Fourth Of July. Your Pets Idea Of The Apocolypse

We all like happy endings. Unfortunately, life doesn't always hand them to us.

It was a quiet catch up day at home. It is early summer and we have a few monumental projects underway on our old house. Most of our weekends get one weekend day dedicated to renovations. Today was "gut the old kitchen" day. Eight years I have waited to take a sledge hammer to the red grouted hideous horror that was our postage stamp kitchen. The doors were open, the dust, debris, and busted up interior circa 1970 kitchen was headed to its final resting place when around noontime an  unknown truck drove slowly, almost tentatively, down our long drive.

I went out to meet a 'more formal than from around here' guy who cordially asked "if I had seen a dog?"

My heart went out to him immediately.

He was apologizing for interrupting my day and trespassing our demo-zone.

We live in the country down a long forgotten looking drive to keep the Amish gawking tourists out. He, like every other motorist who has driven our drive, thought we were just a farm trail. I walked to his truck to try to ease his concerns and to slow him down so I could gather the information fast enough to be able to help. His stress, fear, and worry were palpable. I have seen this parental worry for an in-danger pet more times than I can count. I have been there, and I empathized completely!.

The celebration of the Fourth of July is the mid-summer kick off marked by loud noises, incredible fireworks displays, heat, humidity, and food. For our pets, and those of us veterinarians who serve them it, symbolizes heat exhaustion, heat stroke, death due to hyperthermia and dehydration, hit by car emergencies, pancreatitis from over indulgence, gastric/intestinal obstructions from ingestion of inappropriate foods and lost pets due to running away from the fear of those loud noises.

The next few blogs are going to focus on these Fourth of July fiasco's that I hope you and your family can avoid by learning from other peoples pet emergency stories.

After a few awkward moments of trying to convince our visitor that we were not upset about his visit, or taking up our time, I was able to collect a few details about his plight.

He introduced himself as Chris and told me that he was visiting his brother with his dog.

"My dog ran away from my brother's house. He lives at the end of the road that is off of your drive. I think that his property is adjacent to yours over the cornfields." Chris said.

"Oh, yes, I know the house." I said, as the crow flies it is about a mile away. "When did he run away?" I asked.

"At about ten a.m. He is an 8 year old male Golden Retriever, he has a collar and tags, and he is micro-chipped." It was a little after noon now.

Thank-god, I thought! A micro-chip is such a relief to have when your pet gets lost. If your pet is found and if that someone tries to find you the microchip is the best way to do this. (Important point, if your pet is micro-chipped have your vet scan for it, check that the number the scanner reads matches the number you have on their records, and call the micro-ship provider to make sure that the information they have is up to date and correct. A micro-chip is only useful if it can find you).

"What is his name?"

"Teddy."

I introduced myself and told him that I would call the local emergency and veterinary clinics to notify them, in case anyone brought in his dog (run-away's do get hit and some people think, erroneously, that if they hit a pet that they will be held financially responsible for this..YOU WILL NOT..but please never leave an injured pet behind)..see my blog on Emergency Kit and Emergency Procedures. Please call for help, or bring an injured pet (if you can do so safely and without further injuring the pet AND without injuring your self), to the nearest emergency clinic. I also told Chris that I would post Teddy on our clinic's Facebook page.

Chris thanked us and drove away saying he was going to keep driving around looking for Teddy.

I made my calls to all of the local clinics and left my number as the contact person.

There are a few big advantages to living in a rural country setting. One is that I know everyone in the small veterinary world around me..I asked every clinic to spread the word and told them I was posting an Amber Alert on our clinics Facebook page, and I asked that they all share it.

Then I hit social media. One of the key factors in catching the Boston Marathon bombers was social media, it is by far the quickest way to spread the word and join massive numbers of people on a common mission.

A few minutes later Teddy's story was being shared by friends, family, clients, and neighbors.

My husband and I got in the Gator and headed into the corn fields, a leash and phone in hand. We traipsed in 4WD through the mud, the brush, the streams, and the fields searching for any sign of a red dog running. We tracked what I imagined to be about a 70 pound dogs' recent foot prints captured in the mud from the just rained on little dirt road that runs between the corn fields, but after two hours and a thousand lashes from the pricker bushes came home empty-leashed.

