18, 19, 20... Wow that's a lot of toes!

It's always dangerous to refer to something as "normal" or "abnormal." Normal is in the eye of the beholder, right? Instead, I will employ the word "typical" when discussing supernumeray feline phalanges.

In otherwords... Polydactyl cats.

When I was a new graduate I practiced in New England. I didn't appreciate it at the time, but there were a LOT of polydactyl cats in Connecticut. I did some research into this and it appears that polydactyl cats originated in England, probably in Wales. The genetics quickly found their way to Boston. The appearance of polydactylism around the New World appears to be related to when various governments began trade with Boston. Most sailors considered polydactyl cats lucky and they were therefore regular stow-aways on trade ships.

Remember - domestic cats, like horses, did not exist in the Americas until the dang europeans brought them. Horses became fairly popular, but I don't know how the native peoples felt about cats. My guess was that after we killed them all with Smallpox and stole their land, they were pretty reluctant to embrace our feline friends. Horses could be ridden and used to carry things for you. On the other hand, have you ever tried to get a cat to do anything USEFUL? Maybe if THEY WANT to do it or they think it's their idea, but they sure as hell won't do it because you ASKED them to do it. The phrase pack cat just doesn't sound as useful as pack mule.

But I digress...

The typical cat has 5 toes on each front foot and 4 on each rear. Grand total = 18. Anything more than this is polydactyl. Even if it's only one extra. Usually cats are polydactylier than just one extra toe and they are usually symmetrical. Most all of these guys are polydactyl on the front feet only.

The extra toes can sometimes be used as opposable thumbs. My nephew cat Thomas (named for Tom Thumb, not Tom Cat) uses his thumbs to play and catch with. He's practically simian with the things. I'm surprised he hasn't learned how to open the door with them.

The extra toes aren't always attached to the wrist by good bony joints. Sometimes the toes are kind of "floppy" and other times they are fully functional. The wrist is designed to have tendons and ligaments for 5 digits. Anything more than that and there usually isn't enough anatomy to go around.

I've had one person tell me that all polydactyl cats came from Hemmingway's house in Florida. Nope. He had a particular fondness for them and most of his cats were polydactyl, but that's all.

FYI - the current Guiness Record holder has 28 toes. That's impressive!

AMH

Male Calico

Did you know that the gene for calico coloring in cats is sex related? Two copies are required and they both belong to the female. So only females can be calico.

Unless...

You have an XXY male - also known as Klinefelter Syndrome in humans. Approximately 1 in 10,000 calico cats are male. That's the last published statistic I've found. Rumor has that they may be slightly more common, but either way - it's pretty rare.

XXY males also have the unfortunate side effect of being sterile. This means you can't breed more male calico cats. They simply happen at random.

Interesting.

AMH

Treats for Tricks

What kinds of treats are OK to give my dog?

Everything in moderation, and nothing to excess. -Aristotle

This is a pretty common question I hear every day in practice. Anyone who has seen me in person (especially in profile :P) would agree that I think treats are pretty important. We get into problems when we forget that they are TREATS and as such should not me a major part of our diet.
In my case - scoop of ice cream=good. PINT of icecream=BAD.
In your dog's case - dog biscuit=good. Handful of biscuits=BAD.

First and foremost, keep in mind that most biscuits and treats for dogs and cats are about as calorie dense as an equal amount of their kibble. I've had owners complain that their dog "only eats a cup of food a day" and are shocked that they have gained weight. After we really look at what goes into the dog over the course of the day, I find out that they get 10 mini-milkbones a day. That's nearly another cup of food!

Just walk down the treat isle at the local pet store and you will be shocked at the sheer number of different options. Notice that nearly all of them are marketed to you, not your dog! Does your dog really care that his food is in the shape of a bone? He eats poop, afterall. Would he like it any better if it were a poop shaped cookie?

There are an unfortunate number of treats that are much to hard to be safe. Nylabones (sorry Nylabone people) and dried beef bones are just plain dangerous. Same goes for ice! Your dog will bust a tooth on one of these. I believe Nylabone does make a flexible/squishy chew. That's OK.

Rawhide: One of the most popular treats. Dried cow skin. Cousins to this would be pig snouts/ears and bully sticks (dried beef penis - I kid you not). Rawhide can be a great treat IF your dog isn't an idiot and tries to swallow it whole. Rawhide does NOT digest once swallowed. Big chunks of rawhide will cause obstruction. Some dogs methodically chew and gnaw the strip down to little bits. Rawhide is great for them. These treats do absolutely nothing for the teeth unless they are enzymatically or antimicrobially treated. They simply turn to slimy wads of old skin. Pretty disgusting, but dogs love them!

Greenies (all all associated copy cats): Greenies were the chlorophyl treat that made all of the other "edible compressed starch" chewies popular. The original form of the treat was too hard and if swallowed in big pieces, would cause obstruction. The company has long since reformulated them and they are now completely digestible. Some dogs get diarrhea when eating a Greenie (or similar). This is probably the case with all treats, but Greenies seems to be accused more than others. Don't know why. Any of the compressed corn starch treats or compressed veggie treats are probably fine.

Table foods: Look below for a list of acceptable fruits and veggies. This section is specifically addressing table foods. We humans eat some very, very calorie dense foods. It doesn't take much "table food" to provide big-time calories to our pets. We MUST be careful with this one.

Fats: High fat items are dangerous for your dog. Steak trimmings, bacon, nut butters, and dairy butter are very effective triggers of pancreatitis. Pancreatitis can be exceptionally dangerous and even fatal. High fat foods must be fed in small quantities only if they are fed at all.

Bones: Raw bones are soft and can be great to chew on. You have the issue of microbial food safety, but the bones won't cause damage. COOKED bones are an entirely different story. Ribs, steak, hambones are all popular treats but should not be fed. Cooked bones have all of the fat and soft tissue cooked out of them and the result is that only the hard calcium matrix. This can not be chewed through. It's harder than a tooth and will break a tooth pretty easily. Once swallowed, cooked bones cannot be digested and can cause obstructions or perforations.

