Kitty Kidneys

Did you know?
As a cat matures (sorry kitties, it happens to the best of us) it is important to keep an eye on his or her kidney function. That seems like a rather obtuse statement so let me clarify. Unfortunately, older kitties are more prone to develop kidney disease. The clinical name you might hear is chronic renal failure or CRF. Cats tend to be discreet and try to hide any symptoms of sickness so it is often late in the game before chronic renal failure is diagnosed. The best outcome for a cat with CRF is directly tied with an early diagnosis and supportive care from a loving owner.

Let me tell you why.
The easiest symptom change to watch for in an indoor cat is increased drinking and increased urination. Other symptoms include dehydration (indicated by dry gums and skin that is slow to return to normal when pulled up at the base of the neck), constipation, weight loss, change in smell, drooling and/or nausea or vomiting. CRF is the process of the kidneys slowly loosing the ability to filter waste and toxins out of the blood. Often, by the time these symptoms appear the kidneys can be as much as 70% shut down and treatment is needed right away. Unfortunately, the damage to the kidneys is usually progressive and irreversible.

Two common tests that will be preformed at the hospital are blood chemistry and a urinalysis. The blood test may be either a full blood panel or a quick test and is used to monitor creatinine levels, electrolyte levels, and blood urea nitrogen (or BUN, the waste levels in the blood). The urinalysis is used to measure the amount of protein in the urine and the concentration of the urine.

Depending on the progression of the disease, therapy might include subcutaneous fluids, where fluids are administered through a needle that is inserted under the skin of the cat and then absorbed into the body, or IV fluids for faster rehydration; medications to control nausea, vomiting, and anemia; and dietary management. Diet management can vary, but it usually means canned food that has a higher water content, home prepared diets, or special diets with a lower protein content.

There are some wonderful websites available that provide a lot more detail about the development, progression, treatment and potential outcome of CRF diagnosed kitties.

- Feline CRF Information Center - http://www.felinecrf.com/
- Cornell University College of Veterinary Medicine put together a very nice video that provides information on many aspects of CRF. http://tiny.cc/GioD4
- Pawprints & Purrs, Inc., a non-profit educational organization - http://tinyurl.com/nf87pd

The moral of the story...regular care through your family veterinarian can help keep your kitty's kidneys healthy.

Pointed Discussion

Did you know?
Ever gotten poked by a porcupine quill? Maybe, especially if you have an overly curious family pet who likes to get up close and personal with the prickly beasts. Actually, porcupines are quite timid and don't release their quills unless cornered or attacked. Then they swing their quill covered tail until it finds its mark right in the face of your dog or cat. Now you have a choice to make, do you try to remove the quills yourself at home or take the animal to your family vet or veterinary emergency room? Our suggestion, head for the vet's office.

Let me tell you why.
When I was a kid, every summer we could count on our dog "Christmas" getting too friendly with a porcupine. One June he got quills in his snoot so many times that when it happened he headed straight for the truck and looked at us as if to say "ok, I know the drill, let's go see Dr. Sue", our neighbor and family veterinarian. Just once my Dad tried extracting the quills from the soft flesh of the dogs muzzle and realized quickly just how painful that procedure must be for poor "Christmas". Dad decided that paying the vet bill was much better than taking the chance of "Christmas" reacting in pain and biting him or my Mom.

The possibility of getting bit by your animal isn't the only reason to take "Lucky" to the vet to have the porcupine quills removed. Porcupine quills have little microscopic scales on the end that point in the opposite direction. When a quill gets embedded in your animal's skin the scales make the quill very painful to pull out. Those scales are also what can cause the quill to burrow into the flesh and migrate to other areas of the body. Though rare, Veterinarians have reported quills being found in the lower spine, elbow, eye, or abdomen weeks or months after the animal has had quills removed from its face or legs. If a quill migrates to the chest there is a possibility of needing surgical removal so it doesn't wreck havoc on the heart or lungs.

