:00

After nearly three weeks at my new full-time position, I continue to look forward to going in to work, to working long days, to a fantastic, talented, and industrious group of employees, to a friendly and down-to-earth clientele, to a plethora of challenging cases, to learning, to sharing my knowledge, and to invest in this position.

Though my hours are long, my schedule allows for plenty of days off during the week, allowing me to enjoy all of my personal activities.

Malassezia (yeast) infections: something extremely common in cats and dogs, especially during allergy season. These little buggers can cause nasty ear infections, and if you look for them properly, can be found anywhere on the skin.
Incidentally, our microscope in the clinic is suberb, but not an electron microscope (as what has taken this image).

Antibiotics do not suppress the immune system

2009-06-07T00:07:00.008-04:00

If somebody asks me one more time, "Aren't antibiotics bad for the immune system?", I'm going to blow a gasket.
As a veterinarian trained in the West, I've been trained to use antibiotics for bacterial infections, not homeopathic remedies, nothing freshly grown and picked from the earth.
I believe I am diligent about the prescription of antibiotics... a pill-pusher I am not, unless of course pills need to be pushed.
If a dog, cat, or human being, has a bacterial infection (pneumonia, for example), the infection itself stimulates the body's immune system (because the bacteria are antigens - unrecognized by the body's immune system), while the stress of the entire infection on the body can eventually weaken the immune system. Immunity does not always deal with an infection by itself, especially with serious infections. Antibiotics, when properly prescribed, will kill bacteria, render them unable to multiply, or make them more susceptible to the body's natural immune defenses. Antibiotics are nothing but synergistic allies with the body's immune system. This doesn't mean that physicians should have carte-blanche when faced with treating infections in patients. Pros and cons need to be heavily weighed so that 1) the patient has the greatest chance of recovering and 2) the greatest care is given so that drug resistance does not occur (too late for many types of infections, unfortunately).
If an overwhelming bacterial infection kills the organism, well then, there's no immune system left now, is there?

Pneumonia-causing bacteria.

When used judiciously, these will deal with those above.

Cats don't normally....

2009-06-03T16:05:00.005-04:00

... consume much carbohydrate. Felis catus, like the larger Felidae, are strict carnivores. The only carbs the large cats consume come from the gut contents of their prey (herbivores). Felines typically don't eat bread, grains, seeds, pasta, rice, couscous... you get the point. Not to say that they won't eat these things, right? Cats, though much more discriminate than dogs, also enjoy food!
So I came home to find my cat chowing down on a zucchini-carrot muffin, which he stole from the bottom of my gym bag. Especially for a diabetic cat, muffins are really not the way to go!
He's voracious all right.

Things he'd eat in a second. How 'bout your cat?

Air France crash

2009-06-03T09:34:00.003-04:00

Apparently, a member of a royal Brazilian family, a dancer from the famed "Riverdance" group, and a couple of CEOs from some big company, were amongst the 228 killed in the Air France crash.
Everyone on that plane was someone's "royal," someone's dancer, someone's boss or employee, someone's love.
They were all human and every death caused as much devastation to a family as the next. Who cares what the ---- they did for a living or how popular they were in society... all mattered equally to somebody.
My thoughts are with the grieving families.

Humane Society Woes

2009-06-02T13:54:00.007-04:00

Many years ago, soon after I moved to Toronto, I visited the Toronto Humane Society. I told them that I recently graduated as a vet, and management took me on a personal tour of the facilities, which had impressed me greatly at the time. Granted, there were exponentially less cats there at that time than today, but the wards were spotless, the dogs appeared clean and friendly, their runs were well-kept, and the cats lazily purred away while their owners-to-be agonized over which ones to choose. Upon questioning the manager about the THS's long and altruistic history, she reached for her bookcase and provided me with a copy of the THS Calendar, published in 1887, explaining and beautifully illustrating the Society's raison d'être.
Now we read in the Globe and Mail about the Globe's investigation into allegations that the THS has been ignoring the pleas of employees and volunteers to provide them with the necessary means to prevent suffering of their animals.
There appears to be compelling evidence thus far, even after reading just two articles on the subject. Witnesses seem to be coming out of the woodwork to expose their rather shocking personal experiences, while citations from THS management reminded me of the wind gushing from the mouths of yet unelected politicians (or managers who don't know what the ---- is going on in their businesses or institutions). I would have lent far less credence to the nauseatingly lefty writings of the Toronto Star (see last week's coverage regarding dog getting shot by cop - of course let's blame the man) - glad to be reading about this in the Globe.
Whatever occurs, the reputation of the THS must be restored so that its modus operandi not be eschewed for petty politics. Its mandate: to help alleviate the pain and suffering of (people and) animals.

Detail from an image in a previous post, from the Calendar of the Toronto Humane Society, 1887.
Update: OSPCA executes search warrants at Toronto Humane Society. Read here.

Cute AND tasty?

2009-05-27T12:28:00.005-04:00

I could almost hear the collective "awwwwwwwww..." after the country learned of the piglet that wiggled its way from the confines of a transport truck onto the shiny asphalt of North America's busiest freeway, the 401, to then be saved by a good Samaritan who brought the pretty porcine to the THS. The piglet was examined by veterinarians there and will be treated for a broken leg.

Though admittedly adorable, I cannot but think of the piglet's fate, had it not fallen from the truck: it would have arrived at a pig farm, to grow and be fattened up over a few months or more, to then be slaughtered and used for our consumption, the beings so willing to wolf down menu items of pork chops, bacon, and pancetta, and yet with hearts so warm as to rescue this pre-fab menu item in order to alleviate its suffering. This story should be both heart-warming and also a reminder of the thousands, no, millions of adorable piglets and pigs being led to slaughter at this very moment.
Is this blatant hypocrisy or rather a more innocent manifestation of our contemporary human condition?

Humans eat pork products willingly. Our hearts also warm when seeing images such as this.

Carrying your dog around

2009-05-18T23:48:00.004-04:00

I've blogged about this before: how inappropriate it is to conduct your day with your dog in a purse or other semi-capacious item not normally used to tote living things.
How it has come to incense me so, I do not know, but that I feel sorry for the dogs is clear.
Humans had it right millenia ago. Their behavior towards humans has changed little since then, while ours towards them has inexorably led to the very many doggie behavioral issues that need to be eschewed from the development of our intimate human-canine relationships.
I will continue to bring this topic up, as I would like to drill it into the minds of as many people as possible, in an effort for all of us to achieve the healthiest human-canine bond possible.
It's work, but well worth it!

The skull of what may be the earliest known dog, which dates to 31,700 years ago. The prehistoric skull was excavated at Goyet Cave in Belgium ( photo: Mietje Germonpre).

Human rights

2009-05-17T15:32:00.004-04:00

Unrelated to veterinary issues, I am ashamed by the most heinous violations committed by Russia against the gay community during a pride rally in Moscow. Activists were arrested during this peaceful rally, hours before the all-inclusive Eurovision finals were to take place (which was won in 1998 by Dana International, an Israeli transsexual). As GPOC writes on his blog: an attack on the liberties of one group is an attack against us all. Where are Toronto's lefty protests now? We must all decry Russia's devolution to barbarism.

It's 2009 and this is still occurring on this planet.

Training Tips

2009-05-12T22:08:00.004-04:00

I knew Twitter was good for something: I would never have found this page with 12 excellent tips (I think they're essentially mandatory) every dog owner should follow.
Click here for an obedient dog.

Lookee the photo I found online.

Twitter

2009-05-10T15:08:00.003-04:00

I joined Twitter yesterday in order to boost readership of this blog. I have many great followers and readers (for which I am grateful), but I would love to reach out to more people out there in the blogosphere. Is it egotistical to want this? To want thousands and thousands of people following what I have to say? My training as a vet has helped bring me to this: a practitioner, a blogger... someone who is opinionated and isn't afraid to share it.
By joining this ultra-popular networking site, I, too, have been introduced to some spectacularly interesting blogs - there are some darn incredible writers out there!
My quirkiness notwithstanding, there are important things to bring to the forefront and I hope that this blog, my writing, my opinions, will evolve towards something more important, more intelligent, and of course, remain relevant to all of us.

Tweet.

Spring is here!

2009-05-04T16:14:00.007-04:00

Spring is a time when many people take their pets to the vet for their yearly check-up. The snow has melted - in areas that receive snow - and pets become exposed to different things, like plants, dirt, baseball fields (and therefore baseballs), fossils, fault lines, fleas, ticks, and trolls (where they're indigenous).

