Chocolate is for Easter Bunnies

We usually think of chocolate overdose in dogs as a problem around Easter or even Valentines Day. I have to tell you that today was our first chocolate ingestion of the Christmas season. In this case, a 40 pound dog ate an 8 oz bag of Hershey's Kisses. Now I like chocolate as much as the next guy, possibly even more than the next guy, but at least I pause to unwrap them before I scarf down the entire bag.

Sometimes we eat chocolate plain. Sometimes we eat it baked into cakes, mixed into ice cream, etc. The first problem with these sweets is the fat. A sudden high fat meal (such as the above bag of Kisses) can create a lethal metabolic disease in pets called pancreatitis. Vomiting, diarrhea, and abdominal pain are just the beginning of this disaster. Remember, in the case of pancreatitis, it is the fat that causes the problem more than the chocolate itself.

The fat and sugar in the chocolate can create an unpleasant but temporary upset stomach. This is what happens in most chocolate ingestion cases. This was certainly the case in our patient today. The amount of chocolate that he ate was not enough to cause serious neurologic signs

Chocolate can be, however, directly toxic because of the theobromine. The more chocolate liquor there is in a product, the more theobromine is present. This makes baking chocolate the worst for pets, followed by semisweet and dark chocolate, followed by milk chocolate, followed by chocolate flavored cakes or cookies. Theobromine causes:

• Vomiting
• Diarrhea
• Hyperactivity
• Tremors
• Seizures
• Racing heart rhythm progressing to abnormal rhythms
• Death in severe cases

Toxic doses of theobromine are 9 mg per pound of dog for mild signs, up to 18 mg per pound of dog for severe signs. Milk chocolate contains 44 mg / ounce of theobromine while semisweet chocolate contains 150 mg per ounce, and baking chocolate contains 390 mg per ounce.

Number of OUNCES of CHOCOLATE a Pet Would Need to Ingest for TOXICITY
Weight of Pet in Pounds	5	10	15	20	25	30	40
Milk Chocolate (ounces)	2	4	6	8.2	10.2	12.3	16.4
Dark Chocolate (ounces)	0.7	1.4	2.1	2.8	3.5	4.2	5.5
Baking Chocolate (ounces)	0.23	0.5	0.7	0.9	1.2	1.4	1.9

50	60	70	80	90	100
20.5	24.5	28.6	32.7	36.8	41
6.9	8.3	9.7	11	12.5	13.8
2.3	2.8	3.2	3.7	4.1	4.6

(I appologize for the screwed up graphics, but my technical ability is less than medical talents)

As you can see, smaller dogs are at a greater risk of toxicity because of their size. It is much more likely that a small dog will get their paws on a few ounces of chocolate than a big dog will find a pound of the stuff lying around.

GI upset can occur at much lower doses.

It takes nearly 4 days for the effects of chocolate to work its way out of a dog’s system. If the chocolate was only just eaten, it is possible to induce vomiting; otherwise, hospitalization and support are needed until the chocolate has worked its way out of the system.

So, while you are curled up on the couch drinking your hot cocoa this winter, make sure to keep the candy out of your pet's reach.

Have a safe and happy holiday season

Keith Niesenbaum

www.PetsNeedFood.com

www.TheVetsChoice.com

Holiday Time and We all Need to Watch our Waists

So the holidays are upon us and not a moment too soon for those of us that love to gorge on the mounds of baked goods that arrive at the office, interspersed with gooey chocolates and the occasional fruit basket. Unfortunately for the staff as well as our patients, too much of a good thing is ... well, too much. While we are watching the scales (well I am watching the scales) trying not to undo all of the good that I did training last year, our patients are not always so vigilant.

First up was the post Thanksgiving turkey toxicity rush. You know, all the dogs ( and some cats) that were able to con their owners with plaintiff looks and whines, into forking over way too much in the way of table food. These guys and gals were in all week after the holiday with vomiting, diarrhea, and the occasional more serious case of pancreatits. I must say, quite the mess.

It's not that I'm against treats in moderation, but pets that are eating a particular diet should not get rich treats from the table. Owners don't seem to realize that their pets don't know what is best for them and will eat whatever we put into their bowls or toss them from the tables. Don't do it! You know who you are.

This is also the time of year that we try to emphasize weight loss to our clients for thier pets. It is difficlut to get them out to exercise because it is getting colder and the streets can be slick. However, this is the time it is the most necessary. Since I know that you all aren't going to listen to my about not feeding treats (Oh, I know it is always the spouse/kids/parent/in law), you must work on the other side of the equation, that is calories burned. Get out for a walk with your dog twice a day. Start with 15 or 20 minutes and build from there. If it is cold and your dog seem chilled, get a sweater or a coat for your pet.

Cut out the treats, or at least cut back. Try a low calorie, but high quality diet and feed according to the label. Here is a good place to start as the site has a weight loss diet and some low fat treats. Or ask your veterinarian for specific dietary recommendations.

Remember, weight put on now is tougher to take off than weight never gained. I guess I will never have a career in platitude writing.

Stay halthy and have a happy holiday season.

With Every Season ....

OK, although Labor Day weekend is not technically the end of summer and autumn is still a bit away, we all think of it as the time to pack away our white pants and leashes, and pull out our more earthy toned garb.

This September is the first time in a while that I don't have any races on the fall schedule so I took the opportunity to take a leisurely run across the George Washington Bridge to NJ and back. Too late for it to be really hot. One week to early to see the ships sail up the Hudson. Still not foliage change. Seems like I blew it, except that it was really cool. I would have taken pictures but alas and alack, no camera, no blackberry, just me, nature, some bike riders and about a thousand cars, hanging out above the river. The view was great, you'll just have to take my word for it. Cookie, bless her heart, stayed back in Washington Heights with her sister. Didn't think her little legs were up to the trip, although she would have been game for at least part of the journey.

Next weekend, it's off to the Catskills. Yes it is still too early to see the leaves change color, and no, there is still no race on my calender. However, it is the inaugural weekend of Canine Club Getaway. A weekend vacation for people and their dogs. I'm going to be the camp doctor and my wife is coming along for moral support. It should be interesting at the very least. I'm giving a lecture on canine first aid and running a fitness evaluation clinic. We will also be doing a microchip clinic and screening for Heartworm, Ehrlichia, Anaplasma, and Lyme disease. These are all insect borne diseases that we see hear on long Island.

Heartworm is spread my mosquitoes. I don't need to tell you what the wet spring meant for mosquito populations in our neck of the woods. Heck, they are bigger than some of the dogs I saw in the office today.

