Fun with Pus

As a veterinarian, I daily come into contact with many different unsavory bodily fluids. Vomit, drool, diarrhea, pus...the list goes on. Drool's my least fave because it tends to cling to everything and anything. It's slimy and gross. The worst is when big, drooly dogs come into the exam room and shake their heads, coating everything within a 4 foot radius with the nasty stuff. It ain't easy to clean off of glasses!

Today I had a bouncy little dog in for the removal of the stitches I had placed during his castration surgery. The dog was accompanied by a young boy (equally as bouncy as his pet) and his father. On examination of the surgical site, I noticed a small pustule about 1/2 inch in diameter near one end of the healed incision. Turns out the dog had been licking the area extensively during the healing process, even though the owner had been warned about this when the dog went home. As the pustule seemed to be superficial, I decided to drain it and clean up the area. A good firm squeeze of the swelling sent a tiny spray of pus jetting across the exam room, missing the boy's face by mere inches. His eyes widened and he pronounced the whole episode to be, "Cool!".

See? Pus can be fun!

Read the Fine Print

Well...didn't I feel like a tool today! Our local humane society has just recently started early spay/neuter of kittens and puppies before adopting them into their forever homes. Yesterday I saw the first of these! It was a lovely, bouncy, black and white MALE 16 week old kitten. Mid-way through my 'kitten talk', I started my usual feel for the testicles to make sure they were where they should be. Nothing. Checked to make sure it was a boy. Yup. Sometimes, one of the testicles won't descend into the scrotum, and instead hangs out in the inguinal area (inner thigh) or abdomen (belly). This is called cryptorchidism and these boy bits need to be removed as they like to become cancerous. Even more rarely, neither testicle will descend. This is known as bilateral (both sides) cryptorchidism and I wondered if this kitten would be my first of these cases. As said kitten was being a major squirming unit, I took it into the treatment area to have my technician hold him for a better look. On closer inspection, under the fur, I could see the healing incisions of a castration surgery. Sure enough, a closer look at the file revealed that this kitten had been neutered at 8 weeks of age! Hello!

I walked back into the examination room, feeling sheepish, and admitted to the owner that I had been looking for something that wasn't there, and didn't I feel the fool! Luckily they laughed (while likely wondering how competent their veterinarian was!). Always read the fine print!

Timber the Chewie Whore

There's no polite way to put it. I have discovered that Timber the samoyed is a chewie whore.

I've been feeling quite under the weather lately and, as a result, have been spending as much time huddled under the covers as time will allow. Last night was no exception. I was feeling rather sorry for myself when Timber, uncharacteristically, jumped onto the bed and crawled his way across it until he was snuggled up next to me, his head under my arm. "Awww", I thought. Timber understands that I'm not feeling well and is trying in his doggy way to do what he can. I'm so naive. However, I'm not to be blamed, because Timber was demonstrating a level of subtly formally unknown to him.

As I gave him scritches, he turned himself over onto his back, stretching himself with little grunts and groans. Ok, this was pushing it, even for Timber. He has a massive coat and usually finds about 2 minutes on the bed more than he can handle before he gets too warm. Then a lightbulb, albeit a dim one, went on above my head. Toby was on the floor beside us, chewing on a piece of rawhide he'd managed to scrounge somewhere in the house. Timber didn't have one. Timber kept shooting glances at Toby whilst nudging me yet again. Darn it. In no way was my dog acting on his Lassie-like need to succor an ailing loved one. He just wanted a flippin' chewie! To test my theory I said, "Chewie?" Off the bed in a flash, I found him in the kitchen sitting eagerly next to the pantry door where said chewies are stored. Nice. My dog has learned to prostitute himself for treats.

Oops

When Timber, my Samoyed, didn't eat his dinner, I became a little worried. That boy NEVER misses a meal. In fact, I can often hear the lid of his food bin banging up and down if I'm late with the vittles (Timber's idea of a subtle hint). I ceased to be worried when I found the empty bags that used to house 2 dozen day-old donuts slated for the chicken's lunch. Sigh...

Dear Clients...

I had a client in today who gave her 8 year old a cup of our complimentary coffee before coming into the exam room with her 2 children and 2 cats. Needless to say, it was all I could do to have myself heard above the cacophony. These situations are always a bummer because the patient and the client lose out with most of my recommendations being lost into the ether.

