Henry's Big Day. Neutering a Small Breed Dog

Henry and I on Sunday December 1, 2013.
He was at the clinic for our annual Pets With Santa event.
Coincidentally this was the day before his neuter.

Henry is a 7 month old Yorki-Poo. How is quite possibly the cutest scruffy pup you will ever see.

He has been to the clinic almost weekly since his parents adopted him at 8 weeks old.

There are a few important things that a small breed puppy needs.

First, every new puppy (or pet for that matter), should be to visit the vet within their first three days with you.
Bring your puppy and a fresh fecal sample.

Also, bring a list of questions. Your first visit (and every one thereafter), is the time to get your feet solidly in the ground.

For small puppies, (or sensitive dogs), I recommend splitting up vaccines. You are more likely to see a vaccine reaction if you give multiple vaccines. Smaller dogs seem to be more sore after vaccination also. The advantage to splitting them up is that we can reduce the likelihood of soreness and if you do get a reaction you know what vaccine caused it. The disadvantage, well, you have to make more trips to the vet. At my clinic, however, you will not pay for a separate office visit if we decide to split up the vaccines. But this is something to ask at your first visit. The cost of a vaccine is somewhere between $10-$30, but an office visit might be $30-$50, or more.

Another note on vaccines: All vaccines have the potential to cause a reaction. It doesn't really matter how many times a pet has been vaccinated, had the same vaccine, or whether they have never had a problem before. It can happen at anytime and with any vaccine. For this reason, I always recommend that you vaccinate your pet on a day that you can be with them after the vaccines have been given. You should also have the vaccines given as early in the day as is possible. Nothing worries me more than vaccinating a pet with known prior reactions 15 minutes before closing time. The worst reaction (anaphylactic shock, respiratory or cardiac arrest, or even death) is most likely to occur within the first few minutes to hours of the vaccine. Pets with known previous reactions should be watched very closely for a few hours after their visit. Some of my patients stay in the clinic for about 30 minutes after in the reception area so we are steps away from help if needed. Assume a reaction might happen and be prepared for it. But, remember vaccines save countless lives so please keep your pet vaccinated, and if you do have a problem talk to your vet about it. There are lots and lots of options!

At the puppy visits we discuss basic training, housebreaking, leash walking, socializing, behavioral concerns, any special breed health concerns, how to successfully get your pet used to having their teeth brushed and nails trimmed, etc.. We also set up the vaccine schedule for the first four months (or longer if you started late) of age. Spaying and neutering age is usually about 6 months old.

Henry dressed up in our ravens room.
Looking so dapper!

For Henry, like most small breed dogs, we waited and watched for his deciduous (baby) cuspid (canine) teeth to shed. This is never normally a problem in the larger breed dogs, but many smaller  breed puppies do not shed. These can cause significant and severe dental disease, tooth decay and affect overall health and longevity. If the teeth have not fallen out by 9 months old, they probably never will, so they should be removed under general anesthesia either with the spay/neuter or as a separate anesthetic event.

In Henry's case we waited until he was 7 months old in the hopes that they would depart on their own accord.

When they did not we scheduled his neuter and removed them.

Lucky for Henry, our resident dental expert was on hand. She removed his baby teeth as I removed his testicles.

Dr. Hubbard, our resident dental expert works on the front end, while I neuter the back end. Only the luckiest of dogs has two vets to work with them at the same time!

A prefect extraction!
The entire tooth was removed and the adult tooth was not damaged
or jeopardized in the process.

Henry also has vestigial rear dewclaws. Puppies should have these removed between days 2-5 after being born. Henry was not adopted from a breeder who followed this. So we removed them at his neuter.

Many clients ask me about dewclaw removal, (I have been asked to remove them from 10 plus year old dogs). The discussion about removal is multi-factorial and needs to be a discussion with your vet. Don't just ask them to remove them without your vet examining the feet and discussing the surgery.

For Henry the rear dewclaws were not articulated with the foot. They were what I refer to as "just hanging in the breeze." They had nail, but they were small. These nails will grow and bleed if you cut them too close, but becuase they are not held close to the leg they often catch on things and can tear easily. Because they are not articulated (joint and bone attached to the foot) they are easily surgically removed. Removing them at the time of neuter saves having to risk anesthesia and pay for a another surgery.