The others are tick borne, also a pest that seems to have enjoyed a growth explosion, exploiting what ever weather change it is that they like.

Anyway, I will be micro blogging on twitter all weekend with plenty of photos. Follow me at www.twitter.com/knvet for up to the minute details. Next week, I'll post a detailed synopsis of what went on, complete with 8 x 10 color photographs with descriptions of each on.

Keith Nisenbaum, VMD
www.CrawfordDogandCatHospital.com
wwwTheVetsChoice.com

Yet anoter Pet Peeve

It seems that summer is more stressful here at Crawford Dog and Cat Hospital than other times of the year. Or, perhaps, I've just learned that venting on line in writing is better than committing violent felonies against random people in the name of maintaining my own sanity and there has been no real increase in incidents.

The latest button pushing is the dumping of cats and kittens by my back door. Now this infuriates me for several reasons.

1. People dump these kittens in boxes with inadequate ventilation in all kinds of weather in the back of the parking lot assuming that we will find them before the elements cause them irreversible harm. (so far the idiots are right about this one.)
2. People dump these kittens (oh and lets not exclude the adult cats as well) assuming that I won't just put them to sleep or send them off to the shelter where they will put them to sleep. (Don't tell anyone, but they are right about this one as well. The exception is sick animals which are humanely put down)
3. I spent hundreds of dollars for video surveillance cameras and a sign pointing out that there is a system in place, only to have these morons circumvent the system or keep their cars out of the field of recording so I can't get their licence plate number and call the cops and prosecute them to the fullest extent of the federal law that they are violating. I would also publish their names and photos in the local papers so that they could be humiliated.
4. The final infuriation, the straw that breaks the camels back, the proverbial whatever it is that pushes me over my limit, is that I am accumulating cats again.
   

So, here I am. Defeated by the irresponsible, reckless, potential animal abusers. Outsmarted by those that I choose to assume are idiotic, morons (much dumber than a regular moron) that dump their responsibilities on my doorstep and leave all of their pet related problems for me to solve. And now dear readers, and I know you are out there because you all told me you are, I need your help. Look at these faces. They are attached to cats and kittens that need a home. They are growing up and their cuteness window is closing.

If you know anyone that wants a kitten, FELV and FIV negative, parasite free, and current on vaccines, have them give me a holler. I'm on Long Island and these guys are ready to go. I would keep them myself, but I've done that before and I have 5 of my own living in the hospital already. Call the office at 516 746 1566 or check us out on the web by following the link above.

Keith Niesenbaum, VMD
www.TheVetsChoice.com

The Scientific Method

Summer is finally here and we all have heard about the evils of leaving a pet in the car, even with the window's open a slit to keep it cool inside. Gosh, it's supposed to get hot enough to fry an egg in there. Now, if you've been following me on twitter, you know that I have been trying to figure out how to get multiple pictures in a single post. Well this little experiment is dedicated to the scientific method and multiple posts in the search of truth.

It is 90 degrees here in Nassau county and the humidity is somewhere near 90%. My car is white, as you can see above and the rear windows are covered. Take my word for it (I could only post a limited number of pictures), it was around 80 in the car with the AC on. I parked the car and put this thermometer on the dash. This reading was at 1:51 today, 10 minutes after I got out of the car.

Now, you're going to say, "yea, but that's the dashboard. What about the seat" Once again, due to photo limitations, you will have to take my word for it. The shady seat was only 100 degrees. The sunny seat was about 110. Both pretty hot, I would think. But remember, my car is white and the windows are covered. So lets move to the next car in the parking lot.

This little black beauty has been sitting in the lot all day. Windows are up and as you can see the temperature on the seat is maxed out at 120. Could be higher, don't know, didn't want to break my brand new thermometer. I know that I will have other uses for it and I don't want to cook it the first time that I play with it.

So 120, probably won't cook an egg. The car's owner wouldn't let me try. Some silliness about ruining the cloth seats with yolk. Still, way too hot for a dog. A simple experiment showing how hot it can quickly get in a car. Of course we don't know how long a dog would actually last in this environment, but something in my professional oath probably prohibits me from putting my dog into the car to find out, no matter how much she keeps my up snoring at night.

So, as you can see, no live animals were harmed during this experiment. Don't leave your pets, or kids in the car unattended. We haven't seen any cases of heat stroke and lets keep it that way.

Keith Niesenbaum, VMD

www.TheVetsChoice.com

Julie, Julia, and Niesenbaum

I saw the movies Julie and Julia last weekend at it was a momentous occasion for several reasons. First off, I saw a movie in the theaters rather than from the preferred location which is via Netflix in the comfort of my own bed. The Netflix/bed option has several distinct advantages over the theater. I can start and stop the movie as needed, I can snack on my choice of foods without taking out a mortgage to pay for them, the floor is not sticky, and of course, I am in my bed, with my wife and there are no strangers to interact with. Now, movie purists would argue that I am not getting the full movie experience as the film maker intended, but that would be way to big of a digression for my animal blog.

So why am I writing about this movie at all? Well the truth is, I identify with it on so many levels that I wanted to share.

First, I am old enough to remember The French Chef television show, not just the Dan Akroyd version, but the real show. Prior to Top Chef, Iron Chef, and the rest of the crop of current TV cooking shows, I was reared on Julia and Graham, both of whom entertained me as they worked their way, imperfectly through complex recipes that I could make at home if I purchased their books and was older than 10. I loved/love cooking shows as I love cooking and eating. Hence I liked the film.

Second, much like the second main character in this movie, I am blogging. This is an exercise that sometimes feels quite unappreciated. Sort of an unrequited labor of love. You see, until recently, I felt that I was ruminating (cow reference appropriate as I continue to eat and become more bovine as time goes on) only for myself. A sort of therapy, an exercise for me and unseen by anyone. Or so I thought.

You guys are reading this. Yeah!!! Not only are people commenting on the blog (please keep them coming) but people who follow me on twitter are letting me know that they are reading as well. Unlike Julie, I'm not getting 80 comments a day, but in all fairness, she is probably a better writer than me anyway.

Everyone have a great weekend.

Keith Niesenbaum, VMD
www.TheVetsChoice.com
www.PetsNeedFood.com

That's What I'm Talking About

Not that I want to gloat, but I would like to follow up on my last post about following recommendations of people that may not know what they are talking about.

I saw a dog last week as a second opinion. It was one of those cases where the first opinion wasn't wrong, the people just had a sick dog and wanted someone else to have a look at it. As a matter of fact, while I was having a look at it the first opinion veterinarian called the owner on their cell phone and actually suggested that they do a test that turned out to be the absolute correct test to do, but I jump ahead.

