Tales from the Pet Clinic

Constipation in Cats

2013-01-10T21:17:31Z

By Ann Hohenhaus, DVM

Topaz’s family called me from his Christmas vacation in Florida. They were concerned because they found this older gentleman of a cat straining in his litter box, but not producing any stool. Since I was here at The Animal Medical Center and he was 1,000 miles away, I suggested a safe treatment of canned pumpkin mixed into his food until he returned home and could come visit me a couple of days later.

Complicated constipation

I was anxious to see Topaz when he returned because cats with constipation can be difficult to manage, and there is often an underlying problem causing constipation. I thought the problem might be as simple as dehydration from traveling and being in a strange environment. But Topaz’s family said he was drinking water, in fact, drinking a lot of water.

Too much water

Excessive water consumption in a patient gives some very specific clues to the underlying problem, which may include kidney problems or diabetes.

I checked Topaz’s urine, but it did not contain sugar like a typical diabetic patient. The urine sample was submitted to the laboratory and they reported white blood cells were present, suggesting an infection. Based on this finding, I asked the laboratory to test the urine for the presence of bacteria.

A blockage?

Sometimes constipation is not a medical problem but due to an intestinal blockage. A fractured pelvis, tumors of the colon, or pelvis impinging on the pelvic canal can all prevent normal fecal passage. This possibility forced me to perform a rectal examination, much to Topaz’s chagrin. He was happy since it was normal and because I promised not to do that to him again.

Blood tests tell the story

In addition to testing the urine, I also submitted blood to the laboratory. Routine blood tests screen for a wide variety of common conditions such as anemia, infection, liver problems and kidney disease.

Topaz’s tests showed a mild anemia and elevations in tests indicating a kidney problem. Kidney disease is common in older cats and often leads to dehydration and constipation. Because of the white blood cells in his urine, I was suspicious that the cause of Topaz’s kidney problem was an infection.

Treatment

Topaz got an injection of a long-acting antibiotic, and since his family is experienced with sick cats, they already know how to give fluids under the skin to keep him hydrated and help flush any infection out of his kidneys.

After a few days of home health care, Topaz has fully recovered.

Topaz’s story demonstrates how early intervention can help achieve a positive outcome for your pet and highlights some important reasons to take your cat (or dog) to the veterinarian, including:

Increased water consumption
Increased urination
Constipation

Photo: Dr. Philip Fox

Corn Cobs Are Not For Dogs

2013-01-09T15:49:20Z

By Ann Hohenhaus, DVM

A sick young dog

Early last week, Steel, a healthy, well cared for young Labrador, was rushed to The AMC in the wee hours of the morning for intractable vomiting. The poor dog looked miserable with vomit on his face and paws. The emergency doctors determined he was dehydrated and started intravenous fluids along with mediations to help control nausea. They also performed a critical test when they took an abdominal x-ray.

X-rays hold the key

The abdominal x-ray showed that several of Steel’s intestinal loops were over distended with gas and fluid. The distension exceeded that of normal intestinal gas and suggested something was blocking the progression of food through the intestinal tract. As he scanned the x-ray further, the radiologist saw a one and three-quarter inch long tubular object containing little bits of gas evenly distributed throughout. To the radiologist, this structure looked like a corn cob, but Steel’s family had not served any corn on the cob lately.

Surgery answers the question

Shortly after the x-rays were taken, Steel was anesthetized and wheeled into the operating room where the emergency surgeon readily identified the obstruction in the intestine. Because the intestine had been damaged by the obstruction, a small portion of the intestine was removed (resection) and the ends sutured back together (anastomosis). In surgical terms these procedures are often called an R&A. Once the damaged intestine was removed, it was opened revealing – you guessed it –a corn cob! Where the corn cob came from, Steel is not telling.

Steel’s abdominal x-ray shows gas filled intestinal loops and the offending corn cob, which I have outlined in red.

