Heartworm Resistance?

There is a potentially emerging problem here in the US....potential resistance of heartworms to current preventative medicines.  While it's not time to panic, there is reason for concern.

One of the worst areas in the US for heartworm disease is the lower Mississippi River region.  The presence of water as well as high temperatures and humidity throughout the year make it an excellent breeding ground for the mosquitoes that carry heartworm disease.  In the last few years there have been several cases reported of dogs who had been consistently on prevention yet still developed heartworm disease.  It's gone beyond a couple of questionable cases to the point that top parasitologists are investigating the possibility of resistance.

All of this fear is currently speculation and hasn't been confirmed.  It's also only been a worry in certain areas of the Mississippi where heartworm disease is the highest.  There is enough prevalence of the parasite in this area that breeding and reproduction is rapid, allowing many generations in a short period of time.  If anywhere was going to show a resistant population of heartworms, this would be it.  However, before we panic and run around like Chicken Little, there is still much study and research to be done.

In a worse case scenario, development of resistance to current preventions would be a major health issue.  Unfortunately, only about 56% of American dogs are on consistent heartworm prevention, much less than it should be.  However, those dogs are well protected.  If medicine starts being ineffective, even these dogs could be at risk.  Then you would have pet owners who are doing the right thing suddenly learn that their pets have a potentially fatal disease that is expensive and somewhat risky to treat.  There is the potential for a real canine health crisis if this turns out to be true and the resistance strains spread to other parts of the country.

This is definitely a topic to continue watching closely.

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Sick Feral Kittens

Here's a question from Patti....

Back in August I spotted a tiny kitten lounging on my driveway. I felt sorry for it because of the heat and decided to give it water and a bit of food. (I know not to, but it was a kitten!) Anyway I set it out there, the kitten ran off, then I saw what turned out to be mama cat and another kitten. I opted to continue feeding all three of them. Mama seemed to bail after about a month or so. It was getting colder outside, so I fashioned an old cat carrier into a shelter with a blanket. They use it too. So here is the problem. The kittens both have been sneezing and the smallest one is really congested. They are so skittish, so I can't grab them up to take them to the vet. I talk to them to try to put them at ease. They will allow me to play with them using a toy I rigged up on a piece of yarn, as long as the railing around my front porch is between us.| Do you know of a way that I personally can capture them? Is there a humane device I can rent, or do I have to get animal control involved?

First of all, I never recommend feeding or taking care of strays. I know it pulls at your heart strings, but feeding them encourages them to come around and can lead to a small population of cats at your place.  Stray cats have a high incidence of leukemia and feline AIDS and when they come together there is an increased risk of fighting.  Depending on where you live, food outside can also encourage raccoons, skunks or other wild animals, some of which can carry rabies.  Though rare in cats, rabies can happen in them and you certainly don't want to be exposed to that.

Now all of that being said, there is something that you can do. I don't know that you can rent them, but there are humane traps that capture animals alive and safely.  You should be able to get them at a home supply place like Lowes or Home Depot, as well as possibly Tractor Supply or garden centers.  You put food in the back and when they go inside the door closes, trapping them.  Unfortunately, you may catch something besides the kittens, so be aware of that.  If that doesn't work you may have to call animal control.

When the kittens are taken in, have them tested for feline leukemia and AIDS.  If they are positive, their chances of getting better are very low, and you wouldn't want to release them back into the wild as they could spread the disease.  As hard as it may seem, the best thing to do in these cases is euthanize them.

I hope this helps.  Good luck!

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Post-Bone Problems

Donna sent this in...

 I am writing in reference to my 7 mo. old English Mastiff. I recently gave him a large raw cow bone on Monday afternoon and the following Wed. he became ill. I fed him his kibble which he started hacking and proceeded to throw all that up. He started to  shiver, hack just general not feeling well.  I took him to our new vet and my pup did have an elevated temp. 103. the vet said he had a bacterial infection poss. e-coli, salmonella. He kept him overnight and I picked him up the next morning with the only instructions to give him his antibiotics and pain meds, Tramadol 2 50mg every 12 hrs.  There was no bloodwork or x-rays taken. I got my pup to eat some boiled chicken and rice shortly after I got him home (about noonish)" then later that evening some kibble with the same c & r topper.  He finally moved his bowels, very small amount which had 6 large bone chunks in them. I asked the vet upon leaving about his coughing hacking and he said he would either hack up the shards or pass them. about 11 pm. I gave him 1/ pc of bread and after that is when he passed them. He is still hacking and gagging as if trying to throw up something or dislodge. I  called my vet about x-raying and he said to wait and let the meds take effect. He is eating but I am concerned that there may still be something lodge somewhere.  I really dislike taking a wait and see approach if something could be there and then have a life or death situation on my hands.  he is also limping terribly on his right front leg, no connection I am sure but has gotten severely worse since being at the vets.  in relation my pup also has generalized Demodectic mange and a 4" hygroma on his right knee. Do I have reasons for concern or am I being an overprotective paranoid furmom?