These nice people own a nice dog that went to their regular veterinarian because it wasn't feeling well. Turns out it wasn't feeling well because it was in liver failure. The vet diagnosed this and told them the dog had hepatitis (inflammation of the liver) Their friends said that if this dog is so sick you need to take him to see Niesenbaum (bless their souls). I examined the dog, and the blood tests the other vet had done, and looked at the x rays the other vet had taken. I also noticed a large bruise on the dog's chest. I suggested that we repeat the blood tests since things seemed to be getting worse. I added a clotting profile and a leptospirosis titer. (Link to previous post that I mentioned) First vet called and suggested we do a lepto titer (see above line). The blood count showed almost no platelets. An ultrasound showed mild to moderate liver disease and the rest of the clotting profile and the lepto titer were pending.

I started treating for the low platelet count (thrombocytopenia) and put the dog on antibiotics that would cover the possibility of leptospirosis. The dog stabilized and there was no more bruising. Guess what?? The lepto titer came back today and it was positive.

So all you pet owners that live in areas where your veterinarian tells you that there is a risk of catching leptospirosis VACCINATE YOUR DOGS! This dog almost died. It is not out of the woods yet. It exposed the staff at the previous vet hospital as well as my staff, and the family that owns this pet to a potentially dangerous disease.

Boo hoo, if it had been vaccinated it might, I mean might, have had a reaction. Most likely not and if it did, most likely very mild. It would have saved the owners thousands of dollars between the two hospitalizations. It would have kept dozens of people from getting exposed to a zoonotic disease. It would have prevented me from ranting about this topic twice in a week.

Keith Niesenbaum, VMD
http://www.thevetschoice.com/
www.CrawfordDogandCatHospital.com

A Veterinary Rant

Up until now, I have tried to keep my posts educational, non-opinionated, and free of controversy. But... all good things must come to an end. I need to ventilate about one of my pet peeves, breeders that think they are veterinarians.

Now, when I started practicing, I was more easily intimidated by breeders. I mean, they would say things like my breed can't do X, or my breed needs Y. They would tell the people that they sold to puppies to that they had been breeding all their lives and veterinarians don't really know anything about (fill in the blank for the breed). I was a baby vet, never mind that I had been in school for longer than most of these breeders had been in business, but it can be difficult to convince a new pet owner that the wizened old breeder that sold them Fluffy the maltipoodoodle has had no medical training and is talking out of a hole other than their mouths. So for years I would just nod and let it drop.

Now there is a new axe to grind. I have been practicing medicine for 25 years, the last 21 as a small animal veterinarian on Long Island and I know what I am talking about most of the time. If not, I refer to a specialist that will cover the rest of the time. My Ivy League education and years of experience should count for something.

That is why I am starting to loose it every time a new puppy owner comes in and tells me that their breeder said the dog can't have a leptospirosis vaccine or it will explode or something. I know that historically, this vaccine has caused more reactions than other vaccines. But hey, every vaccine that I ever got caused at least some reaction. Ever had a painless tetanus shot? Also, in our area, leptospirosis is a real problem, made worse by the wet summer that we have had. We have had several cases of lepto this year. I know dogs that have died of leptospirosis. Oh yeah, Mr. and Mrs. Breeder, it is contagious to people as well. So let's not vaccinate these dogs and let them bring a disease into the homes of these nice people that you sold this puppy to and make everyone sick. You know I only recommend these vaccines to make money anyway, or so I've been told.

So people, pick a veterinarian you trust and follow his or her recommendations. Get your information from a reliable source that has done some research, or read some research, or at least knows what they are talking about. Don't just take my word for it, here is what the CDC says about leptospirosis. They have some idea of what they are talking about, unless you think they are part of the greater government conspiracy to over vaccinate your dog. Your veterinarian is also a good source of information. They spent at least 8 years in school learning to take care of your pet and untold hours of continuing education since graduation honing their knowledge. The years that they have spent practicing have not been for naught, they actually have learned something over the years. If you don't trust your veterinarian and think that he or she is an idiot because the breeder told you so, find a different veterinarian, or a different breeder, or you will get what you deserve in the end. Unfortunately, your pet may be the one to suffer along the way.

Keith Niesenbuam, VMD
http://www.thevetschoice.com/

Cookie Week Three

So the little Shih Tzu that could is still kicking. It seems that the medication that we started her on, along with my obsessing, regular ultrasounds to evaluate her heart (by more than one veterinarian) and a cardiology consult have saved the day.

OK, maybe she is just stable and all the fussing isn't really doing anything other than make me feel better. She did have a follow up ultrasound with the Doc that helped me with the initial diagnosis. Dr. Leleonnec was kind enough to let me rush my beast down to his house on a Friday evening so that we could get the echo cardiogram. He even ruined the finish on his dinning room table with the alcohol that he used for the echo. (oops). We repeated that study last week and the disease hadn't progressed. I am trying to be good and remember to give her her medication every night. So far, success.

I also had Dr. George Kramer, a local cardiologist, have a look at her. He agreed with the echo diagnosis but thought that the condition was more chronic than I had first thought. To be fair, Dr. Leleonnec said the same thing. It appears that this is just a case of the murmur sounding much worse than the disease. He seemed to feel that exercise restriction and medication is not needed at this time. I think I'll keep her on the benazepril and not run her ragged fetching the stuffed duck. However, if she continues to keep me up at night with her bizarre sounds and snoring I'm going to feed her a bunch of salt and push her into failure I swear.

I'll keep you all posted.

Keith Niesenbaum, VMD

www.TheVetsChoice.Com

Doctor becomes an owner

I think I'll digress a bit from my earlier series on cruciate ligaments and their treatments to share a bit with you all. Last week my dog, Cookie, was diagnosed with a serious cardiac disease. We can talk about the specifics in future posts but for now I just thought I would use this forum to let some people know what is going on with her. She is well known by my clients as well as my friends as she comes to work every day and camps out behind the front desk in the hospital. She is always with me as she has a bit of separation anxiety and hates to be alone. If you take a look at our web page, there is a shot of her in the community section sitting on my gym bag at the Pet Expo last year.

On Friday, she was sitting behind the front desk, acting normally, when Kate picked her up to show to a client. She immediately noticed that her chest was vibrating. What she felt was a grade 6/6 systolic murmur, associated with her mitral valve. I called in a favor that night and ran her over to my friends house. A quick echo cardiogram on his dining room table revealed the severity of her condition. We immediately started her on cardiac medications and I have a call in to see if there is something that we can do surgically to correct the defect. I'm not sure that there is.