This 'tongue-in-cheek' email floated around a few years ago. Even though it's meant in jest, there's a lot of truthful bits in it. Don't get me wrong. The majority of our clients are wonderful people who truly care for their pets.

Letter to our veterinary clients,

Welcome to our practice. The following are some suggestions of how to make things easier for you and more interesting for our staff.

As you have already figured out, your scheduled appointment time is just a suggestion. Feel free to ignore it and do as you please.

If you are not going to show up, please do not call. We like the suspense of trying to figure out what you are going to do. Some times we run bets on it. So as you can see, calling and informing us of your intentions would just take the fun out of our day. Our other clients are all rich and don't mind having to pay extra to go the emergency vet because we didn't know your appointment slot would be available.

Verbal abuse is always appreciated. If possible, wait until the waiting room is full. Please be creative in your profanity, we all like to expand our vocabulary, as do our clients and their children.

Please do not put your dog on a leash or you cat or bird in a carrier. Just let them loose as soon as you walk in. The staff enjoy a little pandemonium and breaking up animal fights. If you do actually use a leash for your dog, make sure it's at least 20 feet long or longer. We enjoy being tripped by leashes and getting your dog out of our lab. It keeps us on our toes. Or better yet, just let the leash loose on the floor so the dog can roam anywhere it wants while the leash drags behind it.

Bring as many small children as possible. Three or more are preferred. If you don't have that many, borrow from your neighbors (look for the poorly behaved ones). Make sure they all have juice and crayons because we all love to clean. Also we encourage them to jump up on the furniture, play roughly with the hospital cat, and go through the drawers.

Making an appointment time when your child is too sick to go to school with some Ebola like disease is a great way to use your free time. We love getting your child's diseases. It reminds us of our childhoods. Making an appointment time when you are too sick to go work pleases us as well. We often enjoy being short staffed and having the flu bug now and again to remind us to update our own flu vaccines.

Do not bring any prior records as we request. Calling other clinics gives us time to catch up with old friends. Our other clients don't mind waiting 20 minutes past their appointment times while records are faxed. They don't have anywhere else to be anyway.

We're just kidding when we suggest that you bring stool or urine samples in. That's gross. We'll just get it off of our waiting room floor while your unattended dog relieves themselves everywhere.

Please feel free to stay on your cell phone as long as you like as we have all day to wait for you. Hands free headsets are preferred because it really makes it a challenge to figure out if you are talking to us or the person on the phone. Make sure to call us back later that day and ask questions about all the things we were trying to explain earlier.

When giving us information about your pet, please be as vague as possible. The doctor is psychic and can communicate with your pet so it's just a formality anyway. Please send your teenager or neighbor in with your very sick pet with no information as to what exactly is wrong with the pet and cannot answer any specifici questions. We like trying to guess what is wrong and how to treat it.

Be sure to bring along your spouse who will give us an entirely different history than you do. If this is not possible, you can insist that we call him/her at work to get the history. Then after we are finished, we can call him/her back again to repeat the exact same instructions that we just gave to you.

If you are coming in for a second opinion, be sure to bring along no less than 50 pages of information that you have downloaded from the internet. This is far more important than any previous records, lab results, radiographs etc. The doctor will be more than happy to sift through all this information and discuss it with you at length. The clients in the waiting room understand this and don't mind being 40 minutes late because your appointment time was only scheduled for 30 minutes. We understand that it's our fault that you have to pay twice to do lab work, radiographs that you had done at the other vet because we didn't have the records.

Be sure to insist we follow your breeder's recommendations, especially about anesthesia and vacccines. Our years of schooling and training really don't teach us anything so we appreciate the guidance. If the breeder doesn't know, don't forget to ask your groomer, otherwise just ask your neighbor for the advice you need.

Give medications as you see fit. We just put prescription labels on because we think the label printer is really cool. We understand that when the condition doesn't improve because of this, it's our fault, not yours.

Always complain about the bill. We know our prices are too high. In general we tend to be greedy and don't really care about your pet in the least, we really just want that Beverly Hills mansion instead.