Fruits and veggies:
Pretty much any fruit or veggie is OK with a couple of major exceptions:

Grapes and raisins are expressely forbidden! Bad. Some dogs die of horrid renal failure after eating grapes or raisins. Others have absolutely no problems. So, NO GRAPES FOR YOU!

Onions and garlic (allium family veggies) are dangerous to cats. Dogs can handle small amounts, but you must be careful. Cats have acutally died from drinking onion soup broth. The reason for this toxicity is that cat red blood cells (and to a lesser extent, dogs) are very sensitive to the oxidative damage that allium species do to the surface of the cell. They get damaged, the body takes them out, and the pet ends up with dangerous anemia and expires. Onions-cats-bad.

Some favorites I've had people give: frozen green beans (or fresh - dogs seem to like the crunch), carrots (fresh - NOT frozen), celery stick, sliced apple, sliced pear, and red or green bell pepper.

Post a comment on your favorite treat for your pet. There are tons out there. I'll comment back if you'd like.

AMH

Cancer Treatment - How to kill the tumor and not the patient

The title sounds a bit hard-core, but it's the truth.

Our last discussion was about how and why we get tumors. Some of these tumors become what we would refer to as cancer. Once a particular tumor has been identified and we know what we are dealing with, we can then begin discussing treatment.

The words radiation or chemotherapy often begin to evoke visceral reactions from owners. Most people have been exposed to the idea of chemotherapy or radiation because of a family member or friend who has battled cancer. Some chemotherapy and radiation options are pretty rough on the body. Some patients get very sick. But not everything that counts as chemo or radiation is hard on the body at all It really depends on the specific protocol.

In my opinion, it's all about QUALITY of life. Some would see it differently and say that QUANTITY is the more important half of the equation. I disagree. Quantity is nothing without quality. The sticking point becomes defining the point at which quality and quantity intersect at an acceptable point for YOU and YOUR PET.

By example, I am currently treating my own dog for stage 4-b lymphoma. That's about as bad as it gets. We decided to start chemotherapy because many of the initial drugs I was going to use in her treatment were fairly benign and it was worth a shot. Surprisingly, she's responded very well to her chemo and hasn't had any bad days because of it.

Until now.

I made the decision to go ahead and give her the doxorubicin. That is the one most likely to make her 'feel bad' for a few days. My decision to use that drug was based on the fact that a few days of nasty were worth the few weeks or months of happy. That was my take on it. Others would argue that the cost and misery of a few days is not an acceptable price to pay for a few weeks or months.

The take-home point is that the decision to treat and the decision how to treat is not something that can be made for you. Your doctor should give you options and you should consider the total picture and make an informed decision. For some, the answer is an easy. Hopefully you enjoy the support of a caring oncologist or primary care veterinarian and you will be an active part in the decision making process.

Staging the tumor:
Staging is something done when we are dealing with a malignancy (cancer). The goal of staging is to evaluate how 'badly' the tumor is behaving so that we can determine what therapy is required. It is necessary to help direct types of therapy in most cancers.

How we stage a tumor depends on tumor type. Some tumors tend to metastasize to the lungs first. Others met to a regional lymph node first. In the case of lymphoma we have to determine if the tumor is in the spleen, liver, or thymus and if it is in lymph nodes. Different locations have different prognoses because. Believe it or not - the same tumor found in two different places could behave dramatically differently.

Surgery:
If we are able to physically remove the tumor then we often take this as our first course of action. After all, why would we poison the entire body if we can cure the cancer by physically removing it from the body. There are many tumors where this is the ONLY treatment recommended.

Other times, our goal is to de-bulk the tumor. We know we won't get the entire tumor. We know there will be microscopic tumor left behind. But if we get all of the visible tumor, it makes the microscopic much easier to heal.

Because there is often microscopic invasion of the tumor in surrounding tissues, the amount of tissue to remove is sometimes impressively large. As an example, mast cell tumors require margins of approximately 3cm in every direction. By the time you account for the shape required to close the defect, a patient with a 1/2" mass may end up with a 6 inch incision.

Just like with real estate, it can all be about location, location, location. That same mast cell tumor on the foot simply can't be removed. There's not enough foot left to close the wound. So there are times that tumor location may dictate amputation of a particular body part (toe, ear, etc). Amputation doesn't have to be a bad word. Life without a toe isn't a bad idea if the only other option is death.

Radiation:
Radiation therapy means that energy in the form of radiation (gamma rays, x-rays) is poured into the tumor in hopes of causing such severe damage to the tumor cells that they die off. Unfortunately, normal tissues always get caught in the crossfire. There are some great new technologies that allow for the very precise delivery of radiation to a very tiny area and help minimize the amount of collateral radiation damage. Local reactions like burns (mild or severe) are the usual side-effects. When talking about the skin, that's not so bad. But if you are trying to irradiate a tumor in the pelvic canal, you end up burning the colon a bit, and the colon does not handle this very well. Again - Location, location, location.

Some tumors are particularly sensitive to radiation and die off quickly and easily. Some are very resistant and radiation doesn't really work. Radiation is usually applied to a very specific and focused location, but there are times where it is appropriate to irradiate an entire limb or an entire body. Whole-body radiation is something usually reserved for killing off the bone marrow in leukemia patients prior to marrow transplantation.

Chemotherapy - The 'other' Big C:
The goal of chemotherapy is to poison the body JUST ENOUGH that the tumor cells die but the patient does not. Chemotherapy is generally administered to the entire body. This is good if you have tumor around the entire body, but it also means that you are exposing all the normal cells in the body to the drug.