The good news is that other than slowing down a little bit, she is not aware that she is so ill. We had a ton of company over the weekend and she handled it quite well. Her appetite is good and she is still eager to come to work each day. Needless to say, the family and my staff are devastated. I will try to keep everyone up to date, and if people are interested, we can also discuss the specifics of her condition here on the blog.

Treatment for ACL injury

So I still haven't mastered posting multiple photos to the blog, but fortunately I do know how I do this surgery. There are many ways to repair an injured ACL in a dog but this is the way I have been doing it for years with very good success. First the meniscus cartilage, which is not visible in this picture, needs to be inspected and removed if damaged. Then the remnant of the ACL is removed along with any cartilage buildup that will interfere with joint function. The joint is flushed, and closed. I then inject some local anesthetic into the joint before we go on to stabilize the knee.

The photo below shows the knee joint closed and the lateral stabilization suture in place. I use a large nylon suture and a crimp instead of a knot to hold it.

You can see the crimp on the suture. In this dog, a large dog, a second suture is place to insure stability. The skin is closed and we use ice and IV pain medication in the immediate post op period to reduce pain and swelling. We also treat the joint with a laser immediately post op and the next day to speed recovery.

There are many different techniques to repair cruciate injury. Many people will advocate one over another. I have found this approach to be straight forward and easy on the patient. It is also less expensive than some of the other repairs. I have tried to balance outcome and cost so that we can help as many dogs as possible. For clients that request it, we are fortunate enough to have many referral hospitals where surgeons can do the more technically difficult procedures such as tibial plateau leveling and tibial crest advancement if it is indicated.

In the next posts, I'll address post op care, rehab for stifle joints and long term treatment of the degenerative disease of the stifle joint.

Keith Niesenbaum, VMD

http://www.crawforddogandcathospital.com/

http://www.thevetschoice.com/

http://www.petsneedfood.com/

Why is my dog lame?

So I was out running the Long Island Half Marathon with a couple of members of Team Crawford, our unofficial hospital running team, and had plenty of time to reflect on knees. I saw old knees, young knees, normal knees, knees with braces, ... you get the idea. Runners have plenty of knee issues. I'm at the age where many of my friends have had surgery on their knees for either meniscus damage or cruciate ligament injuries. So this problem is common in active older people as well as in dogs. The thing is, the nature of the injury is different in dogs and people, although the clinical signs (pain, swelling, lameness) are the same.


In people, injury to the ACL (anterior cruciate ligament) is usually a traumatic injury. You know, the tennis ball goes one direction and your knee goes the other. In dogs, ACL injury is usually a degenerative injury. The difference is subtle but important. In people, the ligament is often normal and is injured by the trauma. In dogs, the ligament is abnormal, and although the lameness is often proceeded by a perceived trauma, most often this ligament was going to pop sooner or later. The implication of this distinction is that the other ligament is often bad as well. So dogs with an injury to one ACL are at a much higher risk of tearing the ligament in the other knee.


Once the knee is destabilized by a torn ACL, other horrible things can happen in the joint. If you remember from the last post (It's OK, take a second to look back at the beautiful pirated photo of the knee model) there are other structures in the joint. That soft cushion of cartilage, the meniscus, is often torn at the time that the ACL goes. (see the illustration below) This causes more pain than the torn ligament sometimes. Knees with chronic partial tears can cause intermittent lameness. These knees tend to develop pretty bad arthritis over time.





Next post we'll talk about some options for treatment and possibly things we can do to minimize the undesirable effects of this condition. Until then, you might want to check this out to help your pet's joint health. Many runners I know use similar supplements designed for people, why not use one designed for dogs. I also know dogs that use Omega 3 fatty acids for arthritis. It is the major active ingredient in many joint diets, but in far too small a quantity. Here is a great way to get enough of a really good thing for you and your pets.

Keith Niesenbaum, VMD

http://www.thevetschoice.com/
http://www.crawforddogandcathospital.com/

What the H_LL is the ACL

OK, things got out of hand at work and I slipped back into an old pattern and I haven't posted for a while. I guess that when I decided to write about cruciate ligament injury in the dog, I found the topic so overwhelming that I just avoided the entire project. So, I'm going to divide it up into several smaller posts and the task will be easier for me to tackle. This post will deal with the ligament itself, and an explanation of some of the anatomy of the knee.

The knee is a pretty remarkable joint. The photo shows a model looking at the knee from the front. The joint, is a hinge, designed to flex and extend in one plain of motion similar to the way a door hinge opens and closes. It also has some very amazing shock absorbing principles, that allow us to run and jump. The joint runs into real problems when we ask it to do things it isn't designed to do like rotate, or hyper extend beyond it's normal range of motion.

There are extra articular structures (outside of the joint) that keep the knee stable. The muscles of the thigh that cross the joint and several collateral ligaments that do the same. You can see these collateral ligaments on the outside of the model.

Inside the knee, there are two cushions of cartilage, called the menisci. The medial meniscus on the inside and the lateral meniscus on the outside. They are labeled in the photo above. Finally, making a cross in the center of the knee are the two cruciate (cross) ligaments. The anterior (ACL) and caudal (CCL) cruciate ligaments. These guys keep the knee from sliding forward and backward. In fact the instability caused by injury to the ACL is called anterior drawer sign because when the muscles are relaxed you can actually pull the tibia (shin bone) forward like a drawer in a desk.

So now we all know where everything is. Next post I'll talk about what can happen to these structures. Then finally, we'll get around to explaining how they can be fixed.

Until next time, check us out at:

www.TheVetsChoice.com

www.CrawfordDogandCatHospital.com where you can search our library for free information

Feline Stomatitis

I just watched my associate finish a dental procedure on a very painful mouth that looked a whole lot like this one. Since I missed Pet Dental Health Month, (not yet blogging regularly) I wanted to share this with everyone so that hopefully your pet will not have to go through such a prolonged, painful course of disease before you seek treatment.



Feline Stomatitis, is a painful, inflammatory condition of the mouth. We are not sure why some cats get this condition. Some veterinarians think that there is a chronic viral infection with Calici virus. Others think it is from chronic poor dental hygiene. Still others think that it is an over reaction to the tarter, plaque and bacteria, found in the cat's mouth. One thing most veterinarians agree on is that there is some sort of immune system over reaction in the oral cavity. If recognized early, stomatitis can sometimes be controlled with frequent dental cleanings, anti biotics and a stringent home oral care program. Once the cat's mouth looks like the one in this photograph, the only treatment is surgical..

