You Make The Diagnosis: Diseases Found In Soft-Coated Wheaton Terriers

This handsome boy is a Soft-Coated Wheaton Terrier named Satchel.  He is a high energy, curious, healthy dog who enjoys life to the fullest.  Unfortunately, this breed is also prone to four serious medical problems.  Name the diseases.  This is a difficult challenge so there are bonus points to those who know all four. . .  

The four diseases are:      1)  Protein-losing Nephropathy (PLN)
                                             2)  Renal Dysplasia
                                             3)  Addison’s Disease 
                                             4)  Protein-losing Enteropathy (PLE)

PLN is a kidney disease in which large amounts of protein are lost in the urine.  Dogs with this problem often lose weight, have a poor appetite and drink tremendous amounts.  In PLE, the protein is lost through the intestines instead of the kidneys.  Common signs of this problem are vomiting, diarrhea and weight loss.  In severe cases, fluid might accumulate in the abdomen giving the dog a pot-bellied appearance.  Animals with either of these diseases may throw blood clots before other symptoms are noticed.  In Renal Dysplasia the kidneys do not develop properly.  The abnormal morphology (structure, size or shape) predisposes these dogs to renal failure.  I suspect this problem when I examine puppies who are not developing normally.  Addison’s disease is also called hypoadrenocorticism.  In this disease, the adrenal glands do not function properly.  These animals are depressed, weak and may collapse without warning.  

In order to catch these diseases early, I recommend the following tests on an annual basis: Complete biochemical profile, CBC (Complete Blood Count), urinalysis and either a urine protein/creatinine ratio or an ERD (Early Renal Disease) screen for microalbuminemia.  If abnormalities are found, additional tests to consider include an abdominal ultrasound, ACTH stimulation test, fecal alpha -1-protease inhibitor test and tissue biopsies.  

As is so often the case, early detection is critical.  While none of these diseases can be cured, they may be treated to lessen severity or slow disease progression.  I am happy to say that my friend Satchel is free of these conditions.  He is a wonderful dog and always a joy to see in the neighborhood.   
 

Bedside Manner

For the last several days, I suffered from a severe case of food poisoning.  I owe a debt of gratitude to a wonderful cat named Genevieve.  This magnificent cat stayed with me through the entire ordeal.  Genny slept next to me or on top of me for two solid days.  She also followed me whenever I left the bed.  When things were really bad, she sat by my head, touched my face with her paw and purred.  Those who read my original post about her know that she was an orphan.  This tortie (tortoise shell) was brought to me at a day old missing the lower part of her back right foot.  In the beginning, she was the most ungrateful cat.  Now, with seventeen years together, it was precious to have her by my side.  Genny reminded me that the best care in the world often involves the gift of touch and of quiet presence.  Thanks Genny for the wonderful nursing care.  You’re the best and have a purrrrrrrrfect bedside manner! 

Tribute To Cristy Iverson, D.V.M.

The following is a tribute to Dr. Cristy Iverson.  Yesterday I attended a beautiful celebration of her life at Shepherd of the Valley Lutheran Church.

Last summer, my husband heard a pathetic meow when he walked into a gas station.  A feral kitten was trapped in the downspout.  The employees poured water down the roof drain and washed him out (this is a bad idea by the way).  The poor little tan kitten with chocolate brown swirls looked like a drowned rat.  The next day, I brought him with me to Alta Vista Veterinary Hospital hoping someone would give this little guy a permanent home.  

 
Dr. Iverson spotted the furball hiding behind a towel.  The card on his cage read ‘Michael’ in honor of Olympic swimmer Michael Phelps and the kitten’s close call with water.  Even though Dr. Iverson knew it would take a lot of patience to tame this feral boy, she brought him home that evening.  From that day forward, Dr. Iverson updated me on Michael’s progress every time I worked with her.  She showed me pictures of him on her cell phone and regaled me with funny stories as he grew into his big paws.  Her face beamed when she talked about her animal kids.  
 
At her desk in the clinic, Dr. Iverson displayed a picture of her human children.  She taped a picture of Lindsey and Greg holding Cody and Trevor above her desk.  When I asked her if the handsome family was hers, she stared at the picture for a minute and then nodded.  A warm smile spread over her face.  She glowed as she told me funny grandma stories.  Cristy really loved her children and grandchildren!  She could not wait to welcome her third grandchild into the family.
 
There are many ways to describe Cristy Iverson including talented bell ringer, the only science major in the ASU choir, gifted veterinarian and devoted mom.  But the best description I heard came from a surgical technician named Rochelle.  When I asked her to describe Dr. Iverson, she said, “I love Dr. Iverson.  She’s a teddy bear to work with.”  I could not agree more.  I will always remember Cristy as a blonde teddy bear with gifted hands, a quick mind and a huge heart filled with love for the people and animals in her life. 
 
