Greta. Getting the Answer BEFORE Giving Up. WARNING, surgery pictures are included.

Greta. Sunday January 26, 2014

I saw Greta on a Sunday exam. She arrived wagging her tail, looking around inquisitively and happy overall. But, I noticed that even under that think dense dark coat she was looking a bit "pendulous." A "pendulous belly" is term vets use when the abdomen looks distended. The belly can be distended due to having fluid, (called ascites), enlarged organs, weakened abdominal muscles, or even air inside of it. There are lots of fluids that can leak into your abdomen. They include urine (called uroabdmonen), blood (hemoabdomen), gastrointestinal perforation or leakage, abscesses or infections can leak puss into the abdomen,  bile leakage, chyle, or angry organs (think liver, pancreas, heart, and lungs). Regardless of the inciting cause a pendulous belly is something to pay attention to immediately.

Can you see a pendulous abdomen?

Greta was accompanied by her mom Patty. I have known her for many years. She is one of the women who started All Shepherd Rescue. Patty is a stoic woman with a strong determined personality. She is dedicated to helping shepherd's find homes when the public fails them. As a popular breed they need strong, staunch support because many people under estimate their need for work, attention, mental stimuli and a good dermatologist. They lead the breed category list for behavioral problems,  (ALWAYS due to lack of socialization as a puppy OR boredom) and dermatological disorders. Don't get a German Shepherd unless you are well informed as to the complex needs of the breed. Please?. Greta came to them as they all do; on death row as an old dog with multiple needs. She had been in the rescue for about two years.

Greta arrived on Sunday a few minutes before closing. After all, she looked and was acting normal to the average on looker. When I met Greta in the exam room her mom said rather matter-of-factly that Greta was here simply because she was drinking more. She just attributed it to old age, and the awful weather. In veterinary medicine we call this polydipsia. Polydipsia can be caused by a multitude of factors. A few are easily treated, and a few are serious and can be life threatening. Never ignore  pet that you think is drinking excessively.

AND NEVER EVER WITH HOLD WATER!

Some pets come to me with the other end of this problem, called polyuria. Polyuria is excessive urine output. Some pets demonstrate this by urinating outside of the box, or peeing in the house after being housebroken for years, but in (almost) all cases the polydipsia is causing the polyuria. And,

BOTH REQUIRE QUICK VETERINARY ATTENTION.

As I examined Greta her mom asked me, "Well, what do you think it could be?" Still sounding as if perhaps she might be over reacting to bringing her in on a Sunday.

I looked at her and said, "Well, she has a pendulous abdomen, an excessive heart and respiratory rate, muffled heart and lung sounds and I am very worried about her. She needs an x-ray, full blood work, and probably an ultrasound before I recommend exploratory surgery."

Greta is a fit and trim girl, BUT, she has lost her normal taper at her waist.
This can and does happen quickly IF there is something leaking inside that belly.

Her mouth opened a bit, she stayed very still, as if waiting for a punchline and then hesitantly asked me "if I thought it was serious?" She was clearly not expecting any of this.

We took x-rays and blood for a complete CBC and chemistry as well as a urine sample. Based on her normal temperature, attitude, and mucous membrane color we decided to have her return first thing in the morning for her ultrasound.

Her x-rays were as I expected, pendulous fluid filled belly with undefined organ definition. Of greatest concern was the inability to see her spleen. I sent a text to Dr. Morgan to beg her to come in on Monday (her very deserved day off) to do an ultrasound for Greta.

On Monday morning Greta returned. But she was a shadow of the girl she had been a few hours ago. She was no longer eating, or happy. She was lethargic, quiet, reluctant and pale. Her blood work from the day before was normal..very normal. The blood was not giving us a clue that she was as sick and critical as she was. Her ultrasound showed an enlarged spleen with nodules and an abnormal liver.

I sat down with Patty to talk about where to go from here. It was not an easy conversation.

She had some very valid concerns, a whole belly of unknowns, and other mouths to save and feed. I get it.

I had a whole host of concerns to. Add to that a dying dog who is a sweet gentle girl, the emotional gravity of the situation, and two strong minded animal advocates, and the boiling pot can explode.