Nearly all chemo drugs target fast growing cells. This makes sense because the tumors are usually growing quickly. However, there are lots of cells in the body that have to grow quickly. Bone marrow, cells lining the intestines, and hair follicles are the major players. Not all drugs cause the same problems. For instance - vincristine is one of the drugs in lymphoma treatment. It is VERY well tolerated and is pretty uncommon to cause any issues. Doxorubicin, on the other hand, is quite likely to cause pretty severe gastrointestinal problems. In some dogs, it will cause balding.

The moral of the story is that you should not let the name chemotherapy scare you away all together. Some drugs are fairly simple and may provide excellent responses with nearly NO side effects. Others may be tolerated well in one patient but horribly in another. You simply have to weigh all the variables - patient, prognosis, finances, transportation, side-effects.

This posting does not even begin to cover everything. My hope was to at least cover the big picture. Like I say - I'm happy to entertain questions about specific tumors, drugs, or topics anytime. Just e-mail me!

AMH

The Big "C"

WOW - I just realized how long it's been since I posted. Sorry, folks. I could give reasons, but they'll just sound like excuses. Let's get back to work!

Cancer. This is a loaded topic and one for which there are entire textbooks. I'll discuss cancer treatment in the next posting. For now - we'll talk about what it is, why it happens.

First some definitions:

Tumor - a coherent overgrowth of abnormal cells. This can also be used as a pleural noun.

Mass - I use tumor and mass interchangeably. For me - mass is more accurate. I feel a 'mass.' There is a 'mass' on the shoulder. Mass does not describe the behavior of the cells.

Neoplasia - Anytime a group of cells starts growing in a way that is not 'normal' like the parent cells, it is neoplasia. So neoplastic cells aren't just overgrowths of normal cells, these are cells that have chosen to ignore convention and strike out on their own. Neoplasia can be benign or malignant. It simply means that it is a 'new growth' of cells.

Benign - This is an adjective (or adverb) that describes the behavior of the tumor. A mass that behaves, will not spread to other parts of the body is benign. Benign masses in bad places may do bad things (a benign tumor in the brain is still not a good thing to have - there's only so much room up there to deal with and the brain needs all the room it can have).

Malignant - The opposite of benign. This describes a tumor or behavior that is not going to behave. Malignant tumors are usually associated with something that will spread to other parts of the body or will invade locally. Malignant = bad.

Cancer - a term that is used interchangeably with malignant. Some folks use cancer to mean all tumors. Usually if you say cancer - you mean something that is bad.

___________________________________________________________

How do tumors start?

Believe it or not - you have cancer. Seriously. Every day your body has a few cells in it that don't replicate like they are supposed to. They forget who they are. The don't listen to the body when the body says STOP. There is simply something WRONG with them. 99-100% of the time, the body recognizes these guys and sends in the killer-T cells. These white blood cells see the bad cells and then kills 'em. Kills 'em dead.

And then there is the exceptionally rare cell that survives. The body doesn't recognize that it is bad. It's allowed to continue growing because the body thinks it's supposed to. Next thing you know - there are a few billion cells and you have a mass, or tumor.

So what does it mean when I hear that some chemical or product causes cancer?

ANYTHING that damages cells or screws with their DNA could cause them to start behaving badly. If it brings about a change in the cell that would ultimately cause a tumor is referred to as oncogenic. Lots of research goes into this field.

There are oncogenic chemicals (saccharine, tar), radiation (sunlight, x-ray, gamma ray), and even oncogenic viruses (feline leukemia). Some of these causes trigger damage to DNA (radiation) that will cause random mutation and tumor genesis. Others cause certain genes in the cell to turn off or on and as a result the cell stops listening to instructions.

Some cancers have a genetic predisposition. Some individuals may be more likely to develop cancer because they either have a gene or lack a gene that regulates the cancer formation. We don't understand all of these genes yet, but it's a HUGE area of research.

You can try and prevent exposure to environmental triggers of neoplasia. You wear sunscreen, you don't use a tanning bed, you filter your water, are careful with household chemicals, eat healthy, and don't smoke. You can't control your genes. You were born with them. So you try not to piss them off and instead try to help the body recognize when they've gone wrong to catch a tumor before it kills you.

In humans, there are certain familial cancers. In dogs and cats, there are breeds that have been associated with particular tumors. Boxer dogs and golden retrievers are seriously over represented when it comes to cancer. So clearly these guys have something that either pre-disposes them to making a cancer OR something that keeps their body from catching the cancer once it's formed and killing it before it becomes self-sufficient.

What happens after the tumor is started?

By the time the tumor is operating on it's own, it is no longer listening. It's past the point where the body can stop it. It's like a petulant, super-independant child. The body can try to convince it to slow down, but it doesn't want to. It still gets all of it's energy from the parent, still relies on the body for a home, but doesn't care what's best for it's host. It's parasitic.

So now we have to think in terms of benign versus malignant. Benign means it usually won't invade and it will not spread to distant parts of the body. Lipomas, or fatty tumors, are good examples of this. Nearly anyone with a dog has seen a fatty mass. These usually feel soft, slightly squishy, and are just under the skin. These guys are benign. They aren't going to spread. However, they may not behave. If you get one in the armpit that decides to grow to the size of a melon you may not have function in that leg. Benign tumor - bad result.

Malignant masses are going to be locally invasive, aggressive, and may spread to distant places. These are the bad guys. The cancers. Malignancy typically means that we must intervene and treat or they will kill you. Next post I'll talk about different treatment options. Generally speaking, we're talking surgery, radiation, or chemotherapy.

These are just general principles. I can discuss individual tumor types in future posting. If you have a particular cancer/tumor that you want me to discuss, please e-mail or post so I can write on that topic. There are some really interesting tumor types out there that do all kinds of weird and horrible things to the body. There are simply too many to try and lump together.

I promise not to allow so much time to elapse between postings. Talk soon.