Donna, you've mentioned several things and I'll try to at least touch on all of them.

I don't like giving bones to dogs as I've seen too many problems with them.  Raw bones can indeed carry bacteria, and can lead to infections like your dog may have.  Salmonella is only one of the bacteria that can be a problem, and these can be difficult infections. Bone shards can also cause constipation or intestinal irritation, as well as potentially become obstructed if the pieces are large enough.  Bones can chip teeth and even get stuck on teeth or the roof of the mouth.  I really, really don't like giving bones to pets, even though it's the stereotypical thing to give to dogs.

I don't want to second-guess your vet since I'm not able to examine your pet myself.  I will usually defer to my colleagues when I'm not involved in the situation.  Personally, however, I would consider taking some radiographs, especially if there seems to be continued hacking or gagging.  This is a case where I would consider bone shards being a problem and would want to look for them.  Bone shows up well on an x-ray, so if they are there it shouldn't be difficult to find.  Blood testing may not be absolutely necessary initially, but it's never a bad idea.  If the problem is persisting I would definitely want to run these tests.

The other problems won't be related.  Limping is certainly not related to eating the bone, and could be anything from developmental problems (not uncommon in large and giant breed puppies) to a sprain or bruise.  If it's persisting or worsening I'd want to take radiographs of the affected leg.  Demodex is also not related, but if widespread should be treated.  It's a little unusual to have a hygroma at seven months old, but this is a common problem in large dogs.

Donna, I can't say whether or not you need to be extremely concerned as I can't examine your pet.  However, the potential for a serious problem exists.  Salmonella and E. coli infections can be serious and lead to severe complications.  A bone obstruction can be life-threatening and require emergency surgery.  If it's been 2-3 days since starting medication and there's no signs of improvement, I'd want to run full blood tests (chemistry panel and CBC) and get some x-rays of the abdomen and chest/neck.  If your dog is worsening since starting medications I'd want him seen as quickly as possible.

I hope this helps your decision.  Good luck with him and I hope everything turns out okay.

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Normal Play?

Yesterday I had a client that was worried about her seven month old puppy being aggressive.  In the exam room the dog was energetic and sweet with no signs of behavioral problems.  As I questioned the owner and delved into the behaviors I realized that the owner was describing normal play behaviors.  It's actually not uncommon for an average pet owner to be confused, as some play behaviors in dogs can appear aggressive.  And since animal behavior is a strong interest of mine, that's today's blog topic.

Here is a recent picture of my two dogs:  Inara on the left and Yvaine on the right.

Looks pretty fearsome, right?  That's actually them just playing around and neither one is aggressive.  In animals, play behavior is often practice for life as an adult.  Carnivores will practice stalking and hunting.  Social animals will practice behaviors that will determine social hierarchies.  It's just like human children playing "house" or pretending to have jobs.  Childhood is a good time for any animal to start learning and honing skills they will need to be successful later in life.  So in pets you will see behaviors that may seem like hunting, aggression, and so on.

So what indicates play?  There are some key behaviors and body languages you can look for.
1.  The most common and universal behavior is the "play bow".  In dog language this is an invitation to play.  The front end will be down and the hind end raised.  Whenever you see this the dog is in play mode, even if there are seemingly aggressive vocalizations.

2.  Another common behavior is a "play face".  This is universal across animal species.  The eyes are wide, the mouth somewhat open, ears normally erect and alert, and the face relaxed.  Like the play bow, this is a sign of playfulness.

3.  Wagging tails are also a good sign.  However, some dogs will wag when they're nervous or uncertain.  If a wagging tail is seen with the above behaviors it's play.  If there are raised hackles, fierce barking, or bite attempts, it's a sign that the dog is uncertain how to react to the situation.
4.  Many dogs will bounce from side to side or forwards and backwards when they are wanting play.  Like the play bow this is an invitation behavior.  Basically the dog is saying "Hey, come get me!  Play with me!"
5.  Barking and even growling, when combined with the above behaviors, is merely an indication of play.  It's like kids yelling and shouting at each other during wrestling or a ball game.
6. Dogs don't have hands and fingers to manipulate their environment.  Instead they use their mouths and teeth to interact and grab things.  So biting or grabbing during play is common and normal.  It may not be desired, and should be discouraged and trained out of the dog.  However, it's not a sign of aggression.