Her concerns were;

1. Greta is 8 years old. That is about the normal life span for a German Shepherd.
2. She has multiple lesions on her ultrasound.
3. To treat her she needs an expensive surgery. At our clinic it is about $1,000. And she runs a rescue.
4. The average lifespan IF the surgery is successful is about 6 months. 
5. Greta will have a recovery period after surgery. She was very concerned about putting her through surgery.

My concerns, and replies to her concerns, were;

1. Age is not a disease. I know people use it as a reason to decline treatment but I just don't agree with giving up on treating a pet because of age. We decline more pets lifesaving and beneficial quality of life treatments because we use age as an excuse not to do so.
2. Multiple lesions can be evidence of the spread of disease, but they can also be found because we were looking. For example, I took my old dog Ambrose in for an ultrasound and we found three distinct lesions in his abdomen. They included a nodule on his kidney, spleen and in the omentum. I was getting the ultrasound in preparation for chemotherapy to treat the cancer he had on his elbow. Can you imagine how bleak I felt his prognosis was when I realized he had four problems instead of just one? What did I do? I had an exploratory surgery done. Turns out that ALL three abdominal lesions were unrelated benign things. They had nothing to do with his cancer. He went on to have his radiation and did remarkably well for another 6 months. How many other people would have looked past three lesions?
3. I cannot argue that resources are scarce for many of us. BUT, what I did argue was that we were at the place where we were deciding to put her down with presumptions. We were about to end her life based on educated guesses. I am not ever content with this. Further, putting her on the surgery table and exploring her abdomen would give us a definitive answer. AND, if it was worst case scenario, where she had metastatic cancer throughout her belly we would know for sure, and we would humanely euthanize her on the table. The cost of this would be about $100.
4. I cannot argue with the sands of time. I can only promise to try to offer the best options to return a happy pet to a place where pain is minimized and quality of life is paramount.
5. Surgery has inherent risks, and dogs need to be kept quiet and monitored post-operatively. BUT, many pets do very well post-operatively, and there are many good pain medications available, just like in people, to help with this. 

At the end of our discussion Patty agreed to give Greta another chance.

 Within  few minutes Dr. Morgan had Greta on the operating table. Greta's abdomen had 350 mls of blood in it. We removed this and when we did we saw that her liver was engulfed in tumors of all sizes. Her spleen looked similar and her cancer was too advanced to treat. 

Removing the free abdominal fluid.
Hemoabdomen.

A very abnormal spleen

A peak in the abdomen.
The liver is full of round tumors.

Patty said goodbye to her and we stopped her surgery.

Now I understand that many of you will read this and be angered that we put Greta on the table. I want to add that at no point was Greta stressed, or uncomfortable. Putting her to sleep under anesthesia is not any worse (or better) than while she is sitting in front of us. She was not consciously put through anything  that was painful or unnecessary. It was done in an effort to save her life. When I spoke to Patty afterward I asked her if she was OK with everything. 

She sent me this;

Greta came to All Shepherd Rescue in March 2013 at the estimated age of 7.  Her previous owner had had a stroke and could no longer walk or care for the dog. Greta weighed an unhealthy 114 pounds, her coat was matted, and her skin was very dry with some open cysts draining.

Greta was placed on prescription diet food and allowed unlimited exercise in the large yard.  She thrived chasing squirrels and chipmunks and playing with the resident dog. 

By mid-summer, Greta was a svelte 95 pounds with healthy skin and a glossy coat.

Greta did not appear ill during the months it took her cancers to develop.  She was at the vet for treatment and observation in December, 2013 after she ate a loaf of raisin bread.  All blood tests were normal and Greta returned home to continue counter surfing.

As January progressed, I noticed Greta seemed to be eating less.  She was moving more slowly but I attributed that to the cold weather and possible arthritis.  Greta had always enjoyed her water and I was filling the water bucket more often.   Saturday night 1/26 Greta drank a gallon of water and refused her dinner and breakfast.  We went to the vet that afternoon and sadly she was euthanized the following day.

I have adopted Greta.  Every dog at All Shepherd Rescue gets a home eventually.