AMH

Heartworm Preventatives

Now that I've talked about heartworm disease, here's the skinny on heartworm preventatives:

You now know that mosquitoes are the carrier for heartworm. Exposure to mosquitoes is therefore required. Risk is highest for dogs outdoors at the hours of dusk and dawn when the little buggars are out feeding.

HOWEVER...

Mosquitoes come indoors! Dogs go out to pee or at the very least poo (usually). Although your risk is lower as an indoor only cat - about 1 in 4 SICK cats are considered 100% indoor by their owner. There is no such thing as a dog that doesn't need preventative.

Preventatives are critical. One common misconception is that heartworm preventatives work for the NEXT month after they are given. What's happening is that the preventatives are killing off any larva that the pet has been infected with over the LAST month. In other words, we assume that the pet has been infected and the preventative is killing them before they grow to adults.

There are many different heartworm preventatives out there. They all do the same thing - they kill the larva. All of the preventatives you should be able to get today are in the same class of drugs. Some people are still using Filaribits (DEC) but if you are - STOP. Some preventatives have activities against other parasites - some kill intestinal parasites or fleas in addition to heartworm larvae.

Common products you'll find are:

• Heartguard (plus)
• Interceptor (or Sentinel)
• Advantage Multi
• Revolution
• Iverheart (plus)

They each have really pretty literature that shows how they are the best product on the market and all of their competition sucks. The truth is somewhere in the middle. They all have their ups and downs. Go with your veterinarian's recommendation. I'm a Heartguard man. Always have been. Always will be. All of these products are effective. All of these companies support their product claims. It's really a matter of your situation, what you think is easiest, and what your veterinarian recommends for your area.

The most important concept is that they are all intended to be given once a month. You have to use them once a month. The one exception out there is ProHeart. This is an injectable heartworm preventative that is given every 6 months.

AMH

Heartworm Disease Overview

http://www.heartwormsociety.org/

The link above will give you lots and lots of good information on this subject. The pictures above are small, I know. I don't have any larger pictures. Maybe someday I'll get a good heart to get pictures of.

I'm going to post a separate blog on preventative choices, feline heartworm disease, and heartworm treatment.


Here are a few common myths and answers. There's discussion below.

Myth: Heartworms are found in the stool. Your dog gets heartworms by coming in contact with another dog's stool.

Fact: Heartworms are exactly that - they are found in the heart. The larvae are found in the blood stream and they are transmitted by mosquitoes.

Myth: Only dogs get heartowrm.
Fact: We used to think so. We were WRONG. Cat's do get heartworm. So do people.

Myth: My dog is indoors, so I don't need preventative. Same argument for cats.
Fact: Turns out this is absolutely false as well.

Myth: Preventatives are over the counter. My vet is just being a pain in the butt about requiring me to come in.

Fact: See my previous posts on the importance of regular physical exams. Preventatives are all PRESCRIPTION products. This means we can't just sell it over the counter or we get huge fines and risk loosing our license. We're not being a PItA. We're following federal drug law.

Here's the skinny on heartworm disease.

These worms start out as baby larva in an infected dog. These larva are referred to as L1 larva. A mosquito comes along, takes a blood meal that includes the L1 larva and flies away. The larva grow and develop into L2 and then L3 larva. Same mosquito bites another dog and those little L3 larva come down the mosquito's mouth and climb into that tiny hole and into the dog (cat, human, wolf, fox, etc). The larva then continue to devlop into L4, L5, then adult worms. As L5 and adults they take up residence in the right side of the heart and the pulmonary artery leaving the right side of the heart and into the lungs. You must have both males and females to reproduce, but once you do - the life cycle begins over again. Adults live for about 5 years in the dog.

The canid is the definitive host - meaning they are the host the parasite is intended for. Dogs, fox, coyote, wolf are all routinely infected. Other species can be infected with the parasite, but the body kills it off before it can become an adult. In people, it's usually killed off in the skin but it is possible for it to migrate to the lung and form a little granuloma before it's dead.

We used to think that cats were an uncommon host for the parasite - we were incorrect. See my companion post about cats and heartworm disease.

It takes about 4 or 5 months for a worm to go from larva to adult. The preventatives only work during the first 30-45 days of this period. Tests used by your veterinarian are only positive when there are adult female heartworms present. It is therefore possible to have worms in the heart and a negative test if either 1) they are only 4 months old or 2) you have all males or less than 3 females. 100 males, 1 female = NEGATIVE test! (This is uncommon, but it happens!)

The timing on this is important because this means there is a period of time between when a larva can be killed and when the test would become positive. For this reason, a pet that has been off preventative cannot be considered negative until a repeat test is done 5-6 months later.

What happens if I don't treat or prevent heartworm disease? Honestly, a dog can probably tolerate a small worm burden (1 or 2 worms) for a lifetime. The will have changes in the blood vessels in the lungs and will have chronic bronchitis-type problems. Most dogs with the disease don't just have one or two worms and therefore get progressively get sicker and sicker with hearts that fail and lungs that don't work. They may develop clots in the lungs and can suffer sudden death. Untreated heartworm disease kills. It's pretty nasty.

Next posts will be on prevention, treatment, and feline heartworm disease.

AMH

Car and Truck safety

I'm one of those people that really, really, really gets chaffed when I see a dog riding in the back of a pickup truck without any kind of restraint. It bugs the crap outta me. I've had to put a couple of these guys back together after they jump out, and I've had to put a few in the freezer because they didn't survive the jump.

When traveling in the car or truck, use the same kind of common sense you would when traveling with a three year old. In other words, expect them to do what you don't want them to do. Ideally, dogs inside the car are either in a crate or have a harness on that straps into the seatbelt. The big reason for this is that in the event of an accident, 30lbs of dog become an impressive projectile and can kill you outright when they collide with your head. It also ends badly for the dog too.