Ok, jokes aside: dogs (and cats - cats are more complicated with respect to heartworm disease) require heartworm testing, monthly flea, tick and heartworm prevention, and possibly vaccines/boosters.
You should always your vet which vaccines are being administered to your pet and why. Ensure that a rabies vaccine is not given more frequently than what is labeled by the company (i.e., 1 year vs 3 years for rabies) or less frequently than required by law (which often correlates with manufacturer's recommendations. "Core" vaccines, like distemper and parvovirus (for dogs) and panleukopenia and rhinotracheitis (for cats) have been shown to provide immunity for at least several years, if not lifelong immunity. That's right: lifelong protection. I am confident that my patients are protected if their titers are sufficient. Vaccine titers are therefore becoming ever more popular. This entails the measurement of antibody against a certain disease (virus or bacteria). My recommendation is to check titers every year (if affordable - remember, the more people ask for this service, the more vets will offer it, and certainly vice versa - prices should go down as a result). I do not subscribe to yearly vaccines - this practice is outdated and medically unsound.
This does not mean that I don't believe in vaccines! In fact, the opposite is true. I would convince every owner whose puppy/kitten or naive pet (naive in the immune sense, meaning never vaccinated) that their pet MUST be vaccinated and booster a year later.
Dogs living in areas where Leptospirosis and Lyme disease are endemic should discuss these vaccines with their vet.
Not all dogs are candidates for all vaccines. So ask your vet, you've got the right to know!

Which one is right for your pet? Find out more by reading the American Animal Hospital Association (AAHA) canine vaccination guidelines here.
Guidelines for cats can be found here.
Lotsa reading, folks and may be complicated - my apologies!

Voracious cat

2009-05-01T21:15:00.003-04:00

As you now know, my cat is acromegalic and diabetic. This means his diabetes is difficult to control and his high levels of circulating growth hormone (and uncontrolled diabetes) means he's constantly hungry. As I blog, he is bothering me for crackers and peanut butter, and is slowly making his way towards the New York style banana pudding (courtesy of Red Rocket Coffee).
Aside from a lick, which he now and then steals, I do not let him eat these things.
While slightly humorous, I must remember that not long ago, he would never have wanted to eat these things. Isaac, I must remember, is sick. This fact I have accepted.

Not Isaac, but I haven't ruled this scenario out.

More "Dog Whispering"

2009-04-29T22:50:00.004-04:00

At my favorite neighborhood café, I kindly asked two young ladies if I could give them a short training lesson, after their dominant Chihuahua became aggressive when I introduced myself to him. It seemed he had a combination of dominance, fear, and territorial aggression. After the dog bit my fist (which I made so that fingers would be spared), I quickly put my left index finger around his tiny collar, and constrained him on my lap in this painless manner. After expressing his stinky anal glands and urinating all over me, I used my right hand to gently correct him until he was calm and submissive.
The two young ladies were very pleased. I made sure the dog could not see his owners (both sitting to my right), and would allow him to see them only once he was calm. He did not dare show me his teeth, growl, or bite afterward.
After his owners told me that this tough, little guy showed aggression towards larger dogs, I had another dog owner walk by a few times with both of her tail-wagging black Labs, as I held the little guy on the ground. The Labs very kindly introduced themselves to the Chihuahua, with barely a peep from the latter. We did this about a half dozen times.
This was the first time his owners could remember that he did not lunge or bark at the larger dogs. I insisted, rather drilled it into them, that these corrections must continue with them, lest his aggressive behaviour persist. I hope the bite on my knuckle and ensuing sepsis were not in vain.

An absolutely adorable Chihuahua.

Horner's syndrome

2009-04-25T20:12:00.005-04:00

.... revisited, again, for the third time. Not that I'm complaining or anything, it seems Horner's is quite common. With over 70 million dogs in the US and 4 million in Canada, I would imagine that a significant number have been afflicted with Horner's syndrome at some point in their life. Have you heard of this syndrome? Has your dog or cat (or you) had Horner's? If so, tell me about it. Any questions? I'll try to help you out the best I can.
PS: See my post "Iranian kisses woman's breast," and the comments. By golly, I've been branded a racist.

A woman with Horner's syndrome (see previous two posts for photos of cat with Horner's).
Addendum: The eyes of two different colors, called heterochromia, is NOT part of Horner's syndrome. Note the small pupil and droopy eyelids. In cats and dogs, we'd also see the 3rd eyelid protruding. A sunken eyeball is often a subtler sign of Horner's.

Polo horses drop dead

2009-04-23T22:03:00.003-04:00

It appears a pharmacy's mixing error is to blame for the death of 21 horses in Florida this week. Many of the horses started dropping like flies at a prestigious Polo Club in Palm Beach. Five horses not given a mixture of vitamins were the only ones that survived.
How utterly devastating. While this does not appear to be a deliberate intoxication of the animals, it is nonetheless heart-wrenching.
If I can digress: I'd rather see a horse running free in a field than chasing a ball in one.

I'm ok with this.

Painting

2009-04-23T15:49:00.005-04:00

"Guppy," 48 inches X 36 inches, acrylic and mixed media on wood panel.
Not vet stuff, sorry.

Prolific

2009-04-20T01:05:00.005-04:00

Not in the bunny rabbit sense. However, I have been busy painting my butt off the last few weeks. Some of my artwork will be going up at Red Rocket Coffee May 1st. How exciting!

Untitled, 36 X 24 inches, acrylic and mixed media on wood panel.

Puppies from China

2009-04-18T16:36:00.004-04:00

Today the Toronto Star reported that a Toronto woman has spent thousands of dollars bringing seven puppies from China to Canada. Our country (continent actually) has enough rescue organizations which could have used that money to save a few cats and dogs. Perhaps a few fractures could have been repaired on a few Canadian rescue dogs (who will now have to be euthanized)? I am certain that this woman could have expended the same energy to find them a home in China.
Of course, most of us are gaga over the (never-ending) sensationalist Star coverage: adorable, happy little puppies in their recent Canadian photo-op. This story and photo likely turned thousands into doting, sniveling mashed potatoes.
This woman thought with her heart, not her head.

Dogs that could use a few bucks.

Acromegaly in a cat.

2009-04-16T22:15:00.006-04:00

My 14 year-old domestic short-haired cat, Isaac, has been diabetic for a little over a year. He was well-controlled, and even went into diabetic remission, meaning that he was completely off insulin for a few months (cured, essentially).
Then he started drinking and urinating more, a clear sign that his glucose (sugar) was high. Chronic stress could lead to insulin resistance, however, this cat is virtually never stressed. He's the coolest cat I've ever met (no bias there). A herd of wildebeest can run through the house and he would not bat an eye. Three dogs were recently brought over to the house while family was here for dinner. Isaac lazily plopped himself in the middle of the living room while three dogs goaded him in vain to initiate a game of dog-chase-cat. No such luck.
While his insulin requirements crept up with no drop in his blood glucose, I became strongly suspicious of an underlying problem. Possibilities include an infection (anywhere in the body), a tumor, or another endocrine (glandular) problem, like Cushing's for example, and other issues.
Extensive testing, including an abdominal ultrasound and chest x-rays revealed nothing - not an iota of an inkling of a suspicion of a problem, including Cushing's.
He started to become even more pot-bellied and when he would hitherto eat nothing but the right cat food, Isaac started asking us for table food: pizza, (the occasional) McDonald's hamburger, risotto, filet mignon, chicken breast, deli turkey slices, yams, fries, and the list goes on.
This prompted me to suspect a disease (some say close to a third of diabetic cats are affected) called acromegaly, also known as gigantism. Test results came in today and Isaac's numbers were unequivocally consistent with the disease. This explains the consistently high blood glucose. Besides the high sugar, I am relieved that he is clinically well and he could stay this way for months to years.
Here, the vet has diagnosed acromegaly for the first time - in his own cat.

The same woman, young and normal in appearance on the left; older with signs of acromegaly in the middle and on the right (pronounced chin and underbite, enlarged head, and severely thickened fingers, etc.).

Pet Shop Boys and PETA

2009-04-13T15:06:00.004-04:00

Last week, it was reported that PETA, People for the Ethical Treatment of Animals, had asked the famed 80s British pop band, The Pet Shop Boys, if they would change their name to "The Rescue Shelter Boys."
Why not "The Vegan Tofu Granola-Crunchy Boys," or the "I forgot that I'm a Human Living on Planet Earth Boys?"
PETA, land your UFO back on solid ground and get the heck back to Earth.
Temple Grandin, who has revolutionized the way animals are lead to slaughter, eats meat - have the nutbars at PETA boycotted her books??

In addition to many of their other shenanigans, PETA are seeking to have the word fish changed to sea-kitten. This way, it seems, we would be less likely to consume something called a sea-kitten. The only problem with this is that all the PET SHOPS would have sea-kittens flopping around in their front windows. Nothing cute about that....

Hit-and-run

2009-04-05T01:38:00.004-04:00

Very sadly, a man driving a pick-up truck struck a rider and her horse in Collingwood, Ontario. The rider sustained minor injuries while her horse did not fare nearly as well. The full extent of what transpired is not known, however, we do know that it was a man in the truck, and that he fled the scene after the incident.
Let's hope they catch him.

Jessica Ruppel, riding Bella. A brief description of the horse's injuries and the suffering she endured after being hit nearly brought tears to my eyes.