I am certain Steel’s family wishes they knew where the corn cob came from to prevent another serious illness for their dog. Make your best effort to protect your dog against eating something dangerous by:

Covering and locking all trash cans
Keeping human food out of your dog’s reach
Storing human AND pet mediations up high and in closed cabinets
Keeping your dog busy and out of trouble by providing an enriched environment with window seats, interactive feeding toys and plenty of exercise
Watching your dog during walks to prevent him from eating garbage or foreign objects

For other interesting stories about the strange eating habits of dogs, read about Lola and Rachet.

Photo: iStockphoto

Books for Pet Lovers

2013-01-04T15:00:41Z

By Ann Hohenhaus, DVM

If you are like me, you received gift cards during the holidays. What better way to spend them than on books about dogs and cats. Here are a few titles that are currently sitting on my nightstand:

Dogs: Man’s best friend
The Divinity of Dogs: True Stories of Miracles Inspired by Man’s Best Friend is a collection of stories about life changing dogs. Each section of stories has a title: “Love,” “Comfort and Forgiveness,” etc., but for me they all ring true to the wonderful role dogs play in our lives. Some stories, no more than two pages long, will provoke hours of thought about the special gifts of dogs.

Spoiler alert: get out the tissues! When I attended the author’s book reading, the hors d’oeuvre trays should have had tissues instead of napkins. These stories touch the very depth of your soul and remind you why you love dogs, and more importantly why we can’t live without dogs.

Dog: Detective’s best partner
A Fistful of Collars is another installment in the Chet and Bernie mystery series. Chet, the narrator of the book, partners with Bernie, a private detective. Chet is a dog with an opinion. He relishes dinner at the local rib joint, thinks shoe polish is tangy, and muses over words like “collar.” He doesn’t understand why Bernie always talks about collaring perps when they never seem to wear anything around their necks, but instead end up wearing orange jumpsuits! For dog lovers, this book offers a fresh perspective into a dog’s mind.

New kitten and puppy tips
My friend and former AMC colleague, Dr. Jason Nicholas, aka The Preventive Vet has two new titles being released early this spring: 101 Tips for Puppies and 101 Tips for Kittens. I have read the proofs of these attractive and informative books and think they are a must read for new pet families. Beautifully illustrated, even children will like these books and they can be used as a way to actively involve children in the caring of the new family member.

Cooking fun
The Organic Dog Biscuit Cookbook is not on my nightstand, but is on my kitchen shelf. It contains over 100 “tail wagging” recipes. I made the Great Dane Candy Canes as Christmas gifts for a few select dogs. The ingredient list includes brown rice flour, oat flour, parmesan cheese, egg and tomato paste. These biscuits proved very popular, and Marley, the dog with an office across the hall, comes by and sits by my desk every day, hoping for a sample from the test batch. Dog owners like them too as they are really cute done up as holiday treats. I think cats would like the Going All the Way Upstream treats, which contain salmon. Testing these treats on some hungry cats will be my next cooking project.

Resolve to Be a Responsible Pet Owner

2013-01-03T18:17:31Z

By Ann Hohenhaus, DVM

It’s that time of year again; the time when we make New Year’s resolutions. I seem to make the same ones every year: eat healthier, exercise more, be kinder. My suggestion for 2013 is for every pet owner to be a responsible one. To achieve that goal, the American Veterinary Medical Association has developed a list of guidelines for responsible pet ownership.

Tales from the Pet Clinic believes this is a good list for pet owners to review before making their 2013 list of resolutions:

Commit
As the holidays approached, I received several tweets discouraging pets as holiday gifts since a pet is a lifetime commitment and acquiring one should not be an impulsive decision. You must choose the right pet for your lifestyle and should have as many pets you can comfortably care for, both physically and financially.

Good pet care involves more than food and water. A successful pet parent provides exercise, a stimulating environment and training.

Invest
Having a pet requires an investment of both time and money. Preventive healthcare saves money in the long run and helps prevent costly emergency visits.

Although vaccinations are part of a preventive healthcare program, the rabies vaccine protects human health as well.

