Thursday, October 30, 2014

Kitten Head Tilt? Maybe? Upper Respiratory Infection? Maybe? Polyp? (See the video!)




This is Louie the first exam that I saw him. In the first few photos he was about 2 months old. He, like almost every kitten we see came from a barn, or an outside colony, and was saved by a loving family from having to follow in the footsteps of his parents. There is a terrible epidemic of neglect and responsibility among too many people that think that it isn't their obligation to spay and neuter their pets. Of all of the adorable kittens I see I know there are dozens more who grow up feral, abused, or eaten by wildlife. Louie was very, very lucky, he is, as you can see, also adorable!

He had been to the clinic twice before for an upper respiratory infection (URI).URI's are one of the most common ailments that we see in young kittens. Typically they present as a sniffling, sneezing, subdued, lethargic kitten who has stopped eating. Sick kittens usually have both ocular (eye) and nasal discharge that is thick yellow green snot. Sometimes they even arrive open mouthed breathing because the nose is so stuffed. They usually also have a fever. He had been on two rounds of two very good antibiotics and yet his nose remained snotty.

Louie also had a significant head tilt to the right. Because his head tilt was so marked I wanted to see how he navigated. In itself a head tilt isn't indicative nor detrimental on its own, but it can affect the pets ability to ambulate and eat. For Louie it didn't seem to affect him at all. He could walk in a straight line, focus and hit his target, and turn both to the left and the right.

video





Anatomy of a head tilt. The right ear is lower than the left, Louie tilts his head to the right.


The head tilt is consistent through all ranges of head movement, looking up down and even side to side.



At Louie's exam we discussed all of the things I was thinking. I explained that I thought Louie was functioning just fine even with his trademark head tilt. I also mentioned that he still had a little bit of green snotty discharge from the left nostril, but he had no other signs of infection.

Most importantly, his heart and lungs sounded normal. He did however have a very audible consistant stertor, which sort of sounds like a low pitched snore. It occurs when there is a mechanical obstruction at the level of the larynx, or back of the throat. I was very suspiscious of Louie having a naso-pharyngeal polyp. He sounded clear and normal everywhere excecpt the back of his mouth/high trachea, he had no evidence of still having an URI expecpt the left nostril and he was happy active and playful. I suspected that he had a polyp or mas in the back of his soft palate that was occluding air flow therefore making his constant snoring sound and irritating his nose constantly so that it was goopey incessantly.

Here is where I got concerned. If I was right he and the polyp would continue to grow. Polyps can get so large that they cut off your ability to breathe. We usually wait to neuter kittens at about 6 months. That was 4 months from now. I didn't want Louie to wait that long. I was afraid that if we waited we would be risking his life. We vaccinated him that day and he returned two weeks later at barely 3 pounds for his neuter and oral cavity exploratory. I was nervous. I am always nervous. What if I was wrong and there was a problem with anesthesia, he was so little, and he had been through a lot already.

Surgery/Neuter Day;
One back rub before surgery.


As soon as I opened Louie's mouth there it was! Hiding, lurking all pink and tumor-like behind the soft palate, a big giant polyp!

I intubated Louie and then used a soft tipped hook to gently pull the soft palate forward so I could get a better idea of how big and how easily this thing could be removed. Even though Louie was just going under anesthesia pulling and moving the mass caused him to cough and swallow. Removing a polyp is a 2-3 person task, one to hold the head and mouth open, another to hold a light, and me, well I need both hands to try to fit into a tiny kitten mouth..


Here is a video of us trying to get a look at the size and scope of his polyp.

video


Pre-op the mass is in front of the surgical elevator.


The moments of us in awe and utter jubilation that it came out! For as much as this job can be hard, demanding, and gut wrenching, there are moments like these where we all work together and make a huge difference in a patients life.

video



When the polyp was in the back of the throat it was bright pink. Now that it has lost its blood supply it looks white.
The polyp, at almost 2 inches long!
The rest of Louie's procedure; the neuter.
Neuter time

Waking up with the chest elevated.

