Tuesday, March 29, 2011

The Reason

Mondays are notoriously chaotic at veterinary clinics.  Yesterday was no exception with an afternoon chock full of appointments and an emergency surgery going on in the back.  Naturally that's when the hysterical client walked in, covered in blood and begging us to save her puppy which she had accidentally run over with her car.  And not just any puppy.  This particular puppy had shown up at their house shortly after her husband had passed away and she believes that he had sent her this dog.  No pressure there right?

I was really worried what we would find when we got to the parking lot but there in the car was an obviously injured but still tail-wagging puppy.  I breathed an internal sigh of relief and we carried the pup inside to assess the damage.

She was bleeding from her nose and mouth, her gums were gray, breathing was shallow and harsh sounding and there was some loss of function to her front leg  But she seemed relatively alert and not overly distressed.  All the while I was going over the puppy the owner kept asking if she would live.  I assured her I thought she would be ok but we needed to start treating her and getting some x-rays. 

We started her on fluids for the shock and got some pain medications, light sedatives and a few other medications on board.  In no time she was more relaxed and breathing easier and her gums were getting pinker.  Radiographs (x-rays) showed significant lung bruising but no broken bones.  Bloodwork showed a mild amount of blood loss.  Although she has some nerve damage in her leg that may or may not fully resolve she was a pretty lucky girl. 

This morning she was walking (with a little difficulty) begging for tummy rubs and wolfing down food.  Her mom is so happy and grateful and relieved and tomorrow she gets to go home to continue recovering

Stories like that is why we are in this profession.  It's the reason we can get past all the rude, unhappy, non bill-paying clients who never follow our advice anyway. 

Monday, March 28, 2011

NADAC agility...with video!

The girls had a great weekend in Norman, OK at the NADAC trial.  Lyric went an awesome 5/6 with Qs in novice tunnelers, novice weavers, open jumpers and two in open standard.  She got almost all of her weave poles on the first attempt! 

Legend wasn't quite as solid but she sustained a great attitude and speed all weekend.  Most of her errors were ones that she or I really shouldn't make but she did end up with 5 Qs as well in elite regular (two), elite jumpers, open weavers, and open chances which finished her open chances title.  She was awesome on the open chances course, espeically considering it was her last run of the weekend-she was super fast and attentive and showed as much drive as she ever has.  I was very pleased to go home with that run in my head!

So here are some videos...

This is Legend's Elite Jumpers Q
video

Lyric's Tunnelers Q
video
One of Lyric's Open Regular Qs
video

Legend Open Chances-if you are not familiar with chances it's important to know that the handler can't cross the pink line. 
video

If you watched them all, Thanks!  Getting them uploaded was kind of an ordeal! I actually had a few more uploaded but they didn't load right so I will try again later. 

Friday, March 25, 2011

It's back


After a few days of spring and summer weather today is cold (as in barely above freezing) and rainy. But fortunately we are headed to Oklahoma where it is supposed to much warmer and sunnier for a NADAC trial. The girls are very excited but first they had to have a bath since they were crusty from Po slobbers and stinky from pool water.



Zodiac is content to hang out a home. I know he looks sad but this is really his preferred activity.




And as you can see Icy is back to her normal oddities.



Well, we're off! Ok, first stop Walmart and then we're off!

Tuesday, March 22, 2011

Mange: Part 2

Sarcoptes or Scabies

The second type of mange is vastly different from Demodex in almost every way.  First of all these dogs are itchy, and I mean really itchy.  Sarcoptic mange is one of most pruritic diseases out there.  Although the dog can be itchy anywhere the most commonly affected areas are the elbows, hocks, ears and face.  These areas will frequently have sores and crusting present. 

Diagnosis of sarcoptes is quite different as well.  Although skin scraping is the first line of defense in diagnostics they are frequently negative as Sarcoptes are very hard to find. Even with multiple scrapings mites are only found in about 30-50% of patients.
 . 

Sarcoptes scabiei under the microscope

Another easy diagnostic tool is the pinnal-pedal reflex. In about 90% of patients with sarcoptes rubbing the ear flap will cause the hind leg on the same side to scratch or thump in a scratching motion. This can also be present in dogs with skin allergies so it is not a specific test. Frequently a therapeutic medication trial is used to diagnose or rule out sarcoptes as a cause of itching and skin lesions.

Fortunately Sarcoptes mites are easy to kill and many treatment options are available.  A large number of the heartworm and flea medications used are effective against sarcoptes.  One of the easiest and safest treatments is Revolution every 14 days for 3 treatments. 

