Oh, My Aching Joints

Gena sent in a question about her dog's arthritis. Apparently, little Piglet has problems with his knees bothering him. Many pets of all sizes suffer from osteoarthritis, so this is a good topic for discussion.

When most people say "arthritis", they are meaning what doctors call osteoarthritis. This is different than rheumatoid arthritis, which is a disorder of the immune system. Osteoarthritis is wearing and tearing on the joint surfaces over time. Certain breeds can be prone to this and orthopedic injuries can increase a dog's risk of it developing. Within a joint there are some basic structures: synovial fluid, which acts as a cushion and lubricant; hyaline cartilage, which covers the bone and helps with smooth, low-friction movement; ligaments and tendons, holding bones together; and the bone itself, underlying these tissues. As a joint deteriorates, the cartilage begins to wear off. As it does, it exposes the underlying bone. When bone contacts cartilage or another bone, that touch and movement causes pain and inflammation.

Once degerative changes begin in the joint, they are pretty much irreversible. Truly degenerative joint disease (DJD) will never return to normal, and can result in some extensive changes in the shape of the bone as the body tries to compensate for abnormal movement or instability. Even surgery can only do limited things to improve the condition, and are usually small changes such as removing bone spurs.

The keys to improving the lives of arthritic patients lies in helping with pain and inflammation. This can be accomplished through several means. One that most people are familiar with is prescription anti-inflammatory medications. The category of drugs is called "non-steroidal anti-inflammatory drugs" and is commonly abbreviated as "NSAIDs". You are already familiar with these products for human use as acetominophen, ibuprofen, naproxen, and many others. In veterinary medicine we have Rimadyl, Etogesic, Deramaxx, Melicam, and several others. Though they are all in the same category of drugs, they have slightly different efficacies between patients, and slightly different potential side-effects. That's why Tylenol works better for some people than Advil, or vice-versa. These medications help to reduce pain and inflammation, and can be the only thing to really help pets. They are not without potential dangers, though, especially with continual, long-term use. Currently these medications are available only by prescription (at least, in the US), and you should consult with your vet on these options. I do not recommend using human medications in dogs unless you are under a vet's instructions to do so. Dogs and cats are more susceptible to the side-effects than humans are.

Besides prescription analgesics, there are other things that can help, and I usually recommend them as a first choice unless the patient's pain is extremely bad. Glucosamine and chondroitin supplements can work wonders, and are readily available over-the-counter. They help to increase the lubrication of the joint, and can rebuild some of the cartilage. Numerous studies have shown their efficacy, and I have seen many of my patients dramaticly improve on them. They will take 2-4 weeks to show an effect, so don't give up on them after a few days. Many pet foods now have them included in the diet, especially for large breeds. There really are no side-effects, so they're a great supplement to use. Make sure to use one designed for pets, though. Even if the basic ingredients are the same as a human equivalent, we have a different digestive system and so the ingredients may not be absorbed as well if you use a human product.

Along the same lines is MSM, a natural dietary sulfur. This is another nutritional supplement, and works differently than glucosamine. MSM will act as a natural anti-inflammatory, which can help reduce discomfort. Using glucosamine and MSM together form a two-pronged approach that may eliminate or prevent the need for NSAIDs.

It is also very, very important to get your dog to a normal weight. Obesity can dramatically increase the pain of arthritis. First, there is extra pressure on the joints that the body was not designed to hold. Second, fatty tissue has been found to produce numerous hormones and biochemicals. Rather than being an inert substance, it actually is a very active one. These chemicals have been shown to increase inflammatory reponses in the body, which is one of the problems with arthritis.

If you have a pet with arthritis problems, talk to your vet. They may recommend x-rays to assess the amount of damage, and whether or not surgery is an option (as it may be in certain types of hip disease). They will also help design a management program that best suits your pet's needs.

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Rid Of The Worms?

Here is a question from Christina...

I recently took a stray cat in to the vet for a checkup, vaccinations, etc. The vet discovered that he was "loaded with roundworms" and gave me a topical dewormer to administer when we got home, which I did. It's been about 36 hours and the cat has had 2 bowel movements, but I have yet to see any worms in his feces. Should I be worried? He is eating, drinking, and eliminating normally. How long after the dewormer was applied should I expect to see the worms being expelled?

A great question, Christina. Roundworms are a common parasite, and no surprise to find in a stray. They live within the intestinal tract, and you will rarely see them come out in the stool. If the infestation is bad enough, they will sometimes vomit worms, but that's uncommon. As long as the worms are alive, they will stay within the intestinal tract, and there may not be any obvious signs that they have them. When we examine a fecal sample, we are looking for the worms' eggs, not the worms themselves. The numbers of eggs we find will depend on several factors: the number of worms in the pet, the current state of the reproductive cycle when we get the sample, the amount of fecal material collected, and the method of preparation of the sample prior to microscopic examination. Studies have shown that it's possible to have a "negative" result, even if worms are present. In fact, there can be as high as a 20% chance that we can miss worm eggs even if the worms are present. I mention all of this because quantification of the worm eggs doesn't always correlate with the actual numbers of adult worms.