I know, I know, we all survived growing up riding in the back of grandma and grandpa's huge boat of a station wagon or a suburban with no seatbelts, crawling around, waving at the cars behind us while we rode backwards. And we didn't die. Well, now we know better. I'm guilty as the next person for letting my dogs roam freely around the car while I drive. Now I put them in the back of the SUV where at least there's a high seat between us. I need to get one of those gates to put up in the back.

Also, don't assume that your dog knows better than to jump out the window. I'm not exaggerating when I say I've put more than a few of those guys in the freezer after they jumped right out of the window.

Cats should be in a carrier. Scared cats have been known to climb owner's heads while traveling at high speeds down the highway and have caused accidents.

Dogs in pickup beds should be restrained. DON'T just tie a leash to the edge of the bed - they'll just hang themselves. Your best bet is a large kennel for the bed of the truck, or you can get a tie that strings across the bed of the truck and their lead then attaches to the center. This way they can move from side to side, but can't fall out and strangle themselves.

AMH

Sedation for Flying

Pets can travel one of three ways on a plane with the owner. They can go as cargo, meaning they are on a different flight from the owner. They can go as checked baggage. Or if they are small enough they can ride in the cabin with the owner. The first two methods mean that the pet is in cargo in the belly of the plane. It's pressurized, but not temperature controlled.

I routinely have people ask if they can sedate the pet for flying. If the pet is flying in cargo - the answer is NO. The American Veterinary Medical Association even put out a position statement that says not to do it. In the belly of the plane with no heat, a sedated animal can't be monitored and is at great risk for hypothermia. Truth be told, most of these guys settle down and sleep when they are flying because it is loud and dark.

For pets riding up in the cabin, a sedative MAY be appropriate. Most importantly, we need to know if the prescribed sedative actually sedates the pet or if they get an idiosyncratic reaction where they actually get hyperactive.

I'm reminded of my daughters. When we flew with them the first time they were something like 8 months old. We gave them Benadryl. We figured that a little over-the-counter chemical restraint wouldn't be all bad :) One daughter passed out and slept the entire flight. The other one went CRAZY. Screaming, upset, crying, flopping about like a fish outta water. I spent most of the flight in the tiny airplane bathroom trying to calm her down. After 2 hours the flight attendant came and knocked on the door to say they needed me to go back to my seat. Luckily, by then she had calmed down and did not scream the rest of the flight.

Here's the point- don't give a medication for the first time right before you take off. You may end up spending two hours in the bathroom with a freaked out dog.

I'm a fan of using the Valium-type drugs in dogs. Better for sedation and anxiety. Many folks try acepromazine (Ace) and like it. Ace makes a dog drunk, but if they are anxious enough, they're just a stressed out drunk. Remember, this recommendation only counts for a small dog riding in the cabin with the owner.

In cats, the Valium type drugs can be problematic, ESPECIALLY when given orally. Ace can knock them on their tush and can be too much. There aren't as many good options for cats. I like using Feliway. It's a pheromone spray that stimulates the brain to calm down. Pretty cool. Google it and you'll find information on it. There is a similar product for dogs called DAP. These products don't work for all dogs and cats, but work very well in some.

Ask your veterinarian before you give your pets anything, though. Every pet is a bit different and what I may recommend for one, I might not for the next.

These recommendations also apply to travel by car. I'll even sedate a big dog in the car if necessary because you can watch them closely.

AMH

How do I cut my pet's nails?

This seems to be something that most owners are very nervous about. It's really not that hard.

Anatomy: The dog's nail is the same as ours, just a different shape. The nail bed produces the nail just like our cuticle generates ours. A dog's nail is rounded and covers a fleshy end of the toe that is known as the "quick." The quick is bone at the base, but out towards the end of the nail, it's just soft tissue, nerves, and blood supply.

Most folks find white or clear nails to be easier because you can see the pink underneath and know what NOT to cut. Dark nails are harder because you can't see it as easily. Trust me - seeing the quick helps, but sometimes they look like they are much shorter than they really are.

Here's the deal - you WILL at some point cut the nail too short and your pet WILL bleed and you will feel awful. Go into it expecting that at some point.

There are two types of nail clippers you'll find. The guillotine style made by Resco are the common, usually silver, clipper that the nail slides through the little loop at the end and when you squeeze, a blade slips across this and snips it off. The other type is referred to as bypass clippers. These have a pair of scallopped edges that trap the nail and when you squeeze, the cut from both sides. Which is better? Whichever you like. Usually - big dog nails are easier with bypass. I like guillotine for small dogs and cats - but I can use either.

How far do you trim them? As short as they'll go without bleeding. Sometimes that's easy to see. Sometimes you'll have to learn based on the first couple of nails what is too far and what's far enough. Picture an imaginary line extending out from and parallel to the bottom of the toe pad of an un-extended toe. The line will cut across the nail at about the right place to cut. In other words - the nail shouldn't touch the ground when the pet is standing in a normal position.

How often? When they need it. For most puppies, that means once every week to two weeks. For adults, usually once every 2-4 weeks. Some pets nails grow even more slowly and can go 6 weeks between trimming.

The best way to avoid having to trim the nails much at all is to take your dog for regular walks on concrete surfaces (i.e. - daily walks around the neighborhood on sidewalks). Short of that you are probably going to have to trim nails.

• Technique 1 - Use a Dremmel (or other high-speed rotary tool) with the sanding drum on it. Use this to grind the nail back. The heat generated is useful to help drive the quick back. It's also nice because you have a softer surface as opposed to the sharp surface created by the clippers. Many dogs will respond to the heat of the Dremmel and start pulling back when you get close to the quick. YOU CAN STILL MAKE THEM BLEED. It's just a bit harder.
• Technique 2 - Using either form of nail clipper, trim the nail just past the end of the quick.