Looking for these behaviors should tell you when a dog is playing.  If you're worried about aggression here are some signs to look for.
1. Raised hair on the back and neck (though Inara will do this during play sometimes, so with her I've had to look at the other behaviors).
2.  Tail straight or lowered and not wagging.
3.  Ears back or down.
4.  Persistent growling for several seconds or minutes and not just for brief spurts.
5.  Lunging with fierce barking.

Dog's don't commonly show all of the signs at once for any behavior, so look for some of the signs and use your best judgment. If you don't know the dog and there are any signs of aggression, please do not interact with that dog!  If you're worried about your own dog's behaviors, find a vet who is skilled with animal behavior and have him or her evaluated.

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You've Worked Too Long As A Vet When....

Part of my goal for this blog is to peel back the curtain of veterinary medicine and let people see what the life of an average vet is like. For those outside of the profession this may be a bit of an eye-opener at times as you see things that you never realized. This may be another of those times.

A friend of mine who is also a vet comes up with some great humorous lists that always have surprising truth in them. I saw him post this list a few days ago and really laughed at it. There are many things here that non-veterinarians (or their staff) simply won't understand or find funny. But those of you who have been in the profession for any length of time will likely laugh out loud. One of the most amusing thing about this list is that it is completely and utterly true...and to those of us in veterinary medicine, that truth is what makes it funny. Enjoy!


YOU HAVE WORKED TOO LONG IN THE VETERINARY INDUSTRY WHEN....

You look at a cardboard box and recognize its coffin potential.

You go out to a club and when the black light comes on you check yourself for ringworm.

You can eat lunch while cleaning up a Parvo blowout.

You can keep your milkshake frozen in the freezer around the dead bodies.

You take your kids temperature and think 102 is normal.

After seeing what goes into the washing machine at work, your own laundry doesn't seem so dirty.

Your work clothes look like your pajamas.

You open your lunch container and find a spleen.

You have no problem eating your lunch on the wet sink where they have just finished a necropsy.

All of your pets are either 3 legged, lame, or blind in one eye.

You've done an anal probe on a bird.

You can detect maggots at 100 paces, just by the smell.

To you, pets are more recognizable than their owners are.

When eating and you find a hair in your food, you pull it out and keep eating.

The first thing you wonder when opening up a big cat abscess is, "Where are the Ritz crackers?"

You cough up hairballs.

You are the first one in the hospital in the morning and you don't notice the smell.

You start to like the smell of anal glands.

You can play connect the dots with all of your scars and puncture wounds.

When NORMAL people won't eat meals with you.

You get the flu and begin to sympathize with the Parvo dog.

Your paycheck barely covers your food bill, but ALL of your animals eat a premium brand food!

Your medicine cabinet holds nothing but animal medications.

You have ever picked up Poop with your bare hands.

You can put a muzzle on with one hand tied behind your back.

You know that "pink juice" and "blue juice" are not flavors of kool-aid.

You get a rash from just LOOKING at a Shar-Pei.

You can take a dog's rectal temperature without looking.

No one asks you what you did at work today while you're eating dinner.

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Cancerous Eye

Good week for reader questions! Here's one from Darlene.

Our cat, Tig, is a 13 year old (indoor only) domestic short haired cat. She has been in very good health until the last month or so. We began to notice the color of her iris began to get darker. In addition, sometimes her pupil began to stay open wider than the other pupil in the other eye. She has not shown any signs of pain. She does not wash that eye anymore and will let you pet her face near that eye. We recently took her to the vet to be examined.
They informed us she likely has an iris melanoma with glaucoma in that eye. They have recommended she have an enucleation procedure performed. They would have the eye sent to UGA to see if the tumors in the eye were Cancerous. We have become more comfortable with the removal of her eye. However, we are very concerned that if it is Cancerous, has it spread to her other eye or any other part of her? This has all happened so fast with the change in eye color just in a month so we are very concerned if it is cancer and if the cancer has spread.
Is there a way to screen her for cancer to find out if it is through out her body? I have attached her photograph. Sadly, if she does have cancer in the rest of her body we would not like to put her through the procedure removing her eye and the cost to us for only extended her life briefly.


All good questions, Darlene. I didn't include the pictures in this post because they weren't as clear as I would like, and it's hard to tell as much as I would like. But I can see some potential issues, including the darkening of the iris.