I texted Chris to see if  he had any luck, but only heard the torment in his down-trodden voice when he said, "Nope, still no sign of him."

At 6 pm I got a text from a good friend who was once our clinics groomer but was now stay at home mom, that another mutual friend of ours, and another old JVC employee now turned Animal Control Officer of our county, saying that she had received a call that someone who had picked up a dog running on Rte 851. State route 851 is our nearest big road..and I say big because people routinely travel this road at 60 plus mph. I immediately called her and got the name and number of the good Samaritan who had picked up the dog to hunt down the first and only lead we had so far on Teddy.

A minute later I was on the phone with Mary. She and her son were traveling in our neck of the woods and saw a red dog running west on 851. They stopped when no one else did, pulled up to him and opened their car door. Teddy jumped right in and they all headed home. Not having a dog of their own at home they stopped at the grocery store to pick up dog food. Mary told me that Teddy was now comfortable on the couch with her husband, and that although they had had plans for the evening she had decided to stay home with him to keep him company. Mary had alerted animal control, but they told her it would be Monday before they could do anything about him. So with a few days ahead of them they had all settled in together.

Mary was so kind, and generous, and she even offered to drive Teddy home. I thanked her and told her that she had likely saved his life. She said that no one else was stopping and that people were speeding around him..she knew she had certainly spared him from being hit.

I called Chris and gave him Mary's information, hoping that her stray was his.

What were the chances of a Golden Retriever on 851 and it not being the same dog? Hopefully, very slim.

Mary called me a few minutes later to say that Teddy was back with his dad. I once again thanked her.

Chris came by our house again to introduce Teddy and to say "Thanks."

We shared Teddy's story over a beer. I offered him a Loose Cannon, (ironically of course), and he offered me a bottle of wine.

It wasn't until now that Chris had the time or valor to admit the whole story to me.

He said that Teddy was at his brother and sister in-laws because his wife and kids were at State college for the day and she didn't trust him with Teddy alone. (Sorry, honey, but all wives who love their pets like kids feel this way). When he and Teddy had gotten to his brothers house he let Teddy out of the car to go down to the pond. A short time later off in the distance someone started firing off a rifle? or cannon? (I had heard it too, I think cannon), and it scared Teddy enough to set him running off into the corn fields.

Once a dog is spooked, and it can be from any abnormal, or loud, or different noise, they will run. Without a leash or a fence big enough to contain them they will go. They will not listen to a command and they will not think through their fear. It is a primal unstoppable fear based response.

The best way to protect your pet from the dangers of the noises that drive pets to run away is to:

1. Keep your pet with you, leashed to you, or in your house, at all times when loud noisy activities are going on.
2. Use a reflective collar to alert motorists should your pet be out at night. 
3. Have your pets information on their collar. I like to embroider my phone number on their collar, so that if a tag falls off the information is still there, but there are also metal plates that can be mounted on a pets collar.
4. Have a tag on the collar with your pet's name, your phone number and "MICROCHIPPED" written on it, if your pet is micro-chipped.
5. Have your pet micro-chipped.
6. Assume your pet will over react to loud noises and be prepared for it. Any gunfire, fireworks, or even overhead airplanes can cause a pet to run. if you hear any loud noises look at your pet. If they are looking scared, perplexed, or anxious get them inside or on a leash immediately.
7. If you are inside and your pet is looking fearful place them in a safe, enclosed, secure space. The smaller the better (most pets feel safer in a small contained area like a cage versus a room). 
8. If they are still feeling overwhelmed by the noises, try to dampen them by placing a blanket over the cage to block out the noise.
9. If your pet is calmer with you then keep them next to you. Don't intensify their fear by baby-talking to them. This will often reinforce their fear. If they think that you are afraid too it will just  compound their insecurity. Be kind and gentle but not afraid.
10. Keep pets away from windows. I have seen dogs jump through a window to run.
11. For any pet that has had an issue with thunderstorms, or fireworks, etc. in the past, once they have a fear then they will likely have it forever. Expect this and prepare for it. Ask your vet for help with dealing with fear based anxiety issues. Most behavioral issues worsen and intensify with time. Expect this and prepare for it on the first occasion.
12. Even with training to try to ease their fears (we call it conditioning) the chance of them over reacting to a threatening stimuli is present. There are things to try that might help. I would encourage you to try them. They include:

• Thundershirt. The Thundershirt is designed to snuggly around your pet like a shirt. These can calm a pet without drugs or training and they are very affordable. I am now using it on my 17 year old dog Savannah. It is helping her anxiety issues.