Dog Portraits

2009-04-03T11:43:00.006-04:00

By now, most know me as a guy who is not into eccentric "doggie culture." That said, the leftopath Toronto Star recently ran an article on pet portraits. Far from cheesy, these pieces of art demonstrate incredible talent. Beautiful and original, they really capture some personality and charm. Here are some examples.

A Katie Sonnichsen portrait. Fantastic.

Paul Boddum's work. Apparently, this is his dog. What incredible talent!

Puppy strangles

2009-03-30T12:24:00.003-04:00

By request, I am posting about a disease called puppy strangles, otherwise known as juvenile cellulitis. While we don't see cases of it every day, it is nonetheless not rare.
Affected puppies are usually between one and four months of age. with symptoms that are often quite shocking in appearance. They include a swollen face, ears, muzzle, and spectacularly enlarged lymph nodes. The symptoms are consistent with other diseases and must be differentiated from a severe bacterial or fungal infection and mange (Demodex or Sarcoptes mites under the skin). Puppy strangles can be quite painful, unlike the other diseases just mentioned.
While it may appear that these dogs have some sort of infection, true puppy strangles is an auto-immune disease, meaning that the puppy's own immune system has, for some reason, gone a "little haywire". Therefore, treatment involves the use of prednisone, as an immunosuppressant, for cure. Within one to two weeks of treatment, affected puppies respond very favorably. The disease is curable and does not recur.

Puppy with juvenile cellulitis, or strangles (photo from the Pet Health Library).

Dogs in the news

2009-03-27T16:33:00.004-04:00

Today, The Globe and Mail reported that a 4 month-old Lhasa Apso, sealed in a bag, was found in a Toronto dumpster. Nice, eh? A maintenance worker heard the whimpering of the poor animal and discovered it in the refuse bin. The adorable little puppy is up for adoption at Toronto Animal Services.
On the opposite page in the Globe, you can read about how another two dogs, belonging to one owner, were likely deliberately poisoned in Whitby Park. This after a weekend of deliberate poisonings in nearby Port Perry. These dogs had ostensibly eaten treats laced with ethylene glycol (antifreeze). It imparts a sweet taste to anything so would be undetectable in an already-sweetened treat. It causes acute and often irreversible kidney failure. It is treatable if detected early, and fatal if left undetected. A Boston Terrier, one of the intoxicated dogs described above, has already died. I cannot imagine the devastation and utter sadness that has been wrought upon this dog's owner.

The culprit who tossed the puppy in the bin, left to suffocate, should never be permitted to own a pet, of any kind, ever again in his/her life. Period. Of course, add a massive fine or jail time... let authorities figure that one out.
Please, let authorities find the s.o.b. who has been killing our dogs and and be harpooned (literally?) with the harshest sentence possible.

Not a dog, not a cat, not a guppy, not a newt. People should be banned from owning any animal after found guilty of any act of cruelty towards animals.

Horner's syndrome 2

2009-03-18T17:19:00.008-04:00

When you type "Horner's syndrome" and "dogs" in Google's search engine, VetBlog shows up on the first page. Considering this syndrome is not uncommon, many people have posted questions on this blog in the comments section of my previous post on Horner's syndrome.
Due to its popularity, I have decided to post again on this subject.

Horner's syndrome (or Horner syndrome) is not a disease but rather a constellation of clinical signs resulting from a lesion to the sympathetic branch to the eye. The symptoms are 1) a droopy eyelid, 2) miosis (a constricted or smaller-than-normal pupil), 3) enophthalmos (a sunken eyeball) and 4) a protruding 3rd eyelid or nictitans.
The sympathetic branch (in this specific case) is a a part of the nervous system that courses down the spinal cord, does a U-turn at the upper thoracic spine, and then courses back to innervate the eye. It is responsible for doing the opposite of what we see in Horner's: bulging eyes, wide pupils, retracted 3rd eyelid, and eyelids that are kept up. You're correct if you've come to the conclusion that this occurs with either a "fight or flight" response. When an animal is frightened, its sympathetic nervous system kicks in.
Ok, enough anatomy!
Again, Horner's is not a disease but the manifestations of an underlying disease process, or its idiopathic.
Idiopathic Horner's syndrome means that no underlying disease can be found and the symptoms typically resolve in a few weeks or less.
Due to the coursing of the sympathetic branch through the middle ear, otitis media (or infection of the MIDDLE ear) often results in Horner's syndrome (and often accompanied by facial paralysis, from the 7th cranial nerve being concurrently affected). Middle ear infections often result from an outer ear infection that ruptures the eardrum, and then spreads to the middle ear. This needs to be diagnosed correctly so that proper long-term treatment can be instituted.
Horner's is rarely caused by tick-borne diseases and an underactive thyroid (hypothyroidism). Growths (especially polyps in cats) and tumors can also cause Horner's syndrome.
Protruded discs in the neck or upper thoracic spine can also cause Horner's syndrome.
A CT scan or MRI is not always necessary to make the diagnosis, but may be the most accurate. The prognosis depends on the underlying cause. It can range from excellent with middle ear infections, to grave with tumors.
Please keep posting on this subject - I hope I can continue to help you out.

If you see your pet with these symptoms, please contact your vet.
(note the droopy eyelid, the constricted pupil, the prolapsed 3rd eyelid - the sunken eyeball can't really be appreciated in this photo)

Practice makes perfect

2009-03-17T22:31:00.004-04:00

I don't know how to tell this story modestly, well, because it was simply impressive and exhilarating (how's that for modesty?!). I was sitting in a café this morning reading some notes on canine rehabilitation when a young woman approached me and asked me, half-jokingly, if I could help her rehabilitate her anxious and aggressive dog, Chico, a middle-aged Chihuahua. He was sitting outside on the deck barking his head off, with the owner's other more psychologically-stable dog. We shared a chuckle when I told her that I was reading about physical rehabilitation therapy and not about dog behaviour.
However, I did offer to try something, with no guarantee that it would help - something I learned from watching and reading (-sigh!) the Dog Whisperer. Cesar Millan would certainly classify this dog in the "Red Zone."
I asked the young woman to wait in the coffee shop while I met with Chico outside on the deck. I approached both dogs, very closely, said not a word, and allowed them to smell me. After a few seconds they settled down, there was no barking, no growling, just calmness. That is when I reached down and gently held Chico by his collar with one hand, while I held the leash with the other. He literally freaked out for about 30 seconds. Growling, baring all teeth, he desperately attempted to turn around to get a piece of me. When he realized that his actions were in vain, I picked him up, sat on a bench, and plopped him down on my lap in a sphinx pose. Any little growl or manifestation of aggression was quickly corrected with a gentle tug on his leash, a quick and firm touch to the back, and a silencing "shh" or "tss."
I continued this for at least 10 minutes. Only while the dog was calm, would I say his name, give him a loving scratch on the head and muzzle, and gently stroke his fur and massage his back. I immediately felt a connection to him. Was I crazy or was this little devil starting to like me?
His owner was astounded (as was I). She said that nobody had ever sat with him like we were. It seemed like we were old friends.
Now was the second important test. Would Chico bark incessantly when the owner would leave him alone on the deck, as he had always done? I put Chico down, picked him up again, at which point he again freaked out and tried to get me. I quickly repeated what I had previously done: a very gentle correction and he was back on my lap, quiet and calm. I put him back down without notice, and told the owner to follow me back into the café.
We stayed inside for at least 5 minutes, our eyes and ears never leaving the dogs. Not a peep out of Chico. That was the first time Chico was quiet while he waited outside for his owner to return. I left her with a few tips so that the dog continues to improve.
We were elated. Internally, I was glowing.

I would not have attempted this with a dog much larger than this one.

A dog in a wheelchair

2009-03-11T21:52:00.004-04:00

Today on 1010 AM, CFRB, John Moore was commenting on a story he heard about, in which a 3 year-old, paralyzed dog was in a wheelchair, and whose owners had to "squeeze" him several times daily in order for the dog to urinate. The host commented that he would not be willing to devote so much time and energy to a paralyzed dog and would have had him euthanized instead.
Many callers phoned in to convey sympathy and understanding for these owners' willingness to do so much for their beloved pet.
Firstly, I am not condemning this man. I believe he is neither heartless nor callous. Some people simply would not be able to do these things, whether constrained by money, time, energy, whatever. I would never judge. For something I believe as innocuous and simple as giving my cat insulin twice daily, may be just too much for some pet owners. The extent of what people are willing to do for their pets depends on many factors. What's good for one may not be good for another.
In this case, it appears the owners realized that their pet is 3 (and not 13), has a whole life ahead of him, and do not seem burdened by the care that is required to sustain their pet.
If pet owners in a similar situation, however, are negatively impacted either physically and/or mentally, their health and lives cannot be trumped by those of the pet.

How beautiful is this? I see no suffering here...

