Them Bones, Them Bones

So, I was out for a long run on Monday. Actually, I didn't have access to a car, my daughter having absconded with it and I had no other way to go home. Now a more sane person might have called someone for a ride, or at least picked the most direct route home. But nooo, I mapped out a 12 mile route, including a little turn around the high school track for good measure and trotted off. The thing about long runs is that there is a period of time where there is nothing to do other than to let one's mind drift, and drift mine did. As various things started to ache, I focused on a bunch of things that I wanted to write about, most of which I have forgotton, but I'll try to stick with the free association that I went through over the two hours it took me to get home to dinner.

First, I was thinking how I should think of things to write about. Seems to make sense. Then I realized that no one, not even one person, ventured a guess about the film references. I'm not going to assume that there are no readers out there (my ego couldn't take it) so I'll assume there are no Italian film fans. The references were to Amarcord, a 1973 coming of age film with everything a guy could want in a movie with subtitles except there was no karate.

Then I realized that no one knew that in our practice, Bichons, are the master stone formers. They just pop back and forth between struvite and oxylate, frustrating the heck out of their owners and their doctors alike.

By the second mile, I was all warmed up and feeling pretty good. I looked down at my feet and realized that I will need new running shoes after this race in September. (I never race in new shoes) Then I was thinking about the shoe drive that we are running at our hospital, collecting used but wearable shoes to be distributed by souls4soles, a non profit outfit that is actually in Hati right now as we speak, delivering shoes to those who are bare foot.

That kept me distracted for a while, until I started thinking about my pace and heart rate and all of those mundane things that I need to keep track of if I am to finish this run in any kind of shape and still be able to get the rest of my work outs in over the week. I was trying to juggle my schedule so that I didn't have runs on back to back days because that is really hard on my legs. Which led me to think how lucky I am that my knees are good. My mind quickly did some trick to ward of the evil eye and then I thought I should talk about arthritis in pets. There was one brief digression as I ran on a bit of roadside path that made me worry about ticks and lyme disease, but that topic doesn't really fit the trend of nutritional posts I wanted to write and maybe I could put that off for a week or so, even though we are getting into the second peak season for deer ticks that spread the disease, even tho we don't have a lot of deer in my area and then I notiticed that I hadn't taken a breath and the run on thought had become a run on sentence and I was going to pass out if I didn't slow down.

So miles 4 - 8 were mostly on joint disease. Now, both dogs and cats are subject to degenerative joint disease. I am talking about the type of arthritis that is caused by wear and tear on the joints. There may be underlying instability in the joint as in hip dysplasia. Sometimes it is a genetic predisposition such as the abnormal looking joints in Basset Hounds. And sometimes, it is just part of the aging process. We think of dogs as being arthritic, but there was actually a retrospective study that looked at the x ray films of cats admitted to hospitals for other reasons. 22% of the cats over a year old in this study showed radiographic evidence of osteo arthritis.

So what are we to do? There are plenty of medications out there to treat arthritis in dogs, not so many in cats. Some are non-steroidal anti-inflamatory medications (not in cats please). There are nutriceuticals such as glucosamine, chondroitin, green lipped muscles (who knew they had lips). There are surgical treatments (not so good). New research shows promise using stem cells. And we have had some very good success using our laser to treat painful joints in both dogs and cats. But what if you could do one thing to prevent, or at least mitigate, the degenerative changes in the joints.

Well, if you are a regular reader, you know that weight control is very important in preventing arthritis in pets. Purina did a great study in labs showing a correlation between arthritis and increased (excessive) body weight. (Leaner dogs also lived longer) So, work with your veterinarian to get the weight off of your heavy furry friends. Or, better yet, don't let them get fat to begin with.

What if they are thin and have arthritis anyway? It does happen you know. There was a series of three articles published in the past year in the Journal of the American Veterinary Medical Association (JAVMA) showing that there was an excellent response to a diet made by the folks at Hills. Dogs fed J/D (Hills cleverly uses initials to make it easier for veterinarians to remember what the food is for. Joint Diet - get it?) had a good resolution of clinical signs related to arthritis. In fact, there were all sorts of things that were measured and showed improvement over the initial 30 day period that the food was fed. I know, these diets are expensive. Not really when you consider that one of the articles demonstrated that dogs could reduce the amount of NSAID that they took when they ate this food. Add that savings in (not to mention that there are no side effects to feeding J/D and there can be with medications) and then the food is not that expensive after all. Oh, what about cats you ask? Well, they just came out with a diet for cats (Feline J/D, so clever those folks at Hills) and it works great too.

Now stop your whining before you start. "My cat won't eat that food" I can hear it already. They have a money back guarantee, my rep told me so today. If your cat won't eat the stuff, you can return it to your vet and get your money back.

So, here it is, you can actually decrease your pet's chances of getting a debilitating disease by feeding it optimally to prevent obesity. And if your pet is unlucky enough to develop osteo arthritis, you can "treat" the condition with food. Hey we all have to eat anyway, why not feed something that will make your pet's legs get better.

I'm not going to go into what I ws thinking about for the last couple of miles of the run. It wasn't pretty, and the thoughts were not all that pleasant. Just leave it to I finished, I was happy with the time it took, my legs felt OK and I had a cold beer waiting for me. My idea of optimal, post workout re hydration and recovery.

Something's Amiss if a Dog ....

OK, so no one read the last blog post. It can't be that no one knows where the film quotes are coming from. But just in case there are hundreds of you out there and you are just to shy to let me know what movie I'm rambling on about, today's post title is another hint.

I also purposely skipped dogs in last week's post about lower urinary tract disease. No, not because I think dogs are second class pets. It's just that their disease is actually easier to write about and the photos that I have are better, or at least more dramatic.