Identify
Every pet should have both permanent and temporary identification. Permanent identification should preferably be a microchip, but a tattoo is a viable alternative. A collar with tags is a good temporary and immediate method of letting people know where your pet belongs if he should become lost.

Limit
Help decrease the nation’s pet overpopulation problem by spaying or neutering your pet. Preventing unwanted litters limits the number of animals entering shelters each year.

Prepare
Prepare for your pet’s future like you prepare for your family’s future. Assemble a “go bag” for your pet.

Include your pet in estate planning; don’t assume your family is prepared to add your pet to their household and make provisions for your pet in case you can no longer be the primary caretaker.

Photo: Stockbyte

Exocrine Pancreatic Insufficiency: Cats Get it Too!

2012-12-28T13:57:24Z

By Ann Hohenhaus, DVM

Last week, I highlighted a common pancreatic disorder in dogs, pancreatitis. The following day, the New York Times Well Pet blog wrote about a much less common, but equally serious pancreatic disorder, exocrine pancreatic insufficiency (EPI). The article focuses on EPI in dogs, but cats also can suffer from this disease.

Pancreatic function

The pancreas has two main functions: first to produce the hormone insulin to control blood sugar and second to produce digestive enzymes. Production of insulin is the pancreas’ endocrine function and production of digestive enzymes is an exocrine function. Deficiency of insulin is called diabetes.

Deficiency of the digestive enzymes has a much more descriptive name – exocrine pancreatic insufficiency.

What a cat with EPI looks like

The classic cat with EPI is skinny, greasy, and has bad diarrhea. The absence of digestive enzymes prevents the gastrointestinal tract from breaking food down into it components, and if they are not broken down, the nutrients cannot be absorbed. If your cat has this disorder, he will eat lots of food and lose weight rapidly. Cats with EPI are greasy because they cannot digest fats without pancreatic enzymes and all the undigested fat in their stool gives them nasty diarrhea.

The causes of feline EPI

This disorder is thought to be inherited in certain dog breeds, most commonly German shepherds. Cats never want to be like dogs. Exocrine pancreatic insufficiency in cats does not appear to have a genetic component and is more likely to be the result of chronic damage to the pancreas from long standing pancreatitis. These cats may also be diabetic if the pancreatic damage is severe enough to prevent production of both digestive enzymes and insulin.

Testing the skinny cat

When I see a cat with weight loss, I commonly collect blood for what The Animal Medical Center calls a GI panel. This quartet of tests looks at the digestive function of the pancreas and small intestine. One of the tests measures trypsin-like immunoreactivity and is the diagnostic test of choice for feline EPI. Another important test on this panel measures vitamin B12 or cobalamin. A study of feline EPI cases at The AMC and Purdue University found all cats with EPI were deficient in this important vitamin.

Replacement therapy

Once lost, the pancreas do not typically regain exocrine pancreatic function. Management of EPI requires lifelong supplementation with pancreatic enzymes and vitamin B12. Vitamin B12 supplementation is simple: a small injection given under the skin once a week. Pancreatic enzymes come as a powder and are sprinkled on the food. This is where cats can be challenging since many cats refuse food that has been embellished. Raw pancreas (which contains the digestive enzymes) has been recommended, but I haven’t tried it on any patients, yet. The good news is our study of feline EPI showed most cats will respond to therapy.

Resources on pancreatic disease

Exocrine Pancreatic Insufficiency

Pancreatitis

Texas A&M University

WebMD

Idexx Laboratories

Photo: iStockphoto

Dog Noses Put to Good Use

2012-12-26T11:21:58Z

By Ann Hohenhaus, DVM

In a post last week, I wrote about a serious intestinal infection, Clostridium difficile and how a radical treatment similar to one used in cows, sheep, and goats is helping humans.

While researching some information about C. difficile, I found an interesting story of a dog named Cliff who could sniff out patients infected with this deadly bacteria and could do so faster than traditional laboratory testing.

The superior sense of smell possessed by our canine friends is truly amazing. Here’s a small list of what your dog’s nose knows, and it goes all the way to the Supreme Court!