The polyp is as big as Louie's face!

Looking down Louie's throat, nice, clear open airway!

Louie's endotracheal tube remains in place AND inflated as he wakes up.
 As we watch and wait for Louie to wake up I make sure the the endotracheal tube is in place and still inflated so that any blood that might have occurred as we removed the polyp comes out of his mouth instead of going down his trachea to his lungs.

I hold him with his head down and gently coupage (cup your hands and pat the sides of the thorax to break up and help expel any stuff that doesn't belong in your lungs), as he starts to wake up. We also keep a bulb syringe next to him to suck up any saliva in the back of the mouth.



 Louie wakes up smiling! And breathing quietly for the first time!

Every patient gets a kiss after  surgery, (lol, like it or not...)


Louie woke up a quiet, peaceful kid, still a little bit of a head tilt, but I suspect it will resolve a little...although it is pretty cute.. and his trademark.

For another blog on naso-pharyngeal polyps see Kiki's story.

If you have a pet question, or want to learn more about a pet illness, disease, behavior, etc.. you can ask me on Pawbly.com. If you want to share your pets life please join us in celebrating the amazing tales of our companions at Pawbly. Pawbly is a free on-line community dedicated to helping people learn about how they can take better care of their pets.

You can also find me on Twitter @FreePetAdvice, or Facebook, or at the clinic kissing my patients, at Jarrettsville Vet in Jarrettsville Maryland.

Wednesday, October 29, 2014

Halloween Pet Hazards.


Jekyll, the shark.
Not a fan of the costume.

It is that time year where the sun sets earlier and we are all reluctant to remove ourselves from the warm blankets to witness the frost kissed windows. The trees begin their self-preservation vasoconstriction causing their limbs to squeeze the life blood from their leaves causing them to shed like jewels from their crown in a glorious display of an autumnal ticker tape celebration. It is a magnificent time of year. The heat has dissipated, the allergens are receding to hibernate until another summer day months away, and  the cataclysmic onslaught of the offspring of those incredibly prolific breeders has taken a small break to let the reproductive organs regroup and refuel. It is fall!

The holidays are looming and the drum major of them is Halloween. The time to dress up, unleash our inner ghouls and dance in the darkness in search of high calorie, sugar laden treats! It is Halloween the gala of costumes, the parade of marauders, the display of gallantry and cacodemons. 

Ah, it is as entertaining to watch as it is to participate in. But like all haunted hallowed eves there are dangers that lurk.

Monty, (who's dad is my very good college friend), 
as Little Orphan Annie
Here's my list of Halloween pet dangers to beware of;

Costumes;
Remember these are foreign items to your pet, and most pets are frightened of them. They are afraid to be dressed in them and don't understand why other dogs turn into alligators, superheros, and cheerleaders, etc... Any frightened pet will act erratically, and erratically can manifest as cowering, hiding, fleeing, and even attacking. Do not demand more of your pet than they are capable of handling. Halloween is a one day of the year event and trying to condition them to every monster in the universe for this one day is a beneficial endeavor. Choose your battles, and know your pets limitations and tolerances. Do not leave a pet unattended with a costume on. Your pet views that costume as a scarlet letter. And as fast as a ferret they can twist, turn, convolute, and intussuscept all in an effort to escape the straight jacket you placed them in. All costumes, wigs, clothing, jewelry, and accessories can be, might be, and should not be, swallowed. To compound your dilemma they are in most cases made of synthetic unforgiving, indigestible material. The only good news is that much of it will show up nicely on either your x-ray or ultrasound. Dress your pet, snap your photos, and start leash walking to collect your booty.  Once your escapade is over strip your pet back down to their birthday suit.

Charlie, the black sheep,
and Jekyll the bunny.