In the case of our kitty today, he was admitted for blood tests, general anesthesia, a good dental cleaning above and below the gum line and dental radiographs to evaluate the extent of dental disease. Then all affected teeth (most of the uppers as well as a canine_ were extracted. He will be sent home on anti biotics and some oral rinses and we will recheck him in two weeks. If we are lucky, the mouth will heal well and we can control this disease just by having the owners take care of the mouth at home.



To have success, we must make sure that radiographs are taken and no roots are left behind under the gum line. In many cases, this treatment is not aggressive enough and we have to go back surgically and remove all of the teeth and diseased bone. Long term anti biotics follow the oral surgery. There have been many reports of cats doing very well once all of the teeth have been extracted and the diseased tissue removed.



The most common objection I get from clients is their fear that their pet won't be able to eat with no teeth. In fact the cats do better after treatment as their pain has been alleviated. Some will still eat dry food, but we try to get most onto a diet of canned cat food.



You should check your cat's mouth regularly and call your veterinarian if you see any signs of redness, swelling or bleeding from the gums. If the cat chatters it's teeth when you are looking in, then the mouth is painful and needs immediate attention. Your veterinarian should examine your pet's mouth as part of the regular physical examination and let you know if anything needs to be done to keep the oral cavity healthy,



Dental health is a team project. Good nutrition, regular dental care, and home care with observation will keep your pet's smile intact and breath fresh and clean.



Keith Niesenbaum, VMD

http://www.thevetschoice.com/

http://www.crawforddogandcathospital.com/

Heartworm Infections in Dogs and Cats

The diagram to the left (still working on images on my posts but I seem to be getting better at it) shows the life cycle of the heartworm parasite in the dog. There is an important distinction between dogs and cats but we'll get to that later.

Remember posts ago, I said that I like to have my pets on year round parasite prevention. It's not for the heartworm, because as you can see, the vector/intermediate host is the mosquito and there are none around in the cooler months here in NY. Those of you in the south need to talk to your vets about heartworm season. We keep our pets on parasite control all year round because of intestinal parasites.

The infected mosquito bites our pet, our us (although people are rarely infected as our immune systems take care of the problem) and the parasite goes through development and matures to an adult. Males and females live in the heart and the large vessels of the lungs. They mate and baby worms (microfilaria) are released into the blood stream to be picked up by the next mosquito and the cycle continues. The time from infection to microfilaria in the blood is about 7 months, so when your pet is tested this spring (and the American Heartworm Society recommends testing all dogs yearly even if they are on preventatives) we are really looking for last year's infections. In cats, the worms do not really mature as well and we often see single sex infections or no adults at all, but in a moment we'll discuss why this disease is still important in our cats.

In dogs, the most common clinical signs that we see are those associated with congestive heart failure. Large masses of worms are in the heart and obstruct blood flow. I thought I could post a photo of a heart with worms, but It seems that if I try to upload more than one image per post it just stacks them at the top of the post and it doesn't look right.

In cats, we see respiratory disease or sometimes just sudden death. The syndrome was recently identified and named Heartworm Associated Respiratory Disease or HARD. Many cats with chronic coughs have had previous infections with heartworms.

In both species it is easier to prevent disease than to treat them. We have already reviewed different medications and your veterinarian can recommend one that he or she feels is best for your pet.

There is no treatment for cats. We have to wait for the parasites to die and hope that they don't kill the cat first. Seems like a good reason to put them on prevention. We did a massive screening test on our feline patients about 5 years ago, sponsored by Pfizer (the manufacturers of Revolution) and found several cats that had heartworm exposure and one that had active adult infection. Interestingly enough, indoor and outdoor pets were equally affected. I guess those screens do have some holes in them.

In dogs the treatment involves hospitalization and treatment with several injections of an arsenic compound. Some dogs cannot withstand the treatment and some are left with permanent damage to their hearts and lungs. If caught early, most will respond OK and go on to live happy lives. But it seems given all we have talked about concerning our options, that prevention is the way to go.

I'm going to try to post some interesting cases that I've seen in the next couple of weeks. However, you all know that I can get distracted. Until then, follow me on twitter at www.twitter.com/knvet and check out our web sites.

Keith Niesenbaum, VMD

www.TheVetsChoice.com

www.crawforddogandcathospital.com

Great Opportunity

Would You Like To Get Your Pet Food For Free & Earn Extra Income?You are invited to attend a special conference call to learn how you can get your pet food for free and earn extra income!

Don't let a bad economy get you down! The pet business is BOOMING! People will spend anything on their pets and only want the very best for them.Find out how YOU can be a part of the booming pet industry!

The Purr-Fect Business For Pet Lovers And Pet Professionals!•Trainers •Groomers •Breeders •Kennels •Pet Sitters •Dog Walkers •Veterinarians •Daycare Operators •Shelter Workers and olunteers •Animal Rescue Operators •Emergency Service Professionals (K-9 and rescue units)

Date: Monday, March 30, 2009
Time: 8:00 PM EST
Phone Number: 616-347-8200
Passcode 800479#
Contact: Keith Niesenbaum, VMD
Phone: 516 746 1566
http://www.thevetschoice.com/

FLEAS!! And what to do before you burn your house to the ground.

I know it is probably bad formatting to start with a picture, but I want some credit for being able to post an illustration at all. Now I'll explain it.

The adult fleas live on our pets, they take a blood meal (bite the pet) and then mate and the female lays eggs. These eggs may stick to the pet, or fall off into the environment. They hatch and molt and develop into larvae. These in turn make a cocoon and pupate. The pupae then mature into adults, hungry for a blood meal and the whole cycle starts again. How long does this cycle take? It depends on the environmental conditions, but if things are just right they can go from adult to adult in a couple of weeks. Even more ominous, the pupal stage can survive for months in the environment, hatching out when conditions are right.

This life cycle is important to understand because it will help you to prevent flea problems and aggressively treat infestations if you missed the opportunity to prevent the problem.

Prevention is easy. Monthly application of a topical flea product that not only kills adults but prevents the immature stages from developing will keep your pets and your home flea free. We recommend Frontline plus or Canine Advantix for our dog patients. These pets are on monthly parasite control (see previous post) so we don't need to worry about worms or heartworms (see next post). For cats we recommend Advantage Multi or Revolution. You can use a product that is only for fleas and ticks, but if you are going through the trouble to use a product for fleas, why not take care of internal parasites and heartworm disease at the same time. Yes, cats can get heartworm disease but that is for a future discussion.