It is best to get the quills removed as soon as possible. On the way to the vet try to keep your dog from rubbing his face with his paws which can cause the quills to break off under the skin or can transfer the quills to his legs and paws. To remove the quills "Lucky" will be placed under general anesthesia and the veterinarian will painstakingly remove each individual quill. Special attention has to be paid to the inside of the mouth as the quills can be far back in the throat or be easily hidden in the soft flesh of the gums.

After recovering from anesthesia "Lucky" will be sent home with pain medicine and 7-10 days worth of antibiotics to decrease the possibility of infection. It is virtually impossible to find and remove every single quill. You'll need to examine your pet for a few days after the porcupine encounter to look for signs of infection or a forming abscess (swelling, redness, puss, oozing). If you notice any of these signs bring your pet back to the vet for follow-up care. You might find a quill that has worked its way to the surface and is easily removed with tweezers weeks later.

The moral of the story..."Lucky" shouldn't poke his nose where it doesn't belong or it's gonna get poked.

Hook, Line, and Sinker

Did you know?
My son has fishing pole envy! We were up at Lost Lake on Mt. Evans and a little boy was casting away with his Dad and friend. My 5 year-old boy was quite jealous and had to be pulled away when it was time to go. I started looking for kid sized poles in the store and was drawn to the rest of the gear. The hooks caught my eye and I was reminded of a vivid x-ray I'd seen not too long ago of a fishhook lodged in the esophagus of a dog. It is amazing what dogs, cats and small children can find with which to get themselves in trouble. This particular pooch was lucky that the hook passed safely through the other end. But it all depends on where the hook gets lodged, internally or externally, for the type of care "Lucky" might need to get "un-hooked".

Let me tell you why!
Fishing hooks can be quite attractive to animals because of the smell of the bait or because of the colorful wiggly fly. I've seen a fish hook poking out of a dog's nose and have heard about accidents where the hook is lodged in a lip, in the tongue, on the face, in a leg or toe, and yes, even swallowed. Treatment for each of these can vary depending on the location, the sensitivity of the spot, the type of hook, and the reaction of your pet.

If you Google this topic you'll find multiple sites that recommend pushing the hook through the lip of an animal then cutting off the barb and pulling the cut part through. My belief is that the percentage of animals that will let you do that are small and you run the risk of getting bit or scratched up should you go that route. The best bet is to bring your animal to your Veterinarian. The veterinarian can anesthetize the area around the hook, also called a local block, and perform the same procedure with less pain to the animal. The exceptions are aggressive animals that need additional sedation to be comfortable or animals that have actually swallowed the hook.

It really is true, and very important, that you not pull on the fishing line protruding from your dog or cat's mouth. Pulling on the line can set the hook and make it that much more difficult to remove. Also, if you need to cut the line leave at least a foot or longer outside the mouth. The line can be used as a guide for the location of the hook and the fishing line has its own set of dangers if it gets swallowed and caught in the intestinal tract.

If the hook is still in the esophagus it is possible to sedate your animal and use an endoscope to locate the hook and then retrieve it with a special tool. If the hook passes into the stomach it is possible for the animal to pass it through it's system with no further complications. Surgery would be necessary if the hook pierces through internal tissue and is unable to be expelled by the animal's body.

The moral of the story...pets can get caught swallowing hook, line, and sinker.

Mary Jane

Did You Know?
If you live in Colorado you probably thought of the ski resort from reading the title for this entry. But you would be incorrect. In this post I'm talking about something recreational, but not the mountain climbing or skiing kind of recreation. Here's another clue, I attended a concert at Fiddlers green last night and the smell of this recreational substance was heavy in the air once the sun went down. I got to wondering if the smokers of said recreational substance (aka cannabis, weed, grass, marijuana, pot, and yes, Mary Jane) were animal owners and if they knew what would happen to their animal should "Lucky" accidentally get a hold of their stash or eat a marijuana brownie. According to the ASPCA Animal Poison Control Center "Lucky" could get very sick.

Let me tell you why!
You may think it odd or even inappropriate to mention this topic on our blog site. But I tell you the truth that I only write about medical topics that we actually experience in our ER. So, let me clear up some myths and let you know how you can help us help your dog should you experience this type of situation.