Candy;
Sorry. Any and all of it is forbidden for your pet. They are a very poor choice of calories, detrimental to the pancreas and chocolate in larger quantities can even be toxic. Not to mention the wrappers being an obstructive potential. Your two legged kids are your decision. (Don’t ask the dentist for their vote though).

Savannah, the mouse.


Light;
It is super important that the trick or treating Halloween entourage be highly visible. I like to use reflective tape. It is very safe, very effective and leaves your hands free to collect candy. The other bright ideas are glow sticks. They say non-toxic, but who wants to find out how non-toxic they are? Dogs will eat anything, especially if it dangles, flashes, and swings from your best friends body. Last note, keep your pet as highly visible and as close to you as is possible. The biggest danger to your pet is when they are about 6 feet away from you on the end of a dark leash. A driver will automatically be focused on the group of children and may not see your pet lower to the ground and not well lit.

Jekyll the pumpkin
Jack O'Lanterns;
The carved pumpkins are the harbinger of the Halloween season. Nothing says spooky like the flicker of a candle in the hollow of a carved pumpkin. The flicker glow of a candle is alluring and calls inquisitive noses and whiskers. Your glowing Jack on the porch should never be left alone with your pets.

Trick Or Treating;
This is Pandora's box on public display. My honest heartfelt advice is to leave your pet at home. Why? well, because there are too many strangers, too many opportunities for accidents, mishaps, and mischievous beings. Too many people want to approach your scared, reluctant pup and place their hands on them. It is already dark out, and a pups ability to see well is significantly lessened in low light. They know this, and they will hyper-react to stimuli because of it. So here’s what we have; First, decreased ability to see, and second, increased anxiety due to loud chaotic goblins fleeting about. The result? We have two criteria in place for a perfect storm. Add your pup to this and voila! Trifecta! Keep your pet at home.

Trick or Treaters;
Remember those little goblins at your door are intruders to your guard dogs and spooked house cats. The safest place for your four legged kids is safely is in their crate closed away from the bustling activities, or in a quiet enclosed safe room. Set them up in their safe spot early and return to them after the front porch light is off.

The old superstitions that put your pet in danger;
Black cats and stray pets. The night of all hollows eve is notoriously dangerous to these guys. Keep your pets inside under close supervision and be the advocate for them. Lastly, help dispel the superstition by adopting a black pet(s) (the lowest adoption rates is among the black cats and dog) and embracing the beauty of a pet in dire need of a friend.

Do you have any pet Halloween insights to add? Please let me know.

Oh, and another last note! Please, please send me those photos! Have a wonderful safe Halloween everyone!

My baby bunny.


 Halloween, it might be your children's favorite holiday of the year, but it probably isn't your pets. Be safe, be proactive, and be wary. There are ghosts that linger in the night.

The 2014 Halloween photos

Charlie the cowardly lion.

Jekyll the spider.

..the shark.

..the frog..


Charlie the  pirate

..the dragon.

..the other dragon..

and the boys...


Oh, and another last note! Please, please send me those photos! Have a wonderful and safe Halloween everyone!
My mom and sister. When we collectively dressed as the Addams Family.
At my house.
Which never requires too much decorating to look like the Haunted Halloween House.

If you have any pet related questions you can find me, and a whole slew of amazing people, at Pawbly.com. We are happy to help you, and we are always FREE to use! Come join us as we help people take better care of their pets. Also on Twitter @FreePetAdvice.

Sunday, October 19, 2014

The Wounds That Lie Beneath. Dog Fights and Dire Consequences




There is a certain thrill in being involved in medicine. It is the mystery of the unknown, the deep rooted feeling of being able to improve a life, assist in comforting, and alleviating pain. It takes a little leap of courage every so often to do something that you have only read about, to diagnose and treat something a bit out of your comfort zone. But it allows you to grow, it strengthens your medical or surgical skills and it broadens your resume so that you can in turn assist more patients.