Now, dogs with lower urinary tract disease often have infections. These respond well to antibiotics. The diagnosis is made by clinical signs, (frequent urination other than marking by unaltered males), +/- blood in the urine, a urinalysis indicating infection or inflammation, and sometimes a culture. Simple UTIs (urinary tract infections) are more common in females than males, an anatomical issue not a sexist one, and should respond to a short course of antibiotics. Cure should be confirmed with a follow up urinalysis. UTIs that do not respond to treatment usually fall into one of several categories. 1. The antibiotic chosen was not appropriate for this specific infection due to bacterial resistance, solution, culture to get correct antibiotic sensitivity. 2. Antibiotic was appropriate, but not given for a long enough time or at the correct dose. 3. There is some sort of underlying problem causing the infection or the clinical signs that are interpreted to be an infection. These can be any of the following; bladder failing to empty completely due to anatomical defect or neurological problem, obesity causing anatomy problems leading to ascending bacterial infections, bladder tumors, or (if you peaked ahead) bladder stones.

This radiograph is a much better illustration than the cat photo from last week. Need I point out the mass of minerals in this poor dog's bladder. I hope not because I still haven't gotten around to the use of arrows in my photographs. (any hints on this would be greatly appreciated.)

Bladder stones in dogs are similar to urinary stones in most mammals. They are mineral concretions that form in the urinary tract. We do see calcification of the kidneys as well, but clinical kidney stones are less common than bladder stones in dogs. The most common stones historically were struvite stones. These phosphate based stones need a nidus to form, usually a bacteria and are therefor associated with UTIs. An important factor when talking about prevention. Struvite stones are usually smooth, yellow to tan colored little rocks. They tend to form in alkaline (not acid) urine but I have seen them look like anything and form in all sorts of urine. The only way to tell what type of stone the dog has is to get one and send it off to the lab. Now, in male dogs, there is usually only one way to get one, surgery. I have been lucky in females and have been able to get them to pee out a small stone that we can have analysed. The other cool thing about struvite stones is that they can be dissolved by diet. While the SO diet by Royal Canin will do this, I find that S/D (could that be for stone diet?) made by Hills does a great job. Struvite stones can be dissolved in about 1 month in most dogs. There is a catch for the guys tho. I don't like to try to dissolve stones in a male dog. The thing is, that before a stone dissapears, it becomes small. Small stones can pass out of the bladder and get stuck in the urethra, just above the os penis (penis bone) This can cause an obstruction, a true surgical emergency.

So for all you guy dogs out there, and you know who you are, your choice is surgery. Here's what came out of the bladder above.

Pretty impressive collection, huh? Now once the stones are out, if they turn out to be struvite, we do put the dogs on S/D just to make sure that we are good to go and that nothing else is forming. Then we put the pet on a maintenance diet and monitor the urine every month. What are we looking for? Infection. Remember, these stones need a nidus of bacteria to form, so if we can catch the UTI early, we can prevent the struvite stones from forming. The thing we have to be careful about tho is the other end of the spectrum, stone wise. We used to try to promote an acid urine, either by diet manipulation or by adding acidifiers to the diet to prevent these stones from forming. That's when we started to see an increase in the number of oxylate stones in our canine patients. These stones cannot be dissolved by diet, do not need infection to form, and must be removed surgically in males and females. They are rough surfaced and can stick to the lining of the bladder. They can be difficult to remove and I can only assume that they are quite painful. Once out, we usually use the Royal Canin diet to prevent them from coming back. This diet maintains a neutral ph so as not to encourage struvite stone formation and works by decreasing the precursors for stone formation in the bladder. Another new improved option is Hills C/D multicare, it does the same thing. I won't put another set of links to the website, just follow the ones above.

So the take home message is, re occurring bladder symptoms in the dog are not usually just repeated infections. Additional testing needs to be done to find out why the dog is having the problem, what the problem is, and what can be done to cure this episode and prevent future ones. It is an on going problem that can be managed very well with diet and follow up.

Oh, and if anyone thinks they know their stones, here's a little trivia question. What breed do you think has the greatest incidence of bladder stones in our practice. I'll give you a hint, nah, no hint, but I will give you a prize. First person that doesn't work at my hospital to leave the right answer as a comment will get a $10 gift certificate for some really outstanding pet food. Check it out at www.TheVetsChoice.com.

To be Fit as a Fiddle, a Cat Has to ....

OK, there it is, right in the title, my homage to Fellini. Not that the oblique film reference has anything to do with today's topic, I'm just trying to show that I am a multi dimensional kind of guy. The first person to identify the reference and leave it in a comment will win ..... My undying respect for your film knowledge. I mean come on, I gave you the artist, you should be able to figure this one out.

But on to our first topic in nutritional therapy, feline lower urinary tract disease. (maybe we should have stayed with Italian films). Back in the dark ages, when I graduated from vet school, (go Penn class of '84), we used to see a lot of cats with signs of lower urinary tract disease. You know, increased frequency of urination, perhaps some blood or straining in the litter box with little urine produced. In male cats it would frequently get bad enough that they would block and be unable to urinate at all, necessitating surgical intervention of some sort. Ultra sound was not readily available, so we assumed that these cats had infections and gave them antibiotics and made some diet recommendations (at the time Hills Prescription Diet C/D was all that was really available) and lo and behold, most of these cats got better. Logic, incorrect as it might have been, dictated that there was an infection that the antibiotics cured. Current theory was that the ph of the urine (measure of acidity calculated by the inverse of the negative log in base 10 of the hydrogen ion concentration, but now I am just showing off) was too high so we added acidifiers to the diet as well.

Theories came and went over the next few years, but the antibiotics stayed. In that time we thought it was the ash content of the diet, the magnesium content of the diet, the ph of the urine, and people even thought that urinary disease in cats was related to the phase of the moon. What did change, is that we started to culture some of these cats' urine and we found, you guessed it, no infection. So what was going on? We had made the urine acid, we had given antibiotics, but then after really screwing up the urine of these felines, we started to do some imaging. First was x rays. It's hard to see in this photo, (and I don't know how to put arrows in these yet but hey, I'm an old dog learning new tricks.)

The bladder is to the left of the bones and to the right of the black gas. If you look carefully, you can see a line of small white stones. This is what we started to see on a certain percentage of our bladder x rays. Stones are made of minerals so they show up white. Most are struvite (phosphate) or calcium oxylate stones. It is hard to tell which are which on radio graphs, you need to take them out and send them off for analysis. The thing is, a lot of cats had urinary tract signs, negative cultures, and no stones on radio graphs. Enter the ultrasound machine. Now, some people can read ultrasounds with no problem. I on the other hand have difficulty. So, I have a doctor that does imaging come to our practice to do our studies. And what he finds in many cases, is simply a thickening of the bladder wall. No infection, no stones, no nothing.

