Dr Kay's Advice on Dogs and the Ebola Virus

Sharing an informative and well written blog on Ebola by Dr. Nancy Kay. She is a veterinary internal medicine expert, author, and the recipient of many prestigious awards. Her blog can be found at SpeakingForSpot.com.

Dogs and Ebola Virus by Nancy Kay, DVM Nina Pham with Bentley. Courtesy of Pham family

As I write this, Teresa Romero Ramos, a nurse assistant in Spain, is battling for her life against Ebola virus disease. Despite local protests and objections voiced via a global social media campaign, a court order mandated that Teresa’s elderly, but overtly healthy dog named Excalibur be euthanized. His remains were “put into a sealed biosecurity device and transferred for incineration to an authorized disposal facility.”

And now, a nurse in Texas named Nina Pham has tested positive for the virus, the result of helping care for the first Ebola victim in the United States. Nina also has a dog, a Cavalier King Charles Spaniel named Bentley who has been moved to an undisclosed location and is under the care of Dallas Animal Services. Dallas County Judge Clay Jenkins stated,

When I met with her parents, they said, “This dog is important to her, judge. Don’t let anything happen to the dog.” If that dog has to be The Boy in the Plastic Bubble, we’re going to take good care of that dog.

Here are two vastly different approaches to two similar situations. Which approach best serves public safety and peace of mind? I certainly don’t have a well-informed answer to this question. I’m not sure there is anyone who does.

What we know

I was able to come up with only one study pertaining to Ebola virus infections in dogs. Published in 2005 in Emerging Infectious Diseases, the authors examined 439 dogs, some of which were living in the midst of an Ebola outbreak in Gabon, a country on the west coast of Africa.

Blood samples from the dogs were evaluated for antibodies to Ebola virus. (Antibodies are the foot soldiers of the immune system that are manufactured in response to the presence of an infectious organism.) Of the dogs from villages with both infected animal carcasses and human cases of Ebola, 31.8% tested positive for antibodies to the virus. None of them showed any symptoms of disease.

This study clarifies that dogs can be infected with Ebola virus, and they experience no infection-associated symptoms.

What we don’t know

There remains a great deal to learn about canine Ebola virus infections. Given the evolution of Ebola and growing public awareness and concern, we are in critical need of answers to the following questions:

• How do dogs become infected with Ebola virus?
• Do infected dogs shed the virus in their bodily fluids? If so, which bodily fluids and for how long?
• Is canine Ebola contagious to other animals, including humans?
• Do dogs serve as fomites for Ebola? A fomite is defined as an object (animate or inanimate) that is capable of carrying and transferring an infectious organism from one individual to another. Classic examples of fomites include used tissues, drinking glasses, and articles of clothing. We know that the Ebola virus survives for days if not weeks after being shed into the environment.
• How long do antibodies remain in a dog’s bloodstream following infection?
• Why don’t infected dogs become sick? The answer to this might shed some light on ways to mitigate illness in people infected with Ebola.

Information from the Centers for Disease Control


The Centers for Disease Control and Prevention (CDC) is currently working with the American Veterinary Medical Association to provide information for veterinarians pertaining to pets and Ebola virus. The CDC has a new page on their website devoted to “Questions and Answers about Ebola and Pets.” Have a look, but be forewarned- you may come away with more questions than answers.

What’s next?

I really don’t know how the concerns about pets and Ebola virus will play out. My hopes are that panic will not prevail and that research efforts to understand more about Ebola virus in pets will become an immediate priority.

Veterinarians, myself included, are pondering what we will do if asked to care for a pet that has been exposed to Ebola virus. Given how little evidence-based information is available, I think our skittishness is justified.

I will keep you posted on any new developments in our understanding of how Ebola virus impacts our pets. In the meantime, let’s all keep our fingers crossed for Teresa Romero Ramos, Nina Pham, and Bentley.

How do you feel about the recent decisions made concerning Excalibur and Bentley?

If you would like to respond publicly, please visit: speakingforspot.com

Sending you and your four-legged family members best wishes for abundant good health,

Dr. Nancy Kay

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog's Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

 For more information on Ebola please see the AVMA's guide here.

To find Dr. Nancy Kay please visit her blog and website here.

Many thanks to Dr. Kay for letting me share her article.

If you are looking for any pet advice please find me at Pawbly.com. Pawbly is an open platform designed to help other pet people by providing a place for the free open exchange of animal centered information to help people provide better care to their pets. Pawbly is free to use and open to anyone and everyone with animal welfare in mind.

You can also find me on Twitter @FreePetAdvice, or at the vet clinic, Jarrettsville Vet, in Jarrettsville, Maryland.

Be safe out there everyone, and always, please also be kind.

a Fan of Speaking for Spot on Facebook

Induce Vomiting? To Puke Or Not To Puke? The Vets Most Common Question

My Jekyll's early morning yawn,,
although it does look exactly like his "I'm about to yack" yawn.

One of the great mysteries of life is why dogs and cats eat the things they do?

