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.