In either case, keep some Quick Stop powder (or styptic). A pinch of powder on the bleeding end of the nail helps stop it quickly. If you don't have any Quick Stop, an easy home remedy is to use a pinch of flour or corn starch with gentle pressure on the end of the nail. That'll help it clot.

Cats are easy to see where to cut. Take the narrow, sharp, pointy part off. Try not to use human nail clippers. Cat nails are laminar and they will shatter with human clippers. They do better with little nail clippers.

Cool fact: Because the nail is laminar, cat's "sharpen" their claws by pulling successive layers of nail off the end, leaving the harder, sharper point below. Anyone with a cat has found these bits of nail that look like a cast of the end of the nail laying around. When you trim the nail, it has to grow out before it gets pointy enough for them to catch on anything.

Please, please, please, please, please - pretty please - start trimming your dog or cat's nails when they are little bitty babies. Foot/nail phobias are very common in dogs and cats. You have to start young or they may become so nervous about it that they become phobic. I can't tell you how many patients I have that require a wrestling match that potentially includes poop, pee, booty juice (anal sacs), slobber, and teeth. 99% of those patients could have been avoided if we had only started when they were 8 weeks old. It's just like with our own kids - you have to get them used to having their teeth brushed and their nails done when they're little. If you both get used to it when they are babies life is SO MUCH EASIER.

If you're still not comfortable cutting nails - take them to the groomer or your veterinarian starting when they are very young and get them used to it.

AMH

Easter Lily Toxicity

This is the week that lots of folks are going to have Easter Lilies around the house (if you're of the Easter persuasion). Asiatic lilies make attractive flowers for the home and garden. Many people grow them indoors in pots. These are definitely plants that require special attention to keep your pets safe.

All plants in the lilium genus are toxic to cats. Some daylilies are also on the list (hemerocallis) Dogs seem to be much harder to make sick. All parts of the plant are toxic. Ingestion of even one leaf on the plant can be fatal to a cat.

Oddly enough, we don't know exactly what causes the damage. We do know that the kidney's tubular lining is toasted, so there is some kind of direct cell death. The result is acute, severe, and usually irreversible kidney failure.

Early signs include vomiting, usually within a few hours. This will progress to weakness, lethargy, vomiting, changes in volume of urine within a day or so. Death follows.

Ingestion of the plant MUST be treated as an emergency and these guys need to be emptied out (by vomiting) and need to have lots of charcoal. Once they are sick, we support them with fluids and intensive hospital care, but it is a watch and wait situation. Patients who are not producing any urine or are more than two days out from ingestion carry a much poorer prognosis.

Please be careful with the lily plants. Dogs require a much larger dose of the plant to cause problems and you rarely hear of them suffering toxicity from the flower.

AMH

Annual Physical exams

A reader just asked me a question that reminded me of something.

I don't mean to suggest in my vaccine discussion that if vaccines aren't due every year, you shouldn't see your veterinarian every year. Absolutely not.

The physical exam is by FAR the most important thing and that SHOULD be done at least once a year. Pets age quickly. Annual physical exams (or even bi-annual) are very valuable and your doctor will check:

• Teeth - time for cleaning? Problem spots?
• Heart and lungs - murmurs, abnormal sounds
• Skin - infections, hair loss, changes in quality that may suggest a systemic problem or a problem with the body hormones
• Palpate the abdomen - feeling for masses, etc
• Weight - are we gaining? Loosing? Do we need to talk about diet changes?
• Annual blood work - see if everything is working as well on the inside as it is on the outside. Many chronic conditions can be found FIRST on blood work. Things like early kidney disease, diabetes, thyroid problems. Not to mention the importance of heartworm testing.
• Bones and joints - arthritis?
• Dozens of other little items like neurologic problems, urinary problems.

The vaccines should take an "oh by the way" place in the annual physical exam.

AMH

Vaccination Situation #1

Here's a subject that is likely to spark controversy. I'm only going to address vaccinations in adult animals in this post. Puppies and kittens require their own review. I'm going to split this one up into two parts. It's just too much information and it's too important to skip around.

Why does this matter? What's the hubub all about? Why do we care what vaccines are done every year, what vaccines are done every three years?


The answer isn't straight-forward. To put it simply, we want to use vaccines to prevent disease, not cause disease. The current concern regarding vaccines is that vaccines in general may not be as absolutely safe as we once thought. There is the autism debate in human children, the hypothyroid debate in people and in dogs. The autoimmune debate over things like lupus being related to vaccines. We don't know for certain that vaccines cause any of these things, but it sure looks suspicious.


So if we don't know for certain if vaccines cause problems, what are we to do about it? The answer is that we should re-evaluate how we choose and use vaccines so that we are limiting our exposure to only those things that are necessary to try and prevent disease. Our goal should be to use just enough, and not too little or too much. If there isn't a compelling reason to use a vaccine - WHY DO IT? The real fight becomes when you try to identify a "compelling reason" since different people feel strongly in one direction or another.


In other words - we have to be smart about our vaccine choices. We can no longer just blindly go in to get our "shots" whenever we're told we need them. We need to treat the right patient with the right product taylored for them.

Tune in tomorrow for the next post of specific types of vaccines and specific recommendations.

AMH

Over the counter pain medications

I am frequently asked if a pet can take anything over the counter for pain. Typically, the answer is NO. In cats, the more specific answer is not just no, but NO!


Dogs and cats are so very, very physiologically close to us in many ways and yet worlds apart in others. One of the big differences has to do with the way their livers process certain toxins (or drugs). Because of this, drugs in the Non-Steroidal Anti-Inflammatory Drugs (NSAID) designed for humans are exceptionally bad for dogs and cats. Instead, drugs had to be developed that they could tolerate. These drugs are all prescription and there are no over the counter equivalents.