Now if you were naive enough to think that your pets would never get fleas and your house is now infested with the pesky buggers, you have to deal with the fleas on the pets, and the fleas in the environment. I no longer recommend owners treating the surroundings themselves. Gone are the days of setting foggers off in the home and contaminating the environment with toxic pesticides. If you have a severe infestation, use a professional exterminator.

In moderate to severe infestations, you can still get by without dumping poisons into the living room. Use a quick kill product such as Capstar that you can get from your veterinarian. This will kill all of the adult fleas on the pet in less than 24 hours. Unfortunately it doesn't last so new adults will jump on. I have clients use it every 2 days while we are getting a problem under control. Then add a topical product to every pet. This will continue to kill fleas as they jump on the dog or cat. The growth inhibitors will also control fleas in the environment where the pet spends most of its time (the pet bed or corner of the run where they sleep.)

Vacuum the house well and throw out the bag when you are done. Wash all bedding in warm water. You can use an area spray for the highest traffic areas. If you are going to bath your pet, do so before you put the topical products on, no sense in washing them right off.

Now I know you are going to think, I can get a cheaper product from the pet shop. Fight the temptation as not all of these products are as safe or effective as those that your veterinarian will have on hand. In addition, the person advising you at the store may not be well trained and could possibly give you incorrect advice.

And why is it important to treat these fleas? Well besides the fact that they are gross and icky, they can cause disease in people and pets. I have seen dogs and cats actually die from anemia as these parasites suck the very blood from these poor animals. What a horrible way to die. They are also vectors for diseases that can infect both people and pets. If you follow this post, you already saw the link to Ted Nugent last week.

Next post I'll finish this series with a discussion of heart worm disease in dogs and cats. Hopefully by then I'll be able to put my graphics in the middle of my post.

Keith Niesenbaum, VMD
www.TheVetsChoice.com
www.CrawfordDogandCatHospital.com

Worms

As promised, here is the second post in a series of four on pet parasites. I picked the generic title to try to titillate the search engine spiders in an attempt to get more readers.

Intestinal parasties, or worms, are parasites that live in our pets' (you guessed it) intestines. They are important because not only do they cause disease in our pets, but some of them are zoonotic, meaning they can cause disease in people as well. This is why we emphasize regular fecal tests, parasite control for all dogs and cats, and prompt treatment when worms are found. At Crawford Dog and Cat Hospital, we follow the recommendations of the Center for Disease Control as Outlined by the Companion Animal Parasite Control Comission. Their website will provide excellent information on different parasites, their life cycles and more in depth descriptions of each worm.

Well how can my pet get worms? "My cat never goes outdoors", or "my dog doesn't even like other dogs". Many pets are infected long before they came to live with youl. Both round worms and hook worms have very short life cycles and can infect puppies and kittens in the uterus, before they are born. Most treatments, do not kill all of the larval stages of these worms, so even if your fluffy one has been dewormed, only the adult worms were killed. The larval forms will continute to mature and eventually shed eggs into the environment. Potentially re-infecting the pet or exposing the people in the home to parasite infections as well. This is why you need to deworm them multiple times if they are infected.

Older pups and kittens can be infected through their mother's milk. And after weaning, pups and people are at risk of infection from microscopic eggs in the environment. It is very important to clean up pet wasted before these eggs mature. In the south, it is very important not to walk bare foot where hookworm larva may be in the soil.

The curious thing about round worms and hook worms, is that they can lay dorment in their animal hosts for years. That's why it is important to test all pets regularly and use some sort of preventative. These dorment infections can become active later in life, so the mature cat that is walking on the kitchen counter can have rondworms eggs on it's feet, even if it hasn't been outdoors for years.

Prevention and detection is easy. Regular fecal examinations are a must. Twice a year for dogs and cats that go out. Yearly for cats that have tested negative in the past and haven't been outside for years.

All dogs should be on a monthly parasite control medication such as Heartguard, Advantage Multi, or Sentinel all year long. (that's 12 months of the year) This will prevent heartworms, control intestinal parasites (treat them with some of the products) and some of these products will help to control fleas as well. (fleas will be the topic of an upcoming blog post).

All cats should be on montly parasite control programs as well. We recommed Revolution or Advnatage Multi for cats. Ideally all year long, but for indoor cats, 6 months of the year is probably adequate. These products also control fleas, a source of the bacteria that causes cat scratch fever, the bacterial infection, not the Ted Nugent song.

So we can live safely with our pets. Just keep in mind that prevention beats the crap out of treatment and disease, especially when it comes to intestinal worms. Next post, we can talk about flea control as the weather hopefully starts to get warmer here in the Northeast.

Keith Niesenbaum, VMD
http://www.crawforddogandcathospital.com/
http://www.thevetschoice.com/

Parasite Control 1 of 4

I have been trying to keep my hospital staff trained on the topics of parasite control and prevention in our pets. Here is a summary of what I tell them, regularly this time of year.

I divide our parasite control program into 4 parts. We emphasize prevention over treatment, and I tell them and our clients that there is no one product that can control all 4 parts. The trick is to determine a particular pet's risk factors and create a custom program to keep everyone healthy.

Today we'll talk about ticks. Here on Long Island, ticks are an important vector of disease. Not only are they gross (non-medical term) but they transmit the bacteria that causes Lyme Disease, Ehrlichia, Rocky Mountain Spotted Fever, and anaplasmosis. In other areas of the country they can carry other things as well. Many of these diseases are contagious to people as well as dogs and cats.

There are several different species of ticks, and they vary in size and appearance. For a good set of pictures of ticks in their different life stages follow this link. Suffice it to say, different life stages carry a different risk of disease transmission.

With ticks, prevention is the key. Once a kennel or home is infested with ticks, good luck getting rid of them. Also, preventing tick attachment is the best way to prevent disease transmission.

Several tick myths debunked:
1. Ticks do not burrow under the skin and disappear into the host animal. They do feed, engorge with blood and drop of into the environment to moult to the next life stage.
2. The best way to remove a tick is to hold a match to it. Actually, the best way to set your pet on fire is to hold a match to the tick. You can coat the tick in Vaseline as this will block it's breathing pores without the risk of combustion. Or, using a tweezers,gently grasp the tick behind the head, and applying gentle traction, pull it from your pet's skin. Here is one of several tick removers you can use. (Disclaimer: I have not used this particular product and am not associated with the company in any way)
3. You can get ticks off your dog by soaking it in motor oil. See above for combustion comment. If you really think this is a good idea, we need to talk, I mean really talk.