Patty Visser

If you have a pet related question you can ask it, meet other pet lovers, and help a pet in need next door, or across the globe. You can also find me answering questions for FREE, at Pawbly.com. 

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Butterscotch, How To Care For A Found Cat.

Butterscotch

There are some pet stories that remind me to sit back, shut up, and regale in the beauty of sharing the magic of the joy of a pet. For those of us who sleep uncomfortably short-sheeted, contorted, and without moving for fear of disrupting the sleep of our pet bed hog, or share our meal time with the sad begging eyes of the Fido food vultures, or even those of us who put out bird seed everyday just to gaze at the beauty of the winged visitors to our feeder, you will understand what I am talking about.

Sometimes we meet someone who just understands exactly what we are about. Such was the case in meeting Butterscotch and the soft hearted guy whose house he crashed one very cold winter night.

Arrival

I first met Butterscotch on a busy weekday morning. He was a scruffy bony boy who arrived in a copy paper box. Now if you know a thing or two about cats you will know that scant few felines will allow transport in a box. Fewer still will sit contentedly in that box and watch the chaos of a veterinary clinic just pass by.

But, there he sat. Unabashedly perched high, nose inquiring, calm, and cool. As if he was a regular visitor who just landed himself in the box on the bench as a matter of pure fancy. 

The cats that demand the least in attention are those I naturally gravitate toward. If curiosity ever claimed a cat, mine was going to need a resurrection after meeting Butterscotch.

A quiet ominous man sat next to the red box slowly and methodically petting Butterscotch. They were a quiet calm pair in a room of commotion. My fist guess would have been that they were old solid chums. 

When I introduced myself the man he replied that he was here because this cat was huddled up next to his house and "I couldn't leave him outside to freeze to death, and I can't keep him. I am already over my allowed limit." 

"Argh!," I thought. He was here to dump a cat. How many of these do I see every week??,,,at least one..

We have been having record low temperatures. The kind that freezes unfortunate souls in hours and few things tug at me harder than a person stepping up to help, a pet in need, and the dilemma of trying to care for "just one more cat."

With these scenarios the plan is always the same.. Think a second, take a minute to process everything that you are about to say,,, long sigh, deep breathe, and try to figure out a way to help all parties involved without putting the clinic yet another kitty in the Jarrettsville Vet Center general population, or discouraging a good Samaritan from ever helping another creature again. Be strong and kind and don't get frustrated...(all much easier said than done).

Now don't get me wrong, I love having clinic cats. They remind me everyday why I do what I do. And without us every cat in the JVC clinic would have met the end of their days via lethal injection under our roof. We take the cats that clients no longer want, or are able to care for. Lately these stories have left us with our two resident blood donor cats, a diabetic, a chronic stomatitis cat, a back injury cat who cannot urinate voluntarily, and two cats who's parents died unexpectedly. We have four house cat cages and seven cats. Clearly my ability to maintain our 4 cat max policy lacks discipline.

I apologized for being full and offered to help him find this overly sweet cat a home. 

The man asked me to give the cat an exam, a rabies shot and said he was going to keep the cat inside overnight and try to decide what long term plan for him would be tomorrow. 

We quickly discussed the availability of being adopted at the local humane society, or being taken by one of the rescues, and agreed that based on his age and the over abundance of cats in a similar predicament, this cat's options were limited, and his fate bleak if he wasn't taken in by someone we knew. 

At the end of the exam Butterscotch departed in his box to the front desk.

Thirty minutes later the receptionist found me to inform me that that scruffy ornage box cat was now Butterscotch. And he would be back next week for the rest of his shots. His new dad was keeping him, and "to hell with the consequences!" 

Testing for FeLV/FIV

A week later Butterscotch was back at the clinic for the rest of his recommended health items. After a thorough examination, vaccines, a fecal sample, de-worming, flea preventative, and a microchip, Butterscotch was his same cool collected self, but a bit bolder in the seeking affection from anyone and everyone department and a bit bulkier in the body condition.

Looking for more

He was thriving! 

The only photo I could get without him head butting me

He has a corneal defect on his right eye that we are monitoring. With his lack of any sort of medical history I am taking an educated guess and presuming it is an old injury. He is on an ophthalmic antibiotic just to rule out that I am wrong and will be re-checked weekly until we convince ourselves one way or the other.