Dog left in van

2009-03-04T18:47:00.005-05:00

Michou, a handsome, grey, curly-haired, little poodle, spent 19 days in a van at a Vermont airport while his owner was vacationing. Pascal Bellon, the said owner from a charming little town in the Eastern Townships of Quebec, told authorities he did not know the dog was in the car.

His fine: $100. Authorities could not prove he wasn't telling the truth so he got off with a slap on the wrist.

Michou lost 50 percent of his weight over 19 days of starvation, dehydration, and freezing temperatures. There was an outpouring of both compassion for the dog and outrage with the fine against the owner.
I know humans are an imperfect species, but I wish we weren't quite so imperfect.

A sufficient fine? Where are those tough laws now (see previous post)?

Toughest animal cruelty laws in Canada

2009-03-03T10:54:00.004-05:00

On March 1, 2009, the government of Ontario amended animal cruelty lesgislation, last changed significantly seven years after the Titanic struck an iceberg and sank on that fateful night in 1912. Ninety years ago, these laws were avant-garde, showing a society that was ready to care for its animals as well as its hungry, sick, and homeless human citizens.
The new legislation sees increased fines and tougher sentences brought upon those who harm animals. Veterinarians are now required by law to report cases of suspected animal abuse, the government assuming all responsibility for liability.
Strangely, animals used in law enforcement will have separate (and likely increased) protection. Why not a seeing eye dog? Why not an eighty year-old whose only companion is her Golden Retriever? Why not my cats whom I care for deeply?
I am elated and proud of the changes brought on by the government of Ontario. Now why not set the bar high enough to view all animals as equal, regardless of whether or not that animal has a "job"? Punishments for cruelty or causing distress in animals should be severe in every single case, regardless of species and use of that animal in contemporary society.

From a very early edition of a publication of the Toronto Humane Society

In West Palm Beach

2009-02-23T18:27:00.002-05:00

I've just returned from Florida where I completed the second of three courses leading to a certificate in canine rehabilitation therapy (see previous post on canine rehab). Canine rehabilitation uses different modalities (like ultrasound, laser, stretching, manipulations, and various exercises) to physically rehabilitate dogs with various musculoskeletal disorders, those recovering from surgery, obese animals, or to increase performance in working dogs. The course was taught by a spectacularly entertaining instructor: Laurie Edge-Hughes, a physiotherapist (physical therapist for those in the US), certified in canine rehab, with a Master's degree in animal science from the University of Queensland, Australia. She runs a successful rehab practice in Calgary, Alberta.

Most of what we learned was fundamental to recognizing and diagnosing musculoskeletal, neurological, and joint disorders in dogs. However, we barely touched on these concepts in veterinary school, at least not ten years ago.

With renewed passion, I launch myself into this relatively new and exciting field.

Not using it to its full potential but a start nonetheless...

Killing stray dogs

2009-02-14T21:47:00.008-05:00

What is there to do when dogs attack civilians in a country without adequate resources? Police and veterinarians are killing stray dogs in Baghdad as there are too many strays to save and many are extremely aggressive towards people, often attacking them.
There is no mention in the CNN article of the SPCA International proposing how veterinarians in Baghdad would implement mobile spay and neuter clinics. Perhaps they can propose and pay for novel and painless ways to have some of these dogs euthanized instead of having them shot. Since these dogs are not dying instantly, they must be experiencing some moments of pain and sheer terror. I think using tranquilizer guns would be the least traumatic and painless for these dogs. Once tranquilized, the dogs can easily, safely, and painlessly, be euthanized. How much more would tranquilizer guns cost than shotguns?

The lives of people trump those of feral, aggressive dogs, but the manner in which this cull is being executed is completely unacceptable.

Appropriate tool to perform euthanasia?

This'll make you laugh

2009-02-12T12:11:00.004-05:00

I would like to subject you to a video that made me laugh out loud. As you will see, cats are not the perfect, poised, calm acrobats we think they are.

Euthanasia: at home or at the vet hospital?

2009-02-11T17:40:00.003-05:00

If I were not a vet, I would only trust a veterinarian I know well to euthanize my pet. I would not call upon somebody I didn't know to perform such an intimate, solemn, and heart-wrenching procedure. Where would you have this done? What if you didn't know a veterinarian very well?

"Don't talk to the animals," says autistic professor

2009-02-09T18:31:00.006-05:00

Here I'll lazily direct you to an article published in the Globe and Mail. A must read.

Her basic tenet is this:

What she really wants us to do, if we're at all interested in providing animals with a decent life, is to approach them more on their terms than on ours - to see and feel the world completely as they do.

As I maintain in many of my posts, we need to stop treating our pets, livestock, and all animals, as humans beings.

Click here to read the article.

Professor Temple Grandin
Listen to an interview with her on NPR here.

FYI

2009-02-08T21:52:00.007-05:00

is less closely related to this

than this is

to

Now guess the breeds... Ok, here's a hint, but apparently there's some debate as to the breed depicted here - confused?

Both the vet and the client

2009-02-07T16:12:00.005-05:00

Soon before I left NYC, my cat's diabetes became quite uncontrolled. His previously controlled blood glucose became consistently high, and could not be regulated, even with increasing doses of insulin. This is called insulin-resistance. While he didn't have "text-book" insulin resistance, I knew something was awry.
Diabetic cats' insulin requirements can dramatically increase when they have a concurrent illness. Things to rule out are: urinary tract infections (including pyelonephritis), chronic pancreatitis, hyperadrenocorticism (Cushing's), acromegaly (increased production of growth hormone), dental disease, heart disease, and different types of cancer.
So I brought him to the hospital where I was working, performed full-body radiographs: normal. Full CBC, chemistry, T4, urine cortisol-creatinine ratio, feline PLi, urinalysis, and urine culture - all perfectly normal. Hmm....
There was not a clue as to what was going on. While a little frustrated, I knew there was a strong possibility there was still something wrong with Isaac. When I returned to Toronto, I scheduled an ultrasound for him. The ultrasound showed mildly enlarged kidneys, consistent with pyelonephritis (I've already posted twice on this disease). Interestingly, and frustratingly, his previous urinalysis was completely normal - crystal clear - and his culture was negative; not a hint of an infection.
With chronic disease, though, this is still possible and therefore not a complete mystery.
I started Isaac on a 6-8 week course of antibiotics and so far, he's doing great.

Had I not performed the ultrasound, he would likely have deteriorated.

What are the lessons here? 1) To understand that tests are not always diagnostic - of course they can be - and that normal test results do not necessarily ruled out everything.
2) In many cases, further work-ups are necessary. After preliminary tests, this often (but not always) means imaging, such as x-radiography, ultrasound, MRI (magnetic resonance imaging) or CT (computed tomography).
3) Sometimes, even specialists (in medicine, too!), cannot achieve diagnoses - there are true mystery illnesses.
4) Follow your suspicions: in this case, there was some, but not overwhelming, evidence that Isaac was sick. I was most probably right.

Isaac's diagnosis of pyelonephritis is strongly suspected, but is still not confirmed. I am now both the client and the veterinarian, and will just have to be patient for now....

Will Isaac have to go back?

Something I didn't learn in vet school

2009-02-03T13:47:00.007-05:00

In vet school, I was taught extensive anatomy, physiology, histology, pathology, and medicine in dogs, cats, ruminants, birds, and equines. I learned how to auscultate the heart, lungs, and digestive tract of all of these species. I learned how to treat IMHA, GDV, colic, conjunctivitis, Addison's disease, VPCs, and the ABCs of resuscitation. I learned how to make radiographic diagnoses, when to vaccinate animals, how to spay a cat, and how to remove a portion of a cat's small intestine.

What I was not taught was how to deal with career exhaustion, burnout, and compassion fatigue.

I blissfully entered the field sporting an invisible cape and hero suit on which "Super Vet" was emblazoned - at least that is who I wanted to be. Lo and behold I am not the superhero veterinarian I thought I was, but rather one who has come to question his future.

There are alarming statistics regarding career burnout in veterinarians. Vets are four times more likely than the general population to commit suicide. This is truly shocking. Please read the entire article here (I think the author went a little nuts about veterinarians' abuse of the drug ketamine, but I digress).
Why is this? Vets are typically happy-go-lucky people who have "the best job in the world," right? As pets become ever-increasing members of the family, the quality of their health and care must increase in tandem. This puts increasing pressure on veterinarians to perform, to heal, and to cure, added pressures to an exceedingly-high pressure profession.
Attesting to this fact, many vets are perfectionists, therefore a lack of "success" in treating veterinary patients and medical errors can lead to feelings of utter failure, lack of self-esteem, and eventual depression.

I was not taught that I would have to deal with eccentric and overly-demanding pet owners. I was not taught how to deal with the stress associated with such pet owners, difficult-to-manage cases, a physically demanding job, euthanasia, and grieving clients. I had to do this on my own. Self-taught, I believe I was only partly successful. I do, luckily, have other "teachers" to get me through this...
Given the statistics regarding occupational (mental) health in veterinarians, it is incumbent on veterinary schools everywhere in the world to sensitize veterinary students and prospective veterinary students to the many stress-related issues facing veterinarians today, these issues unfortunately eschewed by veterinary institutions.