Don't tell us that all the other vets had to muzzle your dog until after they try to bite. It keeps our reflexes sharp. Besides, it's more of a challenge to attempt to muzzle a dog once they're all worked up.

If your cat is hissing and upset, please put your hands and face as close to their mouth as possible. They would never bite you. If a bite does occur, we realize that it's our fault.

Ignore the employee only signs. Just wander about as your please. Stick your hands in all the cages, open all the drawers and cupboards. If your child is wandering around, we prefer them to be barefoot.

If your pet is sick, please wait a minimum of three days before having them seen. A week is preferred. Be sure to exhaust all treatments available over the counter or at the pet store before bringing them in to be examined. The best time to call is on Friday afternoon.

Be sure to call 5 minutes before closing and tell us that it is an emergency after waiting a week. Then please complain when you are charged an emergency fee for coming in after hours. Our staff actually don't like their families that much and aren't in a rush to be with them.

Feel free to express your ideas about what is wrong with other client's pets at the checkout counter. Feel free to tell them that whatever we recommended is unnecessary and too expensive and can be easily fixed with a vitamin.

Please do not bring in more than $20 with you and no credit cards or checkbooks. Our office manager previously worked in a pawn shop so she will be happy to appraise any piece of jewelry or household item. Payment plans are available, no interest for 6 months and we can send the bill to your ex-spouse for your convenience.

Please expect us to subsidize yor pet's health care cost. You know we all become vets to work at the vet hospital because we love animals and want to help them. Since we are already doing what we love we don't expect to be paid for it. Our creditors will completely understand that because of this we can't pay our bills and we really don't like electricity, heat, food or vehicles so living without them is a relief.

When you buy two female dogs from your breeder, expect and DEMAND a discount for their spays, because you deserve it for having two dogs. The same applies to cats as well.

Remember that, if you adopt male and female puppies from the same litter, you won't need to spay and neuter them because brothers and sisters don't mate, that's gross.

If you are running late and have other errands to take care of, please drop off your pet at the front desk. Do not give us any more information that 'needs some shots', or 'isn't doing right'. We'll have your prescription and pet ready for you to pick up within the hour, or next Tuesday.

We look forward to caring for your pet. If you, your neighbor, breeder, or groomer have any suggestions about what we can do to make life easier for you and more difficult for our staff, please do not hesitate to let us know.

Paws in Print

This is the first in a series of reposts of articles I wrote for the local paper:

The Take on Teeth

Imagine not brushing your teeth for a year. Your friends stop dropping by. People give you horrified looks as they pass you on the sidewalk. Neighbours leave bottles of mouthwash in your mailbox. You've got bad breath. It hurts to eat because your gums are sore and a couple of your teeth are loose. You feel generally sick because bacteria from an infection in your mouth have spread through your bloodstream, wreaking havoc on your kidneys and the rest of your body.

A lot of people have imagined themselves in their pet's shoes (or paws!). In the past, we've never really considered the dental health of our pets. Wolves and tigers don't brush, right? They also don't have meals placed in front of them in handy-dandy kibble form!

Dental care is an important part of looking after your dog or cat. At each yearly physical, your veterinarian will examine your pet's teeth to determine the amount of tartar present and for the presence of gum disease. Dentistry may be recommended. This involves the scaling and polishing of all the teeth while your pet is under anesthetic. Extractions can be done if necessary.

If possible, you should brush your pet's teeth on a daily basis. I admit I'm a bit lax and only manage it about once a week. Some pets love it! Icey, once of my Samoyeds, starts to drool as soon as I get out the toothpaste. Tundra puts up a fuss, but eventually gives in with a big sigh when he realizes I'm not going to give up. You need to use a toothpaste formulated for pets, as regular paste can cause stomach upset. If you have a puppy or kitten, start brushing their teeth now so that they'll get used to it. With an adult pet, you may need to start with a 'finger' toothbrush. It fits over the top of your finger and tends to be less 'scary' to an animal than a big brush.

Special 'tartar control' diets are available from your veterinarian which are designed to remove plaque while being eaten. Rawhides and other chewies are good for gums and teeth. Just make sure you keep an eye on your dog while he's eating them. A lot of dogs are gluttons and will literally bite off more than they can chew!

Some Updates...