First, let me talk about reporting. As a medical institution we are not obligated to report marijuana ingestion by your pet to the local police. Since the symptoms of marijuana toxicity can look like many other types of poisoning it is important to let your veterinarian know if you suspect this type of exposure. It helps us know what type of supportive care we need to provide and can cut down on having to perform multiple tests.

Fortunately the majority of marijuana ingestion cases are not fatal, but the potential is there depending on the size of your dog and the amount of marijuana eaten. The fatality could come from a decreased heart rate, decreased breathing rate, or seizures that are all possible side affects of the marijuana. The onset of symptoms can occur within 30 to 90 minutes of exposure. Symptoms can range from extremely excited and spastic to extremely sedated and comatose. Your animal may also vocalize or bark a lot, stagger or have uncoordinated movement, have hallucinations, or dribble urine. Gastrointestinal signs could include vomiting, diarrhea, dry mouth or excessive drooling.

Once we have confirmed exposure, treatment will vary depending on how much time has elapsed since ingestion. Attempting to have the dog vomit is usually the first step but the anti-nausea effects of cannabis can make it difficult to get a dog to vomit if it has been longer than 30 minutes since ingestion. If still alert and breathing well, activated charcoal can be administered to help absorb some of the toxin. Otherwise, supportive care includes IV fluids, temperature control, and body rotation if the animal isn't moving or has slipped into a coma. To the other extreme the drug Diazepam may be needed to decrease excitability so the animal can rest. Animals usually recover completely within 12 - 72 hours of exposure.

The moral of the story...cats and dogs really shouldn't get stoned.

Mushroom Mania

Did you know?
Who would have thought Colorado could possibly have been in a drought just a couple years back with all the rain we've had this year. Increased moisture levels for May, June, and July have contributed to abundant flora growth. The Denver Botanic gardens didn't even have to water one of its gardens until last week. Unfortunately, not all the flora is friendly. In fact, some of the mushrooms can be downright deadly.

Let me tell you why.
There are numerous varieties of mushrooms that grow here in Colorado. I think I've seen seven varieties in my own backyard. Most are harmless and don't even cause an upset stomach for your dog, but others can cause a severe reaction that can lead to death in a matter of a few hours.

Unfortunately, it may be difficult for you or your veterinarian to determine if the mushroom consumed by your family pet is dangerous, even if you bring a sample to the clinic. It would take a mycologist (a person who studies mushrooms) to differentiate one brown mushroom from another. Because of that we choose to treat according to the possible ingestion, the animal and the symptoms, not according to the type of mushroom.

Mushroom toxicity can affect the kidneys, liver, autonomic nervous system, central nervous system, and the gastrointestinal tract, depending on the species. The symptoms of toxicity can include vomiting, diarrhea, staggering or acting drunk, excessive drooling, and being mentally "spaced out''. The toxin can cause an immediate response and the dog will exhibit some of these signs of poisoning right away, or the affects may take 6 to 24 hours to appear.

Treatment for mushroom ingestion, and possible poisoning, most often includes making the animal vomit and then administering activated charcoal to help absorb any remnants of the toxin from the gastrointestinal tract. The animal may also be placed on IV fluids to help flush the kidneys. Additional treatment may be needed if the toxin has affected the liver or kidneys. Repeat blood tests will help to monitor enzyme levels for both organs to determine the type of medication needed.

The moral of the story...magic mushrooms cause misery.

(Note: Special thanks to Kristine Rotundo, CVT for her research on this topic)

Cat Air

Did you know?
It seems my posts have been slanted towards "dog world" of late and the cat content has been sorely lacking. I don't want to leave the kitties out, it just seems like the dogs tend to get themselves in trouble more often and end up taking more trips to the emergency room. So, from that point of view it probably is better that the felines have had fewer posts. Unfortunately, that doesn't mean that we never see them in the ER.

One of the reasons we might need to see your sweet kitty "Lucky" is if she starts struggling to breath, opens her mouth, starts panting, and has pale or grey gums. These physical signs are what we call "open mouth breathing" and can be very serious.