I want to finally accept my limitations as a veterinarian, and as a human being so that my feelings of ineptitude and guilt can finally be extirpated from my being.

A documentary the world needs to watch.

2009-02-02T21:11:00.008-05:00

While this doesn't pertain to veterinary medicine per se, it is something that has provided me with more food-for-thought than virtually anything else I have seen or read. Ever.
Here's a documentary that examines a chilling scenario. Chilling for us, perhaps. Stunning for the planet and, save us, all of its inhabitants.
The documentary is based on the international bestseller,"The World Without Us," by Alan Weisman.
I wonder if the planet will ever again thrive in our presence.

Bulldogs get makeover

2009-01-21T16:54:00.004-05:00

Bulldogs in Britain will have their exaggerated characteristics weeded out after a few generations, after the (British) Kennel Club made an unprecedented decision to revise the standard for the British Bulldog. Other breed revisions include those for the Chinese Sharpei and the German Shepherd. Please read the full article here.
I do not wish to offend any Bulldog owners and this post is not a reflection on them or their dogs. However, I have been saying for years that the classic characteristics of bulldogs, including a flat face, and short and stubby legs, lead to serious physical constraints. The most important one, in my opinion, is the respiratory tract. The dog's flat face and therefore severely shortened respiratory tract, makes it difficult to breathe. They often have stenotic (barely-open) nostrils, shortened nasal cavities (where air is warmed and is filtered), and an elongated soft-palate. These dogs are walking emergencies. Routine exercise in the heat can be life-threatening.
I am all for it. In the long-term, this means that vets will still be seeing bulldogs and Shar-peis, but perhaps not for the classic health issues that plague the breeds (respiratory and skin/eye issues respectively).
Remember, human beings are solely responsible for the evolution (yes, evolution) of the hundreds of breeds of dogs found on the planet. It is our responsibility to ensure that their physical characteristics do not impair them in any way or cause harm, no matter how cute, pretty, fluffy, flat-faced, bald, tiny, or huge we want them to be.
Kudos to the Kennel Club.

So darn cute, but I'll bet that the revision will demand for a reduction (or absence of) skin folds on the face and body. Yup, you guessed it, they cause health issues.

Online "Expert"

2008-12-31T11:04:00.005-05:00

I recently applied and was accepted to be a pet health expert on JustAnswers.com.
If you have any questions related to dog or cat health, you can visit the site and ask your question. In fact, you can essentially get expert advice in just about any field (medicine, law, mechanics, etc, etc). You can even request the "expert" you want to respond to your question. There is a fee involved and the "experts" are paid a percentage of that fee.
Click the link above to be directed to the site. My site name is "Dr. Cliff." Hope to hear from you!

NB: Remember that online advice is for information purposes only. It does not replace a thorough physical examination by your veterinarian. The acquisition of vital information may be omitted through online communication.

A Warm Welcome

2008-12-28T19:28:00.002-05:00

I left NYC on a high. A super high. It was a spectacularly good time. Yes, it was difficult at the beginning as I was lonely and stressed. Soon afterward, however, I quickly got used to work, made close friends, and started enjoying myself.
I'm home because I don't want to make my life in NYC. I knew from the beginning that I would return to Canada, and it is here where I feel the most comfortable.
From the day of my arrival, I have been welcomed warmly. I wanted to thank all those who have greeted me with such warmth and enthusiasm. I have returned for you - you know who you are. I hope to meet all of you and be of help with your veterinary needs.

-Dr. Cliff
canadian.vet.art@gmail.com

Cold weather

2008-12-26T11:45:00.005-05:00

By now, those who know me are aware that I'm not into dressing up dogs. That said, exercising your dog every day is of utmost importance, even if it means taking her outside when you have no desire to feel the blustering cold on your exposed cheeks. Some dog breeds don't have the fat or coat to handle freezing temperatures and so should be "clothed" appropriately. The sauntering Saluki sporting a winter coat in my neighborhood the other day had no qualms about the feet of snow underneath her snow-coloured feet. Her elegant trot was testimony to her comfort outside. I had no qualms about her wearing a camouflage-style (though she stood out like a performing clown at a bar-mitzvah) winter jacket in the sub-zero temperature that day. She was not sporting booties, but they would not have shocked me either, though typically I find them unnecessary (unless the streets/sidewalks are full of salt or ice or other potentially paw-damaging obstacles).

The Akita and Samoyed do not require winter-wear. The Greyhound and other sighthounds, yes indeed. The smaller dogs will lose heat more rapidly due to their relatively larger surface area-to-volume ratio. So you can certainly clothe the little guys, though some Shih Tzus (one of the ancient breeds - see previous post below) have such thick coats, it is difficult to imagine them as not being "made" for the snow.

The Saluki: breathtaking... Take a good look: a coat in the winter?

Evolution of the dog

2008-12-14T22:22:00.010-05:00

Having a deep interest in both dogs and evolutionary biology (I failed Creation 101 in university), I recently started thinking about the evolution of the dog. There is much variation within the species, Canis familiaris (i.e., there is a huge number of dog breeds and yet all belong to the same species). Studies suggest that the wolf ancestors of dogs diverged from other wolves around 100,000 years ago, and that domestication occurred sometime around 15,000 years ago. Studies of mitochondrial DNA date the evolution of humans at around 150,000 years ago. It is easy to imagine that dogs (or their ancestors) have been with us, evolved right along with us, for many thousands of years. Not only did we contribute to their evolution (especially recently), but they may have shaped a part of ours.

Though it may be difficult to train a Yorkshire Terrier to herd a flock of sheep, he is still constrained by his genes to behave like a dog. An English Bulldog may be constrained by his stature (and a lack of a thick coat) to pull a sled in the Arctic, though this (or similar) behaviour may still be elegantly encoded in his genes.

Recent DNA analysis has led to the identification of 14 ancient dog breeds, excluding a few breeds previously thought to be the most ancient. While some of these dogs exhibit a phenotype (physical appearance essentially) that is similar to wild dogs (i.e., wolves), I was shocked to see a few of the smaller breeds included in this group of 14. I'm not shocked to see this breed on the list:

The Siberian Husky.

But this one?

The Shi Tzu: an ancient breed. Incredible.

This very fact underscores my long-standing view that 1) these dogs are constrained by their genes (and look how far back the Shih Tzu goes!), and 2) their genetic similarities require us (pet owners) to treat them as equals.

Helicobacter...

2008-12-06T21:20:00.006-05:00

... is the name of a bacteria (bacterium actually), that can be found within the stomach wall in humans, and other species including dogs and cats. They thrive in the acidic environment of the stomach, which caused a sensation when first proposed, as it was believed that nothing could survive in an environment with such a low pH. That is not the case.
This bacterium, which literally, reminds me of a helicopter due to its propeller-like flagellum, is responsible for over 90 percent of cases of peptic ulcers and other serious gastrointestinal disorders in humans. Ulceration is cured with the eradication of the infection. Period. Barry Marshall, an Australian scientist, went so far as to infect himself with the bacteria in order to prove his theory. Indeed, he became severely ill and developed gastric ulcers. For his work, in 2005, the Karolinska Institute in Stockholm awarded the Nobel Prize in Physiology or Medicine to Dr. Marshall and his long-time collaborator Dr. Warren "for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease".

Interestingly, the role of Helicobacter infection in dogs and cats is not known. Many clinically healthy dogs and cats harbor Helicobacter in their gut - and show no signs of disease. However, some dogs and cats with clinical and histological (sections of tissue) evidence of inflammatory bowel disease/chronic gastritis also show the presence of Helicobacter bacteria in their GI tissues. Just FYI, Crohn's disease is a type of inflammatory bowel disease in humans.
So what to do? Thus far, it is recommended to treat the Helicobacter infection first. If symptoms disappear: great. If not, treatment for inflammatory bowel disease is instituted, consisting mainly of immunosuppressive doses of prednisone or prednisolone.

I have just recently diagnosed a cat with inflammatory bowel disease with evidence of a concurrent Helicobacter infection.
My plan is to treat for Helicobacter infection, then re-evaluate. It will be interesting to see what develops.

Little spirally helicopters.
More FYI: Heliko = spiral or helix in Greek.