Is it an old injury? Or a new corneal infection?

The weather has been brutally cold. Everyday is frigid with temperatures hovering around zero. It is not fit for man or beast. Butterscotch is a lucky cat, but he is also a gentle affectionate cat. He wasn't a hard sell, but he was fortunate that his age, medical condition and the size of his adoptive family. His story is not unique, but it is not the norm either. Too many cats are left outside to fend for themselves and too many of them cannot adequately maintain their body temperature in these extreme temperatures and without shelter or resources provided to them.

Fewer found cats will receive needed medical care. 

Here is what you need to know if you are thinking of helping a pet in need.

1. Always assume that a cat is feral. Always. Many cats have had some human exposure, but many are adept skilled survivors, and their intuitive instincts will kick in in a split second. DO NOT PET OR HANDLE AN UNKNOWN CAT! The consequences of your assumption could kill you. If that cat gets scared, and it likely will if you try to approach or pick it up, it will bite you. That bite could kill you if that cat is carrying or infected with rabies. Be careful in your assessment of a cat. Remember rabies can look like the furious (aggressive) form or the dumb (quiet reserved "sick" looking) form. 

2. If a cat looks sick call for professional help. Your local animal control can assist in catching and transporting the cat for care. BUT, be warned if you have not vaccinated the cat, and if they deem it aggressive, sick, unsafe to be handled they can and will euthanize it. A feral cat is only yours if you are caring for it based on the local, state and federal laws. To make the situation worse, IF the cat tests positive for rabies the health department WILL come to your home and CAN quarantine or mandate euthanasia of every pet that IS NOT vaccinated for rabies. I have seen it happen and it has been devastating to the families who love their cats (and dogs). 

3. No Good Deed Goes Unpunished vs. Paying It Forward. Where would society be if we didn't take care of, look after, and intervene for each other? How does humanity survive if people don't have a compassionate soul? It is cheaper and easier to turn a blind eye and walk away from a creature in need? Can any of us say that we earned everything in our lives without the help of others? 

4. If you can help a cat know what you are getting yourself into. It is not enough to provide food and shelter. It is a good start, but you are ultimately responsible for that cat, and that cat will at some point need assistance outside of your abilities. There are rescues, shelters, and non-profits that can assist you if you cannot afford to, or are physically able to help your cats. Prepare for this day today.

In an effort to help Butterscotch his physical examinations were done pro bono. 

Related Articles;

The Risk of Rabies

The Raccoon Seven. How Seven Puppies Almost Died.

How Can Cats Be The Most Popular Pet AND Yet The Most Neglected?

Cold Weather and Outside Pets

Wordless Wednesday for January 29, 2014

A typical day at Jarrettsville Vet.
Two receptionists and one, or more, dogs visiting for doggie day care and stealing an office chair.

Levi

Sonny receiving acupuncture for his intervertebral disc disease.
We are so excited to have Dr. McCadden with us.
She specializes in acupuncture and Chinese medicine.
To meet here or discuss her services just give us a call.
She is helping me treat Savannah's cognitive dysfunction, and keeping her up and ambulatory!
Thank You Dr McCadden!

This is a what we call a slab fracture of PM4, or what Dr Hubbard calls "a long, must needed dental extraction."

JoJo was here for a diet and exercise plan..at 18.5 pounds a summer slim down will help him live a longer, happier, and healthier life.

Dr Morgan showing us all how to correctly walk a dog after a rear limb injury or surgery.
This is Cletus who had his second TPLO surgery for his cruciate ligament rupture last week.

Munchkin is squeezable cute

Coot, our resident cat watching Dr Hubbard discharge Sam.
Sam came to the clinic in a carrier and on a harness and leash.
Way to live like a king Coot and Sam!

Dressed for the chilly weather!
This little dapper man is ready for any event in any weather!

Dr Morgan examining Charlie, the Great Dane

Rio, showing his puppy training.
He is exceptional at "Stay" for about 15 seconds.

The dog beds have been very popular at my house..
and cuddling to keep warm is a necessity!