Bedbugs

These days all urban areas are having trouble with bedbugs. Ridding your home or office of these pests is expensive and time consuming. Dogs specially trained to sniff out bedbugs come to homes and offices to help exterminators target areas requiring treatment or to give the all-clear sign indicating successful treatment of the environment.

In New York City, Roscoe the bedbug sniffing beagle has celebrity status and is frequently recognized when he is out and about working or when he comes to see his doctors at The Animal Medical Center.

Diabetes

Until recently, service dogs have helped humans with physical disabilities, for example, those who are blind or use a wheelchair. Now, a registered charity in the United Kingdom trains dogs help to manage chronic medical conditions such as diabetes.

These dogs sniff out low or high blood sugar and warn their owners in time for them to have a glass or orange juice or an insulin injection. These dogs can even bring their “patient” essential medical supplies.

Justices to rule on sniffing

Recently, the Supreme Court heard two cases regarding the Fourth Amendment and drug sniffing dogs. The Fourth Amendment states:

The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.

The case involving Aldo the drug-sniffing dog revolves around whether or not a drug-sniffing dog constitutes probable cause for a vehicle to be searched for drugs. The second case asks the question, “Does a dog sniff indicating the presence of drugs equal a search without a warrant?”

Finally, dogs will have their day in court.

Poop Therapy

2012-12-21T19:04:30Z

By Ann Hohenhaus, DVM

We live in a world obsessed with clean. Our floors are scrubbed with antibacterial cleaners, we squirt hand sanitizer gel on our children’s hands and wipe down our kitchen counters with antibacterial wipes. Knowing this, you shouldn’t be surprised there was a big buzz when a poop transplant between a mother and her toddler son was used as treatment for a serious intestinal infection, Clostridium difficile.

Scientifically known as a fecal microbiota transplant, this unappealing therapy was a lifesaver for the sick child.

This veterinarian is not surprised

As a veterinarian, the concept of transplanting bacteria from a healthy patient to a sick patient is really nothing new. A “cud” transplant has long been used to transfer good bacteria to sick ruminant animals (sheep, goats, and cows). Ruminants have a biochemically complex digestive process required to break down the dense plant material that forms their diet. The cud is a wad of partially digested food which returns to the mouth and is chewed a second time as part of this complex process. Veterinarians collect a cud from a healthy ruminant and feed it to sick one, transferring the healthy digestive tract bacteria much like the fecal microbiota transplant did in the sick toddler.

Fecal microbiota transplantation

Every living animal has its own microbiome on the skin and in the gastrointestinal tract. These endogenous bacteria help keep us healthy. Illness and antibiotic therapy disturb the normal bacterial and allow bad bacteria like C. difficile to proliferate and cause illness. Transplantation of bacteria takes several forms. The toddler received a fresh fecal transplant, but feces from a donor can be frozen for future use. There are even synthetic cultures of bacteria commonly found in the gastrointestinal tract. Transplantation of the good bacteria occurs via a nasogastric tube or by colonscopy.

A very recent study shows improvement in 79% of patients treated in this dramatic fashion.

Dogs and cats are lucky

Today, ruminants are the only veterinary patients receiving fecal microbiota transplant therapy; although pets sick enough to spend time in an ICU may contract C. difficile. Fortunately, this infection doesn’t happen as often as it does in human ICU patients.

Therapy dogs visiting human health care facilities have a greater risk of being colonized by C. difficile.

If your pet develops diarrhea following hospitalization or while taking antibiotics, be sure to tell your veterinarian as further testing may be required.

If your dog is a therapy dog, follow the healthcare guidelines and the visitation rules of your animal assisted therapy organization to protect your dog against this type of serious infection.

Photo: Hemera

Pancreatitis: Systemic Effects of an Unhappy Organ

2012-12-19T06:53:15Z

By Ann Hohenhaus, DVM

One of my friends was in the hospital last week. Not a human friend, but a dog friend. Happily, I have dog friends who are not dog patients and Decoy is one of those. This lovable lab is a member of a family who are friends of my family.