It wouldn't be possible to tell 100% for certain that this is a melanoma without sending tissue samples off, though this certainly sounds and looks like the main possibility. If a tumor is growing on the iris it can affect the outflow of fluid from the eye, leading to glaucoma. Glaucoma by itself is pretty serious and can lead to permanent blindness as well as being painful. Add a likely tumor to the issue and you have a bad situation. Either one of these problems alone could warrant removing the eye, and when you combine them the best solution is to have the surgery done.

Pets do very well with only one eye. It's a bit harder for cats because of the loss of depth perception, making it harder for them to judge distance when they're climbing and jumping. But they quickly learn how to compensate and live with the difference. I've removed many eyes myself, and certainly think it's a valid procedure and better than the alternative.

So let's talk about the other concern. What about metastasis (spread to other locations)? This is a valid question, and one that should be examined. However, there is no way to be completely certain that a tumor hasn't spread. All you can do is your best due diligence, examine as much as you can, and pray that there isn't anything hidden. Some tumors are small enough that we can't detect them with any means, and there aren't simple blood tests for most forms of cancer. In a situation like this you want to perform a full blood chemistry and blood cell count, looking for signs of organ abnormalities and alterations in the white blood cells. You also want to do chest radiographs as the lungs are a common place for tumors to spread. If these tests are normal, you've done the best you can to screen for cancer outside of going to a specialty clinic and having a CT or MRI performed on the pet.

If there are abnormalities, especially tumors in the chest, I would agree that major surgery like enucleation wouldn't help improve longevity and would be unnecessary. If everything is normal, I would recommend having the surgery done as soon as possible. There will always be the chance that something was missed on the screening and you may have tumors appear later, but that's a risk that everyone takes when dealing with cancer.

I hope this helps with the questions. Good luck!

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Painful Swallowing

Here's a case sent in by Kristin...

I have an 8 month old Maltipoo that I rescued 4 months ago. He was late getting his shots because the previous owners did not give him his shots. He has had his 6 in 1 shots but has not received Bordatella because I thought it was included in the 6 in 1.

Recently he has been sick. Slight cough, slight fever so I took him to the vet and he has been on antibiotics for approximately a week.
Nothing too abnormal about this scenario so far right? Well, here is where it gets interesting.
I told the vet the first thing I noticed about him being sick was an unusual behavior. When he would attempt to eat he would extend his front left leg out in front of him and whine in pain. He went off his feed entirely just prior to me taking him to the vet for about 3 days. The vet prescribed him doxycycline twice a day and he seems better in the sense that he is not lethargic, wants to play. However he still does not want to eat and still exhibits discomfort when he does try to eat.

I know you say its unlikely he would have anything stuck in his throat-as did my vet but he is acting normal with exception to this behavior and he refuses to eat. Whenever he does attempt to eat he extends that front leg and it seems painful to him. I've tried force feeding him baby food, canned food and soft table scraps. He wants to eat but then he remembers that its going to hurt and only eats a very little when hes practically starving.

If he did have kennel cough, wouldn't a weeks worth of doxy get him back on track-why is he still experiencing pain? Any thoughts, advise or experience you may have had with these symptoms would be so greatly appreciated. 

This doesn't sound like kennel cough to me, though I can't say for certain without having seen the patient.  Kennel cough normally causes a dry, resonant cough that can be easily stimulated with palpation of the trachea.  Doxycycline is a great antibiotic for this kind of infection, though it can take 10-14 days to fully resolve a case.  The pain and odd behavior that you describe isn't something that we see with kennel cough or other respiratory infections.

I'm a bit puzzled as to what could be causing the behavior based only on the description.  It sounds like there is pain in swallowing, which may be related to a problem in the esophagus. I would want to rule out some kind of stricture or narrowing of the esophagus, which can be very difficult to determine in a general practice.  The two best ways are with an endoscope or fluoroscopy.  Fluoroscopy involves a moving x-ray taken while a pet is in the act of swallowing, and requires special radiology equipment that you won't find in a private general practice.  Some veterinarians do have endoscopes, so this might be another option.

However, a simpler option could be pain from an inflamed throat or esophagus, similar to what happens to us when we have a sore throat.  This should improve with antibiotics, though it may take longer than a week.  Analgesics or steroids prescribed by your vet could also help.  I would recommending talking to your vet about this option first, and if you don't start seeing results within a few days look into further diagnostics.  Keep in mind that such diagnostics may involve being referred to a specialist and will not be cheap, but at the same time he can't go for long without eating easily.

Make sure to do follow-ups with your vet.  Good luck!

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