Sarcoptes is contagious to other dogs and animals.  Transmission is generally through direct contact and occasionally from contact with a contaminated environment.  Sarcoptes is a zoonotic disease meaning it can be transmitted to people but they are relatively species specific mites who don't survive long off the natural host, the dog.  Treatment of all dogs in the household and cleaning or disposal of all bedding, etc is needed to fully eliminate the mites from the household. 






Monday, March 21, 2011

Summer-like

Although Saturday was cool and drizzly, Sunday was warm and mostly sunny which allowed for a great day to get stuff done outside.  Both girls worked nicely in some agility and Legend dusted off her obedience skills.  She did great after no practice for months.  So where is this dog when we go in the ring?  Oh well, we will just keep practicing and see!  And then of course everyone played and we filled up the pool which Legend and Po loved! I put Lyric in and she usually just jumps out but it must have felt good today because she stayed in for awhile.

Then she got the zoomies!  Isn't she the cutest thing ever?
Po enjoying some pool time.  Sometimes he gets really silly and tries to catch the splashes!

 Zodiac overseeing the chaos!
Then it was time to move on to something more productive.  I cleaned out the garage and then vacuumed out the truck but as you can see I had some "help."  Not sure how helpful this really was since I was trying to get hair out of the vehicle!


And Icy is feeling well enough to pose for some pictures...


Sunday, March 20, 2011

Two

Since I was not at a trial this weekend I got to attend Kennedy's second birthday party.  Her mom chose a pool party this year and the kids had a great time!  Doesn't she just get cuter every day?


Wednesday, March 16, 2011

Surgery Photos

As promised here are some of the photos from Icy's surgery!  The mass is the big red ball on the right. 



It was approximately 10 cm in diameter when they got it out.  Amazing that she showed no signs for so long!  The final pathology report came back today-diagnosis was a liver hematoma (in a fibrous capsule) which, although not terribly interesting, is completely benign.  She continues to improve daily at home. 

Tuesday, March 15, 2011

Road to recovery

Icy is doing well.  When we got her home and let her out of the carrier she just started trucking across the room like she was on some sort of mission.  She was not at all impressed with being confined to the large dog kennel though.  She was so unimpressed that we had to move her out of the bedroom so we could sleep!  She is eating pretty well though and her incisions look great.  She's really good about leaving them alone so she has been freed of the evil e-collar.

Last night she got to enjoy some time out of the kennel lounging in front of the space heater-one of her favorite things.  Here she is showing off her embarrassing new hair cut.

I guess she's not too upset about it huh?

Tonight I tried to let her out but she's a bit more active today and jumped up on her cat tree and used the scratching post.  I thought it was a bit too soon for jumping so she's back in the crate.  In a few more days we will recheck her red blood cell count to make sure it's coming back up towards normal. 

Sunday, March 13, 2011

Coming home...and agility too!


We are on our way home with Icy! She's still quite anemic but should continue to regenerate over a few weeks. Her appetite is great now that the mass is not compressing her stomach and her breathing is much better now that it's not smashing her diaphragm. She was so hungry she was trying to eat the whole time they were taking her catheters out! We are of course still waiting on the biopsy but something benign is high on the list.

Meanwhile...

After six hours in the car and ten hours in the hospital on Friday I arrived home after 11PM and got up at five to take the girls to the agility trial. Lyric rocked her standard run with a time 18 seconds under SCT, but with a refusal at the table. I didn't get to work on it as much as I had hoped but sure will before the next trial! She also had a nice JWW run but had to make two attempts at the weave poles. I thought Legend Q'd in standard but I guess she missed the a-frame contact so I was a little bummed. Nice JWW run though and picked up 10 pts.

Today Lyric had continued issues with table and weaves in standard but totally rocked her JWW run and got MXJ leg #3 with an impressive 13 points!! Legend continued to be rock solid with a nice standard Q for 15 pts. And she was not to be outdone by her sister as she got her fastest jumpers time ever getting 15 points and picking up QQ #9!

All in all I consider that a good day!


Saturday, March 12, 2011

Icy's Saga: The Sequel

If you are not familiar with the rest of Icy's story you might want to check these out first...

How we got her
Icy's Saga
Post-op pics first hernia surgery

So when we first arrived at the teaching hospital we repeated the bloodwork along with some clotting times.  The clotting times were important for a few reasons-if they are prolonged it can be an indicator of liver failure and also the inability to clot adds risk to the biopsy procedure.  The clotting times were normal as was the chemistry panel-unusual because we were suspecting liver pathology.  She was slightly more anemic than previously.  Her original Packed Cell Volume or PCV was 21%.  PCV is the percent of blood that is made up of red blood cells and normal is roughly 25-45%.  On Friday it was 17%. 

