You Make The Diagnosis: Vaginal Discharge In A Dog

Pictured below is the rear end of a middle-aged female dog. Her tail is to the left and her legs are pulled forward, to the right. The dog had a normal heat cycle four months prior. The owners noticed that she was sleeping more than normal and picking at her food. A day later, they noticed a thick, green-colored vaginal discharge. Study the image below then answer the following questions: What does this dog have? How is this condition treated?

 

Diagnosis: Pyometra

Pyometra is a life-threatening condition in female dogs.  It occurs weeks to months after a heat cycle. Increased progesterone levels cause hyperplasia of the endometrium of the uterus. Add bacteria to the mix and the result is an infected uterus. If the cervix is open as in this dog, the pus will drain out of the vulva making the diagnosis easy. If the cervix is closed, the diagnosis requires diagnostic tests (x-rays and/or ultrasound). 

Treatment is simple, spay the dog. The pus-filled uterus must be removed quickly or the dog will die of septic shock. This dog was one of the lucky ones, she made it through surgery and made a complete recovery after several days in the hospital. 

    

Veterinary Insulin Syringe Recall

Med-Vet International has issued a voluntary recall for insulin syringes distributed across the United States. The 1/2cc U-40 syringes were labeled incorrectly. The affected syringes were labeled as 40 units per 1/2 cc when they are actually 20 units per 1/2 cc. If used as labeled, only half the desired dose of insulin will be administered to the patient. Under dosage usually results in hyperglycemia. The most common clinical signs of hyperglycemia (increased blood glucose levels) are increased thirst and urination. So far, the U.S. Food and Drug Administration is not reporting any injured patients.

If you used Med-Vet International 1/2 cc U-40 with 29 gauge 1/2 inch needles, please check the packaging. Lot number 20120610 with an item number of MV1/2CCINS-40 or 1/2CCINS-40 by Oasis are the problem syringes. Please contact the company at 1-800-544-7521 or customerservice@shopmedvet.com for further information. 

Source:
http://www.fda.gov/Safety/Recalls/ucm386613.htm 

A Better Pill To Swallow

    Do you and your pet hate needles? Rani Therapeutics is developing a robotic pill that may replace injectable medications. Currently, many medicines must be injected into the body to be effective. Insulin is a great example. If given in pill form, the digestive enzymes break down insulin, rendering it useless. To combat this, medications are placed in capsules or coated to protect them from stomach acid. Unfortunately, this approach does not work for many medications including insulin and the osteoarthritis treatment, polysulfated glycosaminoglycan. Mir Imran, the inventor behind Rani Therapeutics, hopes to change this with a robotic pill that injects medicine into the intestinal wall. 
    The technology behind this pill is amazing. Needles made of sugar are preloaded with medicine. These ‘sweet’ needles are placed inside a capsule that will dissolve in the intestine, not the stomach. When the outer surface dissolves, it exposes a valve that controls two mini compartments inside the pill. One contains citric acid while the other contains sodium bicarbonate.  When the valve opens, carbon dioxide is formed from the two compounds. The gas increases the pressure within the capsule, driving the sugar needles into the wall of the intestine. Since the first layer or mucosa does not contain pain receptors, the patient gets the medicine without the pain of an injection. Eventually, the needles will dissolve and the rest of the pill is eliminated in the feces. 

I have to caution that this technology is still in its infancy and remains in the research phase.  It is not yet in clinics or even human trials.  However, it has the joint benefits of being a potentially remarkable breakthrough in drug delivery and it is also really cool.  Here is a link to the story in the Wall Street Journal.   
  
http://online.wsj.com/news/articles/SB10001424052702304899704579389042422328308?KEYWORDS=rani&mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052702304899704579389042422328308.html%3FKEYWORDS%3Drani 

Source:
Hay, Timothy, “Can ‘Robotic’ Pills Replace Injections? Mir Imran, With Google Backing, Hopes to Change Treatment of Conditions Like Diabetes”, Technology Section, The Wall Street Journal, Feb. 18, 2014.    

         

Apoquel (Oclacitinib Maleate) for Treating Allergies in Dogs

    Treating dogs with allergies can be difficult. Ideally, I like to test them to see what is causing their allergies and then remove those elements from their environment. If the allergen can’t be removed, I place the dog on desensitization therapy by injecting the dog with small amounts of the allergen. But not all dogs respond to this therapy. In addition, some people cannot afford this kind of treatment. For these dogs, steroids or cyclosporine have long been a mainstay for keeping them comfortable. Unfortunately, cyclosporine is very expensive and steroids are associated with unwanted side affects. Now, there is a new drug to help keep dogs with allergies comfortable. 

