Toes and Butts

Every veterinarian has their own closet full of medical "disaster" skeletons. Those cases and illnesses that have bitten our butts, burned our egocentric self esteem, and reduced us to mere mortals in search of Blackwell's 5 Minute Veterinary text book with each simple case of flea allergy we think? we have.

We have one bad experience with a drug, or a disease, or a surgery, and it is our natural knee-jerk reaction tendency to shun it away like an apple offered from a snake in a tree.

We all have them, all of us. A little bit of paranoia, a hint of doubt, or an irrational fear that we are unable to explain to those who don't bear a chain of responsibility that pulls you to the depths.

To put mine on paper: 1. whopping doses of dex---, I remember the old-timer vet I once worked with would push these enormous syringes (like 30 mls for an 80 pound dog) of straight out of the 100 ml bottle of dexa---(well--anything, sodium phosphate,-asone), whatever he found, into a dying dog. It was the last ditch effort of Pulp Fiction stab to the heart of epinephrine (2. that never works either), they never worked, but they did scare me to death!. 3. Robaxin iv. it kills, every time I touch it. 4. Lasix iv, not in my comfort zone..5. chest tubes, 6. black intestines, 7. any pet who arrives with a temp over 106, (all have died).

Now these items scare me because for the cases I have used them with, the outcomes were BAD!!! The cases were disasters from the moment I saw them. Most of these pets were beyond anyone's ability to save them, but, for me, I still associate the outcome with my treatment. SO, I remain weary of these drugs, diseases, and treatment options.

As for the other items in my paranoia closet?

Butts, and toes.

Toes; 

I get hyper-obsessive about bumps on toes.

If a toe mass comes in on my watch I jump on it like a kitten in a butterfly house.

I examine them, I radiograph them, I prescribe an antibiotic, a steroid, and a firm "come back if it doesn't look a hundred times better in 3 days OR immediately if it gets worse!" finger pointing.

I have too many toe bumps that are cancer stations. And I have had too many cancer stations that have discovered the internal highway system and spread to the whole pet before I can even yield my surgical sword at them.

My message to my clients, "Be proactive, be diligent, and take that toe off for a biopsy if we can't resolve that bump in a timely effect manner."

What is the sequela to my soapbox speech? Well, I amputate a lot of toes.

Butt Holes;

My experience with butt tumors is very much like my experience with toe bumps.

There is a high incidence of "bad cancer" when we see bumps on the feet and anus.

Be swift, be compliant with the instructions from the vet, and definitely schedule a follow up at your initial visit.

 This is Buggs.

He had a large problematic mass just inside his rectum. It was so large that it became very painful and difficult for him to defecate. To complicate an already sad situation the mass would bleed profusely every time he tried to poop, and sometimes just because it was so large and friable.

It is impossible to stop a mass like this from bleeding. The only treatment options available to his mom were to put him down (he was after all bleeding everywhere), or to remove the mass. The veterinarian who saw him initially was very worried that he would lose his ability to defecate voluntarily if the surgery was done, so she did not recommend it.

So, after a few weeks of persistent bleeding that was unmanageable, she came in to see me with the intention of putting him down.

I however never give up on a pet without trying every other option first. After all, what the heck did Bugs have to lose?

He was scheduled for surgery the next day.

With the laser I was able to quickly and easily remove the tumor.

Thanks to the laser, Bugs did not lose much blood during his surgery. As he woke up he had anal tone (a wink from the anus tells you that the nerves are still functioning and that the anal sphincter should have normal control).

He recovered from his surgery quickly and easily, and has had no further bleeding or trouble defecating.

Was it a bad tumor? Yes, it was an anal sac adenocarcinoma.

Is his mom happy that he is still here and very comfortable? YES!

Is this the best we could do for him? Well, it is not the ideal with respect to all that medicine has to offer, but it is what his mom could do for him, and so far (its been about two months) Bugs is doing wonderfully.

If you have any questions for me about anything pet related you can find me @pawbly, or @FreePetAdvice, or you can ask me a question directly at Pawbly.

House Cleaning, Pig-Pen Style.

Today is Friday, July 5th, 2013.

Yesterday, the Fourth of July the clinic was closed so we all got a day off and a reason to hit the pool parties, fireworks, and barbecues. I took full advantage of all!

Today, is the second day of my long weekend and the first official day of the long To-Do list.

At the top was pig house cleaning.

Now I realize most people don't have a pet pig, but, most of us have pets, and all of those pets need a scheduled cleaning and exam.