For those pets with dewclaws that are articulated (tightly adhered to the leg/foot), then we talk about why the client wants them removed. Most clients want them removed because they are cosmetically not pleasing. The client had expected they would have been removed before they adopted their puppy, or they are not comfortable trimming nails. Because these nails are not in contact with the floor they are not worn down naturally so they need to be trimmed. Nails should not be surgically removed because a parent can't (or won't or is afraid to) trim nails. Also those dewclaw that are held tight to the foot (articulated) must be surgically amputated at the joint that is at the very base of the toe. This can often cause a long (anywhere from an inch to multiple inch long) scar. The hair may, or may not grow back over this scar. The cosmetic after may not be as "pleasing" as the owner expects.

Henry's caudal half, post-op. He has some abnormal scrotal erythema (redness) and needed an ice pack post op. He also has two one inch incisions to remove his dangling dewclaws.

Waking up.

I don't bandage the feet unless I am worried about bleeding and want to keep pressure on the incision.

Bandages, in my opinion, are just a cover to hide potential disaster. They get wet, they hold in infection and they provide the perfect hiding place and environment for badness, warmth, humidity, and secrecy! Bandages in my hands are only used for very limited periods of time and under very close supervision. Bandages need to stay dry, be removed as soon as possible if they get wet (water or blood) and never be on longer then a few days.

Now he is awake!

Going home with momma! And an e-collar!
The more incisions you put in a puppy the more they want to investigate them!

Post-operatively for the tooth extractions, Henry should be offered softened food (either add water to dry food and let it sit until softened) or wet food for the first 3-7 days. A healthy mouth will heal very quickly after a tooth extraction, if it is done with minimal trauma, clean techniques, and surgical closure after. 

For the neutering Henry had a cold pack applied to the scrotum to reduce redness and aid in the discomfort of the incision.

For the dewclaws we keep them clean, dry, monitor for infection. Use booties if he goes outside and it is muddy, snowy, etc. 

For more information on puppies;

The Puppy Primer, The First Instructions

Crate training Your Puppy

Housebreaking Your Puppy

Puppy Diets

Baby Teeth Blog

If you have any pet questions you can find me at Pawbly, or on Twitter @FreePetAdvice.

Dude, You Are Stressing Me OUT!

Cooper

Stress.

I say this word frequently during my routine veterinary day. 

Every time I do I have to take pause and explain. 

Stress in medical terms is something that causes an upset or disturbance.

For people when we say the word "stress" and we think "bad," but a disturbance isn't always a bad thing. So I start throwing out examples, like, "remember when you got married, or you moved, or got excited for your birthday? Well, those weren't necessarily bad things but they got your body worked up. And you might have had cramps, diarrhea, or not been able to eat because you were nervous? Well, that was stress and your body reacted to it."

Cooper is a 4 month old effervescent dynamo puppy. He came to see me last week because he had had diarrhea for the last two or three days and his mom was worried. 

I listened to her tell me about Coopers routine and what changes had occurred over the last few days to weeks. She told me that Cooper was normally a very happy energetic puppy. He loved to play, he had a huge assortment of toys, he had been kept current on his vaccines, was on heartworm and flea & tick preventatives and except for the 2 or 3 daily episodes of abnormal loose stool was acting just fine. 

There are a few key points to Cooper's moms statement. In an effort to help educate you all I am going to take a moment to review them.

1. Cooper is acting normally. Always listen to your patient before anyone or anything else.
2. Cooper is current on heartworm medication prescribed by his vet. Dogs kept on heartworm medication are less likely to have intestinal worms. 
3. He was an acute case of diarrhea (clinical signs lasting less than 72 hours). It is so important to seek help inside of this window.

I asked Cooper's mom about his activities and home environment. Specifically I wanted to know if he was being given table food, or snacks, and what type they were, if he tended to eat things he shouldn't like garbage, things outside, etc., and if there had been any changes in his home life.