When the worms die, they may not be released into the feces all at once. It is completely normal for a cat or dog to "poop spaghetti" after a deworming, but this is less common than seeing normal feces. Just because you don't see any worms coming out doesn't mean that it isn't working. If you took each defecation and teased apart the feces, you would probably find the worms. However, I doubt that you would have an interest in doing that, and I wouldn't blame you. I wouldn't do it myself.

Hopefully your vet talked about potential human infections, as it is possible for humans to be infected. Transmission is "fecal-oral", which means that you have to ingest the eggs. This occurs most commonly through touching areas contaminated with infected feces, and then touching your mouth or food without having washed your hands. Simple hygiene will prevent transmission, such as wearing gloves or washing your hands after cleaning the litterbox. Here are some resources from the American Veterinary Medical Association....
Internal Parasites, Larval Migrans

So to answer your question, Christina, this is a perfectly normal situation. You shouldn't expect to see any worms, even if it is working. And it sounds like your cat is not in any health danger. If you want to be certain that the worms are gone, talk to your vet and have the fecal exam repeated in about 3-4 weeks.

Keep the questions coming! I really enjoy answering them!

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Missing Whiskers

Mary sends in this question...

I am writing you a question for my mom who just inherited 2 cats. One of the cats had only one eyebrow whisker on one side when she moved in, and now she has none on one side. Is this a problem? Also, is there such a thing as fake cat eyelashes? ;)

The long whiskers on a cat's face are used as sensors, and have clusters of nerves at the base. They detect subtle touch and movement, allowing a cat to more easily detect their surroundings, especially in dim light or darkness. Your average pet cat won't be harmed by their loss, and will continue in their daily lives without any problems. The whiskers are a specialized form of hair, but are still hair. Therefore they will grow, live a period of time, fall out, and be replaced like any other hair.

Missing whiskers for a short period of time isn't really a concern. However, this may be the first sign of something wrong with the skin or coat. Common reasons for hair loss in cats are fleas, skin mites, and allergies. These normally don't start with just the whiskers, so I don' t know that this would be a concern if it's limited to them. My recommendation would be to have her observe the kitty closely, and if this spreads to other whiskers or other hairs begin to fall out she should take her to a vet to be evaluated.

And no, there are no kitty false eyelashes. :)

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The Solution To Chronic Ear Infections

If the title of this post suddenly grabbed your attention, then you are very aware of the problems some dogs face with ear infections. Most dogs never have any problems with their ears. But others have life-long issues that can lead to permanent damage. If you have struggled with recurring infections in your dog, then this article is for you.

If your dog has more than two ear infections in a year, then this is very abnormal. In these cases, the ear infections are not the problem. The infections are indeed a concern, but they are a symptom of a larger problem. Infections do not happen on their own. There must be some underlying reason for it. And you will never get it fully under control until you discover and treat that primary cause.

Breed has a lot to do with these problems. Certain breeds have long, heavy ears that hang close to the ear canal, preventing good air flow. This allows moisture to be trapped in the canal, creating a warm, moist environment that is a great breeding ground for bacteria and yeast. Cocker spaniels are one of the worst breeds in large part because of this ear structure. Some breeds, such as Labrador retrievers, produce more cerumen (wax) than other dogs, which can trap microorganisms. Small, fuzzy dogs, such as shih tzus and poodles, often have hair growing from deep inside the ear canal, which can clog the canal like hair blocks a sink drain. All of these physical factors contribute to enhance conditions for microorganism growth. However, they may not be enough to make a bad problem.

Low thyroid levels are one of the most common metabolic disorders in dogs. One of the issues hypothyroidism causes is to make the patient more susceptible to infections, especially of the skin and ears. Chronic ear infections can be a result.

However, one of the primary causes of chronic infections is related to allergies. I'll likely talk about allergies in detail later, but for now realize that we're not talking about the sniffles and sneezes that people get with hayfever. With pets, allergies can be to food, fleas, grass, pollens, dust mites, and many other things. Itchy skin and ears is the result, as well as infections. Veterinary dermatologists have shown that sometimes the only sign of a food-related allergy is chronic ear infections!

If your dog is having more than two ear infections a year, you need to do more than simply putting more medicine in the ears. This doesn't really treat the problem, and can lead to more serious problems down the road. If this describes your dog, here's what you need to talk to your vet about. First, have the thyroid level checked. This is inexpensive, and many vets can do it in their hospital. If they have to send it out, the results usually come back the next day. If the thyroid level is normal, then start talking about allergies. A food trial is usually the first step, feeding a special hypoallergenic diet for 2-3 months. If that doesn't work, medication such as prednisone or cyclosporine may be needed to reduce the body's reaction to allergies. If these don't control the problem, your vet may recommend sending you to a veterinary dermatology specialist.