Ack! It's been forever since I've written! Is seems like I'm at work all day, home by 8 pm, cook and eat dinner, clean, feed and pay attention to various pets, then hit the sack with a big sigh. Loving my job makes it all worthwhile, but I find I have little time to do other things, such as sit down and contribute to my blog! I shall try harder.

Molly, the little Cushing's dog, went a little too many days on her initial treatment and had to be put on prednisone. Her parental units weren't the best at following instructions, which is so critical in these cases. When we start these dogs on Lysodren, the owners have to watch for ANY sign that the dog is not itself. Typically, dogs with Cushing's are ravenous and attack the food bowl with gusto when it's offered. During the first part of treatment, I have owners feed the patients 2/3 of what they normally would to keep the patient hungry and assure that they'll want to eat when they're fed. The moment the dog so much as hesitates before eating, or even lifts his head and looks around between munches, treatment is stopped and the ACTH stimulation test repeated. In Molly's case, she was a 'nibbler' of dry food, never eating much at one time. However, she'd scarf canned food like it was ambrosia. My plan was to have her eat canned food during the initial part of the treatment, so that we'd know when her appetite decreased. Unfortunately, her parents refused to feed her canned food, no matter how I explained why it was so important. I failed Molly in that case. As a result, it wasn't until one of my daily calls to the owner when she told me Molly wasn't herself and was whining all the time, that I knew we'd better stop the drug and retest her NOW. When I redid her ACTH stimulation test (that's the one that checks to see how much cortisol her adrenal glands can possibly produce), it showed that her adrenals were now producing too little cortisol. Predictably, she developed diarrhea, vomiting and didn't want to eat. I started her on some predisone, to replace the hormone she was now lacking. Quickly, the vomiting and diarrhea stopped, and she started to eat. She'll stay on this for a couple of weeks until her adrenals recover, then we'll test her again. This has become a very frustrating case for me.

On a happier note, Bailey, the dog with the now-fused toes, is doing great! After a week in the splint, we moved to thick bandages and now to just a bootie over the healing foot. I'm impressed with the cosmetic effect of the surgery and Bailey is walking better than she ever has. Of course she still wants to lick the foot!! It's likely become a compulsive thing with her and if she continues to lick, even after the foot has completely healed, I may discuss some medication meant for this type of problem to her owners. I'll try to post a pic of the foot was it's completely healed.

Some things tend to come in threes, or fours... I have another cystotomy to do next week; yet another hunt for more bladder stones! Will keep ya posted!

Something's Afoot

Pretty gross, huh? Bailey had a similar growth removed from the same spot between 2 of her toes a couple of years ago. The histopathology (where a pathologist looks at the mass on a cellular level to try to find out what it is) had indicated that it was 'Interdigital Furunculosis'. This can be caused by an ingrown hair, allergies, or other foreign bodies, leading to secondary bacterial infections and chronic irritation of the surrounding tissue. Unfortunately, Bailey didn't respond to medical therapy for the problem when it occurred a second time (long term antibiotics, soaking the foot...) and the mass had been allowed to get so big that removing it was going to be a challenge.

Bailey had become obsessive about licking this part of her foot, even after the initial surgery. If she continued to lick the area between her toes after the second surgery, the problem could very well recur. That and because there wasn't going to be a lot of extra skin to close the wound I decided to try a procedure called a 'fusion podoplasty', a fusing together of the toes.

The procedure when really well. The before and after pictures are above. I've sent the mass off to the lab to make sure we're not dealing with a new beastie. Bailey has to wear a splint on that foot for a few weeks to allow it to heal without any pressure being put on it. I'll try to post a pic again once her sutures are removed and everything's healed. I'm crossing fingers that we won't have the problem return.

Stomach Spasms

Had a cat in today that hadn't been to the clinic in a couple of years. The owner reported that 'Felix' had been having these weird muscle spasms the last month or so, but had still been eating and drinking up until yesterday, so she wasn't too concerned.

As soon I saw the cat on the table, it's sides heaving while it tried vainly to suck in enough air to breathe, I knew the problem was more serious than she'd predicted. He was a lovely boy, good to work with even though he was obviously uncomfortable. He'd lost a lot of weight and he had increased lung sounds on both sides. Instead of a soft rubbing noise, it sounded like a crew of lung cells were working away with sandpaper.