Goodbye NYC

2008-11-23T11:46:00.007-05:00

Dr. Cliff is pleased to announce his return to Toronto within the next few months. He looks forward to providing quality veterinary care as a locum/per diem veterinarian in and around the downtown area.
(addendum December 6, 2008: departure date is set for the end of December)

Fleas: more than just annoying little critters

2008-10-20T19:00:00.007-04:00

One clear difference between Toronto and NYC (only 480 miles south-east of the former) is the number of fleas per square inch of dog or cat. In Toronto, I simply did not see the huge numbers of pets with fleas that I see here in NYC. Holy smokes.
I'd say at least 50% of the patients I see have fleas - at least. What's more striking is the nonchalance in reaction of their pet owners - holy smokes. What I tell owners about fleas: 1) they will be on planet Earth when humans are long gone, possibly ruling it, 2) 5% of the flea population are the actual adult fleas - those critters we actually see with the naked eye; the other 95% percent are those stages like the eggs, larvae, and stubborn pupae, that just litter the pet's environment, waiting to emerge to just pop back onto the pet when it goes by, 3) a puppy or kitten can die from a severe flea infestation from the anemia the fleas cause (like vampires, they feed on blood), and 4) most importantly: fleas carry infectious diseases, like the larval stages of tapeworms (if your dog or cat has tapeworms, she swallowed a flea somewhere down the road); Bartonella henselae is a bacterial organism, responsible for cat-scratch disease in humans, that is carried by fleas (usually a self-limiting disease in healthy people, but can be life-threatening in immunocompromised patients); Hemobartonella (now called Mycoplasma haemofelis), a blood parasite, is transmitted by fleas - these blood parasites sit on the surface of the red blood cells and can cause the cat's immune system to start destroying these cells as the system no longer recognizes the cells as "self." Fleas are also responsible for carrying the bacterium Yersinia pestis - you've all heard of this one - responsible for causing bubonic plague in cats and people, the disease which virtually decimated the entire human population in the middle ages (the cute word "booboo" likely comes from "buboes," the lesions that were seen in people with plague - somebody corroborate this for me, please). Fleas aren't fun, folks.
Flea control involves treating the pet, and crucially, treating the environment. Flea collars do bubkiss on toast. Get your flea-control medications from your vet. NEVER purchase these products from a pet store as 1) they don't work and 2) most, if not all, are toxic to cats.
Whatever you do, DON'T use homeopathic or "natural" products (like diatomaceous earth) as the fleas will just be hysterical laughing behind your back.

Bubonic plague: if only they knew about flea control...

Chapter 2: a little off.....

2008-10-13T21:33:00.005-04:00

I met a client whose dog had a mild to moderate intermittent lameness of a front limb. The dog was young and otherwise healthy. After a week of strict rest (those were my instructions), the lameness persisted. A few vets had seen this dog already, taken radiographs, used anti-inflammatory medication, and had not found the exact source of the dog's lameness. Nor could I. When I recommended she see an orthopedic specialist (a surgeon - not for surgery but at least to try to achieve a diagnosis), the owner said that she had visited with a "pet psychic", had spoken to her dog (you heard me), and that the dog asked to see an acupuncturist (note that I strongly believe in acupuncture, especially when used in conjunction with western medicine and diagnostics).
Millions of people on the planet believe in psychic phenomena - this doesn't irk me. But when your dog is lame you bring him/her to the vet, not to a psychic. In any case, shouldn't this psychic have predicted this dog's injury and prevented it?
I feel that imparting your own beliefs onto your dog is irresponsible, and potentially dangerous. A diagnosis can be missed if you're seeking help from people who have no business giving out medical/veterinary information. Trust your vet. This is exactly what we were trained for: not to be pill-pushers but to try to achieve diagnoses and institute appropriate treatments. And who knows? maybe the surgeon would have recommended acupuncture....

If your child were suddenly limping, would you take him/her to the ER or to a psychic?
Puh-lease people, enough.

At least she knows what he wants.

Chapter 1 - Are pet owners... a little off?

2008-10-11T19:01:00.007-04:00

This is an excerpt from a larger piece of work I am writing regarding veterinary medicine, and veterinary care in general in contemporary society. I don't mean to be presumptuous, but publishers feel free to contact me.

In 1994 Americans spent $17 billion (US) on their pets (1) . This climbed to just under $40 billion in 2006, equal to about 1/325th the United States’ GNP, half that of Romania, and nearly 20 times the GNP of Rwanda.
Today, there is at least one cat in 38 million homes, while a dog can be found in nearly 45 million homes. Six million American homes have a “small animal,” that is neither a fish nor a reptile. In the U.S. in 2008, an estimated $16.9 billion was spent on pet food while $10.9 billion was spent on veterinary care. The remaining $15 billion were spent on pet-related products and services, excluding food and vet care.
Pets are ever increasingly being considered a member of the family. This becomes more true when considering that the services and products that were hitherto catered solely to Homo sapiens are no longer: “Max” now has his gourmet raw food, his dog walkers who come in twice daily, a full wardrobe (lumberjacket, raincoat and matching boots, a backpack, and more) a canine sleep-away camp while his owners (2) are on vacation, acupuncture for his arthritis, chiropractic for his pinched nerve, a holistic veterinarian for his liver problem, a veterinary dentist to fix his canine that he broke chewing on the door of his massive crate (3), a veterinary oncologist to treat his skin cancer, and a pet cemetery where he can be interred and remembered by all, forever.
Today, in 2008, you might be amazed at the technology and level of care humans are providing to non-humans. One hundred years ago, a severely lame horse would be shot, ending its suffering. Today, we hear stories of teams of equine surgeons (yes, specialists in equine surgery) reassembling the leg bones of champion horses (4). The technology present is allowing veterinarians to ultrasound pregnant dolphins and camels, to replace a dog’s cataracts with artificial lenses in the exact same way yours were replaced, and to pin the broken wing of a barn owl, releasing it to the wild after its lengthy reha-bilitation. It does not stop there. A veterinarian can become specialized by completing a residency in a specialty field. Veterinary radiologists specialize in diagnostic imaging, while veterinary ophthalmologists have advanced training in diagnosing and treating diseases of the eye. Veterinary internists diagnose, manage and treat diseases such as diabetes, infectious diseases, and everything in between. Veterinarians often refer their patients to one or more of these specialists for confirmation of their diagnoses, if a diagnosis cannot be reached, or if advanced diagnostics are required. The list of veterinary specialists goes on...

Advanced veterinary care certainly has a place in today’s ever more technologically-advanced world, though one must concede that it caters almost exclusively to the upper-middle class, if not to the elite. How many on the planet can truly afford such services? Is it not ironic that our puppies and kitties are fed four-star gourmet cat food, have access to MRI within days (if that), and whose biopsy results require less than a week to be reported, while human beings are often denied these or must wait many months for diagnostic tests, results, and surgery? How would you feel if you heard that some pet owners have spent tens of thousands of dollars on advanced care for their pet? Should a dog with bone cancer be afforded this treatment, while his human counterpart without healthcare receives but palliative care for the same ailment? At this point in human civilization, does human health not trump that of pets? This is not to say that the fate of wild species and the world’s ecosystems are not of primordial importance (domestic pets have long been removed from their wild roots, yet are still strongly constrained by them through their genes).

So what makes a pet owner nuts? When does one become a crazy-cat-lady? How could dressing up your pug in a pumpkin suit be harmful for you and her? And why should you not take your Yorkshire Terriers out in a stroller? Many behaviors exhibited by pet owners that are seemingly cute and harmless can induce behavioral nightmares in our pets. Also, many of such behaviors alienate the pet owners from other human beings (pet owners and non-). Please don’t hesitate to take a step back, no matter how short a step, as you will undoubtedly be reading about situations that you could swear were written about you.
(more to come)
-----------------------------------------------
Footnotes
1 According to the American Pet Products Manufacturing Association, Inc. (AAPPM)
2 This term may be offensive to some: the term “guardian” is being used more and more.
3 I know some people whose bachelor apartments are smaller.
4 What would be the outcome were it not a champion?

Know anyone like her? I'll bet there's a little bit of crazy-cat-lady in all pet owners.... all (and that includes guys).

KIttens in garbage can

2008-10-08T09:43:00.003-04:00

A client came in the other day with a plastic bag she found in a trash can. There were two screeching kittens in the bag, alive and kicking, and likely starving.
What does it take for a human being to drop a few newborn kittens in a plastic bag and throw it away in a garbage can, like a bag of used litter? Is this an act of desperation? Of sacrifice? Of stupidity? Of ignorance? All of the above? Did their mother belong to someone who did not have the savoir-faire to have her spayed, allowed her out, to discover one day that she had surprisingly given birth to a few kittens?
Or was this all a money issue? Could the person who found the kittens simply not afford to care for them?
Was the culprit simply devoid of neurons?

While it is true that there are millions of unwanted cats in the US, that they are considered vermin, like rats, in some parts of the world, they are indeed still living, breathing, animals. Surely a cat owner can tell you just how loving, caring, and affectionate they are... My cats are certainly not rats (and I don't mean to be speciest: I know that there are many who love rats like I love cats, and don't remind me how intelligent rats are...).

The good news is that our hospital will care for these newborns until they can be adopted out when they are older (their eyes have not yet opened!). For all the kitties found in baggies, can you imagine how few are saved? It would be far more responsible, and ethical, to have such kittens euthanized instead of their suffering a slow death from starvation or suffocation. I can't even imagine how horrible that would be.
Now let's be realistic: not all can be saved. Let's put our energy, financial and otherwise, into those that can be saved and most importantly, those we can place in a loving, caring, long-term home.