These are cases of sterile interstitial cystitis. A potentially serious inflammation of the bladder that causes all of the signs that we see. Sometimes it is self limiting and usually episodic. That explains why so many cases get better after a week of antibiotics. They would have gotten better even without antibiotics. Some do not resolve so quickly and others are real bears to manage. They require constant dietary manipulation and medication just to keep the disease under control.

So what do we do to manage feline lower urinary tract disease? Well if we find an infection, antibiotics are still the answer. If we find stones, we take them out. Here are the stones from the cat in the above radiograph. Easier to see now that they aren't in the cat.
We will send these off to the lab and once we know what type of stones they are, then we will make long term management recommendations. The tough cats are the ones with the sterile cystitis (SC). These get a combination of pain medications, anti inflammatory medications and even some anti anxiety medications. But the only thing that seems to have any science behind it is dietary manipulation. Now, anicdotally, colleagues of mine in feline only practices have told me that they have significantly reduced the incidence of FLUTD (feline lower urinary tract disease) in their patients simply by having all of their clients feed canned food. It seems that the increased moisture may play a roll. Cats are notoriously poor drinkers so it does make sense that a more dilute urine brought on by increased water intake might help with irritants in the bladder. There are actually studies showing that feeding canned SO a diet made by Royal Canin actually has been demonstrated to decrease the signs of FLUTD in cats. It will also dissolve those pesky struvite stones and prevent new calcium oxylate stones from forming. It is our go to diet for most of our cats with FLUTD. There are some issues tho, it is high in salt which can be a problem if cats have marginal kidney function.

Another choice is a Diet made by Hills. Remember the C/D I mentioned earlier? Come on, pay attention. Well it has been reformulated. It is designed to dissolve struvite stones in the dry form, so it probably will in the canned form as well. The canned formulation is lower in salt than the Royal Canin diet and we are going to start using this a bit more for our cats with SC.

So we have come a long way from just popping our feline friends with antibiotics every time they strain to urinate. And, we have done far fewer urethrostomy surgeries on blocked male cats, which is a good thing. We can control and treat many cases of FLUTD in cats with diet and common sense. Talk to your veterinarian for dietary recommendations and don't forget to let me know if you figure out the reference at the beginning of this post.

I didn't forget about dogs, they are just entirely different beasts and I will post about them next time.

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You are what you eat, they are what we feed them

I have to say that I was pleasantly surprised by the feed back that I received for the last blog series. Maybe there is something to this whole series concept. People that are not related to me actually sent me suggestions for topics and I wrote about them. I whole new experience for me, positive feedback from the blogisphere.

Now I've made this mistake before. As rush chairman at Penn Iota chapter of Phi Kappa Psi fraternity in the late 70's I did sign off on a series of theme parties that went from the very successful Hawaiian themed rush kick off, to the disastrous "Come Get Mugged", beer mug give away, (those of you that were there will remember that we ended up with hundreds of leftover beer mugs), I'm still going to give this theme thing a go.

So, I would like to write a series of posts on nutrition and the treatment of disease. We use nutritional therapy as a stand alone for certain conditions and as a adjunct therapy along with medicine and surgery for others. Sometimes just diet changes, sometimes supplements. There is a whole lot of misinformation out there. People are making recommendations that are not based in science. Alot of these people want to sell you something. Some of them are just misinformed, Some are just parroting things that misinformed people from the previous sentence told them. Others are just silly.

I'm going to try to limit my discussions to things that the general scientific community knows to be true. I will offer my opinion when I feel it is appropriate, but will tell you when it is my opinion. I will try to provide references when I can to support my statements, and I will try to make them independent or at least independently corroborated when I can.

So what do I want from you dear readers? Well, I'd love you to keep reading. I would also like it if you could send me some subjects that interest you. Disease conditions your pet's have that are being managed with nutrition or that you would like to manage with nutrition; things that you have heard that you would like to know more about; things that have worked for your pets and things that have not worked. I'll do some research, see what I can find out, and then post. You are free to comment, but I'll cut you off at the knees if your comments are just sales pitches to my readers.

Now this may sound like an excuse, but some of these posts will take some serious thought. So, there may be a bit of a lag between them. No, I'm not getting lazy during the height of my triathlon training season, I just want to bring you quality information along with my entertaining wit.

So let me know what you want to read about and we'll get started. I announce my new posts on twitter , so feel free to follow. If the whole twitter thing is too much for you to deal with (I mean who likes to tweet anyway), become a fan on facebook, I announce my posts there as well. It is also a great source of information and cute pet pictures, if I do say so myself.

Keith Niesenbaum, VMD

www.CrawfordDogandCatHospital.com

Live Long and Prosper, the final chapter

OK, those of you that have been following along probably have some documentation indicating that this was going to be a 5 part series and if you've been counting, it's only 4. Too bad, my blog, my rules. I actually am quite surprised that I was able to focus long enough to string together 4 posts over a rather regular interval on a related subject. Fortunately, I just got back from vacation, so I should be able to avoid the rant that happened in a previous post. I'm feeling very mellow after spending some quality time with family and friends and their dog. That's right, a true busman's holiday, their dog Zeus was with us for the week. Just to make me feel at home, my host's fed their dog some table food (you all know how I feel about that) and he had a bout of an upset stomach that ruined a previously reviled and hideous, yet functional area rug in the living room. But I digress. Zeus is a really cool dog of the 60 lb mixed breed type. Not without his foibles like a bit of separation anxiety and a quirk that won't allow him to pee or poop unless he is taken for a walk at the most inopportune time. One thing I will say, he is well behaved. In fact most of the dog's we encountered on this trip to Martha's Vineyard were well behaved. Well, that one black dog did almost knock his owner over trying to get to Zeus on one of our previously alluded to walks and their was the dog aggressive Leonberger on the beach that barely looked like a Leonberger but we'll defer to his owner since the owner and the dog both were trying to behave.