Luckily he was stable enough to take a couple quick pictures of his chest. There it was, the classic 'Christmas tree' pattern of the lungs, caused by the thickened walls of the bronchi. (See radiograph above..you can also see this cat's microchip between it's shoulder blades!) This poor guy had bronchitis; likely feline asthma. More questioning of the owner revealed that someone did smoke in the house which can make these cats much worse. We've started him on corticosteroids, the cornerstone of treatment in many of these cats. Relatively new inhalant therapies, with special kitty face masks, can help too.


2 young rabbits arrived later in the day for 'new bunny' checkups with complaints of not eating well. When I quizzed the owner, their diet for the 3 days he'd owned them included: lasagna, raspberries, 2 lbs of potato peelings, 1 bag of carrots and pasta! I'd be gassy too! I betcha that 80% of the sick bunnies I see are ill because they're not being fed the right diet. The pet store sends the bunny home with a bag of pellets and informs the owner that it's all the bunny needs. Pellets were originally meant for meat rabbits that were destined to gain weight quickly and then grace someone's dinner table. We want our pet bunnies to live a lot longer! That means lots of long-stem hay such as Timothy, fresh green leafies and a SMALL amount of pellet. The hay is so important to keep the bunny's guts in good working order. I'm sure there will be another post on gastric stasis in bunnies at some point!

As for Molly, she's doing well. Her water consumption is slowly returning to normal. If she continues to do well, we'll repeat her ACTH stim test in a few days to see how her adrenals are faring.

One of Those Days

Ya'll ever get one of those days when you know from the start it's gonna be a long one?

This morning I woke up relatively rested and still grinning to myself as I thought about the Simpson's episode last night that featured the music of my all time favorite singer Josh Groban (more on my chance to meet him and talk 'vet' on another day). Things started to go downhill after that.

I was recently gifted with one of those Keurig single-cup coffee makers that uses those little k-cups to make a yummy coffee in funky flavors like vanilla-caramel-nut in mere moments. I can be a bear without my coffee in the morning, so this machine is my guilty little extravagance. Unfortunately, I overestimated the capacity of my also new guaranteed-not-to-spill travel mug (you can see where this is going) causing a flood, albeit a deliciously fragrant flood, on my table. Luckily my nice, please-don't-put-me-in-the-washing-machine tablecloth soaked most of it up for me. One thing about the coffee coming out of these machines...it's HOT. Thus the trip I took to the sink with the overflowing mug resulted in a lot of 'son-of-a-#$$#$'s' and 'hot! hot! hot! hot!'s) (i'm in the mood to hyphen today). After dumping out some of the steaming contents and fitting the leak proof lid, I prepared Bubba, my 13 year old Argentine Horned Frog for his trip to the daycare centre. Some of my zoo earns their living spending time in various classrooms, giving the kids something to ooh and aww over and hopefully teaching them about responsible pet ownership.

As I was carrying Bubba's enclosure up the stairs, I heard a 'thunk' in the kitchen..never a good sound. Timber, my Samoyed you met before in the 'how-to-destroy-a-house' post (and whose mug is in this year's Christmas photo above) had been counter surfing, smelling the piece of polish sausage that was in my bag and slated for my lunch. His nose had managed to scoot my travel mug off of the counter and onto my favorite chicken-themed throw rug. Off came the lid. So much for no-spill. The chickens were wading in a growing sea of coffee. This was, of course, my own fault for leaving something tasty so close to the edge of the counter! Regardless, I was now running out of time, so the rug would have to wait until I got home and I still hadn't had my caffeine fix.