My Jekyll.

My little Magpie.

Coots sister Loon.

Leo and Rocky. These brothers were just adopted from the Humane Society.

There has been a flurry of dogs with bumps lately.
This is Gracie's bump.
Can you tell if this a bump you should worry about?

This is Rio's bump.
How about this one?
Would you be worried about it?

Lovey.
Who got really lucky and wandered into a garage to stay warm, and was allowed to stay.
Thank You to all of those who are helping to care for those pets trying to fend for themselves in the cold.
We have straw available for anyone needing extra bedding,
although we are going to beg that you bring your pet inside.
We are even offering free boarding to pets in an effort to keep them safe and warm.

Inka, mid flight..

Butterscotch, another found and taken in out of the cold cat, came back for vaccines.
The man who found him is going to keep him.
How wonderful is that??

My gang dressed for the five minutes I will let them go outside.
Can you see the misery in Jekyll's face?
He hates to be forced to wear anything!

I just cannot stand how cute Penny is.

Ginger.

The warmest place in our house..
the bathroom.

Savannah,
Still with us, and doing very well.
Maybe I do know what I am doing?
Maybe she is just stubborn and lucky?
Either way I am soo grateful.

Cats 101. The Litter Box

Frankie, female, spayed Snowshoe cat.
She is awaiting a home after her parents, and very dear clients of ours, died.
She and her brother are both in dire need of a new home.
Please help us find them a new family.
They would have gone to the Humane Society and might have been put down as surrendered cats.

There are a few BIG advantages to cats over dogs.

My mom and her kitty Ramsey.
At 15 years old he had been chronically vomiting.
An ultrasound revealed an intestinal mass. It was removed and he has made a full recovery.

There’s the whole compact design, portability, and ease of care. Cats require a smaller space and have simple needs and demands. They also learn quickly

The list of items to provide your cat is short.;

Litter box

Remember there are some guidelines for litter boxes.

1.      Two for the first cat and one additional for each additional cat.
2.      Also remember that cats prefer unscented, non-clumping sand-like litter.
3.      In a large low sided open litter box.
4.      Away from any electric outlets, noisy areas, high traffic spots, or dark scary areas.
5.      It should also be kept on the floor in an area that your cat isn't afraid to go to.
6.      If your cat seems to be missing or avoiding the box, rethink everything associated with it. Size, shape, litter, and placement. Cats are discerning, complex individuals. They are far more sensitive to smell, touch, and their environment. Think like your cat, and provide them what they prefer, not what you prefer.
7.      It is important to keep the litter box clean. Scoop out waste daily and dump all of the litter weekly. Every week the litter box should be cleaned and dried. Be careful to not use any harsh chemicals that might cause your cat to not want to visit the box again.

Jitterbug, scoping and claiming his spot on the bed.
The puppies stand quietly and let him do whatever he wants.

I know many of my clients don’t want to share their living space with their cats litter box, but putting the litter box in the basement, in the laundry room, or garage is fine as long as it is in a place your cat can get to easily, safely, and quickly.

This is my art studio.
There are four cats in my house and Magpie has decided she prefers to not be with them all of the time. So, Magpie has claimed it as her space.
Can you see her litter box?

Litter box issues are one of the biggest complaints I hear from clients. For the simple demands that our cats place on us, the continual use of the litter box is the single greatest demand we ask of them. If your cat starts to have issues with inconsistent use of the litter box see your vet immediately to rule out a medical problem first. Then take a good long well thought out look at your cats litter box and ask yourself if there is anything about it that you would change if you were a cat? Remember the longer there is a problem the harder it can be to fix or resolve it.

Magpie's room has a bed, windows, and her own litter box.

She may not be affectionate with two of the other cats,
but she loves her own time on the couch with me.

For more information on litter boxes, and litter box issues, please see;

The 20 Minute Cure To Peeing Outside Of The Litter Box

Inappropriate Elimination in Cats

Feline Marking

If you have a cat, or any kind of pet question you can ask it for free on Pawbly.com. It is free for everyone to use, so come on and join in the conversation! We are dedicated to helping pets everywhere!

Or you can find me on Twitter, @FreePetAdvice.