Rest in peace Cristy.  Your life made the world a better place.  We will miss you!
   

Questions Regarding The Euthanasia of Macho B

As a veterinarian, media reports and other sources raise serious questions in my mind regarding the entrapment and death of Macho B.  Through posting the questions here, I hope to encourage those conducting the criminal investigation and other inquiries to go as deeply as the evidence leads.  Jaguars are an Endangered Species so we must find the truth no matter how distasteful.   

1)  Was Macho B given fluids during his initial immobilization?
    
Renal problems are common in older felines of all kinds.  In addition, anesthetic drugs used for immobilization may decrease renal blood flow and exacerbate underlying disease.  Fluid administration is the primary method used to combat these issues. 

2)  What drugs were administered to Macho B during his initial mobilization?

Many drugs have side effects that can be detrimental to the kidneys.

3)  Why weren’t diagnostic blood and urine samples taken at the time Macho B’s initial capture in addition to samples for DNA testing?

Since jaguars have a relatively large blood volume, removing a few more cc’s of blood would have posed no risk to Macho B.  There are also portable analyzers that could be used in the field to enhance the well-being of the immobilized animal.

3)  Why in this day and age does Arizona Game and Fish still use indiscriminant leg snares?

4)  Why was the snare checked so infrequently?

Arizona Game and Fish estimates that Macho B could have been ensnared for up to 14 hours.

5)  What kind of anesthetic monitoring was performed?

With so many portable monitors available there is no reason to rely on respiratory and heart rate monitoring alone.

6)  Why did Dr. Dean Rice, a veterinarian at the Phoenix Zoo diagnose Macho B’s azotemia as renal in origin as opposed to pre or post renal?  What did he do to rule out the other causes?

Increased BUN and creatinine are called azotemia.  Azotemia is further divided into prerenal, renal and postrenal causes.  Prerenal azotemia is often caused by dehydration while a urinary obstruction causes post-renal azotemia.  

7)  What was the specific gravity of Macho B’s urine prior to fluid therapy?

Specific gravity is used to measure the concentration of urine.  If an animal is dehydrated, the kidneys conserve fluid by excreting less urine.  If the animal is overloaded with fluids (overhydrated), the kidneys actively secrete larger volumes of dilute urine with a low specific gravity.  In kidney failure, the kidneys lose their ability to either concentrate or dilute urine.  Urine is formed with the same specific gravity as the glomerular filtrate.  

According to the Arizona Daily Star “Did Macho B have to die?”,  the concentration of Macho B’s urine was low on a sample taken after his death.  In my opinion, since the cat was on fluids for several hours prior to his death, these results are of questionable diagnostic value.  

8)  Was a complete urinalysis performed prior to euthanasia?  If so, what were the results?

Besides specific gravity, a complete urinalysis looks for other abnormalities including red blood cells, white blood cells, casts, protein, crystals, etc.  Since capture myopathy was a concern, the urine should have been checked for myoglobin as well.

9)  Why does Dr. Rice believe high creatinine and BUN values mean there was no hope for Macho B?

I have personally treated many domestic cats with equally high values that made a complete recovery with fluid therapy.  One cat ingested Easter Lilly pollen and had values higher than Macho B’s.  I always recommend at least twenty four hours of fluid therapy to see if the animal will respond before recommending euthanasia.  Dr. Dial’s findings concur with my clinical experience and medical training.  

10)  Was Dr. Rice in over his head?  Did Dr. Rice consult with experts for further methods of fluid administration in large cats?  If so, with whom did he consult and what did they recommend?  If no consultations were undertaken, why not?

In an article titled “Feds launch criminal probe of jaguar death” Arizona Republic, April 3, 2009, Dr. Rice stated:

“The question becomes:  How do you treat this animal? Keep him sedated for days?  That’s no good.  You wake him up, you knock him down.  You wake him up, you knock him down.  That’s not good for the cat.  It would be tough for a zoo animal, and this was a wild animals.  . . . I think it was virtually impossible to treat him.”  

Had digital radiographs and ultrasound recording been performed, they could have been sent electronically to experts around the planet for additional perspective and help.

11)  Were a CBC and chemistries performed on Macho B prior to fluid therapy?  If so, what were those results?  If not, why not?

12)  What diagnostics were performed on the swollen paw?  What were the results?

The Arizona Daily Star reported in an article titled “Jaguar may have experienced ‘capture myopathy”, that the paw trapped in the snare was swollen.  A photo released by Arizona Game and Fish at the time of his capture confirms this fact.  The Joyce Corrigan Memorial Care Center at the Phoenix Zoo is equipped with an x-ray machine along with other equipment needed for joint taps, cultures and biopsies.