Treating ear infections should always involve trying to cure the current outbreak with appropriate medications. But if it keeps coming back, you and your vet should try to figure out why, and treat that main problem. Doing so will save you money and your pet discomfort.

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The Slow Season

Did you know that veterinary medicine is a seasonal business? Well, at least here in the US it is. I've never completely understood why, even though I know some of the factors.

Summer is the busy time for us. We see more frequent skin and ear infections, flea problems, and allergy issues. These are complaints that happen more frequently in warm weather than in other times of the year. However, we also see more pets for routine preventative care. The increased number of clients is likely because of several influences besides medical need. Many parents have summers with more free time because they are home with the kids and don't have to worry about school schedules. People need to have their pets ready for boarding, getting them up to date on vaccines in preparation for taking them to kennels while the human family goes on vacation. There also seems to be more discretionary income available.

By contrast, the winter months are very slow for us. Extra money is spent on Christmas rather than the pets, and people tend to get into a greater financial crunch around this time of year. Cold, dry air isn't good for fleas, and is more forgiving to skin problems, so these issues tend to go away for the most part (depending on the part of the country). And since we are now in December, yes, we're becoming much slower and I am getting caught up on some reading that I didn't have time to do in the Summer.

We as a profession have learned how to deal with this seasonality. While many businesses hire seasonal help during November and December as the Christmas shopping season happens, we hire Summer workers to aid in the extra business. Sometimes we'll plan building or cleaning projects for January or February when we know there won't be many clients around. We hate having to reduce employees' hours as the holidays approach, but it's also necessary in order to stay in business.

Apparently, seasonal variations happen in other non-retail businesses. I spoke to my kids' pediatrician once, and she said that because of colds and flu their client flow is seasonal also, but with the height during the winter months. I'm curious as to whether non-American veterinary practices see a similar pattern.

Just another view behind the scenes of a veterinary practice!

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Why Do You Have A Pet (a.k.a. Pet Peeve #4)?

This is perhaps a subset of Pet Peeve #1 (go back and find it at the very beginning of my blog). I talk to people who have a pet and sometimes hear "it's only a (dog/cat/hamster/parakeet/etc.)." I have clients who put their dog or cat outside, and pretty much let it fend for itself. Sure, they provide food for it, and maybe get vaccines done, and if I'm very lucky they will make sure it's on heartworm and flea preventions. But they don't spend time with it, don't train it, don't interact with it, and don't really make it a part of their family. The pet just kind of exists as something they have.

We have come a long way in Western Civilization in our attitudes towards pets. One hundred years ago they were largely there to help around the farm, kill mice, and protect us. However, there have always been dogs and cats raised purely for companionship. Look at the history of some of the breeds, and look at pictures of royalty. There were often ornamental dogs, bred to be small and exotic-looking, and bred to have behaviors that make them good companions with no ability to hunt or otherwise provide a useful skill. In the last century, we have progressed to where the "working" dogs are the big minority, and most people have them as family pets. It's also gotten to the point that we now have monogrammed dog beds, sweaters, Halloween costumes, and other things that make them into little people. The bond between pets and people has grown closer, until now they sleep in our beds and we treat them as our children. And I am of the opinion that this is a good thing.

Having a pet is a big responsibility. You are their sole provider, and it's your duty to provide them with good shelter, adequate medical care, proper nutrition, and see to their well-being. But many people forget about their mental well-being, and this is just as important. These are not wild animals, and have been specifically bred for millenia to be close companions to us. Do you keep your dog outside in a pen or on a leash and only see it when you dump some food in its bowl? Do you cringe when the dog tries to play with you or jump on you out of love and seeking attention? Does your dog have some behavioral issues because it's been left by itself and you never really gave it proper training and socialization? Is your pet becoming an inconvenience and a frustration because caring for it hampers your lifestyle? If you answered yes, then I have to be blunt....why do you have a pet at all?

Many people get dogs and cats (and other pets) because they think it will be fun, and don't really think about the responsibility. When the pet turns out to need care and attention, it bothers the people. Basically abandoning that pet and ignoring it is actually potentially cruel. And it really frustrates people who strongly care for pets and have close bonds with their own. Those readers who are in the pet care or veterinary fields know exactly the people I'm talking about.