After dropping off Bubba, I walked into the clinic only to be told that one of my favorite patients (ok, so I have a lot of favorite patients) had died over the weekend. Now I was bummed. Things were ok for a little while as my first couple of appointments were some adorable bunnies in for routine care. Then a name went up on the board that made me groan. (All the appointments are listed on a dry erase board in the pharmacy area so we have an idea of how the day will go) It's a psychotic little chihuahua who apparently ticked off her larger spaniel house mate one too many times. That's called BDLD (big dog little dog syndrome to the uninitiated). 'Thor' (these little guys inevitably have names which reflect their personality vs their physical size) is one of those chihuahuas that rules the roost. They tend to be aggressive towards their owners and other dogs. Also typically, once you get them away from their owners and they clue in that you're not willing to put up with same shenanigans their mommy does, they're quite good to work with. It's frustrating though, because often the owners will think it's hilarious when the dog tries to attack you in the exam room and can't believe that, or aren't willing to accept that, both the dog and those it has to interact with would be much happier if the human and not the dog was the leader of their family pack. (Don't get me started..I'll get off of my soap-box now). Luckily for Thor, he had escaped with only a couple tiny puncture marks which I clipped up and cleaned. Evidently thankful for my care, he bared his teeth and tried to bite me the minute I handed him back to his owner. Sigh.

Next up was a Shih Tzu that was ADR (Ain't Doin' Right...you're learning so many new things today!). One of the most important parts of any physical exam is the patient history. I asked the owner when she had first noticed the problem. "Oh, it started when he boarded here at the hospital. He just hasn't been the same since." Hmm...the last time this dog stayed with us was 2 YEARS AGO! Okaaaaaaaaay.... I couldn't find anything wrong on his physical exam, but owners know their pets the best, so perhaps there was some systemic problem that wasn't jumping out at me. I suggested we run some bloodwork to give us some info on how the internal bits were doing. That's when the owner decided that, "You know, he really seems to have been doing better the last few days..." I smiled and nodded while mentally banging my head on the exam room table.

My next patient was an extremely wiggly cat that I see routinely for nail trims. The owner is never happy about something: the clipper's aren't sharp enough, I'm not cutting the nails short enough. Personally I'm happy to get the job done at all as the owner insists on holding the cat himself, but not too tight mind you. Today the cat was having none of it and, just to keep up the theme of the day, I clipped a nail too short and had to apply some styptic powder to stop the bleeding. The owner, who keeps up a running commentary through these visits, informed me that I wasn't doing a very good job today. I'm getting really tired of smiling and nodding. My left eyelid started to twitch..a sure sign I'm stressed.

Around 4 pm, after skipping lunch trying to get caught up on everything from the weekend, I realized I was getting tired..and cranky, and I was booked solid from 4:30 to 7 pm. I sat at my desk for a few minutes and tried to channel some positive energy. Caesar Milan would have been proud..

For whatever reason, things went a bit better in the evening. I saw one family whose 9 year old, pony-tailed daughter rocked back and forth on her heels while she shyly asked how old she had to be to volunteer because she really wanted to be a vet when she grew up. She looked at me worshipfully and it made me stop and think. When I was her age, I'd wanted to be a vet too. I can't honestly remember ever wanting to be anything else. And here I am today, having fulfilled that dream and, even aside from the bad bits, loving every day at work. I'd lost sight of that this morning. When I offered to let her come watch a surgery, her eyes widened and she thought that yes, she might like that....when she's a little older!

Another family arrived with their pet rat in tow. They were kind and concerned and the whole family was involved in their furry friend's care. They were grateful they had managed to find someone willing to see their rodent. Even the kids thanked me as they left. OK...so things were definitely looking up.

On the way home in the dark, after the last files had finally been written on, I drove by an accident on the small highway that takes me from the clinic to the peace of my country home. There were flashing red lights and ambulances everywhere. A snow machine had t-boned a car while crossing the road and I worried for whomever had been driving the snowmobile..it was destroyed. It was a sobering scene and made me realize that, no matter how bad my day may ever get, someone, somewhere is likely having a far worse day than me.

Thanks for listening...

More on Molly

The results of Molly's Low Dose Dexamethasone Suppression test came back and there's no doubt that she has Cushing's disease. From the results, we were also able to determine that Molly has the type of Cushing's caused by a problem with the pituitary gland as opposed to an adrenal tumor. Her type is the more common one. Once the diagnosis was confirmed, we ran yet another test called the ACTH stimulation test. It tells us the maximum amount of cortisol her adrenal glands can produce. The results of this test provide us with the baseline we'll use to monitor her response to therapy.