Under the weather

I saw Decoy’s name on the overnight admission list which is emailed to all the veterinarians at The Animal Medical Center at about 5:30 every morning. Decoy came to The AMC ER for vomiting and limping. The ER doctors found abdominal pain, a fever and an elevated heart rate. On my way into the hospital, I stopped by his cage to say hello, but could tell my normally tail-waggin’ friend was a hurtin’ pup; Decoy was living up to his name by looking more like an inert, stuffed dog than a real one.

In the blood tests

Blood tests for AMC patients are available online. To help with interpretation, abnormal results are displayed in red, normal results in black. Decoy’s reports were shockingly red. His illness was impacting his liver, his blood calcium level, and dramatically increasing his infection-fighting white blood cells.

Inside the abdomen

Because Decoy’s blood tests indicated multiple organs within the abdomen were affected by whatever was making him sick, his internal medicine specialists ordered an ultrasound of his abdomen. Ultrasounds let veterinarians look at intra-abdominal structures in a different fashion than x-rays allow. X-rays show bones and lungs very clearly, but we can only see the outline of abdominal organs like the liver and kidneys. The pancreas cannot be seen using x-rays and we rely on ultrasound to help make a diagnosis of pancreatic disease. Because pancreatic disease could account for Decoy’s clinical findings of vomiting and diarrhea and his multiple blood test abnormalities, an ultrasound was done and confirmed the suspicion of pancreatic inflammation or pancreatitis. The ultrasound showed pancreatic swelling. The swollen pancreas displaced the colon out of its normal position and was even causing a small amount of fluid to accumulate in the abdomen.

On the road to recovery

There is no antidote to stop pancreatic inflammation. Veterinarians provide what we call supportive therapies while the inflammation subsides and then we try to decrease risk factors for recurrence. Decoy received intravenous fluids, antiemetic agents, and antibiotics in case the pancreatitis was turning into an abscess. Every day he improved a little bit and he was discharged from the hospital a few days later.

Follow up

To help prevent another bout of pancreatitis, Decoy’s doctors made several recommendations to his family. First, overweight dogs are at greater risk of developing pancreatitis. I suspect a diet will be on Decoy’s list of New Year’s resolutions. High-fat diets increase the risk of pancreatitis. This means he may need to eat a special low-fat diet and certain dog delicacies like bacon will no longer be a menu option for him. In the future, his doctors will avoid certain medications to prevent provoking another serious case of pancreatitis.

Pancreatitis is a common disorder of dogs and it can become a recurrent problem. In Decoy’s case, the problem was quickly corrected, but when pancreatitis becomes a chronic problem, seeking input from an internal medicine specialist is a good idea.

Photo: iStockphoto

Should the Government Regulate Cats?

2012-12-14T12:49:46Z

By Ann Hohenhaus, DVM

This question is a rhetorical one – state, federal, and local governments already regulate several aspects of your cat’s care. And there are good reasons for the government to do so.

U.S. regulations

Rabies is a fatal disease, easily prevented by vaccination. Governments want to protect the health of their citizens and thus require cats to be vaccinated against rabies. New York City statute regulates the feeding of cats. Here, it is illegal to withhold food and water from any animal. But if stray cat feeding is done in a manner that creates a public health hazard or nuisance, New Yorkers may be breaking the law. Again, the government is worried about human health. So why are there currently two high profile legal cases about cat care?

Roman cats

For any cat lover who has visited Rome, Torre Argentina Cat Sanctuary in Largo Argentina was probably a highlight of the trip. The site of Julius Caesar’s murder by Brutus in 44 BC and a cat sanctuary since 1929 AD, these underground ruins are home to approximately 150-160 cats. The “gattare,” or cat caretakers, raise money and provide food, water, and basic healthcare for these cats.