During the first attempt at ultrasound Icy was too wiggly and would struggle to breathe if she got stressed so we decided to anesthetize and intubate her to do it safely.  An IV catheter was placed and she was sedated and returned to ultrasound.  The problematic area appeared to be a large encapsulated structure.  Differentials included a cyst, abscess or the largest gallbladder ever seen in a cat.  The next step was to aspirate or pull fluid out of the structure.  The fluid was bloody-so now we know where the blood was going.  As the fluid was pulled off the pressure was relieved and the clot disrupted and we noticed active bleeding into the structure.  You could literally see blood pulsing with every heartbeat.  In the end the ultrasound left a room full of veterinarians dumbfounded.  The radiologist literally said  "I have no idea what it is, I've never seen anything like it."  So because of the bleeding we stopped the aspirating and sent the fluid for analysis.  Icy was taken back to ICU to recover and I was left with the realization that surgery may be indicated to determine what was going on and stop the bleeding.  Meanwhile, recheck of Icy's PCV after aspiration revealed a drop to 12% so a transfusion was started while we waited on the test results. 

The fluid analysis showed only inflammation and blood and small lymphocytes but no evidence of neoplasia (cancer).  Since we had no reason to believe this might not be a curable problem I decided to take the chance on surgery.  Icy finished her transfusion uneventfully and was anesthetized again.  An additional catheter was placed in her jugular in case large volumes of fluids needed to be administered and an arterial line was placed for direct blood pressure measurements.  Ninety minutes into surgery the tech came out to let me know that she was doing fine but it would be awhile as there were lots of adhesions to break down before they could even get to the mass, likely in part due to her previous surgery.  Another hour and a half later the surgeon came out to let me know it had gone very well and they were able to remove the whole thing.  It was a large, smooth, cystic structure coming off the liver so they also removed the liver lobe it was attached to. The rest of the liver and organs looked good.  It's very possible this was just a benign growth or cyst and that surgery was curative-we will know when the pathology report comes back.  Why she would be bleeding into a benign structure such as a cyst is still a mystery. 

Her post-op PCV was a scary 7% so another transfusion was given.  As of this morning she was back up to 17% and doing very well considering her ordeal.  If she is still doing well tomorrow we may be able to bring her home. 

I'm pretty sure this is now the most expensive stray cat on the planet.  I have requested of Icy that there is no "Part Three" to this story! 

Apparently they took a lot of photos during surgery.  I'm anxious to see them and I'll post some when I get them. 

Thursday, March 10, 2011

Not what I had planned

Tonight I was supposed to be getting ready for the start of a nearby three day agility trial.  But that was before Icy got sick.  She did not eat Tuesday night and has been not eating well and lethargic ever since.  Her exam is pretty normal and her bloodwork showed only mild anemia and a slightly lowered white blood cell count.  But today, her x-rays showed an enlarged and rounded liver.  We put the ultrasound on and the liver was diffusely abnormal.  Neither one of us felt comfortable doing an aspirate and looking at it so tomorrow I am skipping the agility trial to take her to the Vet Teaching Hospital for that test.  We are hoping for something treatable but hepatic lymphoma is a big concern at this time.  My poor kitty has been through so much.  I hope she has a few lives left. 

This is Icy's liver.  It's the homogeneous gray circular structure on the left of the x-ray.  The ribs are overlying it.  The little white lines are staples from her previous surgery.


This is a more normal cat liver-see how it's more triangular with a sharper border.

Monday, March 7, 2011

Mange Part 1

Demodex

Many people present their dog to a veterinarian for evaluation of skin conditions and a fair number of these people are concerned their dog has mange.  Fortunately, mange of any form is fairly uncommon relative to other skin diseases.  It does however, come in two very different forms.

Both forms of mange are due to a type of mite.  Today we will discuss Demodex mites or Demodicosis. Demodex canis are normal inhabitants of canine skin.  They live in small numbers deep in the hair follicles of all dogs.  An overpopulation of mites is what leads to clinical disease.  The mites are passed from the mother to pups in the first few days of life.  The exact cause of why some dogs develop disease is not well understood but it seems clear that the immune system plays a part in keeping mites to a normal population.  It would therefore stand to reason that an unknown immune defect plays a role in determining which puppies are affected.  However, these dogs do not normally have any other health issues or immune dysfunction.  There does however, appear to be a genetic link so dogs affected with Demodex, their siblings, and parents should not be bred. 