Ibuprofen is horribly unpredictable in dogs and can easily be toxic at a single dose. Some dogs tolerate fairly high doses before they get sick. Since you can't predict this, it's not safe to give at any dose. Acetaminophen (Tylenol) is rarely used in dogs, and then only if required because it is in a combination with a narcotic (like Vicodin). Dog livers tolerate it OK, but not well enough to comfortably use it any more than you have to. Do NOT give tylenol to your dog.


But to all rules, there are exceptions. Dogs can tolerate aspirin. Small doses, at least. Before we had canine specific drugs, aspirin was commonly used. The problem with aspirin is that the side effects all happen at doses lower than those required to provide pain relief. Tummy upset and disruption of clotting are the two biggest side effects we are concerned about. Aspirin is a potent inhibitor of platelet function. It's why people take tiny doses daily to help prevent heart attack or stroke. Because aspirin is associated with such potential for problems, I'm not even going to mention a specific dose. There is the occasional dog that can tolerate aspirin quite well and does well on it as a pain medication. This is the exception and those patients are at higher risk of bleeding.


In cats, however, there are no exceptions. DO NOT give your cat anything over the counter. Period. A single Tylenol is fatal. Aspirin has to be given with extreme caution. Ibuprofen is likely to be fatal. I repeat - DO NOT give your cat anything over the counter. Nothing. Nada.


There are some great prescription drugs designed to work well with dog and cat livers. This class of drugs still requires care when using, but the veterinary drugs like Rimadyl (carprofen), Metacam (meloxicam), Deramaxx (deracoxib), and Previcox (firocoxib) are all fantastic in the right situations. Because they are SO safe relative to the over the counter options, it simply isn't worth the risk of giving anything else.


AMH

MRSA or "The Bad Staph"

MRSA or (MERSA) or resistant staph are all terms used to describe a particular form of a bacteria named Staphylococcus aureus. We are all covered in staph organism. It's common. It's usually harmless. However, the concern for these MRSA or methicillin-resistant Staphylococcus Aureus is that these particular bacteria appear to be fairly aggressive and highly resistant to antimicrobials. Every year this population of bacteria seem to become more adaptive and develop new resistance remarkably fast.

It is estimated that up to 25% of people have some kind of MRSA currently residing on their body. This isn't a big deal until the bacteria gains access through a wound or has an opportunity to grow in a sinus infection, at which time it can become a wicked problem to deal with. I have, in fact, had a MRSA cultured from my nose a couple of years ago. Ironically enough, it was resistant to the sexy antibiotics and sensitive to the really cheap, easy antibiotics and we appear to have cleared up up without any problems. Total cost of prescription: probably $0.50.

On the flip side, MRSA kills thousands every year. Why the difference? Individual quirks in a patient's immune system, regional strains of bacteria, or types of wounds for one reason. Some individuals end up spending thousands of dollars on cool, sexy antibiotics compared to my rather plain $0.50 treatment.

I bring these bacteria up, because I have been asked if a dog or cat can either 1) get or 2) give a MRSA to the human in the household. Interestingly enough, the answer is YES to number one and maybe to number two.

There have been a few studies looking a cultures submitted to veterinary labs where a staph aureus has been cultured. The type of staph cultured from dogs and cats is usually staph intermedius. They are usually easy to kill, but not always. As it turns out, there have been S. aureus cultured and when those were checked, some were actually MRSA. This was a pretty scary finding.

You can actually check the genetics and determine that the MRSAs cultured were probably of human origin. When multiple people in a household continue to culture positive for a MRSA, it might be appropriate to screen the pets in the household as well. The current guidelines from the CDC do not recommend routine screening of pets or people unless there are households with severely immunocompromised (Chemotherapy, AIDS, transplant patients, etc) and there have been problems with MRSA. In those cases, every mammal in the household should be screened (people, dogs, cats, rabbits, etc).

Short version - Dogs and cats can apparently grow MRSA organism as part of their normal flora. These probably came from the people in the house. They might be able to pass it back and forth between pets and people. Don't worry about this unless you have a situation where your physician is trying to locate a potential source of re-infection or if you are immunosuppressed.

WHEN YOU ARE PRESCRIBED AN ANTIBIOTIC FOR YOU OR YOUR PET - FINISH THE ENTIRE TREATMENT. DO NOT STOP EARLY. Appropriate treatment with the right antibiotic at the right dose and for the RIGHT LENGTH of time is the main way to fight development of resistance in bacteria. Both human physicians and veterinarians are to blame on this one. Please, please, please follow the instructions on the label.

AMH

Allergies #2

If you are the proud owner of one of these unfortunate souls, you can approach their allergies much like you would your own. First line treatments are usually antihistamines. Benadryl (diphenhydramine) is typically the first choice. Given at about 1mg per pound of body weight every 8-12 hours. (25mg capsule to a 25lb dog). Chlorpheneramine can also be used - most dogs get a 4mg tablet every 6-8 hours unless they are very small (<10lb) or very large (<80lb) in which case they may get 1/2 or 2 tablets respectively.

Second line treatments include medications like steroids or cyclosporine. Steroids (like prednisone) aren't all that bad. They can be excellent for short-term use at a modest dose. The problem with allergy dogs is that these guys are rarely being treated for just a couple of weeks. They are usually itchy for an entire summer and you really shouldn't keep a pet on steroids that long.

Cyclosporine (Atopica) is a very cool drug that basically gives you the same benefits of steroids but without the side effects for long-term use. That's an oversimplification, but basically the idea. Atopica isn't perfect, it makes some animals puke, but it can be an awesome alternative to prednisone. Biggest downside is that it's expensive. It's worth the money if you can afford it. Prednisone is very, very cheap, so it's not a fair comparison.

Regular bathing with a hypoallergenic shampoo once a week or so during the bad season can also help. This rinses the pollens off the skin and can be very useful. You must use an appropriate shampoo - it must be mild, made for pets, and not contain any pesticides. I'll post more on shampoos later. Because the skin is inflamed and abnormal during an allergy outbreak many patients end up developing secondary skin infections or overgrowth with yeast or bacteria. These infections may require special shampoos or oral medications to treat them. The allergy may be part of the itch, but the secondary infection may be what causes the itch to be severe.