For the dog people out there I recommend the following schedule:

• Puppy. Visit the vet within 3 days of adopting your new pup. See puppy primer.
• Puppy. Visits for vaccines based on the puppy visit schedule your vet prescribes.
• Puppy. Set up a schedule for nail trimming, grooming, tooth brushing on a calender. You may also need anal sac visits, ear cleaning, skin fold maintenance and behavior classes. Schedule as needed for as long as is needed.
• Adulthood. Yearly veterinary visits, which may include; fecal examinations, dental cleanings, heartworm, and tick borne disease tests, urinalysis, blood screenings, set up monthly heartworm and flea and tick prevention schedule. Discuss any items to be addressed before the next yearly examination. (This may include re-checks, bi-annual exams, maintenance of persistent or chronic problems, like allergies, arthritis, heart or other disease monitoring, etc.).
• Senior. Bi-annual examinations to better monitor onset or progression of disease or change in health or ability.

My point is to remind all of us that a coordinated and agreed upon schedule is the best way to avoid time sneaking up on us and problems slipping through the cracks of our ever busy lives. 

Every aspect of our pets care benefits from a thorough understanding of what is needed when and how to do it efficiently.

A few very good examples will follow in the next few blogs.

It is always my hope that I can educate my clients to understand, identify and address their pets needs before they get out of hand and need my intervention.

For my house my pet pig, Strawberry, this is; spring hoof trimming (ugh, the drama of that. pig hoof trimming, .), summer housecleaning, and fall is winter prepping. I also check on her daily when I feed her. Everyday is a quick visual exam and careful monitoring for her overall health and mentation.

I watch her walk to her food bowl.

• Is she walking comfortably and in a direct path? Is she using all feet equally and fluidly? Are her hooves too long? 
• Are there any wounds, scratches, or evidence of bruising, hair loss, or drainage from eyes, ears, mouth, etc.
• Does she seem bright, alert, responsive, AND happy? This is an assessment of mental health and mental well-being.
• Does she dive into her food..let me tell you, for a pig, or my beagle this is the one sure sign that they are feeling good. 

I check her house to make sure it is safe, sound, clean, and comfy.

Strawberry's house is emptied from all of the hay that insulates her house during the winter.

For your pet remember to clean bedding, toys, clothes, bowls, and their coat, nails, teeth, anal sacs, ears, etc. on a routine set schedule.

For dogs I recommend;

• Daily. Monitor for mentation, eating, ambulating, hearing, seeing, attitude, sleep behavior, teeth, urination and defecation, etc. Clean food and water bowls.
• Weekly. Monitor, ears, nails, coat. Brush and comb out the coat. Clean bedding. Check all toys, wash or dispose of if damaged.
• Monthly. Provide monthly flea & tick and heartworm prevention. Check grooming schedule. Check yearly, or bi-annual schedule for veterinary needs. Check all pets identification collar, tags, leashes. Replace any that need to be.
• Yearly. Check microchip and confirm information with microchip provider. Plan for the next month and year. Discuss your pets care with your veterinarian at your visit. 

For cats the same schedule applies except I would add; 

• Weekly. Change and clean litter boxes. Add fresh catnip to scratching mats. Clean out the water fountains. 
• Monthly. New scratching mats. Fresh grass to grow in the cats flower pots.

Food is the best way to get pig out of her house so it can be overhauled.

Watermelon is the best summer snack for pigs.
Lots of water and fun to eat!

A clean house, new hay, and fly tapes.

 For those of you that have a pig, or an outside pet. It is imperative to have a shady spot, a safe protected house, unlimited always available fresh water, and a place to hide, or retreat to, if needed.

Strawberry may not be the most popular pet in America, but she shares basic needs that all of our pets do. Like all of my pets, I am responsible for her health and well-being, and I love her for the independent self-reliant little bundle of obstinacy that she is.

The best care that you can give your pets is to be attentive to them. Whether you are two or four legged, toed or hooved, we all need food, housing, attention, medical and emotional care.

This is an interactive blog! Please comment any items that you check with your pet. And please share your thoughts, experiences, and pet stories with me. I can be reached anytime @pawbly, pawbly.com or here, at KMDVM.blogspot.com.

Have a wonderful summer everyone! 

Anal Glands, The "Scoot" Story

There are a few old wives tales that I have made it my life mission to eradicate.

I have mentioned some of them in the past.

The item for today’s gripe is: scooting. 

“Hey Doc, I think that Boomer has worms.”

This the usual way the tale begins to unravel.

“Huh?” I say with a slight pause. “Why do you think that is?” (I have learned over the years to do less talking and more listening).  I expect to hear that Boomer is vomiting and his dad is seeing moving pieces of spaghetti in the vomitus. Or, that Boomer's stool sample had wiggling pieces of rice sized particles making an escape from their transport vehicle...

But instead what I usually hear is, “I've seen him scooting on the carpet.”

“Oh,” I reply, (why I sound surprised I’m not really sure at this late date). “Well let’s check the anal glands first, then talk about skin disease, and then intestinal worms.”

I say it in this order because in my experience this is the order of likely culprits for ‘itchy butt syndrome’.