• Ask your veterinarian for a referral to a behaviorist to help in calming your pets anxiety by getting them more comfortable with it so they do not over react to it. 
• Ask your vet about anxiety medications. If your pet has a growing or worsening list of anxiety issues, or you are having issues with their behavioral changes, please talk to a veterinarian about long term medical therapies. There are many good, affordable, and effective treatments out there. take a leap of faith and try them. For many pets and their families it has made a world of difference. 
• Tagg. A GPS guided pet tracking device that mounts to your dogs collar. You can now follow your dog as they travel. Big brother is watching, and it can find your pet. Although I do not have this device, when Joe and I were trekking around the blackberry bushes getting slashed I was wishing that Teddy had Tagg. 

If you lose your pet start canvasing the area. Knock on every door, ask for help, call the local veterinarians, shelters, animal control, and hit social media. Leave information on your pet including, their age, breed, size, distinguishing marks, collar info, whether micro-chipped and if possible use a recent picture. Everyone may not help, but a few will, and a few can move mountains and make miracles.

If you find a dog that is injured help. You can seek local rescues, veterinarians, and public animal control. Be an advocate. Ask questions, and stay involved. In many cases an injured pet will be taken to an emergency clinic but if no one steps forward on their behalf their fate will be decided by others based on economics and accessibility. How would you feel if your pets fate was in someone else's hands?

If you find a pet that is not injured start asking everyone around the area that you found the pet if they know who's it is? Often a pet has not wandered far from its home. Try to find a safe place to stay with the pet for a few minutes. Their family is hopefully looking for them too, and they will be looking close to where the pet was lost.

If you can house the pet in the interim it takes to find their family you will keep that pet out of a shelter where chance of communicable disease and being lost in the system is appreciably diminished.

Any pet that has been running will likely be hot, tired, and thirsty. Here are some signs of heat exhaustion and intolerance. Signs of heat intolerance

A dog that has been outside in the heat for any amount of time, especially if they are running or fearful, can be at risk of hyperthermia.Death from hyperthermia

Teddy had been in the best hands possible. He was lucky and Chris was so relieved to have him back.

Teddy was reunited by the efforts of many caring people. From the Facebook post I made he was seen by over 6000 people. Many people shared his post, and many people were out looking for him. I am so grateful for their help, and I will work to find a way to have a national Amber Alert system in place to help other people find their missing pets. Until then please keep your pet with you and be proactive. They react with fear and this is the most dangerous time of year for lost pets.

Wishing you and your family a happy and safe Fourth of July!

Teddy and his very relieved dad.

If you have any pet questions, or would like to add anything to this blog please find me @Pawbly, or Pawbly.

I will be writing on intestinal obstruction next,..stay tuned.

The Bumper Sticker Guide To Life

I am not a bumper sticker bearing kind of person. Something about graffiti marking my wheels just doesn't sit right with me...But on a recent long weekend in Cape May NJ I came across a car wallpapered in stickers.

For some reason I felt compelled to stop and read most of them. Within minutes I was laughing and wanted to share my favorites with you.

Just a little levity heading into the weekend.

Do you have any good stickers to share?

I am always in need of another giggle.

Have a great weekend everyone!

Taffy's Tongue Tumor. Part Three of the Mass Removal Series.

Taffy is a 13 year old long haired orange tabby. He has been struggling with a decreasing appetite for months. His mom has been trying every kind of food and every kind of texture to try to convince him to eat. It has been a roller coaster ride that has been full of frustration and worry.