    Apoquel (Oclacitinib Maleate) by Zoetis is another therapy for itchy dogs. Apoquel stops itch by targeting the cytokines that cause inflammation and scratching. The most common side affects are vomiting and diarrhea. Apoquel does not cause excessive thirst and urination which are often associated with steroid therapy.  It should not be used in dogs less than a year of age or in dogs with concurrent infections. Besides treating flea allergies, contact allergies and atopic dermatitis, the drug is reported to also control food allergies. What excites me the most about this drug is that it can be given to dogs while they are being tested. It can also be used with NSAIDS used to treat osteoarthritis.  

    Unfortunately, Apoquel may cause problems in some dogs. According to Zoetis, this drug may increase a dog’s susceptibility to infections, pneumonia and Demodex mange. It may exacerbate certain types of cancer as well.  Please note this drug is not for use in breeding or lactating dogs. 

More information is available at:

https://online.zoetis.com/US/EN/Products/Pages/apoqueldvm/Index.aspx

Cats Who Attack Visitors At The Door

    When I have visitors to the house, my cats head for their favorite hiding spot. As soon as the guests leave, they come running for attention. But not all cats behave this way.  Some cats have the opposite response. Instead of hiding, these cats actually attack any visitor who dares enter their domain. As the aggression and injuries escalate, people either stop having guests or get rid of the cat. There is a third option . . . behavior modification.  With patience, these attack cats can be helped. The following is how I work with aggressive cats.
    The first step is to have the cat examined by a veterinarian to make sure it does not have a health problem that is causing the behavior. If the physical exam and lab work are all within normal limits, I look into the cat’s history. Orphans and kittens who where weaned early miss learning many important lessons from their mothers and siblings. These cats are prone to displaced play aggression which means they mistake people for toys. People often compound this behavior by letting kittens chew on their hands or chase their feet. I also ask about any traumatic experience the cat may have had. Fear aggression is common after a frightening experience.
    After a thorough history, I look into the cat’s environment and behavior. Some cats develop fear aggression because there aren’t any places for the cat to escape. I had one patient who became aggressive toward children after the client’s grandchildren came to visit. Despite their grandparent’s instructions, the kids chased the cat all over the house.  When they cornered him in the bathroom, the cat struck back. Without knowing it, the children trained the cat to be aggressive because they left once he attacked. If there had been safe spots for this cat to escape to, he would have never become aggressive. Environment plays a huge role in fear induced aggression.  Most of these cats are anxious because they don’t feel secure in their environment. Surprising an anxious cat with a loud noise, a stranger in the house or touching them may trigger a violent outburst. 
 
Treatment for displaced play aggression and fear aggression are similar.
1) Remove all triggers from the cat’s environment to prevent further outbursts. If the cat is anxious, medication may be needed for a period of time.
2) Place the cat on a twice a day feeding schedule – no more free feeding. 
3) Teach the “come” command. After a few days on the twice per day feeding schedule, it is time to start. I know this sounds impossible, but it really isn’t. Take half of the cat’s normal meal and use it for training. Place a small amount (one mouthful) on a spoon.  Allow the cat to eat it while sitting at your feet. Now walk a few feet away, call the cat and feed it again. As the cat catches on, move further away until it will come even when you are out of sight because it knows food is waiting.  Keep practicing this command until the cat will come running from anywhere when you call.
4) Stop rewarding bad behavior. Shrieking or pulling away when the cat turns aggressive is a mistake.  Use a toy or a tasty treat to change the dynamic. Toss the food to them or use a wand toy to keep your hands away from harm.
5) Exercise the cat twice a day for 15 minutes to help them let off steam. I use a feather wand with my cats. Let the cat catch and “kill” the toy often.  This will teach the cat to play with toys, not feet and hands. I do not recommend laser play because the inability to catch the dot can lead to frenzied play syndrome. Also, looking into a laser can lead to eye damage. Keep lasers out of your cat’s eyes at all times!
6) Provide plenty of safe places, especially high ones, for the cat.  When given a choice, most cats will choose to escape instead of fight. It will also decrease anxiety.
7) Place a Feliway diffuser in the area where the attacks occur.
8) After you have implemented the above steps, it is time to teach the cat to associate visitors with good things. Have a visitor stand at the door. When the cat appears, call it to come to you for a treat. When the cat is comfortable with this, allow the visitor inside. Again, reward the cat with a special treat. Eventually, have the visitor toss the cat a tasty treat. My cats will do anything for cooked chicken.  Slowly, the cat will learn that visitors bring special treats.

Remember, patience, patience and more patience!  Your cat’s aggression has developed over time and it will take time to reverse it. Consistency is key with cats. 