Prevention is much easier than it used to be. In the old days, OK when I graduated from school, we used smelly, relatively toxic dips. Now there are several products on the market that work very well. We recommend and sell Canine Advantix for use on dogs and Frontline Plus for use on dogs and cats. Both are applied monthly, have good residual activity against fleas and ticks (another post on Fleas will follow) and are safe for your pets. They can be purchased from many sources, but the best place is from a veterinarian or a veterinary supervised source as the product can be assured to be dated well and safely stored. Use as directed and contact your veterinarian if you have any questions.

Next post will be on internal parasites you know, icky WORMS.

Keith Niesenbaum, VMD
http://www.crawforddogandcathospital.com/
Life's Abundance Field Representative

Seizures in Pets

This is an article that I borrowed from a friend of mine, Judy Bishop. I have reviewed the information and with only minor editing changes have posted it here for my readers so that you can have exposure to some very important information.

Seizures in pets are scary, but very treatable. You feel helpless, hopeless and panicked when watching it happen. What should you do if you suspect that your pet has had a seizure? What are the treatment options and prognosis? When are seizures an emergency? In some cases, your dog or cat may not need medication, but there are things you should know about epilepsy and seizures in pets and what you can do to keep you and your pet safe. What is a seizure? Although seizures are often thought of as dramatic events, there are a number of different types of seizures, some of which may appear to be quite subtle. A generalized seizure (Also known as grand mal seizure, fit or convulsion) generally causes an acute decrease in state of consciousness, repeated movements of the body, excessive salivation, vomiting and often a loss of bladder and bowel control. This event may last from 30 seconds to a few minutes. It is generally followed by a period of drowsiness, difficulty walking or seeing as well as changes in behavior which can last around 24 hours. This is known as the "Post-Ictal" period.The other main type of seizure is a focal motor seizure which is a much less dramatic occurrence. A focal motor seizure will cause just a repeated twitching movement in either the face or limbs and usually only lasts a few seconds. These type of seizures may often go unnoticed especially if they involve fairly innocuous movements like swallowing. Seizures are one of the most frequently seen neurological problems in pets. A seizure is also known as a convulsion or fit. It may have all or any combination of the following:1. Loss or derangement of consciousness2. Contractions of all the muscles in the body, stiffness, or sudden, violent shaking, muscle twitching or slight shaking of a limb.3. Changes in mental awareness from non-responsiveness to hallucinations, including staring and altered vision.4. Involuntary urination, defecation, or salivation5. Behavioral changes, including non-recognition of guardian, viciousness, pacing, and running in circles. A seizure may last from one to five minutes. Afterwards, the pet may seem exhausted, confused and disoriented.What causes seizures in pets?Seizures can be caused by numerous things - poisons, skull injury, viral and bacterial infections, congenital malformations, heat stroke, parasites, fungal infections, low blood sugar (diabetics), and so on. By doing a physical exam and blood work, most causes can be eliminated. Seizures occur because of a change in the electrical activity of the brain. This can be caused by a variety of things including diseases of the nervous system and the brain itself such as epilepsy. Seizures may also be the result of a blow to the head, chemicals, poisons, fever and even nutrient deficiencies such as calcium deficiency in nursing mothers.What are the three phases of a seizure?Seizures consist of three components:1) The pre-ictal phase, or aura, is a period of altered behavior in which the dog or cat may hide, appear nervous, or seek out the guardian. He may be restless, nervous, whining, shaking, or salivating. This may last a few seconds to a few hours.2) The ictal phase is the seizure itself and lasts from a few seconds to about five minutes. During this period, all of the muscles of the body contract strongly. The pet usually falls on his side and seems paralyzed while shaking. The head will be drawn backward. Urination, defecation, and salivation often occur. If it is not over within five minutes, the animal is said to be in status epilepticus or prolonged seizure.3) During the post-ictal phase, there is confusion, disorientation, salivation, pacing, restlessness, and/or temporary blindness. There is no direct correlation between the severity of the seizure and the duration of the post-ictal phase.Is your pet in trouble during a seizure?Despite the dramatic signs of a seizure, the animal feels no pain, only bewilderment. They do not swallow their tongues. If you put your fingers into his mouth, you will do no benefit to your pet and will run a high risk of being bitten very badly. The important thing is to keep the animal from falling and hurting himself. As long as he is on the floor or ground, there is little chance of harm occurring. If seizures continue for longer than a few minutes, the body temperature begins to rise. If hyperthermia develops secondary to a seizure, another set of problems may have to be addressed.What is the conventional treatment for seizures? Treatment for seizures is directed at the underlying cause or disease in cases where this is known. Anti-epileptic drugs such as Phenobarbital are commonly used to prevent seizures which are severe or occur frequently.When should I consult my pet’s veterinarian?Seizures are frightening to witness. Stay calm. Try to time how long the seizure lasts. First thing to do is to stay clear. Seizing animals may bite (without knowing it) and trying to hold them down may cause injury. They will not 'swallow their tongue' as you may have heard. Keep fingers away from the pet's mouth. Remove any objects in the area that can injure the animal.Call your vet. With the first seizure, the patient receives a full physical exam, laboratory work up including blood tests, urine analysis, and sometiems an EKG -- seizure control medications usually wait at this point. UNLESS the first seizure is a severe cluster seizure (several happening at once) or a continual seizure called Status Epilepticus, this is a medical emergency. If anything is found on physical or blood work that may cause seizures, the underlying conditions will be addressed and treated. It is important to seek medical care for your pet if he/she has more than one seizure per month, has changed behavior in between the seizures (Excluding the “Post-ictal” period directly after the seizure) or becomes generally lethargic, has difficulty in walking or refuses food.What should I do if my pet experiences seizures?While the owner should keep a diary of when/where the seizures occur, how long they last, was the animal acting strangely/doing any activity in particular before the seizure, and how long after the seizure did it take for the animal to be 'normal'. This may provide clues if a pattern is noticed.There are definite seizure triggers for some animals, and if they can be identified, the number of seizures can be reduced if the trigger (activity, excitement, etc.) can be avoided.What can be done to prevent future seizures?Veterinarians generally prescribe 1-2 weeks of anticonvulsant therapy and then re evaluate the pet. The next treatment is determined by how long it takes for another seizure to occur. That may be days, months, or years. At some point, many animals have seizures frequently enough to justify continuous anticonvulsant therapy other times, medication can be gradually discontinued under veterinary supervision. Veterinarians usually do not recommend medication until seizures occur about every 30 days or unless they last more than five minutes.It is important to avoid sudden discontinuation of any anticonvulsant medication. Even normal dogs and cats may be induced to seizure if placed on anticonvulsant medication and then abruptly withdrawn from it. Your veterinarian can outline a schedule for discontinuing the medication. A prevention plan is a simple method of enhancing the level of nutrition and making lifestyle changes. It is an attempt to address any special needs your pet may have. Rule out other health problems such as Thyroid, Diabetes, Cancer, Liver or Kidney disease. A health problem may be triggering seizures. Over the past decade, natural approaches have been found to be helpful in some patients, either prior to stronger medications or in addition to them, so that you may not need as high a dose. Feed High Quality Food. Poor nutrition is a direct cause of many major and minor diseases. Therefore, a commitment to optimum health and longevity for your pet must include a high quality diet. Research has shown that a low quality diet -- meaning a diet loaded with chemicals, fillers, stabilizers, coloring agents, sodium nitrate (found to produce epileptic-like changes in the brain activity of rats who ate it regularly) and by-products -- can lead to allergies, nervousness, hypertension, diabetes, weight problems, dry skin, and many other common ailments. Because of what goes into pet foods today and what does not, it is important to know how to read labels, and know the history of the company manufacturing the pet food. We recommend HealthyPetNet Life's Abundance Premium Food for Dogs and Cats. HealthyPetNet products use high quality ingredients -- healthy ingredients that are useful to your pet's body. It is essential to choose a high quality food. It is also important to supplement your pet's food. This is important, since every animal is unique and has different nutritional needs. Even healthy dog and cat food may not provide all of the vitamins and minerals your pet demands. Differences in pet age, surroundings, exercise level, and genetic makeup produce animals with widely varying needs. Some dogs and cats may need a quality supplement in addition to a quality food. We recommend HealthyPetNet All Natural Dog and Cat Supplements.