His first visit to the vet revealed an irregular ulcerative red spot under his tongue. Despite trying antibiotics and watching to wait and see over time the mass had grown to cover over half of his tongue. Taffy's tongue was swollen making ti hard to hold in his mouth. The mass was painful and the pain made Taffy reluctant to eat, and he was now drooling constantly. The decreased food intake was causing weight loss and muscle loss. The muscle loss was causing him to have more and more difficulty in getting up and walking. (Quick cat tip: cats often show weakness in their back legs. They will walk plantigrade (with the hocks (ankles) dropped. So instead of walking on their back toes they walk on the foot from the toes to the ankle. If you notice this in your cat go to the vet. This is also one of the first signs we see in diabetic cats). He needed relief quickly or he was going to continue to slip downhill and that down hill slope will get progressively steeper as you slide into the abyss. At some point your pet will not be able to crawl out of that abyss.

I saw Taffy for his surgery a few days later. Before surgery I gave him another thorough examination, reviewed his pre-op history and diagnostics and took some x-rays to make sure that there wasn't any evidence of cancer. We thought that the lesion under the tongue might be cancer so we look very hard everywhere else to see if it has spread. IF the cancer had spread his prognosis would be much worse and the surgery might be done just for de-bulking, temporary relief purposes, instead of getting clear margins. All of these thing are vitally important points to discuss before surgery.

My point is to be proactive and not wait until that mass is your pets death sentence.

Induction agent being delivered to put Taffy under anesthesia.

After Taffy was sedated to be intubated we could see for the first time the complete source of his pain.

Intubating for inhalant anesthesia.

Looking down the throat to see where to put the endotracheal tube.

Looking to check before placing the endotracheal tube.

My very good friend, and fellow veterinarian, referred Taffy to me specifically because at our clinic we have a laser that we can use to remove masses. The laser reduces the bleeding and surgical time and she believed was the best tool to try to remove Taffy's tumor.

Taffy's tumor was in a tough spot. All the way in the back half of the underside of the tongue. Until he was under anesthesia completely we weren't really sure how big or how deep it was. Many times in surgery it is as much discovery and examination as it is attempt to surgically correct and/or remove. (That's why it is sometimes very hard to give a definitive estimate for services). I was not sure I was going to be able to remove this with even the laser, and I was not sure what "IT" was to begin with.

We began surgery with the laser. Removing the mass was made much easier with the laser but there is only so much tissue that you can remove at the base of the tongue and it is a fine line between enough to get Taffy comfortable and able to eat again and too much tissue removed and the tongue becomes non-functional.

Ready to be draped in for surgery.

OUCH!

Ready for surgery!

Begin lasering.

After the mass was lasered off the tongue was sutured closed. The tongue is essentially one large muscle, and muscle bleeds readily. In order to reduce the normal trauma that the tongue encounters as it moves in the mouth and rubs against the teeth I had to close the surrounding tissue.

The tongue is sutured and the mouth should be much more comfortable. I expect that with a few days of antibiotics and pain management that he will be back to eating voraciously.

The tissue should be sent out for a biopsy to diagnose the lesion and help treat it appropriately. The biopsy will also assist in prognosis and future treatment should it recur.

To adress the chance that the lesion might be related to dental disease we cleaned and polished the teeth. Taffy's owners will also be instructed on how to brush them and be advised to do this daily.

Taffy is part three of the "wait until the last minute" mass removal. This series was written to remind us all that medicine is often a juggling act. We are always juggling risk versus consequence. The important thing to remember is that the plan will change as the patient changes. Don't be afraid to re-assess, re-think, and change course.

Be proactive and try not to use age as a reason to deny possible life saving treatment.

If you have any questions or comments about this blog, or any aspect of veterinary care please leave me a comment. You can also find me, and a whole bunch of other pet experts at Pawbly.com. We are happy to help you and your pet live a long healthy life together.

The Rule of Three. Casey's Catastrophic Cyst

This is part two of three of the "wait til the last minute" mass removal series.

Casey.

One of the most common surgeries that veterinarians perform (outside of the spays and neuters) is mass removals. What we term as 'masses' are any abnormal growth of tissue. They can, and in most cases, are usually benign growths that are usually nothing more than cosmetic annoyances. This is not stated to diminish or negate the importance of having your veterinarian look at any growth that your pet might have. It is essential to have a strong bond built on trust with your veterinarian. They should be able to help you make decisions that are in the best interest of your pet when deciding which growths to remove and which to let alone for now with a "watch closely and keep us posted" attitude.