Here's why I asked. Many healthy young puppies (dogs under 1 year old) have episodes of acute diarrhea because of one of two things; they got into something that they shouldn't have (think garbage can raid or the delicacies of wild animal poop), or they got stressed about something.

In veterinary medicine we call the latter item "stress colitis."

Stress colitis causes large bowel diarrhea which is an increased frequency of having to defecate, straining to defecate (many people incorrectly think their dog is constipated because they are straining), soft to watery stool, sometimes with blood visible in it, and is most often affecting young dogs.

For all young dogs with diarrhea it is important to examine a fecal sample. Intestinal parasites are a common cause of diarrhea in dogs and can cause significant weight loss, anemia, and even death. 

For Cooper his stressor was re-visiting crate training.

Cooper, like many young, newly adopted puppies had been started on crate training when he first arrived at his new home. But over the last few weeks he was left out for longer and longer periods of time.

Then his mom had to go back to work and his daily routine changed from having not been in his cage for any measurable period of time, to in the cage for a work shift.

His mom said that she felt terrible leaving him alone all day. But she wanted him to be safe (CRUCIALLY IMPORTANT!!), so she was taking him for walks in the morning before she left and playing with him when she got back home. She wasn't sure that my presumption about Cooper being stressed in his cage so I recommended that she try to leave a video camera on him when she leaves to monitor him. 

She also had a few other clues that made me suspect that Cooper was having a hard time getting all of his needs met.

Cooper was a young very energetic puppy in a household with a couple who were past retirement age but still working. His mom admitted that she was having a very hard time keeping up with him and was unable to play with him to the point if him being tired. So Cooper was being put in a cage with extra energy left over and being left alone all day. His needs for exercise and social interaction were not being met fully.

Cooper is 4 months old and he is stressed already. Worse is that he doesn't have a clear way to start having his unmet needs resolved.

Coopers treatment plan was five fold.

1. Check a fecal and address any intestinal parasites. Remember some intestinal worms are what we call "intermittent shedders" so I will not declare a pet parasite free until we have three consecutive negative fecals.
2. A bland gi diet. This can be either boiled boneless, skinless chicken, or boiled ground beef and rice, OR a commercially available prescription food like Science Diets I/D for 5 to 7 days. A bland diet is designed to not only be easy to digest but also to not over work a body system that is trying to recover. This is done by offering small amounts of the bland diet with an increased frequency. So, instead of feeding a large meal twice a day feed four small meals every 6 hours.
3. Probiotics to help replace the good gut flora that aids in the bodies ability to remove excess water from the feces.
4. A plan to address his future stress.
5. A monitoring protocol to insure that his acute colitis did not evolve into the more difficult to treat and resolve chronic diarrhea.

My advice; Get Cooper a puppy, or something he can exhaust and that will in turn exhaust him.

If you have any questions about this, or any other pet related item, you can ask me at Pawbly.com, or find me on Twitter @pawbly, or FreePetAdvice, or Google+ +Krista Magnifico.

Thanks for reading!

And remember Always Be Kind.

Grass Eating, Vomiting, Car Sick Puppy

One of the best parts of answering Pawbly questions is learning about the ways people perceive their pets and their pets actions. I also love to answer the questions! Here's the question that I received today. It is insightful because I know many new parents are concerned about their puppy/dog getting car sick, and many people don't recognize just how important and concerning some of these behaviors can be.

"Hi, my daughter just got a puppy from a shelter. She is 5 months old. She keeps wanting to outside to eat grass. Earlier today she got sick two times in the car. She also got sick in the car when she was bringing her home. Will eating the grass hurt her or will it help her to vomit?"

Here was my answer; Let me know what you think;

"Thanks for your question.

There are a few things to discuss.

I would like to know how long you have had your puppy, and if she has been to the vet yet? I would also like to know if she has had a fecal check? (she might need more than one). I always worry about intestinal worms with puppies. Especially if they are vomiting or having diarrhea. 

I tell my clients that "most puppies come with worms, it is very common, and worms come with the puppy package. So expect them, check for them, and treat for them."

I am unclear as to whether the vomiting is related to the car trip? Or, if she is vomiting without it being related to the car? Many pets, especially puppies get car sick due to anxiety about being in the car, and the motion of the car. I always recommend taking your puppy with you in the car as often as you can so they get used to the car, used to the motion of a car, and over come their anxiety associated with the car.

