Find more dog breeds here!

Wednesday, July 3, 2013

Refreshed and energized.

Firstly, I wanted to thank all readers for your incredible empathy and words of encouragement. At the time of writing my last entry, I was physically and emotionally exhausted.  Once again, I am refreshed.  I have been working as a locum (relief) veterinarian for the past four months in a clinic near High Park, in Toronto.  The owner of the clinic sadly passed away and I was called to work as a replacement until which time the clinic is sold.  Working alone and being the sole decision-maker at this practice has been exactly what I have needed. It has made me seriously think about opening my own shop and becoming a practice owner.  Perhaps I will be a benevolent boss, similar to those to whom I look up, similar to those who have influenced me during my thirteen-year career.
This renewed energy has been coupled with a hitherto-never-felt connection with my city: Toronto. Why? I bought a bike and started cycling everywhere.  I am now physically connected to the city's infrastructure, palpable through the bike's tires, frame, seat, and finally through me. Extricated from the car, I can now look up, see the skyline, feel the wind, touch the roads.  Without a car for the first time in about a decade, I was gravely concerned about my loss of freedom. Nay, I have never felt more free.
A career change is still possible but such a decision, if made, will be made with a clear mind, no longer clouded and sullied by frustration, anger, and resentment.
I look forward to continuing on this path that is my life. The journey thus far has been marred with obstacles, but like a re-energized Mario, Donkey Kong can throw as many barrels at me as he wishes.    I can jump pretty high now.

Thursday, February 7, 2013

Making life-changing decisions

I have not posted for many, many months. My sincere apologies to all readers. I have been traveling and considering major life-changes since September, 2012. I am strongly considering leaving the profession entirely. This is neither easy to say nor a final decision. I love working as a veterinarian, but it does not bring me the same joy and satisfaction that it once did. I care greatly for the clients and patients, perhaps too much. This might sound pretentious but I think after over twelve years of clinical practice, I can say with at least a mild degree of objectivity that I have given it my all. I am burned out, and this is not the first time during my career in which I have felt this way. Twelve years of caring, coupled with frequent and intermittent spurts of frustration, aggravation, anger, sadness, and compassion, have ultimately led me to where I am today. I am sad, but not afraid to walk away from something that is chronically detrimental to my health. All of this said, I am currently on a "journey" of exploration, both literal and existential. And again, I have not given up on being a vet. I'm simply looking beyond. Please keep posting your wonderful comments, and let me know if there's anything specific you'd like me to write about!

Tuesday, May 8, 2012

Spinal disease in larger species. Maladies spinales chez especes geantes.

Pathology exists in every species, including extinct ones. That's right, dinosaurs had diseases and modern science can be used to study them (called paleopathology). Can you imagine a T-Rex with a fractured tibia? One whip from the tail of a brachiosaur would likely do it. Osteomyelitis (bone infection) was likely common in those species having survived a deep bite from an enemy. Modern molecular biology techniques were used to sequence protein sequences in a 68-million-year-old T-Rex and showed that out of all extant (not extinct!) species, they most closely relate to chickens, adding proof that these gynormous ancient lizards were most closely related to birds, not reptiles! While I am lucky I don't have to treat Archaeopteryx for a broken wing, I find this field of study absolutely mesmerizing
Here there is bony proliferation on the spine of a dinosaur, likely a result of chronic infection or a tumor. This ancient creature must have suffered terribly.

Friday, March 9, 2012

Linear foreign body in a cat. Corps étranger linéaire chez un chat domestique.

The diagnosis was simple. A lovely, older, intelligent lady who's a nurse, came in with her son and their sick pet. The cat had very recently swallowed some string or yarn, while the owners noted that the cat had vomited up a large piece of string, had bitten off the portion that was brought up, and then swallowed the remainder of it once again.
Regular x-rays demonstrated plication (or folding) of many portions of the small intestine along with pearly gas pockets often seen on x-rays when the pet has a linear foreign body (rope, string, yarn, etc).
The owner called her old fashioned husband who declined to have us perform the life-saving surgery required in this case. They cried, took the cat home, and promised to work on Dad. The cat was sadly discharged with pain medication and the owners were advised that a decision would have to be made by the following morning, lest the poor cat suffer a long, painful death (and remember, veterinarians - in Ontario at least - are obligated to report cruelty and/or suffering, this obligation was firmly planted in my mind should they not return within 24 hrs with some sort of decision.
Happily, the owners called me within ten minutes of arriving home and pleaded, "Can we come back for the surgery right now?" The clinic would be open for less than three more hours... "Of course," I replied.
Surgery was performed by my boss. Pictures speak louder than words:

A portion of the small intestine of said cat with intestine completely plicated like an accordion. This is a typical finding in linear foreign body obstruction cases. The string was found in the entire GI tract, from the stomach all the way down to the colon. The tissue was healthy and bowel resection was not necessary. This cat, as all pets often do, made a remarkable recovery.

Tuesday, February 7, 2012

Horner's syndrome (take 2)

By far, my first post on Horner's has received the most comments. Horner's syndrome is not a disease but rather a constellation of clinical signs resulting from sympathetic (not empathetic!) pathology that courses circuitously from the brain to the eye after running down a portion of the upper spine. If I were to run down the street after you, brandishing a knife or other threatening weapon, your sympathetic nervous system would kick in: your pupils will dilate, your eyes would bulge out, your eyelids wide open, and you'd run like heck. In animals (and people) with Horner's syndrome, the sympathetic branch to the eye is disrupted. Therefore, they exhibit a droopy eyelid, miotic (constricted) pupil, a sunken eyeball, and a prolapsed third eyelid (we lost our third eyelid a long time ago so don't worry if you don't have one).
Most cases of Horner's are idiopathic - we don't know why it happens, not due to anything serious, and tends to disappear after a few weeks or months. That said, not all cases can be dismissed without concern. Causes of Horner's syndrome are myriad: middle ear infections, polyps, tumors/cancer, hypothyroidism, spinal disease, thoracic (chest) disease, and more. Even pulling too hard on a dog's leash and ear cleaning (especially in cats) can cause Horner's. Pets showing signs of Horner's syndrome should have a thorough physical exam done by a veterinarian. Keep posting and thanks for all the comments!

(in virtually all cases, unlike dogs, Horner's syndrome in cats has a primary cause. Photo from vision4pets.com.)

Monday, November 21, 2011

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

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.

Saturday, October 15, 2011

Park worm

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).

Wednesday, August 3, 2011

Herpes in cats...

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).

Friday, May 6, 2011

"It's okay..."

"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!

Tuesday, April 19, 2011

Too many pet foods, too little time...

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...

Saturday, February 5, 2011

Food allergies

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

Tuesday, January 18, 2011

Dressing dogs up... take 2

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!).

Friday, November 19, 2010

Pica

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.

Monday, October 11, 2010

A vet's job

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.

Monday, October 4, 2010

Fat pets

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.

Tuesday, September 14, 2010

More on allergies in dogs and cats


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.

Friday, August 13, 2010

Horner's syndrome, revisited, again

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.

Wednesday, July 14, 2010

"Holistic"

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.

Wednesday, June 16, 2010

Familiar species?


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.

Monday, June 7, 2010

Ringworm in a shelter

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.

Sunday, May 2, 2010

Meningitis in a dog

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.

Monday, April 12, 2010

Mourning in dogs

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.

Saturday, April 3, 2010

Whoa, this is interesting:

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.

Thursday, March 25, 2010

Dogs don't think like us

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.

Friday, March 19, 2010

Addendum: take 2

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).