Recently, the sanctuary has come under fire for illegally building on ancient Roman ruins. Government officials in charge of Italy’s archeological treasures want the cats out, but the Mayor of Rome and his cat, Certisino, announced they are “on the side of the cats of Rome. Anyone who touches them will be in trouble.” The outcome of this stalemate remains to be determined.

The Hemingway cats

A little closer to home, the multi-toed Hemingway cats of Key West, Fla. have come under the scrutiny of an agency of the U.S. government. The United States Department of Agriculture (USDA) regulates animals on exhibition, such as those owned by circuses and zoos. Although the Hemingway cats have lived in Key West since 1931, nearly as long as the cats of Torre Argentina have lived in their archeological site, the USDA has reclassified them and threatened the Hemingway Museum with confiscation of the 44 descendants of the original Hemingway cat if they do not comply with USDA regulations. The reclassification stems from the fact that these cats affect interstate commerce because they are a tourist attraction and the Hemingway Museum collects a fee for visitors to enter the Museum and see the cats.

Everyone agrees, cats will be cats

Robert Siegel of NPR, who clearly understands cats, writes about the Hemingway cats,

“As for the cats, they’re not commenting. We have our doubts, though, that they’ll do what the law says. They’re cats.”

Umberto Broccoli, Rome’s superintendent of culture, expressed a similar sentiment when he said of the Largo Argentina cats, “They don’t read bans. They will return to Largo Argentina whether the shelter is there or not, and gattare and tourists will continue to throw food at them. The situation is really not so simple.”

Only time will tell how these catfights will be resolved.

Photo: Photodisc

Holiday Hazards 2012

2012-12-12T08:23:35Z

By Ann Hohenhaus, DVM

The holidays can be fun times for everyone in the family—pets included—but they can also pose dangers to dogs and cats. Here are a few of the holiday-related cases we’ve seen at The Animal Medical Center’s Emergency Service this week.

Tarquin, Gracie and Yoggy snacked from the naughty list

Tarquin, a 5-year-old Cavalier King Charles Spaniel, took advantage of chocolate left within her reach. After consuming most of the bag’s contents while her owners were out, her family returned to find her nauseous and vomiting. A trip to The Animal Medical Center ER resulted in an overnight stay because of a rapid heart rate induced by theobromine, a caffeine-like component of chocolate.

Gracie the Maltese barely tips the scale at 3 pounds. Despite her small stature, she managed to wolf down five dark chocolate truffles. This naughty list indulgence landed her in the hospital getting a treatment of activated charcoal to help bind up any chocolate toxins remaining in her intestinal tract. The darker the chocolate, the higher the concentration of theobromine, and baking chocolate contains the highest concentration. In a dainty dog like Gracie, a few bites of stolen baking chocolate could be fatal.

Yoggy, a young Yorkshire terrier, also ate dark chocolate. His owners discovered him racing around their apartment like a mad man in a chocolate-induced hyperactive state. The ER staff found his blood pressure was elevated too. Yoggy got intravenous fluids and a mild sedative. Lucky for Yoggy, he recovered quickly and was discharged from The AMC the following day.

Other foods on the naughty list include raisins, grapes, onions, and fatty foods. For a yet unknown reason, raisins and grapes cause kidney failure in dogs consuming even just a few. Onions and their relative, garlic, damage the red blood cells of both dogs and cats, resulting in anemia. Fatty foods can induce severe stomach upset or inflammation of the pancreas, so a purloined pork loin should be off your dog’s holiday menu.

Oliver does a mistleno-no

Oliver, a 2-year-old cat, used up one of his nine lives this holiday season when he decided to have a Japanese snow lily salad. These beautiful flowers grace many holiday floral arrangements, but should be avoided in a home with a cat. Ingestion of poinsettia, mistletoe, holly, and cyclamen’s tuberous roots will cause gastrointestinal upset. Some varieties of lilies and amaryllis will cause kidney failure if eaten by your favorite feline. Best to avoid using these in your holiday decorating or you might be spending the holiday with your favorite veterinarian and not with your family!

Photo: Brand X Pictures