Getting car sick and vomiting because of being in the car, but then stopping vomiting after you get home or to your destination is fairly common. But, if your puppy is still vomiting after the car ride stops then I am concerned that we have a puppy who is nauseous.

There are many things that can make a puppy nauseous. The best way to try to determine the triggers for nausea are to visit your veterinarian and start talking.

I am also concerned about your last statement; "Will eating the grass hurt her or will it help her to vomit?" Eating grass can cause a few things. Pets can pick up the eggs of the worms that evolve into the intestinal parasites that can be dangerous to the health of your puppy. Also, I have seen dogs that have eaten so much grass that the stomach becomes a vat of fermenting green discomfort. This grass becomes a stomach full of un-passable, un-movable, obstruction. It can get stuck in the stomach like cement, except this cement is fermenting,. causing their belly to be stretched to the point that the grass is stuck and may eventually cause the stomach to rupture. These dogs are miserable. They are trying to burp to expel the fermenting stomach gas, trying to vomit, to relieve the pressure in the stomach and feeling terrible. I have actually had to do surgery to remove grass from dogs because their stomach is bloating. Bloat is incredibly painful and can be fatal.

So, I don't want you to think that she should be eating grass. A small amount of grass eating is likely to be safe and may be normal for a curious puppy who investigates the world by tasting it, but I am concerned that she is eating grass because she doesn't feel good.

I hope that I have encouraged you to try to identify why she is vomiting, why she is eating grass, and that you will have a meeting with your vet soon to help your puppy feel better.

If you would like to discuss any of this, or see a veterinarian and you live close to us at Jarrettsville Vet we would love to help.

Best of Luck, and here's to wishing you and your puppy a long, happy, safe life together!"

I wanted to add a few other relevant observations. The dogs that lick obsessively (think about carpet, rugs, blankets, etc), graze or eat grass frequently, lick their lips frequently, or burp, might have either nausea, allergies, indigestion, or reflux. All of these behaviors should be discussed, researched, and treatment options offered to keep your pet happy and healthy. 

I don't always discover the reason why a pet does these, but I always try to curb it. I have performed too many gastrotomies (open up the stomach to inspect and empty it), exploratories (open the abdomen to treat or inspect the organs), and passing of a tube into the esophagus to remove trapped air and ingesta (can be gastric dilation and/or gastric dilation with volvulus (GDV)) to ignore these signs. And even if I cannot figure out the reason they are licking, chewing, swallow, etc. is happening I know they have a reason and I know I need to try to solve it before it becomes a problem.

Here is a dog that we treated a few months ago that had bloated from eating too much grass.  He was very lucky that his mom knew what to look for and knew what was going on. She had just picked him up from a boarding facility a few town away and she immediately noticed that he was distended in his abdomen, trying to vomit (nothing was coming out because there was too much pressure inside the stomach to allow it to empty), and reluctant to move. If she hadn't gotten him to us as quickly as she did he likely would not have survived. She had lost her first poodle to this disease, and she knew exactly what was going on. As soon as he arrived at the clinic we tried to decompress his stomach by passing a stomach tube. The stomach tube is used to remove the fermented grass from his stomach to help relieve the pressure. It is also how we treat choke in horses.

This is what I call a stem to stern incision. It extends from the diaphragm to the pelvis.
It is required when you need to get a very large dilated basketball sized stomach out of the abdomen so you can open it, inspect it and remove any other contents.

The table is tilted with the head down so we could pass a tube from the mouth
to the esophagus to the stomach. 

This is what fermented grass looks like after it has been removed from the stomach.
There is about  3 liters of foul bright green ingesta.

 One last note. After the abdominal exploratory surgery was completed we performed a gastropexy to try to alleviate the chances of a GDV occurring again. This tacks the stomach to the abdominal wall to anchor it, so that even if the stomach dilates it can't twist.

For more information on GDV and gastropexys see the links below;

http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/GastricDilatationVolvulus/

http://dogs.about.com/od/dogandpuppyhealth/qt/GDV.htm