Why am I prattling on like this you are probably asking at this point. Well, I would like to address an often overlooked reason for early death in both dogs and cats. Euthanasia for behavior issues. Cats are trickier so we can get them out of the way first. While I have seen cat's euthanized for behavior issues, these are often not training deficiencies, but rather behavior problems. The most common being failure to use the litter box, destruction by scratching and aggression towards people and other animals. These can be stress related, although looking at the lifestyle of most of the cats that I know I can't imagine a more stress free life.

However, the stereotype of the cat collector aside, cats are not pack animals like people. In the wild they are generally solitary hunters, coming together when necessary at common feeding areas and to seek the company of other cats to make kittens. (there, doesn't get anymore G rated than that does it?) We put a bunch of them together in one home and sit back and wait for behavior issues to develop. There are a number of good sources of information on reducing this stress, but my favorite is put out by The Ohio State University, School of Veterinary Medicine. Give it a look see.

To summarize, make sure everyone is neutered (cats not people, different topic and less G rated), have adequate, clean litter boxes with varied substrate, separate feeding and watering areas, and plenty of perches and scratching posts. This should take care of most of you issues. For those that are particularly troubling, consult your veterinarian, and take a look at the Ohio State link.

Dogs are both more complex and actually easier to deal with. They are pack animals and as such can and should be trained. That doesn't mean that all dogs will be neurosis free and never have a bad moment. I mean, my dog Cookie is generally well behaved unless you let your toddler put their face too close or it thunders out. Even Zeus had his moments this week. However, it is a rare dog that can't be made obedient in most, if not all situations. Dogs should listen to their owners, come when called, sit, stay, and go to the bathroom outside. Some can even be trained to pick up after themselves and friends although I think Piglet has way too much supervision in this video.

The point is, well trained dogs are easier to deal with and people will enjoy being around them and therefore, around you as well. So start as a puppy, socialize your pet, and get some basic obedience training. Oh, and you can't just go to some classes when your dog is 4 months old and expect that it will be trained for life, you have to keep working at it and working at it.

If I had read the manual for the digital camera that my wife purchased a couple of weeks ago, I would have a picture of Zeus behaving for you to see and it would make this blog more interesting. So, if you have photos of your dog doing tricks, why don't you post them on my Facebook Fan Page so everyone can see them. Or, if you know how, put them in a comment right here on the blog.

While we're talking about comments. I had to reject a couple in the past week. While I love to hear from you all, please don't submit comments for products or services. If you want to promote yourself, then write your own blog. It's not hard, any well trained dog or cat can do it. Heck, even a veterinarian that can't use a digital camera can do it.

Next week, we'll try to focus on nutrition and specific diseases. If you have any favorites that you would like me to touch on, let me know. These may end up being a little less rambling and a little more educational, but hey, you never know.

Keith Niesenbaum, VMD

www.CrawfordDogandCatHospital.com

Live Long and Prosper, Third in a Series

So here it is, a couple of days late due to a little techno hang up. (I couldn't find any pictures to use for this post even though I have saved many over the past couple of months in anticipation). I think the glitch has something to do with my abandonment of the Blackberry Storm that I have hated for two years and the acquisition of the yet to be mastered Droid Ally. However, I think that my technology foibles can be another whole series of posts for some future date. I'm not here to talk about phones or apps, or even my laptop computer which seems to spend more time at a certain apartment in Brooklyn than it does on my lap. I'm here to talk about one of the most important things you can do to help your pet live a long and healthy life. We've covered vaccines and Nutrition/weight control. Now it's on to oral health.

Now this doggie seems to have nice, shiny, white teeth. You might say, "Gee, the gums look a little red and maybe I detect some staining on that upper 4th premolar." (big tooth with two points). You might also wonder why this dog has a clear tube coming out of it's mouth, and why Kim's fingers are so close to the aforementioned pointy teeth. Well, as you might have guessed, this dog is sleeping and it's teeth didn't look like this a little while ago.

They looked like this. (Cue the horror movie dramatic music)

Yes, it's true, someone probably let this dog lick them on the face and couldn't imagine why it's breath smelled like 2 week old dead fish. But bad breath is not the only problem that we see with dental disease of this degree. As you can imagine, this dog's mouth must hurt. Go to your dog right now. I'll wait, bring him or her back to you computer. Now sniff his breath. Lift his lip carefully like Kim was doing in the first picture. If you smell rotten eggs or see any staining on the teeth, or worse, if you see tarter and red gums like this you call your veterinarian first thing in the morning, hang your head in shame and make an appointment to have your pet's mouth examined and the disease treated. That's right, disease. Oral disease is a painful condition that leads to tooth loss. Infections in the periodontal pocket can cause abscesses. Cat's (not pictured here due to the aforementioned tech issues) also get cavity like lesions that expose the nerves. Bacteria can get into the blood and cause kidney disease, heart valve disease, and liver abscesses. Toxins from these heinous bacteria make your pet feel like crap. This is serious stuff. Oh, I know, your pet is too old for anesthesia and dental treatment. Horse Hockey! (for all you Col. Potter fans). Old age is not a disease but rotting teeth are. Have your vet perform a complete physical examination, including the oral cavity. This, along with some basic blood work will determine the safest way to treat your pet's mouth.

See, here's another dog with horrendous teeth. This guy isn't going to be so lucky. Once the teeth were cleaned and radiographs were taken, it was determined that not all of the teeth could be saved. That's right, we had to make the phone call that owner's hate to hear, "Mrs (fill in your name if you haven't been taking care of your dog's teeth.) we have finished Fluffy's cleaning and radiographs and we have to extract several teeth" The owner always gasps and asks how the dog will eat. I tell them, "better than he is eating now because these teeth are loose and painful."

Notice how clean the teeth left behind are? Notice how many are missing? And this is only one side of the mouth. I assure you that the other side looks much the same. Do not let your pet's teeth get like this. Your veterinarian should be examining your pet's teeth at every wellness visit. You should ask your veterinarian if your pet's teeth are OK and if yes, what you should do to keep them that way. If no, what do you have to do to treat this disease. Once the mouth looks like the pre pictures above, no amount of brushing, or treats, or prayer will clean them. I have to clean them. Then you have to work out a home care program and do your part. Oh, yeah, when your veterinarian tells you the teeth are bad, don't answer with, we just had his teeth cleaned last year. Look in the mouth and have the doctor show you the problem. Then the two of you need to come up with a plan to treat the problem and then prevent the problem from coming back so soon.