Anal glands are in reality the anal sacs. These are found in dogs, cats, and all mammals, (yes, even us humans), and reside just inside the anus at the 4 and 8 o’clock positions. In a normal pet they are about the size of a raisin an should empty every time your pet defecates.

In the wild they prove a very effective defense mechanism for skunks to fend off potential threats. But some domestic animals have lost their ability to empty them voluntarily or efficiently. For these pets the anal glands become full or impacted, and they can also abscess causing a painful infection.

Some pets will ‘scoot’, or ‘drag their butt on the carpet’ in an attempt to relieve the pressure and discomfort of the over filled anal sacs.

The material in the anal sacs is normally a light brown mildly turbid foul smelling oily liquid that some describe as “fishy” but I describe as “pungent and offensive.”  In healthy pets the sacs are easily expressed and empty completely with a digital rectal manual approach. For those pets with difficulty emptying voluntarily the sacs will become distended and the fluid will become thicker. This further complicates the ability to express or empty the material. This makes them more painful to be expressed. If the sac is visibly evident externally and the skin covering it is red, or in the worst case has ruptured due to abscessing, then it will likely be impossible to empty, or even palpate rectally due to it being so painful.

For the cases that can't be expressed or even palpated, I start antibiotics, warm compresses, pain medications and  a re-check in 2-3 days.I also advise an e-collar and very close monitoring.

For the pets with thick and/or more difficult to express anal sacs I empty them as much as possible and schedule a re-check within a few days/week.  We often try to keep the sacs empty in the hope that the sac will return to its original size and not continue to accumulate fluid and hence need repeated emptying.

I have some patients who come in for scheduled anal sac emptying routinely. Some of them are monthly and some of them are quarterly. Every pet is different and the amount of time between assisted emptying varies significantly. How do we decide when to re-check? I usually say to come back in 3 weeks. If they are swollen and distended re-check again in two weeks. If not, try to re-check again in 5 weeks, etc..

For our clinic I would say that the hounds are the most popular breeds seen for anal sac issues.

For those pets who arrive with an impacted or abscessed anal sac we schedule re-checks more frequently and often need to prescribe an antibiotic, an analgesic and I also prescribe a topical antibiotic cleaner (because your butt isn't too sanitary to begin with, and I don’t like the idea of an infection next to the most unsanitary place on the body).  Pets with abscessed anal glands should also have an e-collar to go home with to try to discourage the licking that accompanies any painful condition.

I learned an important “veterinary pearl” from a veterinarian I worked with many years ago. He told me that “every pet that comes in acting painful or uncomfortable in general, or has weird behavioral symptoms, is panting, or that you can’t figure out what is wrong with them, should have their anal sacs checked.” This advice has proven to be correct many times.

If Boomer is still scooting after the anal sacs have been checked and are empty then the next usual cause is itchy skin..dogs with itchy feet, ears, or face often also have itchy butts.

For many of my clients who live with pets with recurrent anal gland issues I offer an in-house tutorial on ‘anal sac expression 101’. I have few clients that dare to try, but it isn't hard, so if you can handle the whole idea of performing a rectal exam, then ask your veterinarian, or veterinary technician to show you how.  Like everything else we do in veterinary medicine, learning how to be proficient at this takes practice.

There are some other aspects of anal sacs that should be discussed.

For future topics of discussion are;

1. Anal sac expression techniques. Why having your vet check them is important, and how your groomer expresses them vs how your vet does.

2. Long term treatment options for chronic anal sac problems.

3. "Why my dog?” What factors contribute to the problem?

I saw little Abby, the sweetest dachshund in the world a few weeks ago. She was brought in because her owners noticed redness on her butt. They had never seen her scoot, or lick, and she had never given them any clue as to having a sore butt or any kind of anal gland problem. After I palpated her anal glands and felt that the left side was indeed as swollen and painful as it looked we started Abby on twice daily compresses of an antibiotic/anti-fungal solution, or antibiotics and an oral analgesic. I rescheduled her for a re-check 3 days later and told her that I was fairly certain that the anal gland would rupture before then.

The anal sac on the left (at the 8 o'clock position) is very inflamed, bulging, swollen, and oh yes! painful! The skin covering the anal sac is thin and fragile. In many cases when the anal sac has progressed to this point it will rupture regardless of what you do. A ruptured anal sac is open to infection and should be treated topically so the infection does not persist or spread.

Three days later, sure enough, the abscess had ruptured. But little Abby was still wagging her tail, and no worse for the wear. This time I was able to empty the right side without causing her any pain. We decided to continue the antibiotics and compresses and discontinued the pain meds.

One week later the abscess and infection were gone. Abby, still happy as can be, was scheduled to be re-checked in a month. We are going to keep a close eye, (and palpate with a finger), monthly to try to avoid impaction and abscessing in the future.

For more information on anal sacs, or to learn about surgical removal of the anal sacs visit the blog on surgery palooza.