A little older than newborn, but I couldn't resist.

PickensPlan

2008-09-21T10:12:00.008-04:00

After hearing an interview on National Public Radio (NPR), I immediately became a supporter of T. Boone Pickens. Though this tycoon man made most of his money in oil, he is now a staunch supporter, or rather leader, in the promotion and use of alternative and renewable energy sources. The gist of his plan is simple: stop using oil, start using wind power, solar power, and natural gas. It is imperative that the planet be weaned from the teats of the oil pits. Read about his plan here. While his focus appears to be on the US, it is evident that his wishes transcend North American and global borders. Please read more about the PickensPlan and sign up today. Follow link above.

Beautiful and functional. How cool is this?

"You must really love animals"...

2008-09-19T10:58:00.005-04:00

is something I hear almost every day from clients. "What a happy/pleasant job you have." is also one I hear quite frequently.
Being a vet is more than just being able to get my face licked off by adorable puppies every day. While I love when this happens, it certainly does not occur frequently enough to call the profession "cute" or even "pleasant."
Being a vet is an enormously difficult, and oft-times a grueling job. Attempting to reach a diagnosis on patients who can't speak, long hours, dealing with unreasonable clients, can all make this job very challenging, sometimes frustrating, and emotionally draining. Being a vet is not easy, far from it.
These are things I did not learn in school. There were no classes that taught me how to deal with grieving clients, no classes called "profound grief 101", and no lessons to deal with demanding and unreasonable clients. These are all things I had to learn on the job. And boy, did I learn them. I must say without tooting my own horn, that these are the "classes" in which I got an "A+". I did get a few "Fs" along the way though.

Despite all of this, there are sufficient puppies, kittens, great clients, happy and proud moments, that make being a vet extremely rewarding. I try to focus on this aspect of the profession.

Cute. Definitely.

A tribute to a dog and her owner

2008-09-13T11:24:00.004-04:00

A warm and caring person whom I know quite well and whose dog I saw for several years, had her dog euthanized after a lengthy, chronic illness. She cared greatly for her beloved pet, and was diligent and compliant in having all the necessary tests performed, and provided all the necessary treatments that were recommended to her.
When it came down to the dog not eating, she immediately had the dog seen by a specialist and hospitalized in hopes that the dog's condition would improve. Alas, no, it did not. Having loved and cared for her for many, many years, it was time to let her go. The owner was able to take a step back and look at things objectively, despite her deep love and affection for the dog. In this case, she was selfless, knowing what was right, and what was best for her dog. The selfish thing would have been to keep the dog alive for the sake of having her dog "alive." That is not living now, is it? True love for your pet includes knowing when it is time to say goodbye.
Otherwise, no matter how noble your actions are, you are thinking only of yourself, when it is not about you. We are their caregivers and when it comes down to suffering, their needs trump ours. Always.

Goodbye to a great dog. The tribute is to her and her owner "G.N."

Back to medicine

2008-08-29T09:46:00.007-04:00

Pyelonephritis: a kidney infection. Literally, pus in the kidneys (see a very early post of mine). I treated two such cases in the last two weeks. These were very sick cats, clinically affected with laboratory values consistent with pyelo (that's what we call if for short). Often, these cats don't read the textbook, but both of these did. Both were painful on kidney palpation, their total white blood cell counts were significantly increased, with mostly the neutrophil component increased, most consistent with infection. Their kidney values, notably the blood urea nitrogen (BUN) and creatinine were significantly affected, indicative of decreased kidney function (and dehydration). And of course, pus in the urine indicating a severe infection. One cat had undergone a surgical procedure a decade ago that essentially turned him into a her. at least externally. He likely had become obstructed on many occasions, or was unable to be unblocked after one serious obstruction. This procedure, called a perineal urethrostomy, is still done from time to time, but not as often as it was in the past. The wider urethral orifice, like that of a female, predisposes the cat to ascending urinary tract infections. Interestingly, the cat was fine for a decade. Perhaps with the cat's advanced age, he is becoming somewhat immunocompromised. He may have had a chronic, mild, sub-clinical infection for quite a while, that ascended his urinary tract to his kidneys.
The other cat, an uncontrolled diabetic, had pyelonephritis and was in DKA (diabetic ketoacidosis). Not a great combination. At first she was diabetic, then uncontrolled, then was hit with pyelo, and the infection threw her into DKA. Ketosis ain't about sugar (glucose). That's how it works.
Over a few days, we got her out of ketosis, treated her pyelo, and turned her into a "regular" diabetic.
After two weeks at home on antibiotics, insulin, and a special diet for diabetic kitties, her insulin requirements are down to almost nil. She will be treated with antibiotics for at least a month. Most importantly, she is back to same ol' kitty she used to be.
We're all very happy with the outcome of these two cases.

Warning: gross photo below:

A kidney severely affected with pyelonephritis.

Enjoying NYC

2008-08-20T18:16:00.004-04:00

Having metamorphosed from a rather melancholic state, like a butterfly emerging from the cocoon, I sense a feeling of "newness" in the air. I am lighter, fresher, though my flying apparatus are internal, psychological, and likely ephemeral.

The previous routine is over, and have since received my scores. While incapable of undoing the fall, the step out of bounds, or the stumble, I am training that they should not recur.

Red Hook, in Brooklyn is an incredible neighborhood. I have the famous Fairway Market less than a five-minute walk away. With a short promenade just by the water, I frequently go out for a stroll, to gaze out at the harbour, and enjoy the vast, industrial landscape in front of me. It is tranquil, peaceful.

I practice in Rockaway Beach, about 15 miles (30 km) from Red Hook. The Rockaways is a beach-side community, a narrow peninsula barely tethered to Long Island by a rope-thin stretch of land. The staff at this practice are friendly and caring, and the clients are down-to-earth and warm. I am enjoying it immensely.
The feedback thus far has been beyond what I could imagine. I must be in a good "place" right now. I find myself living and enjoying the moment, being empathetic and sensitive to my clients' needs, and being a good listener.

Could the last few weeks have been of such great importance to my personal evolution? I am optimistic that the answer is "yes."

Roller coasters and lapdogs

2008-07-22T22:43:00.009-04:00

There comes a point when one realizes that talking or writing about oneself becomes tiresome. Nothing I say or do will shorten this wait, efface this idleness, undermine my uselessness. So I remain patient, and enjoy the ride, despite being in a roller coaster car that is stuck at the top...

While I've posted several times on our eccentric behaviour towards pets, I'd like to continue on this subject. I think the single most important issue in canine medicine right now is the mental health of our dogs. Why are some dogs so darn miserable? Why can't they be walked on leashes? Why are they lunging at the other dogs in the park? Why are they destroying the furniture when we leave them alone? Why?!
Now here's the bottom line, folks. Ready? Listening (or reading rather)?: We've forgotten that our dogs are dogs. Let me say it again: we are not treating our dogs like dogs. In the last hundred years or so, and particularly during the last twenty or so-odd years, we have taken an evolved species and thrown it a major curve ball. Though a Siberian Husky and a Yorkshire Terrier are physically quite distinct, you'd hardly know it by looking at their genes. Remember, they are different breeds, but of the same species: Canis familiaris.
So while it would likely take six hundred Yorkies to pull a sled (on the lolls of the English countryside of course), the desire for a Yorkie to have a "job" is almost certainly there. Its job is not to be carried around in a purse (even if it's a fabulous Louis Vuitton). Its job is not to be put in a stroller, but rather to be walked, exercised, to heel, to sit when asked, and to wait quietly and confidently while his/her owner runs into Starbucks for a grandé, extra-hot, lactose-free, light foam, latté.
I guess you're starting to see my point. What has prompted me to write about this once again was my recent witnessing of an eccentric prominent Toronto couple (no names here though its soooo tempting) whom I see quite frequently, who were sitting enjoying a coffee with their Miniature Schnauzer resting on their lap. I don't really mind seeing a dog sitting on their owner's lap... usually. The problem here is that I've never seen this dog's paws actually touch the ground. These people were there for a considerable period of time and the dog never walked on, or touched, the ground. When they departed, they picked him up and whisked him away in their arms. It was gross. Of course, I felt terrible for the dog... While the owners' intentions may be noble, it is indeed abnormal, eccentric, behaviour which causes irreparable damage to the dog. Granted, I have not met this dog personally and do not know the status of his mental health.... However, I'll bet lots of money that these people rarely (if ever) leave this dog alone. More importantly, I don't think this dog can be left alone without manifesting severe separation anxiety. He needs help!
Think of all the dogs out there that are treated this way (and I'm not purporting that I would be the perfect dog owner). Their genes are speaking to them in one way, while we are showing them hieroglyphics. They just don't get it. What results are messed-up dogs.
Canine behaviours, such as aggression, are strongly affected by genetics. It is true that many traits, including behavioural ones, have been selected for in certain breeds, which have resulted in breeds that are typically more docile than others.
Consider the Labrador Retriever vs the Chinese Shar-pei (though I've met a few nasty Labs and the most spectacular Shar-peis!).
Genetics and environment play a complex role in shaping dog behaviour. There's not much we can dog about genetics (at least not with a particular individual) but we can certainly dictate or manipulate the dog's environment. So let's get on it already!