I would like to add that dogs with seizure ddisorders can lead very long and happy lives. It is important to find and treat any underlying disese, improve the baseline health status of the patient by optimizing nutrition and minimizing environmental stresses, and control serious or frequent seizures with medications.

For more health care information check out our practice web page and follow our blog. We look foward to your comments and suggestions on this and future posts.

What you need to ask your veterinarian

This post is taken from the notes I made in preparation for a presentation on Thursday morning. I am a member of BNI international and each week, a member gets to give a presentation about their business.

I want everyone to think about their veterinarian, specifically, ask yourself if you like your veterinarian. If the answer is no, then this is a short discussion and you have to ask yourself why you still go there. If the answer is yes, or yes, but, then you should ask why you like your veterinarian.

Some people will answer that the doctor is nice, or he/she loves animals. The hospital is pretty, or modern. The facility is clean, and there is no smell. The staff is courteous and helpful. These things are all important, and they are things that you can see and make a judgment on. You certainly don't want to go to an animal hospital that is dirty, or smells bad. You don't want to go where the staff or doctors seem to be unhappy, or don't seem to like animals. But what you can't see, or know, is what goes on once you leave the exam room.

Even in the exam room, you should have a good interaction with the doctor and staff. Do they ask about your pet? Are recommendations made specifically for your pet and it's lifestyle (more about this in a future post), or do the recommendations seem canned and applied to all animals? Do they do a complete physical examination, looking into your pet's eyes, ears, and mouth? Is the chest listened to with a stethoscope and is the abdomen carefully felt for abnormally sized organs or tumors? Are the medical records complete, legible and can you get a copy if you want it? Are all of your questions answered?

While you are asking questions, there are some other things you want to be aware of. If the pet is going to be anesthetized, who will monitor the anesthesia. In NY State, only veterinarians, and Licensed Veterinary Technicians (LVT) can administer medications, anesthesia, and monitor anesthesia. Do they have monitoring equipment? In our hospital, a LVT monitors anesthesia using several machines, keeping an eye on the heart rate, respiration, the oxygen saturation, and body temperature. It looks like a scene from ER, your pet is hooked up to many monitors so that we can do our best to assure a successful outcome.

During anesthesia, do all pets have an IV catheter placed, and do they get fluids to help support them during anesthesia? What types of medications are used and is the pet intubated to maintain a safe airway.

Does the hospital have an in house laboratory for running blood tests. At Crawford Dog and Cat Hospital, we have a complete in house laboratory. This enables us to run blood work the morning of surgery to make sure that everything is OK. It also allows us to get results back for sick pets in under an hour, so that a diagnosis can be obtained and a treatment plan formulated. If your veterinarian does not have an in house laboratory, how long does it take them to get back blood test results? This could be important if your pet is critically ill and time may make a difference in the outcome.

Now I know that everyone assumes that the surgery suite is sterile and clean, but it is important to make sure that the operating room is an operating room and used for nothing else. Here is a picture of ours :
http://www.crawforddogandcathospital.com/site/view/102351_SurgerySuite.pml In addition, ask if a clean sterile pack is used for every procedure. One would think, "of course", but I assure you that this is a place that many low cost clinics keep their overhead down. They re-use packs for multiple surgeries.

The technique for performing surgery is very personal. We use a laser seen here http://www.crawforddogandcathospital.com/site/view/102352_Laser.pml because we feel there is less bleeding, less pain, and a faster return to function. Many practices use scalpels, and this is fine, both are just a way to cut tissue. The important thing is that the surgeon be comfortable with what he/she is doing. It is also important that adequate pain control measures be taken. Yes that's right, surgery hurts dogs and cats just like it hurts people, and all of our pets should have pain medication after surgery.

Speaking of some painful procedures, remember your last visit to the dentist? Now I'm not talking about a simple tooth cleaning, although this needs to be done for our pets regularly. I'm talking about extractions, tumor removals form the gums, or even root canals. Dentistry, including cleanings, cannot be done with the dog or cat awake. It is impossible to safely, and effectively evaluate and treat dental disease above and below the gum line in an awake pet. In addition, dental radiographs should be taken, just like when you go to the dentist. See? http://www.crawforddogandcathospital.com/site/view/102350_Dentistry.pml

Everything that we talked about for surgery and anesthesia holds true for dental procedures as well. Adequate monitoring, good technique, competent, trained staff, appropriate well maintained equipment, and post procedure follow up including pain medication when indicated.

I hope that this little glimpse into the workings of our hospital will give you an idea as to what you need to be aware of when selecting a veterinarian for your pet. Check out our full web site at www.crawforddogandcathospital.com, especially the library page where you can search for articles written by specialists about a variety of topics concerning your pets health. We will be posting on this topic again in the future, so follow this blog for more information. You can also follow me on www.twitter.com/knvet for less detailed postings about our day to day activities here at the office and on the road.

Keith Niesenbaum, VMD
Crawford Dog and Cat Hospital
Garden City Park, NY