You may have noted a bit of terseness in my tone for this post. You are correct, I am ranting again. Next to overfeeding your pet, not taking care of it's mouth may be one of the worst things you can do. It will decrease lifespan and will make for a horrible quality of life for both of you.

I'll calm down now. I hope no one got bitten looking in their pet's mouth. I should have warned you to be careful earlier. I also wanted to thank my associate Dr. Brian Spar for the photos. He has an I phone and he will be glad to tell you how much better it is than any technology I could ever posses. (wait until his I phone 4 starts dropping calls). Also, special thanks to Kim Green for helping to display the oral cavities. She is our Licensed Veterinary Technician and she does our dental cleanings and takes the oral x rays for our patients. She will also be the one calling you to tell you if we need to do extractions or additional work.

One more post in this series, then it's on to another topic. I think there is an over/under poll going on as to how many days it will take me to finish off the series. I was really good for the first two.

Keith Niesenbaum, VMd

www.CrawfordDogandCatHosptial.com

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Live long and prosper, #2

So this could be a first, but I'm actually blogging according to some pre-arranged schedule. Two weeks in a row, keeping to the topic of what you can do to help keep your pet healthy. Last week, I talked about regular vaccinations for your pets. I know everyone read and enjoyed it but in case you need to review, just check it out here.

This week is a topic that is near and dear to my heart and one that will cost you nothing and save you a bundle in veterinary bills over your pet's life. I'm talking about nutrition and fitness, or more specifically, controlling your pet's weight. I touched on this topic briefly in the past, but obviously no one was listening to me because I keep seeing overweight pets. Well it's time to take the gloves off and get down and dirty. If you have an overweight pet then this is for you.

This is a fat cat. It's not cute, (OK, maybe a little), it's fat. There are a whole slew of diseases that fat cats get more often than normal weight cats. First thing that comes to mind is diabetes. Yes diabetes as in your cat has a high blood sugar, will get severe complications and need insulin injections for the rest of it's life diabetes. Fat cats also are more prone to arthritis. Studies have shown that a large percentage of older cats have arthritic changes on radiographs. These cats may suffer in silence. Once can only imagine how carrying around this extra weight will make things worse. Overweight cats also have a higher incidence of respiratory disease, heart disease, and certain tumors. If that's not gross enough, they also have a higher incidence of constipation. You haven't lived until you've had to sedate a cat to pull obstipated poop out of it's butt. DO NOT LET YOUR CAT GET FAT!!! Talk to your vet about appropriate diets, especially after spay or neuter surgery as this will alter your cat's metabolism, lowering their caloric needs. I'll not get into details here, but try to avoid high carbohydrate diets, and stick with a large proportion of canned food that is higher in protein and fat. Think Catkins (Atkins) diet, as I cross over some copyright law line and walk all over Dr. Atkins' name. If there is interest, we can look deeper into this topic in the future. Some blogger guru said that I should keep my posts at around 800 words and those who know me know how hard that is, so lets move on.

OK, dog owners, you didn't think I was going to let you off the hook did you? Dogs get fat too. Actually, it was a run of fat, crippled, could not get up off the floor, dogs that made me decide to write this whole series of articles. I actually had to put a 135 lb Golden retriever to sleep because it was so fat that it had Pickwickian syndrome. Follow the link, I didn't make it up and it is a great SAT vocabulary word for my younger readers. Fat dogs have degenerative joint disease, increased risk of torn ACL ligaments, hip dysplasia, heart disease, and a total lack of vitality. Is it worth giving into that begging at the dinner table? Just say no!

Now I just got back from a half Ironman triathlon this weekend. I don't just throw this out because I want you to know that I can complete the 70.3 miles, even in the brutal heat, (1.2 mile swim, 56 mile bike ride, 13.1 mile run) but because I want you to know that I know what a battle this is (weight control that is). I spent a day getting passed by guys and gals that looked like this greyhound in the picture. We don't have to limit our pets diets until they look skeletal. A Labrador will never look like this guy, and the poor pugs will develop body image issues just looking at the photo. The point is, we all have an ideal body weight and we need to get there to stay healthy.

So, what's a pet owner to do? Feed a healthy diet. Feed to body condition, that is to say, if the amount you are feeding is leading to weight gain, cut it back. If your dog doesn't eat the food that you put down every time, in 3 seconds, but is maintaining weight, you do not have to top dress it with pan drippings (fat), or chicken breast, or hamburger, or anything. And exercise. This is tougher for cats than for dogs, but 20 minutes with a laser pointer every day will do wonders, if it doesn't make you crazy. And dogs need to walk, or run (breed dependent) every day, twice a day if possible. I go crazy when people tell me they exercise their dog every Saturday for 10 minutes if the weather is good. I look at them and realize that they are on the same type of exercise program. They should check with their doctors and veterianarians to make sure that they are starting out on a healthy, suitable program, then get off the couch people, and grab a leash, it's good for both of you. Take a spouse out with you and the dog, talk to each other meet your neighbors. (unless you live up at like 173rd street, then maybe you should leave your neighbors be and make sure you have a big dog and walk before dark.)

Some dogs (not most cats) like to swim. Great exercise. But I have to say, if they learn to ride a bike and pass me at my next triathlon, I'll have to find another athletic activity. My ego can only take so much. I can take being passed by the old men and women, but the first time a dog takes me down at an Ironman event, I'm done.

So, now I'm out of ideas for the next three posts on what you can do to keep your pet healthy. Give me some ideas. If I have any hope of keeping to this schedule, it will be up to you. This idea came for crazyboutdogs on twitter. Follow her at www.twitter.com/crazyboutdogs. Follow me at www.twitter.com/knvet and become a fan of our facebook page at Crawford Dog and Cat Hospital

Keith Niesenbaum, VMD

www.CrawfordDogandCatHopsital.com

Live long and prosper, the first installment

It seems that I have been seeing so many sick pets in the office lately. OK, not so much serious illness, although there has been our share of that, but sort of chronic, debilitating things, mostly things that could have been prevented if a little care had been taken. So, rather than rant and rave as we all know I can, I decided to take a more constructive course and write a series of articles on things that you can do for your pets to help them live to their normal life span with a good quality of life. Some of these things will involve your veterinarian, some of them will be lifestyle changes for you at home. I figure on five articles and only have topics for the first two lined up. So this is your chance to leave me some suggestions for future posts.