Demodicosis occurs in two forms-localized and generalized.  While there is not a distinct definition of what defines the two, localized is generally limited to one or a few small circular patches of alopecia (hair loss).  These areas are frequently confined to the head and legs but sometimes also appear on the trunk.  Generalized disease involved an increased number of patches that can spread all over the body.  Frequently there is secondary infection with pruritis (itching), crusting, scaling, or greasiness.  Demodex most commonly occurs in puppies less than one year of age but there is an adult onset form.  In adult dogs with Demodex there is frequently an underlying cause including steroid use, Cushing's disease, or neoplasia.  A thorough work-up should be performed in these dogs and they should continue to be monitored even if no underlying cause is found as some believe the presence of Demodex can be the first signs of another undiagnosed disease. 

The diagnosis of Demodex is typically made by deep skin scraping where the mites can be found under the microscope.  It would be rare to find a mite on a skin scraping of a dog with normal skin so this finding is considered diagnostic.  Occasionally repeated skin scrapings do not reveal mites and a biopsy is performed in suspected cases to obtain a diagnosis. 

Microscopic view of Demodex Canis

Treatment for very localized disease is typically benign neglect or treatment of the affected areas with a topical antibacterial or follicular flushing agent-most commonly Benzoyl Peroxide.  Most of these cases will resolve on their on own in 6-8 weeks especially if the puppy is free of parasites, in a non-stressed environment, and on a good plane of nutrition.  If the puppy has more generalized lesions with secondary infections or is developing more lesions during the course of conservative treatment then additional therapy is needed. 

Amitraz comes in a dip form (Mitaban) that is applied every 14 days and allowed to air dry.  Bathing with a benzoyl peroxide shampoo prior to dipping helps with efficacy.  Amitraz is also available as a spot on in the form of the flea and tick product ProMeris.  This is also applied every 14 days.  Lethargy is common after Mitaban dips and it needs to be applied in a well ventilated space with protective gear.  For this reason they are most commonly performed in the veterinary clinic.

Ivermectin in commonly used in the treatment of Demodicosis and is frequently the treatment choice recommended by dermatologists.  Ivermectin is given once daily by mouth.  Because of the occasional toxicity to ivermectin at these doses a very low dose is started initially and gradually raised to the therapeutic level over several days.  During this time owners should watch for lethargy, tremors, ataxia, drooling and listlessness.  Ivermectin should be avoided in herding breeds including Collies, Shelties, Border Collies, and Aussies unless they have been tested for the MDR1 mutation.  An alternative to Ivermectin is daily Milbemycin (Interceptor) although this is frequently cost-prohibitive.  Recent studies have shown however that even Milbemycin can be toxic in collies who are homozygous for the MDR1 mutation so this treatment protocol is under further review.

Moxidectin orally has been evaluated in a few studies with good success.  Side effects are similar to Ivermectin.  Use of the topical formulation (Advantage Multi) has been useful applied once weekly for mild disease.

Ideally treatment should be continued for 4 weeks beyond 2 consecutive negative skin scrapings 4 weeks apart.  Dogs with secondary infections are treated with appropriate long term antibiotics and shampoos.  It should also be noted that once treatment has started the skin will typically look worse and be more pruritic before it gets better.  This is due to the body's reaction to the dying mites. 

Demodex is not contagious to humans, cats or other dogs in the household.

Sunday, March 6, 2011

Yes. We were really that close!

As in close enough to touch the stage!  Through an unusual stroke of luck some friends and I were able to get stage side "seats" to the local Rascal Flatts concert last night, and it was AWESOME.  They always put on a good show but being right by the stage was so much fun.  And opening acts Chris Young and Luke Bryan were totally worth seeing as well.  I actually skipped a three day agility trial for this and I must say it was totally worth it.  So if you were hoping for agility stuff this weekend or something veterinary related...maybe tomorrow!
Chris Young
 Luke Bryan
 Rascal Flatts







 "Me And My Gang!"

Thursday, March 3, 2011

When you get off work early

You get to have some fun!




 Who wants this puppy?
 Seriously, who wants him!
 Another good pic of my handsome boy-he's been surprisingly photogenic lately!
 With his beloved giant purple ball
 Love that tongue!
 All Princess...
 All the time...
 Or not!
Hope everyone else had a fun day too!