Let me tell you why.
Open mouth breathing in cats can be a simple stress reaction to a change in environment which will subside if the stressful conditions are removed. Or it can be an indication of a serious condition such as an airway blockage, respiratory disease or heart disease. If you notice your cat struggling to breath or open mouth breathing you should bring "Lucky" to your family veterinarian or, if it's after hours, to an animal ER for care right away.

One type of heart disease that causes breathing trouble might be a thickening of the heart muscle, called hypertrophic cardiomyopathy or HCM, which decreases the amount of blood that is pumped in and out of the heart chamber and increases the workload of the heart. This type of disease, if left untreated, can lead to congestive heart failure and even death. Your family veterinarian may refer you to a Veterinary Cardiologist so your cat can receive specialized care for this condition.

Open mouth breathing might also be caused by a respiratory issue. A foreign body that is blocking the airway, pneumonia, or fluid in the chest are all conditions that the veterinarian will try to rule out as causes to get to the crux of the problem and start treatment.

To diagnose the cause of respiratory distress the veterinarian will listen to the heart and lungs, take a blood pressure, take x-rays, and potentially perform an ultrasound of the heart also known as an echocardiogram . Your cat may need to be hospitalized for a time and be on oxygen to help her breath easier. "Lucky" may also need some medications or further diagnostics to monitor progress.

The moral of the story...let the open mouth tell the story and get to the vet right away.

The Facts About Dog Bites

Did you know?
A tough part of our job in an animal ER occurs when we learn that a person has been bitten by a dog either in a direct attack or when trying to break up a fight between two (or more) dogs. The latter is more often the case, and a recent incident lead me to search out an article that came across my desk earlier this year.

The Coalition for Living Safely with Dogs (CLSD) released the results of a study in May on the dog bite incidents in Colorado from July 2007 - July 2008. The CLSD partnered with the Colorado Association of Animal Control Officers (CAACO) for data collection and contracted with Corona Research, Inc. to analyze the bite data and to create a report on the findings. The project was funded by Animal Assistance Foundation. The CLSD says that "this report is the most rigorous study of its type and the first comprehensive collection and analysis through Animal Control."

I thought I'd share the Key Points and Recommended Actions in this blog. To see the full report you'll find a link to the PDF document on the CLSD website.

1. Most dogs do not bite. Less than one-third of one percent of dogs in the reporting area were reported to animal control for biting a human.
2. Many different types of dogs were involved in reported dog bite incidents. Bites from 129 different breeds of dog were reported to the 17 participating animal control organizations during the one year period of study.
3. Any dog can bite given certain circumstances.
- Running at large (unleashed) was the single most common bite circumstance.
- Many bites were not a result of aggression towards humans, but occurred when a
human intervened in fighting or play between dogs.
- Approximately half of all bites occurred at home, usually when a dog was
protecting property, food, or toys.
4. Whether any breed is more or less likely to bite than any other breed depends on knowing the number of each breed living in Colorado. There are more bites from some breeds than others in the dataset. To draw conclusions about breeds, we need to know whether bites are proportional or disproportional to a breed's population. At this time, there is no dog census for Colorado.
5. Adolescent dogs between one and four years of age were responsible for the most
bites.
6. Children (14 and under) were bitten disproportionately to their population; nine and ten year-old boys were the most common victims. Children were bitten twice as often as would be expected given their proportion of the population.

So What, Now What?
There are some obvious conclusions one can draw from these six key points.

- The worst combination is allowing an adolescent dog to play unsupervised with children 14 and under (especially 9 and and 10 year old boys). Please be sure that proper adult supervision is available to train both the dog and the children about how to "play" with each other.
- Any dog can bite under certain circumstances. As Veterinary professionals we hear many clients tell us their dog would never bite. The tough part for us is that the response of an animal that is nervous and in pain can be very different than when at home with family. So to protect us and your dog we may choose to muzzle when providing medical care.
- Never place yourself between fighting dogs. Avoid getting bit by learning how to break up a dog fight. Here are a couple websites with some good ideas.
http://tinyurl.com/m2d4mz;
http://leerburg.com/pdf/howtobreakupdogfight.pdf (kind of lengthy); http://www.howtoguides365.com/how-to/dog-fight/
- Keep your dog on a leash in a public place.

The moral of the story...stay cool and stay safe.