I had a cat last week who ate 16 oz of raisins. Why would a cat eat raisins? (Which by the way is a very valid discussion that you should have with your vet after you figure out how to deal with the potential raisin toxicity risk).

We get a phone call almost daily from a concerned parent whose pet just ate,,, Well, you name it a pet has eaten it.

The question always gets volleyed to the back treatment area where a veterinarian consults with the parent to try to understand the magnitude and repercussions of the ingestion.

Duke uses his Jedi powers to convince me to surrender a snack.

Here's the take home thumb nail version of ingestion;

1. If your pet eats anything that is NOT DOG OR CAT FOOD, or

2. If they eat an ABNORMAL AMOUNT of any food, or,

3. If they MIGHT HAVE EATEN something that is not dog or cat food.

THEN YOU SHOULD,

CALL THE PET POISON HOTLINE, or your vet. Don't wait. minutes count, and hours can kill.

Angel makes a bold statement.
She's tired of waiting for me, even though
today is spay day.

I am all about keeping things as simple as possible. Why? because in times of panic your brain doesn't think properly. So, just reduce the thinking to two steps;

"I think my dog ate..." therefore, "I will call a professional."

OK, after that we discuss the following;

1. Age, size, breed,
2. Amount of product ingested,
3. Type of product ingested,
4. When it was ingested,
5. Any complicating pet factors, like disease, medications, etc.

Please remember to look at your home and possessions as a place that needs to be protected from a toddler who wanders and ingests arbitrary items. Don't leave out any medications, choking hazards, or dangerous items laying around. Everything in your pets environment that they have access to is a a potential "chew on and swallow" item. Don't leave stuff accessible to them, they will disappoint you, and I would argue that it is your fault, not theirs.

OK, so you have a pet, you have stuff, you therefore need a pet emergency kit.

Your emergency pet medical kit should have 3% hydrogen peroxide. You should call your vet, ER, or Pet Poison Helpline BEFORE using this. Some products should not be vomited!!!

Lia gives a sad face.
She's here for a very minor boo-boo, sore left foot.

Here is my simplified list of things to induce vomiting for;

1. chocolate. I would first emphasize to call the Pet Poison Hotline and discuss the amount and type of chocolate. It takes quite a lot of chocolate, and it usually has to be a very dark  bakers chocolate to cause problems. 
2. plants, that aren't supposed to be eaten.
3. clothing like hoisery and synthetic materials.
4. plastics, unless it is thick and might have hard edges that could damage the esophagus.
5. medications unless they are in liquid or gel cap form.

Here's what you DO NOT induce vomiting for;

1. petroleum products
2. glues
3. bleach, cleaners, most liquids

And lastly, DO NOT INDUCE VOMITING IF IT HAS BEEN LONGER THAN 2 HOURS SINCE INGESTION.

Bella, always a charmer..

The best way to get your dog to vomit is to give 1 tsp per 10 pounds of hydrogen peroxide. The maximum dose is 3 tbsp. You can do this twice about 10-15 minutes apart. If this isn't working head to your vets office or the closest emergency clinic.

Cats, well cats are another story. Cats are better on a case by case basis. And why did that cat who eat 16 ounces of raisins? Well, who knows, it's a cat. But there isn't a safe way to induce vomiting in a cat at home. You need a vet for that.

My sweet girl Magpie.

And, as fate would have it, as I began writing this blog I had a client call today. They had just left the office from their examination, got home, went back to the project he had left, dropped a bolt on the floor and POOF! his dog swallowed it. Without knowing what kind of bolt it was I told him to have him vomit it up. Three tablespoons of peroxide later the bolt was back on his floor. See these blogs do make a pets life better.

Related Blogs;
Signs That Your Pet Needs Emergency Care

Is Your Cat Safe In Your Own Home?

PassOver The Easter Lily, Protecting Your Cat

And if you can't find the answer there, you can ask me, and a whole bunch of other pet experts at Pawbly.com. We are an online platform dedicated to helping people take better care of their pets. We are free to use and open to anyone and everyone who cares about pets.

You can also find me on Twitter @FreePetAdvice. Or at the clinic, Jarrettsville Vet where I help pets everyday.

Too Afraid To Fail? When Your Fear Costs Your Patients.

Porter smiles with his mom.
He looks dapper even at 18 years old.
His story is here.

We veterinarians are all cut from the same cloth. It is the by-product of selective honing of skills to meet the scrutiny of the veterinary school selection committee that we eat, sleep, dream, and pray to satisfy.

If you spend a decade trying to be someone for someone else you get a little blinded and unforgiving.

Betsy, awake after surgery.
She had a mass removed from of her nose Monday.

We work so hard to become a vet that many of us believe that we have to be perfect, (at least to the outsiders eye). Sure, internally we can over eat, under eat, over caffeinated, over chew tobacco, over indulge, over shop, over drink, over criticize, the list is long and dark, but on the outside we have to look like the "perfect vet student candidate." We are conditioned to be someone on paper that will be worthy of an acceptance letter. It isn't a healthy way to live. It is the nature of the beast when you want so desperately to become a veterinarian.