If you're one of the people these people that I'm talking about, please stop, look outside, and look at your pet. Is what you're doing really fair to them? Do they have a good life? Is ignoring them really being a responsibile pet owner? Starting today, make a promise to me and yourself that you will embrace that pet, give them the care and training they need, and make them a member of your family. If that dog or cat is really an inconvenience to you, then please consider giving it to someone who really wants to care for it properly, and will give it a better home...because I promise you that if you see it as an inconvenience and are mostly ignoring it, then you are not the right person to be caring for it. And if you end up giving this pet up, please, please, PLEASE think long and hard before getting another pet, and make sure you're fully 100% ready for what it takes.

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The Weather Outside Is Frightful

Winter is coming, and that means we need to be aware of the weather changes with our pets. Here in the US there are huge differences in weather, from Maine to the Dakotas, Florida to Oregon, California to Georgia. But regardless of where you live there are some guidelines to remember. Most of our pets, especially dogs, aren't really well designed for living outside. We've bred them to be dependent on us, and often have bred coats that don't do well in cold weather. Smaller breeds are especially at risk for this.

Most dogs can do well outside, though long-haired breeds are much more likely to have problems with matted fur. However, dogs that aren't arctic breeds shouldn't be outside in cold weather. A dog house with fresh straw or hay is needed to help keep them warm and well-insulated. The bedding should be changed regularly to keep it clean and hygenic and to prevent insects and parasites from growing. Outside dogs should also have shelter from rain or other precipitation. Don't use heaters in dog houses, as they are a potential fire risk, and we definitely don't want that to happen!

As a rule of thumb, I tell my clients that if the weather is going to dip to freezing or below, pets should be brought inside. Certain breeds, such as huskies, malamutes, St. Bernards, and other thick-furred dogs can do well outside in cold weather with appropriate bedding and insulation. But most breeds cannot tolerate these temperatures, especially small dogs or breeds with short hair. I know that many people have kept dogs outside year-round, so I can't completely argue that. But often that is in warmer climates, or they have very well insulated dog enclosures. The average pet owner likely isn't going to have good preparations for that.

What if your dog is large, or messy, or particularly rowdy and you simply cannot or are not willing to bring it inside your house? Well, a garage is always an option, and is going to be warmer and have better conditions than being outside. If you still can't or won't do that, I'd have to be blunt and ask why you have a dog (again, I can be more direct here than with my own clients). As a pet owner, you have a responsibility to provide them with proper care. Pets can also be extremely rewarding, and bring a lot of joy, fun, comfort, and companionship. If a dog is simply going to be outside all of the time, you might want to seriously think about why you have it.

Now, those of you who have kennels with many dogs for breeding or hunting, I'm not really talking about you. I know plenty of people with these circumstances that interact with and train their dogs daily, and give them excellent care. Admittedly some people simply have so many dogs that it's impossible to bring them all inside. In that situation, make sure they have appropriate places to stay when outside.

The weather is getting colder, and we need to think about our little fuzzy friends. Take care of them and think about whether or not you would want to sleep outside during the winter.

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Pet Peeve #1

I'm going to go ahead and get this off my chest as an early post. Please forgive me if I step on anyone's toes, but this is a big pet peeve of mine, and one I deal with almost daily. I never get to say this directly to my clients, so pardon me if I vent a bit.

If you have a pet, set aside the money to take care of it! Pet ownership is NOT a right. If you have a pet, you have a great responsibility to care for it. Yes, this costs money. Sorry, but that's the reality. If you take shortcuts (not getting vaccines, not using heartworm prevention, etc.), you are putting your pet's health at risk, and will possibly face some very expensive treatments. As a responsible pet owner, you need to set aside several hundred dollars per year for veterinary care, good quality food, and preventative medicines (flea and heartworm prevention). I also recommend to set up a separate fund of about $500 just for any emergencies.

Let me give you a couple of examples. Virtually every day I have a client come in just for a rabies vaccine. They do that because it's required by law, and grooming facilities require at least this one vaccine. Depending on your location, it's only about $10-20. However, the client will decline any other vaccines (for diseases that are MUCH more common than rabies), and will decline heartworm prevention. The excuse is usually that they don't have the money for it. Yet within a couple of days, they'll go to a groomer and spend $30-60 to have their dog bathed and trimmed.

Don't get me wrong. I do believe in proper hygine and care of pets, and think groomers overall do a great job. But if it's a choice between spending $40 to prevent a fatal disease and spending $40 to get rid of mats, which is the best choice for the pet?

Priorities, people!

Example #2. I'll often see a pet for an injury that may require radiographs (x-rays). That can cost $150-200. Some people have to decline it because they don't have the money. The pet is really the one who ends up suffering. That's why I recommend having a savings account just for situations like this.

So to summarize...If you're going to have a pet, please make the decision to actually take care of it. Work the costs of veterinary care into your budget. Be prepared for emergencies. Listen to your vet's recommendations and actually do them. And if you can't afford all of this, don't have a pet!

Okay, now that I have that off my chest, I'll make sure my next entry is a bit more helpful and upbeat.

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