All three of the pets in this series were pets whose growths were watched for extended periods of time. Each case and each mass is different, but each client was very very concerned about the age of their pet and the effects of the needed anesthesia to be able to remove their masses. Deciding to put your elderly pet under general anesthesia is incredibly stressful and gut-wrenching for many owners.

I remember the turmoil and fear I had each time I had to spay, neuter, or do a dental on my own pets. I had to clear my whole day, and warn all of the staff that I was a nervous wreck about putting them under. For my beloved Wren I almost cracked. I get the stress and the fear, I do. I admit it to my clients and I only recommend anesthesia if it is necessary.

Casey is a 14 year old black lab. She is a smiling, wagging, happy girl. She has no idea she is old, she lives in the moment. We should all so lucky, and we should all have that outlook. (Oh, the lessons we learn from our dogs). She lives for her daily walks and her parents adore her.

She has been coming to see me for years. Every year we discussed the mass on her back and every year we decided that it was not bothering her and that the risk of general anesthesia to remove it did not warrant the ugliness of having to look at it.

That was until we got a frantic call from Casey's parents last week. They called panic stricken and asking for an emergency office visit because the mass had "burst." The receptionist tried to convince them to wait until the next day, as we were already booked, but they decided that they were headed over and we would fit them in. They were afraid that Casey's bleeding was too severe and that it would be dangerous to wait.

Our policy is to see every patient that needs us, and in all cases IF the owner thinks it is a big deal AND needs to be seen immediately it is a big deal AND it will be seen immediately.

Casey and parents arrived in very quick order. Casey wagging and happy and parents obviously concerned.

The mass had been simmering and festering for years. But at this point the previously quiet mass had reached critical mass and it was spewing its contents all over Casey's back. They wanted me to bandage it and they were here to talk long term options with respect to maintaining that bandage.

The cold hard reality is that this mass was not going to be bandaged. This mass on the top of his back was about the size of a baseball. When a tumor (in reality every mass is a tumor) gets large enough that there is no longer any normal healthy tissue to allow it to heal it will bleed and not stop. It is impossible to close a tumor with any kind of suture, or bandage, or staple. A tumor will turn into a festering pile of hamburger, and that tissue is friable and unyielding to healing.

I slowly and calmly told Casey's parents that we were at a fork in the road. It was time to talk about surgery or trying to manage a wound that would never shut up for very long.

They listened and listened and tried only twice to convince me to try a bandage.

Scrubbed and ready for surgery.

After a quiet discussion it was decided that the only way to have a hope for a long term manageable solution was to surgically remove the mass.

After a thorough examination, radiographs of the chest (to look for metastasis) and abdomen and a full blood work and urine we decided to go forward with the surgery.

The day of Casey's surgery she was brought in and left behind by some very very worried parents.

For Casey's surgery we placed an i.v. catheter and gave i.v. fluids for the few hours before her surgery. She also received an NSAID for pain and inflammation and an antibiotic.

Casey's surgery only took about 20 minutes. She did great under anesthesia and it was a relief to see her so calm and steady. She had a strong regular heart beat and breathing pattern. I was so relieved to hear the monitors beeping steadily and the breathing bag full and rhythmic.

Removing the last piece of subcuticular fat to take the cyst off.

The removal of the mass left a large elliptical shaped hole.
Thankfully, Casey has more than enough extra skin to close the incision.

Starting to close the incision.

The post-op product is a 6 inch incision, sutures, and a few staples. After care involved warm antibiotic compresses and antibiotics.

The mass is gone and Casey is wagging and walking within a few hours.

I know it was a very hard decision for Casey's parents to make, and I know that we were very lucky that Casey did so well. But, there was no good option other than to try.

With a significant amount of pre-op preparation and planning we went into Casey's surgery with as many favorable indicators as was possible.

Casey is still the happy beautiful girl she always has been, bit now she doesn't have to have a draining open wound prone to recurrent or chronic infection.

I wish them all the very best of luck!

If you have any questions for me, or any pet questions at all, please visit me, or the bunch of us, at Pawbly.com. Pawbly is free to use and open to anyone and everyone! Or find me on Twitter @FreePetAdvice, or on Facebook.