This is why I am a fan of Cesar Milan, the dog whisperer. Though he is not ubiquitously loved by all canine behaviourists, his fundamentals are tenable and sensical.

This may shock you but it was Cesar Milan who said that the healthiest dogs (mentally) are those owned by homeless people. I recently took particular notice of this. These dogs know exactly what they are and it couldn't be more..... refreshing (yet heart-wrenching) to see.

This dog is saner than a lapdog or one in a stroller. Of course, the entire image elicits a feeling of heaviness on my heart.

Bureaucratic obstacles

2008-07-18T22:27:00.003-04:00

Bureaucracy and I don't really mix well. I'd like to take the entire roll of red tape and catapult it into the stratosphere. In my dreams perhaps....

A relevant stream of consciousness: anger, frustration, anxiety, confusion, resentment, delay, bureaucracy, incompetence, anticipation, excitement, idiocy, lunacy.

That is all for today's post.

The Average Bureaucrat, Salvador Dali, 1930.

Moving to New York City

2008-06-29T13:19:00.005-04:00

A move to NYC is something I've been considering for quite some time now. Staying here, or rather not moving to NYC, simply became untenable for me.
NYC was always a place of fascination and inspiration for me. I think proferring an explanation for a move to New York is tautological - I mean it's New York, right?!
I'll be living in Brooklyn, facing the harbour just south of Manhattan, with a view of the Statue of Liberty and her colossal, oxidized, copper torch raised to the skies, an indelible image from my childhood...

My move is slated for the 1st of August, 2008.

More to follow...

My view of her isn't this good.

Grieving pet owners

2008-06-13T13:50:00.005-04:00

A comment on a previous post prompted me to do some research on the services available for grieving pet owners. Losing a loving, devoted companion can be devastating. One must remember that grieving for a pet is normal, and likely necessary for most people.
It is imperative that pet owners who have lost a pet not lay blame on themselves, or others. Part of the grieving process is accepting the death process (whether natural, through illness, or accident), to know that the pet has brought immeasurable and irreplaceable joy to one's life. Once the grieving is over, one must pick up, move on, and thereafter always have but joyous memories of the pet that we loved so much. I'm getting teary-eyed already!
Please click here to read more about services available for grieving pet owners.
You are not alone: know that at some point in our lives, we will all likely become a grieving pet owner.

Isaac, one of my cats. I love this guy. Thanks to Ron Findlay for the fantastic photo.

Dogs aren't laptops... anywhere.

2008-06-09T02:22:00.000-04:00

A California lawmaker introduced a bill that would prevent citizens from driving with their dogs on their laps. He says pets distract motorists and puts them, and passengers, at risk. Absolutely true. Very importantly, this is also a risk for the dogs. With windows rolled all the way down, these dogs now have it much easier to jump out.... and many do. Imagine losing a dog on the highway because you had your dog on your lap with the window down too low. I've seen such cases so many times and once, right in front of me. The dog was unharmed because the car was moving so slowly, but still....

If you don't want your dog, or you, to look like this, don't drive with your dog on your lap and keep the windows at a level where the dogs cannot jump out.

Rehabilitation Therapy for Dogs

2008-05-29T21:25:00.005-04:00

Canine rehabilitation therapy is a practice that uses different treatment modalities to improve function in dogs with various orthopedic or neurological injuries or diseases. It is commonly used post-operatively in dogs having had a fracture repaired or even back surgery to fix a blown disk (yup, dogs get these, too). It is also commonly used in the ever-increasing problem of canine obesity.
I became especially interested in canine rehab after a conference in Toronto, where I met two certified rehab vets who do rehab work at a veterinary surgical practice north of Toronto (click here to see this practice and its impressive facilities). These vets were young, enthusiastic, and were truly making a difference, a significant difference, in the lives of these dogs.
This interest has brought me to Colorado, where I am right now typing this blog. I have just completed the first of at least three 6-day courses that eventually lead to a certificate in canine rehabilitation, through the Canine Rehabilitation Institute, or CRI.
I cannot sufficiently laud the course, instructors, assistants, and facilities. They were spectacular. Though it has been about eight years since I had to absorb that much material, it was an amazing learning experience.
By no means was the course simple. On the contrary, I often had difficulty with some concepts. In the end, though, I believe I gleaned what was necessary.
I am looking forward to the other canine rehab courses and extremely excited to incorporate rehab into my work in the near future.

Got this photo on Flickr. This is Zeke on an underwater treadmill after knee surgery. This exercise will significantly hasten his return to normal function. Isn't this amazing?

Cloned dogs

2008-05-23T09:15:00.006-04:00

Reading about a recent offer by a California biotech company to clone five dogs has left me with a queasy feeling in my gut. An auction will be set up with bidding starting at $100,000. I cannot fathom the arrogance of somebody willing to spend that kind of money to clone their pet. 1) That money could be used for something far more noble, and 2) the cloned pet will simply be that animal's physical twin. Again, a replica. The same model, but with far different software. The cloned pet would likely NOT have the same personality as the original. It would require the same programming, or training. 3) There are millions of unwanted pets in North America. These people should lose their ego, go to a shelter, where they can find the most wonderful dogs. Save a life or two, instead of feeding the pockets of these multi-billion dollar corporations, likely eerily-similar to Cyberdyne Systems Corporation in "The Terminator."

Not a cloned puppy, but the work going into both is identical (though one is fiction).

Disclaimer: I am in favour of such genetic manipulation, if used to produce tissues and not living, conscious, feeling, entities. Such technology can (and will) advance the medical field immensely, to relieve suffering, improve or save lives.

Addendum: Please read the very relevant comments below from Gaya and Mel.

More painting

2008-04-25T15:03:00.006-04:00

Now that I'm idle, I've been spending much time painting - one of my true joys.
(Addendum Dec 23/08: image was changed to a recently completed piece).

A spot diagnosis

2008-04-19T16:55:00.002-04:00

Have you walked down the street, noticed a person or dog with a limp, skin condition, or other visually-obvious ailment and wondered: what is that disease? No? Well, I do it all the time. And so do many of my friends, especially those who are MDs.
Is that person afflicted with alopecia areata or universalis? Oh, that dog is limping.... is it the right or left front... hmm, let me see, oh, it's the left, no right front limb, definitely the right front (I wonder if the owners think it's the left front). Could it be an injury? Osteoarthritis? Post-op? OCD?
And the occasional dog wearing an Elizabethan collar (cone): was she just spayed? Maybe she swallowed a sock and just had exploratory surgery? Maybe much simpler: a small skin wound that she shouldn't lick?
Across the street I see an older miniature poodle with a large, pendulous abdomen, symmetrical hair loss along the back - it's gotta be Cushing's. Definitely. Do the owners know? Was the dog diagnosed? Treated?

I'm always tempted to talk to these pet owners, but decide against it. I'm sure they know what's going on...
Or maybe not?!

The person riding the motorized wheelchair, doing 30 km/hr down Queen street in Leslieville, morbidly obese, and smoking: What's your spot diagnosis?

Not a poodle, but definitely Cushing's.

Watteau: a drawing Master

2008-04-10T16:58:00.003-04:00

I found this drawing on the official website for the Louvre. It is by Antoine Watteau, a French painter born in the late 17th century. Nowhere in the Wikipedia entry for the artist, could I find any references to his drawings. He is a Master at drawing. The three-dimensionality of the subjects rendered in this two-dimensional drawing is astonishing. It appears that only three colours of charcoal or conté are used: black, sienna, and white. Perhaps an expert can tell us more.

I love this drawing (click on the image to enlarge it for more detail).

Getting antsy

2008-04-09T11:15:00.003-04:00

I've been off work for the past seven weeks and am beginning to feel antsy to get back to it. It's amazing, and quite sad actually, that we become defined by what we do and not what we are. Despite the absurdity of it, I certainly feel an element of uselessness and idleness, that I consciously think I should not feel.
I have never been off work for more than two weeks at a time in the last decade or so. I have held two jobs each for decent lengths of time. Why is it that I am feeling so antsy about getting back to work? I am trying hard, and with a moderate degree of difficulty, to take a BIG step back and just allow what is actually me to shine through. Part of that is doing, but I think mostly it involves just being.

Oh my goodness, I've gone all zen...

This dog is a biped

2008-03-27T17:45:00.005-04:00

The word biped doesn't typically elicit thoughts of canines, now does it? However, here's the story of a dog named Faith, born with a congenital deformity (the total absence of her thoracic [front] limbs). It's an endearing story that has just simply warmed my heart. Watch the story here.

Faith, as a puppy.