Molly started treatment with Lysodren yesterday. The drug selectively destroys those cells of her adrenal gland that are producing all those extra glucocorticoids. It's not a fun drug, with the potential for a bunch of side effects such as vomiting, diarrhea and weakness. There's also always the chance that the drug will knock out too much of the adrenal glands, causing the opposite problem of hypoadrenocorticism (Addison's Disease). A protocol actually exists where you purposely nuke the adrenal glands, resulting in Addison's disease. The theory is that it's easier and potentially less expensive to treat Addison's vs Cushing's. It's not a great idea though. If you miss a dose of Lysodren, it's not so bad, but miss a dose or two of the steroids that need replacing with Addison's disease and the patient is in big trouble!

Molly's initiating phase of the treatment continues until she starts to feel ill, stops drinking tons of water or at about the 8 day mark, whichever comes first. At that point we'll repeat the ACTH stimulation test to see how she's doing. Once her test results are where we want them, we'll be able to reduce her dose of Lysodren to the point where she'll only need it a few times a week instead of twice a day.

Bunny Week

I see a lot of rabbits in my practice. They make great pets and a lot of people are really bonded to their bunnies! This week I had some unique breeds in for neutering, 2 Angoras and a Flemish Giant. The pic's of one of the Angoras. He was a lovely rabbit, very calm and he really enjoyed cuddling! They're not for everyone though, as they require a fair bit of grooming to keep them looking their best! The Flemish Giant was a completely different kettle of fish. At 15 pounds, he could put some power behind his kicks!

His surgery was a little different too. Once he was under anesthetic, I confirmed that he was cryptorchid, meaning only 1 testicle had descended properly. As a result, I had to go hunting in his abdomen for the second testicle. If I'd left it behind, not only would it have continued to produce hormones, but it would have been prone to developing cancer too. Luckily I found it sitting near his bladder and swiftly removed it! The pic in the top right corner of this post is of the two testicles. The little, underdeveloped one is the one that was hiding in the abdomen.

The Results Are In!

The lab has sent back the results of Molly's stone analysis. As I expected, they're made up of calcium oxalate. Risk factors for this kind of stone include breed (Miniature Schnauzers, Lhasas, Bichons, Miniature Poodles, Yorkies and Shih Tzus are predisposed), too much dietary vitamin D or C, diseases causing hypercalcemia (too much calcium in the blood stream), diets containing too much oxalic acid (nuts, beans, sweet potatoes, wheat germ, spinach, rhubarb) and Hyperadrenocorticism (Cushing's Disease). It's this last disease that I'm worried about in Molly as she's still drinking up a storm and peeing everywhere!

Cushing's Disease is a pain in the butt. It's relatively expensive to treat and monitor properly. With this disease, the adrenal glands produce too many hormones, especially cortisol. It can be the result of an adrenal gland tumor, a pituitary gland tumor or it can happen if a dog's been on too many glucocorticoids ("steroids"). It's usually seen in middle-aged or older animals and causes symptoms such as drinking and peeing too much, icky skin, a round, 'potty' looking belly... It's complicated. For a good read on the subject, visit "veterinarypartner.com" and check out the Cushing's section.

My favorite test for Cushing's disease is called the Low Dose Dexamethasone Suppression Test (LDDS for short). We've run that on Molly and I'll post her results soon!

A Bladder-Filled Day

Happy New Year Everyone!

Molly's surgery day was a long one. I started surgeries at 8 am, finished at 5 pm, and then saw appointments until 7 pm! I was beat!

Molly had her cystotomy and was much happier with her uroliths (bladder stones) headed to a lab for analysis instead of knocking around inside her bladder! The picture shows the two stones we removed. Once the results are back from the lab, I'll let you know what they're made of. My guess is mostly Oxalates, but we'll see. Once Molly's recovered from her surgery, we'll pursue her drinking/peeing problem if it continues.

You know the phrase, "If it rains, it pours."? I ended up performing two cystotomies that day! A second little dog, a miniature schnauzer, was transferred from the local emergency clinic in the morning. She had bladder stones as well, but her case was more dire than Molly's. One of this dog's stones had lodged in her urethra, making it impossible for her to urinate! As you can guess, this made her very uncomfortable and very ill! We removed 4 large stones and more small stones than we could count from her bladder! She was happily home and eating the next day. I'll see if I can post a pic of those stones as well, as they were quite different from Molly's.