13)  In the same article, Dr. Rice states that capture myopathy was not a problem with Macho B.  How did he rule that out?

14)  Did he examine the brachial plexus of the leg caught in the trap?

In animals who get a front leg stuck and struggle to free themselves, they sometimes damage a nervous structure called the brachial plexus.  If the plexus is severely damage, the leg may be paralyzed.  Muscle atrophy may appear within 5 to 7 days of the initial injury.

15)  Was the muscular atrophy localized to one region or generalized?  If it was localized, was it confined to the leg that was caught in the snare?

16)  Were samples of the atrophied muscle sent in for analysis?  If so, what were the results? 

17)  Was an abdominal and thoracic ultrasound performed prior to euthanasia?  If so, what were the results?  If not, why not?

Ultrasound is very useful for looking at the structure of internal organs.  Since Dr. Rice diagnosed severe kidney disease, it seems reasonable that he would have wanted to look at the structure of Macho B’s kidneys to further assess them.

18)  Why does Dr. Rice believe a small bladder at the time of necropsy confirms his diagnosis of renal failure?

In an article titled ‘Biologist and veterinarians expect lab tests to provide more medical clues on collared Arizona jaguar’ posted in News Media on March 4, 2009 Dr. Rice stated “But, given the extremely small size of his bladder despite aggressive intravenous fluid therapy, it was apparent that his kidneys were shutting down.”                                                        

In oliguric renal failure, the kidneys produce decreased amounts of urine.  When urine production stops, it is termed anuria.  If an animal with either of these two conditions is given aggressive fluid therapy, the fluids will accumulate in other areas of the body since it cannot be excreted via the kidneys. 

The other cause of decreased urine production is severe dehydration.  The kidneys reabsorb all the fluid they can in this situation.  

19)  During necropsy, were any signs of fluid overload noticed?

If Macho B suffered from oliguric or anuric renal failure, the five hours of fluid therapy he received would have accumulated in his body.  Pulmonary edema is a common finding.

20)  If pulmonary edema was found, was it generalized to all lung fields or confined to one side?

Fluid tends to accumulate on the down side.  If a debilitated animal is left on one side for too long, the lungs on the down side swell.  This is prevented by flipping the animal from one side to the other every two hours.  This also occurs in anesthetized animals.

21)  Were Macho B’s brain and spinal cord examined?

Researchers noticed that Macho B had an abnormal gait prior to the second capture.  Since these two organs are vital for normal movement, I believe they should have been examined.

22)  Why wasn’t Macho B’s body sent to an independent pathologist for a complete necropsy instead of having the same veterinarians who treated him perform a cosmetic one?

Allowing the same people to treat, decide to euthanize and then necropsy Macho B brings into question their findings.  To be more direct, in my opinion this is beyond the pale of reason and ethical medical practice.  If criminal intent be found, think of the opportunity this could afford a person seeking to cover-up their acts and omissions.  Not only do I believe this inappropriate in the case of Macho B, I find this typical practice at the Phoenix Zoo to be a major structural flaw in their standard operating procedure.    

23)  Why was a cosmetic necropsy performed instead of a thorough one that would yield far more information about the health of Macho B?

In my opinion, this was a missed opportunity to learn more about this endangered species.  It was also a grave disservice to this individual animal. 

24)  Why weren’t sufficient samples taken to diagnose capture myopathy?

According to the Arizona Daily Star, “the sort of necropsy performed by the veterinarians at the Phoenix Zoo did not provide enough information to determine whether he had the disorder, two outside veterinarians said .” 

25)  Why is Arizona Game and Fish viciously attacking Dr. Sharon Dial for simply stating her professional opinion? 

From the data I have gathered thus far, her opinion seems well-grounded in fact and medicine. 

26)  Why was Macho B euthanized at 5:15pm after only five hours of fluid therapy?

The Joyce Corrigan Memorial Care Center is designed for 24/7/365 care.  It has a cot, kitchen and shower.  In 2005, Dr. Rice abandoned a critically ill gazelle in the hospital.  She was found dead the next morning. 

27)  Did U.S. Fish and Wildlife and Arizona Game and Fish obtain any second opinions from independent large cat experts prior to euthanasia? 

28)  Why is Arizona Game and Fish calling this an inadvertent capture?

In an article contained on the Arizona Game and Fish web site titled “The Story of Macho B” March 13, 2009 they state “The jaguar was captured inadvertently by the Arizona Game and Fish during a black bear and mountain lion research project south of Tuscon.”  Janay Brun, a member of the Borderlands Jaguar Detection Project, stated that she baited the snare with feces from a female jaguar in her fertile cycle. 