There are tiny pearls of wisdom that experience teaches you. These are some of the things that I hope this blog imparts. It is no different than the budding vet students life. You read, you study, you share, and when that fateful day arises a little bell will go off in your head and you will proclaim, "I remember something about this.." and a pets life will benefit from some pearl picked up by someone sometime ago.

This is Angus, an older Jack Russell Terrier who came to see me one Sunday. He was a quiet, timid, handheld package. He had been in a dog fight and was the apparent loser. I will admit that most of the dog fights I see are JRT's, and in almost all of the cases it is an older Jack who lives with other Jack's. Almost invariably the victim is the source of the instigation and the subsequent fight. The older dog challenging the younger kid but miscalculating their size, skill, agility, strength, and swiftness.

Jack's are highly energetic, possessive, fierce little dogs. They love their parents, bond very closely with them, but have a low threshold for other dogs. And, in most of the cases I see the bruised battered Jack lives with other Jacks whom they squabble with every so often over some possession. And every so often that squabble erupts into a battle of bites. They fight quick  and dirty. A grumble turns into a snap and two seconds later someone is bleeding and limping. I have sewn up more Jacks than any other breed combined.

Such was the case with Angus.

Like a true lifelong fighter, Angus has a graying muzzle, a few scars, scratches, and a look of pain and humility in his eyes. Clearly this isn't his first encounter with a disgruntled roommate, and clearly he needs to rethink his self entitled crown.

When I first assessed Angus my first impression was he was incredibly painful. He also refused to use his back right leg. These are signs of an injury that should be seen immediately.


Angus also had a large swelling to the abdomen at the top of his right leg. Of all of his puncture wounds, lacerations, and battle wounds this was the one I was most concerned about.

Here are some of the things that you should seek immediate attention for if your dog has been in a dog fight;

  1. Trouble breathing. Always an emergency.
  2. Trouble standing, or walking.
  3. Cries or snaps when touched. 
  4. Blue tint to tongue or gums.
  5. Reluctant to lay down, sit down, or move.
  6. Limping.
  7. Seizure. Always an emergency.
  8. Bleeding that will not stop with gentle pressure for 5 minutes.
  9. Large and/or deep wounds.
  10. Injuries to the eye, mouth, throat, chest, or abdomen.


That wound on his right side looked like this on the x-ray. The right side of the film is normal. The ribs run down the right side to the body wall and then to the pelvis. The left side however has a bulge of soft tissue to the left of the side of the pelvis.


That bulge the to left of the pelvis is Angus's intestines. They have escaped the confines of his abdomen from a rent (tear) in the abdominal wall.

If left untreated the intestines can strangulate and this will lead to death of the intestines and death of the rest of you.

Hernias can occur anytime there is a whole in the abdominal wall. We see them most commonly in the area of the belly button, inguinal hernia, or associated with a congenital abnormality. They should always be corrected surgically if any abdominal contents can, or are, slipping out of the abdomen.

The next day Angus had his abdominal hernia closed. He was kept on pain medications and antibiotics from the time I saw him through the first two weeks post-op.



He made a full recovery and will live to see another kerfuffle. The next time, hopefully, it will only be a verbal match.

If you have a pet question, or want to help other pets with your own pet experiences please join me on Pawbly.com. Pawbly is a community of pet enthusiasts who all work together to improve the lives of pets across the world. Pawbly is free to use and open to anyone who cares about helping pets.

You can also find me at the clinic, Jarrettsville Vet, on Twitter @FreePetAdvice, or on Google plus.

Friday, October 17, 2014

Crowd Funding Meets Crowd Sourcing. How Schmoopsie Changed The Way I Practice Medicine.



 OK, so maybe I am not the first kid to jump into the newest hottest trend. And, maybe I am a little late to dare to be the next trend spotter. (I watched an episode of Shark Tank where a savvy entrepreneur admitted to having had a career as a "trend spotter." That's a guy who gets paid to fly all over the world to look for kids making fashion statements. It's the established elderly fashion designers way of staying current and appearing to still have a finger on the pulse of the cool hip kids. I sarcastically point out the players and vehemently deny which side I land on in the above scenario).