New pets are a new chance at a healthy pet so let's start with your new puppy or kitten. I think the the most important thing you can do is get them vaccinated. Now, before you get into an uproar about the evils of over vaccinating our pets and how vaccines are responsible for everything from allergies and autoimmune disease to global warming and vampires, I think you need to sit back down and continue reading.

I'm not talking about vaccinating with every vaccine on the market whether it is effective or not. I'm not talking about vaccinating every pet for diseases that they have no risk of ever being exposed to. You need to have a rational discussion with your veterinarian about your pet's anticipated lifestyle and the risk factors associated with this life style. It should be obvious (although I know it always isn't) that a dog that lives on the 53rd floor of a Manhattan high rise and never goes out, even to pee, does not need the same vaccines as the Field Trial Labrador that summers on Shelter Island and competes upstate on a regular basis. (for those of you not in New York you can substitute your own low risk and high risk locations). I'm not neglecting cats either, indoor cats do not need the same vaccines as those that go out. (shame on you if you let your cats go out)

I have worked in areas where vaccination was not emphasized. I have seen cats die of Feline Leukemia or Calici Virus infections. I have seen dogs die of Parvo and Distemper. These diseases are all preventable with adequate vaccinations.

I hate when I see a new puppy or kitten and it has been vaccinated every week from the time it was 4 weeks old. This sort of over vaccination may well cause damage to the immune system and all sorts of problems for the pet in the future. We start our dogs and cats at around 6 weeks of age with core vaccines and vaccinate every 3 - 4 weeks until they are 16 weeks old. Other vaccines are added through the vaccine period according to each pet's risk factors. Do not vaccinate your pet according to some generic vaccine program. At our practice we tailor an individual program for each pet and your vet should do the same. Don't add a vaccine just because it is only a couple of bucks more and you think you are getting a good deal. Save that for the supermarket.

Adult dogs are vaccinated periodically. Some vaccines need to be boosted yearly, some every three years. Some owners prefer to have antibody levels measured to see if pets need boosters at all and this blood test can be done for some of the vaccines on an annual basis.

Vaccines are not always benign. The purpose of vaccination is to stimulate the immune system to fight disease. There can be adverse reactions ranging from tenderness at the injection site, to fever, to severe anaphylactic reactions. There is some evidence that some vaccines can cause tumors in cats in rare instances. Your veterinarian should be prepared to help you balance the risk versus the benefit for each vaccine that he or she is recommending.

Once we have done all that we can to prevent possible fatal or seriously debilitating infectious diseases with a customized vaccination schedule we will move on to discuss things that you can do as your pet matures.

I'm still open to suggestions so leave a comment and let me know what you think. Those of you who don't agree with what I said in this post shouldn't be shy either, let me know what you think.

The links in this post go to my web page, an excellent source for information written by board certified veterinarians. The search function is on the library page and is open to anyone to use as a source. Oh, it's free. Oh, I won't try to sell you anything. No ads, it is an informational web site. There is a particularly good photo of me on the staff page. (If I do say so myself).

A special shout out to a friend on twitter that recommended this topic. You should follow by clicking on this link to the twitter page.

You should also become a fan of ours on Face Book. Crawford Dog and Cat Hospital. Here, I'll make it easy, just click on this link. We have started a weekly give away and we post it on our website. This week's goes until Thursday (tomorrow) so check it out asap and stop by to pick up your prize if you are in the area.

Keith Niesenbaum

www.CrawfordDogandCatHospital.com

www.TheVetsChoice.com

The Garden is Beautiful, but it can also be treacherous;.

I know garden season is in full swing. when I start to see rashes like this on my wife. (No this is not her, just a photo that I got elsewhere.) What would cause her otherwise normal skin to erupt in lines and patches of itchy blisters causing her extreme discomfort and misery?

Well, if you spend much time outdoors in our area, then you will recognize the culprit right here. That's right, we all know leaflets three, let it be ... Poison Ivy.

Now, she is an avid gardener, and in her defense, she not only knows the rhyme, but knows what the plant looks like, most of the time. In fact, we are so defensive about poison ivy at our home that we probably have no pants with three leaves in any of our gardens. But, as cautious as she may be, it seems that every year, it sneaks up on her and she ends up with a nasty case requiring topical treatment with steroids, administered by ours truly, just so she can get through the work week.

"Hey", you say. "Sorry bout your wife, but this is supposed to be a pet blog". Right you are, just using a topical reminder to segue into today's topic. By the way, most dogs don't get rashes from poison ivy. (some do, it's not unheard of). They can gallivant in the woods and get the oils on their coat. Then when they snuggle up to you , the oils rub off and pesto, you have the rash. Remember, the rash is not contagious, it is spread by the oil. The best product I have found for getting the oil off before you get the rash is Tecnu. Check it out.

OK, so poison ivy is not a big problem, you might ask, "what are some common flowering garden plants that can cause a problem for my pets?"

Hyacinths are beautiful and smell great. The flowers and greens of tulips and hyacinths are not generally toxic, but their bulbs contain alkaloids and/or allergenic lactones. If you are sensitive, and my wife is, wear gloves when planting the bulbs. Once you get them in the ground all should be well.

Daffodils contain the toxic alkaloid, lycorine. Ingestion can cause severe vomiting, diarrhea, abdominal pain and potential respiratory distress in dogs or cats. I hope that you will recognize them as the pretty yellow flowers that come up in the spring. I had a photo, but somehow it got deleted and since this blog post is not about a week later than I wanted it to be, I'm not going to try to figure out how to get it back up.

Here's a photo of a common plant that I actually had a client call me about last week. OK, by now it was probably 2 weeks ago. Calla lilies and Peace Lilies are actually not that toxic. Ingestion of the plant or flowers will cause GI Upset. You know, the medical euphemism for vomiting and diarrhea. The cat in my practice that instigated my mentioning these plants was vomiting a couple of times a week, after eating some of the lily leaves in the house.