In some breeds, specifically hounds like bassets or coon hounds, they are likely to have an allergy to the yeast or bacteria growing on their skin. This means that as the yeast that normally live there start to grow, the poor dogs are actually allergic to them and develop a significant itch. Many atopic dogs are allergic to "staph" bacteria and the overgrowth of bacteria can actually make a little itch suddenly turn into a huge, horrible itch.

Last thing to mention is that the only way to truly treat the immune response of the allergy is to see a veterinary dermatologist. Testing can be done to determine what your pet is allergic to. We can then give your pet injections of that compound and hopefully get the itch to stop. This is precisely how it is handled in people.

The veterinary dermatologist can be your pet's best friend if they are suffering from chronic allergy, skin, ear, infection problems. The testing may seem expensive, but the savings in the long run from not having to treat as many infections or spend as much on anti-itch medications can be substantial.

AMH

Allergy Season

This will be my first post on allergies. There's lots of information to be said and even more bunk out on the internet.

When people "get allergies" to thinks like pollen, grass, dust, etc, we typically think of the runny nose, eyes, and asthma. When dogs have inhalant allergies, they tend to have skin symptoms of itching, redness, and then secondary infection. There's plenty of crossover - some people get eczema, some dogs get runny eyes.

So the typical "allergy" dog is a foot licker, armpit scratcher, and face rubber. They also tend to have ear problems (itching, secondary infection). Some individuals only have ear problems or only lick their feet. Some have the whole list of symptoms and are miserable.

"Allergies" are caused when the body's immune system sees something like a pollen and reacts to it instead of ignoring it. The cells in the body that are responsible for reacting to antigen (antigen meaning anything, usually a protein, that the immune system reacts to with an antibody) are full of all kinds of fun chemicals designed to spread havoc. Histamine is the major player. Histamine causes blood vessels to dilate, causes itch, and swelling. Histamine is what makes that mosquito bite swell into a little bump.

Not everything is known about why this happens in certain individuals. Genetics is involved. Offspring of an allergic individual are more likely to have allergies, but it's not a guarantee. We now know that there are some really cool changes in the way the skin of an allergic individual is put together. As it turns out, the "cement" that holds all of the "bricks" of the skin cells together isn't quite right in these people and pets. As a result, the skin isn't as effective a barrier as it's supposed to be. This allows the body to absorb some antigens that you wouldn't normally absorb (like pollen) and the immune system gets all upset and you develop "allergies."

Allergies are also something that develop over time. The typical atopic dog shows signs during their 2nd or 3rd year of life. Sometimes earlier, but usually it's not their first summer. They also get worse over time, so the 8th summer is usually worse than the 2nd summer.

I'll post again with a discussion on treatments. There's TONS of stuff to talk about, so I'll break it up.

AMH

Animal Poison Control information - a MUST have for pet owners

This is the URL for the ASPCA Animal Poison Control Center:

http://www.aspca.org/pet-care/poison-control/

(888) 426-4435

There are many good articles and general information on this site. There are lists of toxic plants, foods, etc. I'll post again on toxic plants to give some more specifics.

Keep their phone number handy. If your pet ever ingests something and you're not sure if it's toxic, you can first call your veterinarian, but if there's any question - call APCC right away and they can save you a lot of time and money. They'll help you by 1) telling you if it's even a big deal and 2) if it is a big deal, they can tell your veterinarian how to effectively treat the issue and that will help save you lots of money in the long run.

There is a $60 fee charged to your credit card, but it's worth every penny!

They will give you a case number to take to your veterinarinan, so keep the number handy.

AMH

How much food should I feed my dog or cat?

This is a question I answer nearly every day. The answer is: It depends.

Start with what the bag says. If you're feeding an appropriate food for your pet (puppy for puppies, senior for senior, etc) then look at what the bag suggests. The bag assumes normal patient with average metabolism. The number listed on the bag is in 8oz measuring cups.

Look at the cup you are using to measure. When in doubt - check how much the cup you are using holds. Typically, you can feed 25% above or below what the bag suggests. Anything outside of that, and the pet needs to be on a different formula food. For instance, if the bag suggests 1 cup of food per day, you could feed anything between 3/4 and 1 1/4 cups and be within an acceptable range.

Puppies - don't worry too much until they are around 4-5 months. If a puppy seems hungry and wants a little more - that's OK. Just keep it reasonable.

Remember, feed the pet, not the bag. If your pet needs more or needs less, feed more or less (within that 25% window). If you're having trouble getting your pet to loose weight and you're already feeding the smaller amount, you really need to have a talk with your veterinarian so you can discuss a veterinary diet that is designed for weight loss. Weight loss is a great topic for another post.


AMH

Cat vision question

Dear Dr. Herndon,

My cat Poppy doesn’t jump up on cabinets or over the wall around the back yard. In fact, she’s just not a jumper at all. She will stair step her way up to higher places such as the 5’ carpeted cat tower in the living room so its not heights that bother her. Do you think she could be nearsighted?

Cynthia

Dear Cynthia:

If her eyes are narrow set like a typical oriental breed or if she has vision problems in one eye, she may not have good depth perception. Is Poppy siamese?

Cats can have vision problems just like ours, so it is possible she's nearsighted. Unfortunately, we don't have any easy way to measure that. (I guess you could try to have her read a Cat Fancy from five paces, but that may not be very helpful either.)

Another possibility is that she has problems in her hips that make it too painful or impossible to jump up. In this case, she'd climb well, but it would hurt to jump. You'd have to take an x-ray to find out.

At least she's smart enough to know her limitations and not try to jump up where she can't see well enough to land.

AMH