But, I am fascinated by the concept of crowd sourcing and funding. I love the idea that a bunch of strangers get together to collectively work on solving a problem. A universal community of do-gooders determined to make a difference. How inspiring is that? We can all be a tiny part of a solution that has real impact, and makes a real difference. I believe in this as the faith to the problems of my tiny microcosm of wishing that I could do more. There isn't a pet loving person on the planet who doesn't feel compelled and almost psychotically driven to spread care to those voiceless pets in need who cower in fear, disease, and neglect both in our own backyards and around the globe.




I practice it in my own clinic everyday. I  know first hand the power of a photo on the internet. Our own Schmoopsie, (the price I pay for letting the staff name the pets), who has spent the last 2 months being hospitalized and intensely cared for is a small example of crowdfunding. She was brought to us a small speck of mangled fur and bones. She was a one month old feral kitten who had been caught in a fan motor at a factory where a client worked. When she was brought to us she was in terrible shape. Her front left leg was mangled to an unrecognizable mashed up appendage, her back left was not much better, and her face was covered in motor oil and grit. Her teeth were broken, and her lips degloved from her face. If she survived the first few days, she would need to have her left front leg amputated, her face reconstructed and her mouth wired. Not many would have looked at her and said, "OK, we will try."



She was a pathetic mangled dirty mess, but the client who found her wanted to try to save her, and so did we. So she was left with us.






A fund raiser effort on two fronts began. The collection basket at the factory yielded $700. The rest of her bill was a combination of donations of staff time, clinic services, and the generosity of others.


A few weeks later and she is a happy healthy three legged force of will power. She is skeptical of any of us in a white coat, (smart girl), and thrives in spite of her handicaps and continued wound care.


She has just been adopted and will soon be out of the clutches of our hospital to live the life of a pampered house cat.



She is the perfect example of veterinary health care free from the stigmas of the excuses too many dismiss as being acceptable.



Yes, there are a lot of easier cases out there. But did any of us go into medicine to just practice our craft on the easy cases?



Yes, she required an immense amount of care and TLC. How else is this job supposed to be rewarding? Our massive paychecks?

Yes, she took up staff time and attention. Why would anyone ever deny them a chance to live their purpose? For their massive paychecks?


She is the story told for generations. The one case that proved to us that a life does matter, and we do make a difference. She is the collaboration of highly trained technicians, veterinarians, and the entire veterinary hospital staff who all loved her, cared for her, looked out after her, fed her, held her, socialized her, took her home overnight for the first critical days and weeks. She is the miracle of a band of people who care.

She is why crowd funding AND crowd sourcing works.

What if we could design a site where people posted their pets needs and the users voted and paid for the treatment?

What if we could build a network of providers who would be willing to provide services that the public helps pay for and the pet benefits from? Everyone participates, everyone benefits, and ultimately more pets are helped?

I'd sign up!

Isn't technology and innovation amazing? Where do you think that I, the veterinarian with the big heart, the bigger dreams, in the little building in Northern Maryland could make a difference? Where could you?

I'm all ears..

You can find me here, please leave a comment I reply to every single one of them, or ask me a pet question, share your pet stories and help become a piece of the crowd sourcing care to help pets the world over. This is Pawbly.com, free to use and open to all pet lovers.

You can also find me at the veterinary clinic, Jarrettsville Vet, in Jarrettsville Maryland. Or find me on Twitter @FreePetAdvice, or Google plus.

Update:

Schmoopsie was adopted last week (October 19, 2014). She is a happy active unstoppable bundle of kitten. Her other injured foot is healing well and although it isn't perfect (she doesn't seem t be able to retract or use the claws of her toes), she can do everything else. She is a true testament to the miracle of a kitten. I don't think that many people would have given her a chance, but she has proven to be a reminder to never give up on life.






video