Oh, look. I found the photo of the daffodils. Here they are on the left below.

Don't confuse the relatively harmless Peace Lilies or the Daffodils with the seriously dangerous true lilies. The Easter Lily above and to the right, Asian Lilies, and Day Lilies are potentially deadly. All parts, leaves, bulbs, flowers, even pollen can cause severe, life threatening acute renal failure in dogs and cats if ingested. I would advise not planting these in gardens or having them in the house if you have pets that are likely to be exposed to them. My former associate almost lost a cat to lily toxins. Fortunately, she is an excellent and tenacious clinician and the kitty pulled through.

Like the coral snake, these flowers are pretty to look at but very deadly. Just as an aside, remember, red on black friend of jack, red on yellow kills a fellow. If you know what this refers to, please leave a comment and let me know that you are out there. There are no photos of snakes or other venomous critters this post, but if you guys want, we can do that some time in the future. Not a big problem here on Long Island, but I bet the crew in the south and south west would have another story to tell.

Finally, most fertilizers will be toxic to pets as well. Keep dogs and cats off of the lawn after chemicals have been applied. Check with your gardener or read the label yourself. A good general rule is to stay off for 48 hours after the stuff has been watered into the grass. Better yet, have an organic lawn or garden.

If your pet has been exposed to something and you're not sure if it is toxic, call your veterinarian. (Gosh, I bet veterinarians hate when I write things like that and they get all sorts of calls, but it is what I am here for for my clients). If you're not my client, call the Pet Poison Helpline at 800-213-6680 or online at www.petpoisonhelpline.com.

I would like to shout out to www.PetDocsOnCall.com for more helpful pet care tips. They gave me the Pet Poison Hotline number and the idea for this blog post. OK, them and my wife's poison ivy.

Keith Niesenbaum, VMD

www.CrawfordDogandCatHospital.com

Get a taste of our practice by becoming a Facebook fan at Crawford Dog and Cat Hospital.

Bacterial Alphabet Soup

There has been a fair amount in the press recently about antibiotic resistant super bacteria that are going to end the world. TV, print, Internet, all talking about MRSA, MRSI, MRSP, and even the dreaded flesh eating bacteria, I think that I will skip the horrid flesh eating bacteria for now, as it is mostly a human disease problem and the pictures would be far to gruesome for this blog. If you have a genuine interest or just want to see gross pictures, you can follow the link here.

Let's start with MRSA. I'll translate, first from alphabet to medicalese, to English. French translation will require a different author. The initials stand for Methecillin Resistant Staph. Aureus. Staph. Aureus is a round (cocci) bacteria commonly found on the skin. While we used to think that all of these potentially disease causing cocci were Staph aureus, it turns out that this is a pathogen of people and other species have there own species of Staph. Here is group of Staph as seen under the microscope, a Staph meeting as it were.




The M is for methecillan, an antibiotic and the R is for resistant. MRSA is resistant to, that is not killed by methecillin or any penicillin type antibiotic. The problem is that many of these bacteria also develope multi drug resistance, that is that many antibiotics will not affect them. As you can see this can cause a big problem.

MRSA has become a huge source of complications in human hospitals as this is a place were there are alot of sick people, and bacteria, and antibioitics to stimulate resistance. (We can talk about how bacteria become resistant in another post if anyone comments and is interested)

Dogs can get colonized by MRSA. They get it from their owners and it might not ever cause a problem. However, if they should have some weakening in their immune system, allowing these bugs to get a foothold, then we can have a problem. At our practice, we have seen several cases of MRSA recently. In each case we were able to trace the source of infection back to an owner that had been treated in some sort of health care facitlity.

What about the other intitials you ask? Well, as I alluded to earlier, other species of animals have there own staph bacteria. In dogs they were reclassified as Staph. intermedious (SI) and most recently, Staph. pseudintermedious. Here is a picture of staph, closer up. Can you tell what species it is? No one can just by looking. Special tests are needed.

In fact, you can't tell if this is a resistant staph or just a plain old staph just by looking at a photo micrograph. Sensitivity to antibiotics is determined by doing cultures and sensitivities in the clinical path lab. We have seen an increase in the number of MRSP infections in our practice over the last few months. I'm not sure if that is because more of our staph infections are resistant to methecillin, or if we are just more aware and doing more cultures. These animal staphs can colonize people and cause diseae if the opportunity arises.

Now, were do we see most of these resistant staph infections in our animal patients? The number one location is in the ear. That is why your veterinarian should not just look at an ear like this and send you home with anti biotics.

Or even worse, just take a phone call from you and dispense antibiotics without a thorough examination. We do a cytology exam on all ear infections. (look under the micrscope to see if there are bacteria present). If there are bacteria, we do a culture and sensitivity so that we can prescribe the best medication to cure the infection. Then we set up a maintenence program to prevent future infections. The indescriminant use of antibiotics is one cause of the increased incidence of resistant infections. You need to wash your hands after treating infections so that you don't pick up these bacteria and have them growing in you waiting to cause disease.

Here is the other very common location for bacterial infection, the skin. People often mistake this type of lesion as ringworm (another topic for another day) but this is a classic presentation for a staph infection in a dog. These also need to be treated with appropriate antibiotics, both topical and systemic.

Now what can we do to prevent the spread of bacterial diseases from patient to care giver, owner to pet, and pet to owner?

WASH YOUR HANDS!! Do it frequently and do it well. Use antibacterial soap. Use the hand sanitizer stations that popped up during the swine flu scare. These will kill bacteria as well as flu viruses.


Keith Niesenbaum, VMD

www.CrawfordDogandCatHospital.com

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Spring is here and the smell of what? is in the air?

So the weather has turned warm and I was finally out for one of those long bike rides that I have been promising myself for the past month or so. My first long course triathlon is rapidly approaching and it is time to get some hours in the saddle as it were. We were out on the North Shore tooling around the hills of the Gold Coast and dodging landscaper's trucks who were also out taking advantage of the nice weather to tend to their chores, when I was taken back to a childhood memory by a familiar smell. Now the overwhelming odor was chocolate, but that could easily have come from the melted Reese Peanut Butter cups that I use to refuel myself on these long rides, but there was a subtle difference. This was a more earthy smell. Now I remember.