Coated With Fur: A Blind Cat’s Love Launch Party

Tuesday, Feb. 11th was the launch party for my second book, Coated With Fur: A Blind Cat’s Love.  We gathered at Changing Hands Bookstore. The night started with fun stories about the human-animal bond as well as some of the animals in the book. After the talk, we celebrated with cupcakes and a book signing. For those of you who couldn’t join us, I wanted to find a way for you to participate. I decided to give away a free e-book of the first in the series – Coated With Fur: A Vet’s Life. To get your copy, simply subscribe to this blog. Within 24 hours, I will send you a coupon code for Smashwords.com with instructions on how to download my book to any e-reader.  If you are already a blog subscriber, thank you! Send me an e-mail and I will send you one as well. Below are some images from the event at Changing Hands. Enjoy!

Please note, this offer for the free e-book will expire on February 28th, 2014.


You Make The Diagnosis: Name This Eye Condition In Dogs

Pictured below is a dog who presented on emergency for an eye problem. This little guy was trying to steal a toy from another dog. The family heard him yelp and found him looking like this. Examine the image below carefully then answer the following questions: 1) What is this condition called? 2) Can it be reversed? 3) How will it affect the dog’s vision?

Diagnosis: Proptosed globe 

Unfortunately, this little dog proptosed his globe which means he popped his eyeball out of the socket. Brachiocephalic breeds with large eyes are prone to this condition because their sockets are often very shallow. A blow to the top of the head, above the eye, can dislodge it. I have also seen this condition occur when a toy breed is grabbed by the neck and shaken violently. Surgery is required to push the globe (eyeball) back into the socket. After it is replaced, the eyelids are sutured shut for two weeks to keep it in place. If the eye is replaced quickly and the optic nerve was not severed, there is a chance for this eye to see again.  In severe cases, enucleation may be the only treatment to make the dog comfortable.

This dog was one of the lucky ones! His family brought him in immediately and his eye was replaced within twenty minutes of being proptosed. He went on to make a full recovery.

Pet Dental Health

Many years ago, the American Veterinary Medical Association dedicated February to promoting dental health in pets. When I am in the clinic working with animals, most dogs and cats I see over the age of four have some sort of dental problem. In dogs, I see chipped teeth, inflamed gums and lots of tartar on the teeth, especially on the back molars. Beside the problems listed above, cats also suffer from a disease called feline odontoclastic resorptive lesions (FORL’s).  These destroy teeth.  The following picture shows a FORL in the lower canine (fang) that has destroyed the base of the tooth.

Since dental disease is painful and affects general health, it is important to keep your pet’s teeth clean. 

https://www.avma.org/Events/pethealth/Pages/February-is-National-Pet-Dental-Health-Month.aspx

Coated With Fur: A Blind Cat’s Love Launch Party

You are invited!  If you find yourself in Arizona next Tuesday February 11th, please join us at 7:00 p.m. for the Launch Party.  We will celebrate animals and this new book – the second in the Coated With Fur series.  I am eager to hear if you like the book.  So please join me at Changing Hands Bookstore as we explore the wonders of the human-animal bond.  

Here is a link to the event;

http://changinghands.com/event/nelson-feb14

Protect Your Pet During the Superbowl Game

Super Bowl Sunday is here again with all the food and festivities.  Before the party begins, take a few minutes to protect your pet.  Here is a list of the most common accidents I see on Super Bowl Sunday:
1) Dogs and cats hit by cars – When guests arrive, pets sometimes escape through open doors and windows.  Often, a door is left open for ‘a minute’ to get something from a car.  Often times, the pet’s absence isn’t noticed until after the game.
2) Alcohol ingestion in dogs.
3) Drug ingestion – This usually occurs in dogs when they get into the owner’s stash.  The most common one is marijuana brownie ingestion.
4) Second hand drug intoxication – When people smoke marijuana, it affects the animals in the home as well. I have seen many dogs, a few cats and one bird who was high from second-hand smoke. 
5) Foreign body (chicken wings) ingestion in dogs – plates of unattended food containing ribs, chicken wings, etc. are irresistible to dogs. I treated two labs who ingested over 100 drummies from the garbage.  Some animals require surgery to remove bones and other foreign bodies from their gastroenteritis-intestinal tract.
6) Pancreatitis in dogs and cats who get into food meant for humans.  These animals vomit and are unable to keep anything down, even water.  I usually see them the day after the Super Bowl.
7) Stress induced gastroenteritis-enteritis – Having a lot of people in the house, particularly if they scream and cheer is very stressful to animals.  Some pets become so upset that it causes vomiting and diarrhea, often bloody.  Blood tests are necessary to differentiate this condition from pancreatitis. 

Keep your pet safe by planning ahead. Place them in a secure area to prevent escape and keep them from getting into things that are not meant for them. If they are extremely nervous, consider leaving them with a friend, boarding them or talk to your veterinarian about anti-anxiety medication.  Take these few easy steps now to prevent a terrible and expensive problem later.