“She said she put the scat out in the presence of a State Game and Fish employee and Emil McCain, a biologist for the project.  Brun alleges that McCain told her to place scat at the site.” (Arizona Daily Star, “I baited jaguar trap, research worker says.”)

The project obtained scat from both the Phoenix Zoo and the Reid Park Zoo.  Mr. McCain used scat to lure jaguars to cameras in the past.  He also secured a tracking collar and advice on immobilizing a jaguar prior to the capture.  It is reported that Mr. McCain is an outspoken proponent of trapping a jaguar to gather further information about the species. 

29)  Why was Dr. Rice so convinced this wasn’t a case of dehydration? 

According to the Arizona Daily Star article titled “Did jaguar Macho B have to die?”, Dr. Dial found a small area of papillary necrosis with mineral build up in Macho B’s kidneys.  Papillary necrosis occurs when the kidneys receive inadequate blood flow.  Some specific causes include dehydration, drug side effects (this is especially common with non-steroidal anti-inflammatory given after a period of anesthesia), toxins including lilies, raisins and grapes or blood clots to both renal arteries.  In 2005, Dr. Corpa published an article which demonstrated that renal papillary necrosis is associated with dehydration in large cats.  (Corpa, J. M. et al, Renal papillary necrosis associated with dehydration in large cats, Vet Record 2005;157(25):814-6.) 

30)  Why has Governor Brewer not relieved the Arizona Game and Fish individuals of duty?

 
    In summary, the questions raised are serious.  Yet many involve basic sound medical practice.  I hope the criminal investigation will not rest until all of these questions are answered in full.  It is critical that complete transparency be paramount in the process.  Dr. Rice has a long history at the Phoenix Zoo.  In addition to the other individuals involved, I am hopeful that a vigorous investigation be executed as it relates to the Zoo and Dr. Rice’s involvement.  We owe Macho B so much more.  But at the very least, we owe him that.

In Support Of Sharon Dial, D.V.M., Ph.D. And The Arizona Jaguar

Recently Dr. Sharon Dial, a pathologist at the University of Arizona’s Veterinary Diagnostic Laboratory examined tissues from a jaguar named Macho B.  Recall that jaguars are an Endangered Species.  I find pathologists to be straightforward members of my profession.  They call it as they see it based on facts and science.  She described her findings to the media which brought into question the cause of death Arizona Game and Fish is putting forth to the public.  (Arizona Game and Fish and U.S. Fish and Wildlife allowed the euthanasia after Dr. Dean Rice, a veterinarian at the Phoenix Zoo diagnosed severe kidney failure.  Dr. Dial found the structure of the kidneys were normal and that euthanasia after only five hours of fluid therapy might have been premature.)  In the face of patently inappropriate, extreme and unprofessional criticism by Arizona Game and Fish, she stood her ground.  Her courage reminds me of another pathologist who spoke out on behalf of animals and effected change at our National Zoo. 

In 2003 Dr. Donald K. Nichols wrote a letter to the Committee on the Review of the Smithsonian Institution’s National Zoological Park that documented problems with animal care at the National Zoo.  As a result, a massive investigation was launched.  Those involved in the matter lambasted Dr. Nichols.  They tried to discredit him by calling into question his motivation and professionalism just like Arizona Game and Fish is doing to Dr. Dial.  The criticism stopped with release of the Animal Care and Management at the National Zoo:  Interim Report.  The animals at the National Zoo were suffering!  The report documented severe problems including a zebra that starved to death, a elephant who suffered with an undiagnosed case of T.B. and red pandas that were poisoned.   

We as a society have an ethical duty to care for the animals.  We also must defend those who through scientific evidence reach inconvenient truths about the manner in which the Phoenix Zoo and our Government may have failed the animals.  This is particularly so in the case of an Endangered Species.  Dr. Nichols suffered horribly for standing by the animals.  He was later vindicated.  I believe Dr. Dial will be as well.  Sadly, it is too late for the jaguar.

Jean McFarland – A Friend To Animals

Animals and people lost a good friend recently.  As a professional speaker, I met Jean McFarland through the National Speakers Association (NSA).  In the course of getting to know her, I came to understand her deep love of animals.  Jean made our world a better place and focused her speaking on the prevention of bullying.  I had not realized the depth of that problem prior to meeting this grand lady.

She cared deeply for animals and not too long ago lost her chow named Drucker.  Her husband noted in the Caringbridge site that it only took Jean four weeks to go from health to hospice.  I wanted to acknowledge the difference she made for me in this note.  Rest in peace Jean.