When I was but a lad, back in the day, my Pop-pop worked in some capacity for the EB Evans Company. The company is still in existence (a quick google search will confirm this but that is really tangential to where I am going with this story.) I remember that his company made Ice Cream toppings. You know, Butterscotch, Hot Fudge, maraschino cherries. Sidebar here, don't eat an entire bottle of maraschino cherries, I seem to recall that it will make you puke. Anyway, attempt at self induced cherry poisoning aside, my Pop-pop would bring us all sorts of great stuff to pile onto our ice cream, or dump into our milk. Although I'm sure this didn't help my weight issues growing up, it was a wonderful thing for a pre-teen boy to have access to. Tastes aside, smell is a stronger memory trigger and I remember that he also gave my dad huge burlap bags of old cocoa hulls to use as garden mulch. Back in the early '60s, this was novel. The company perceived this as a waste product and my dad thought it was the best gardening product ever. As a kid, I thought it was wonderful that the entire yard smelled like a gigantic chocolate bar, only more earthy like a truffle soaked chocolate bar.

Now, 50 years later, cocoa mulch is very popular. I guess that as more people have figured out that this is a good mulch and the companies that probably paid to have the stuff hauled away, or at least turned their backs when employees gave their grandsons early childhood spring time memories are selling it by the ton. Add in the new popularity of truffles, the earthy chocolaty smell of this mulch was everywhere this weekend.

But, if you've been reading some of my earlier posts, you know that there is often a flip side to these sorts of things. While I was content to lay out on the lawn and smell the chocolate, dogs are not quite so content. As with some other items, such as carpet, they eat this stuff. Maybe they think it really is truffle soaked chocolate (mmmmmm) or maybe they are less discerning and just acting like, well dogs. The thing is, chocolate mulch has two problems. One is it's chocolate and we talked about that a while ago. There is enough chocolate in the stuff to cause all the problems we mentioned with eating the real stuff. The second problem is it's mulch, not meant to eat and can cause all sorts of intestinal blockage requiring human intervention to remove the garden supply.


Here we are, a young Rottweiler, on the table with a belly full of something. The hands belong to the talented and patient Dr. Spar who is removing all sorts of goodies from the insides of this silly beast, via an opening that didn't exist until a few moments before the picture was taken. The suspect foreign body was carpeting. I don't know if the dog had read the last post and thought it was an instructional manual or if he came up with the idea on his own, but the owner was pretty sure that carpet was the offending material as some of it was passing out the rectum for several days. Well, we all get to be wrong sometimes and this was the owner's time.

The thing is that this pup isn't particular at all. He didn't even care about the flavoring, he just wanted to eat plant material.

This is just a small sampling of the leaves that were removed from his stomach. If my botany serves me well, they were mostly oak leaves. Can't tell you what type, mostly slimy oak leaves from spending the better part of the week inside the dark confines of a dog.

The thing is, we really need to watch what our pets get into. If this had been the cocoa laced mulch, this dog would have had all the signs of chocolate toxicity in addition to the physical obstruction of the non edible plant material. Happy ending tho, leaves out, dog home, and I will ride on the North Shore again this weekend searching out the smells of my childhood.

Keith Niesenbaum, VMD

www.CrawfordDogandCatHospital.com

and for healthier snack options.

www.TheVetsChoice.com

Beverage of Choice?

I'm posting this photograph of my former associate in surgery a couple of years ago. (She moved out of state, I didn't have a contract put out on her). This dog had eaten a large amount of carpeting and thought that it would be best if we took it out of a new opening since it wouldn't pass out of any existing natural holes in the body. Both dog and veterinarian did very well. so well, that we got to repeat the entire procedure when the dog did it again.

This illustrates a point that I feel that I have to make, we can't leave our pets alone with things that might be dangerous. We saw the kitten that ate the needle in an earlier post. By the way, she came in for suture removal and is doing well. Just to prove that kittens are not all members of Mensa, her owner caught her trying to eat a tooth pick before she was even fully recovered from the first surgery.

Our pets will do things that are dangerous time and time again. They will eat non food items time and time again. They will get into the garbage and end up with horrible gastro enteritis time and time again. And we think, "stupid pet". In reality, it's stupid owners. We have to protect them from themselves. Do not lock them in rooms with Berber carpet that is their favorite flavor. Keep sharp pointy objects away from them. Do not let them in the garbage.

Side note on garbage. We think that our dogs get diarrhea and vomiting because they ate greasy garbage. That might be part of the problem in some instances. I think that a large number of these dogs actually get food poisoning from bacterial toxins in the garbage. Remember, garbage is spoiled food. It is ... well garbage. The same bacteria such as salmonella, e coli, campylobacter, staph, you name it , the same bacteria that make us sick, can make them sick and it does. Time and time again. Keep them out of the garbage.

And just like our children, keep them away from house hold products that might be dangerous.

We admitted a kitten to the hospital today that sat in a puddle of this product. Lysol, kills germs. After all it is a quaternary ammonium disinfectant. Hard on bacteria, hard on cats. This kitty knocked the bottle over and then sat in the puddle while mom ran off to get some paper towels to clean up the mess. The bad news is that cats are very sensitive to these products. Even worse news, when we called the 800 number on the bottle, the lovely person on the other end of the phone did not know that this product is dangerous to cats. They were helpful and tried to get us a poison control number, but by the time they figured out what was going on, we had all the information that we needed from several of our Internet sources and had started therapy.

The biggest problem that these detergents cause in cats is physical trauma to the oral cavity. Ulcers, tissue damaging, even complete soughing of the tongue. This cat had some much mucous it inhaled some into it's lungs. (sorry to radiographs to post this time). A bath, some steroids, some respiratory nebulization to clear the secretions and so far so good. Unfortunately, we might not know the extent of the damage for a couple of days. Hopefully, I'll not have any pictures of oral pathology to share with you. Most of the ones that I saw on line were post mortem. This is nasty stuff.

So please, be careful out there.

Keith Niesenbaum, VMD

www.TheVetsChoice.com

www.CrawfordDogandCatHospital.com

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