Our fan belt baby.
Looking for a home.

Perhaps my viewpoint is a bit skewed? I spent the better part of two decades working for that acceptance letter. But I would argue that most veterinarians share a few common traits. We are hard working, obsessive, type-A, driven people. For most of us we attended vet school in our twenties, or quickly after completing college, and most of us have few real-life experiences to add to our over massaged over ambitious resumes. There simply isn't enough time to study, attend classes, build a competitive work experience history AND become an adult with real-life realities.

Gypsy gives me the eyeball.
I proceed with prudence.

Here's what real-life realities means to me. It means the good, the bad, the ugly, the sticky, the unpleasant, the grit of painful stuff that you cannot elect to experience.

Vet school student hopefuls, present students, and graduates need to fail. We need to know what failure feels like. Every human being will struggle with something along the way. The lessons you walk away with are just as valuable as the tests you ace, the acceptance letters you are graced with, and the accolades you strive to attain. Don't have an expectation to be anyone or anything else than the true core of who you are. Whether that be passionate, skilled, kind, generous, pensive, erudite, crafty, or personable. You can be that one thing without having to be everything else. You don't have to beat yourself up for being something that you are not. But, that shouldn't mean that you cant try to grow into a better practitioner.

Sadie snuggles with her mom, waiting for her first vet visit.

You have to fail. You have to at least leave yourself open to fail. This is a uniquely human quality. I can't use some dog training analogy. You know like I try to with fears, anxieties, conditioning, over coming these with consistent gentle reinforcement. You have to embrace and jump into your fear of failure. There is no other way.

Too many of us try to tip-toe into the surgeries, the difficult cases, the new stuff that we are cautious and afraid of.

Lucy recovers from her other cruciate repair.

My advice, be honest and be open minded. A pet in dire need is a very good excuse to get over your internal doubting voice. Always be honest, always be open and always treat your clients with respect and sincerity. You owe them all of the options. Unfortunately, many people lack the resources or availability of a referral. What happens to these patients? Twenty years ago there weren't many referral clinics. Thirty years ago a veterinarian had to wear every referral hat. It was a matter of both need and necessity and it was the expectation of every new grad. You were forcefully pushed into those deep unfamiliar waters. You knew it was coming, you knew you had to, and deep down you looked forward to carving each notch out of your new tool belt as you tackled broken bones, cystotomies, enterotomies, GDVs, pyometras, C-sections, enucleations, perineal urethrostomies, hit by anythings,, the list is long. It was common practice for the new kid to walk-in and the old guy to walk-out. No cell phone to call a life line, no techs to help you, you were SOL solo. I grew up in this kind of practice. There was no such luxury of some other guy. There was just you, your skills in some variance of expertise and a patient who would die otherwise.

My point is this. Be the person who saves a life. Jump in when there aren't any other options. Build yourself into the vet of our forefathers. Be honest, be trustworthy, and try. JUST TRY. What do you have to lose? In many cases it is a patient and an experience that both of you benefit from.

When all else fails find a friend in need and get some pet-therapy.

If you are looking for a safe, friendly, pet focused place to ask a question, share your pet knowledge, or just post cute photos you can find us at Pawbly.com.

You can also find me on Twitter @FreePetAdvice and the clinic, Jarrettsville Vet, in Jarrettsville Md.

My Favorite Pet Stuff, Fall Edition 2014

My pets favorite treats.
Stewart's freeze dried beef and chicken treats. 
Only 1 ingredient and made in the USA

My cats love them too!
But I have to break them into smaller pieces.

Visit the cat treat aisle and bring home a surprise.
Wouldn't you be bored to tears if you were closed up at home everyday of every year?

The secret ingredient to every happy cats life;
organic cat nip.
Sprinkle it everywhere!
Think of it like glitter and fairy dust,
sit back, then watch the magic happen!

Halloween cat toys!

Halloween dog toys!

Purple tutu harness with matching leash!

A ball, a bear, a bed, a blanket, and lots of love!
Life is good!
Does your kitty feel pampered every single day

 And, it's time to get ready for Halloween!

Charlie the cowardly Lion.

Jekyll the eight legged
(although they would all probably have cruciate ligament ruptures too!)
arachnid. He currently sits at one fixed, one to go.

Jekyll the shark.
Note the slimming tummy strap..

Jekyll models the frog.
He knows he works it..

So what about you?

What are some of your pets favorite fall stuff?

Please share your ideas, and your pets fall photos. You can find me on Twitter @FreePetAdvice, or on Facebook, or the ultimate pet fan site, Pawbly.com. 

Why do I love Pawbly.com? Well, because it is a safe, credible place for you to get help for any and every pet question. It is free for everyone to use, and welcomes any and every companion lover the world over. 

Making Vet Care More Accessible. How comfortable are you thinking AND acting outside of the box?

I think that one of the biggest complaints we hear about in veterinary medicine is that it is too expensive. A hard complaint to dismiss. I would never balk at the gripe of $1,000 being trivial. If you end up at the ER and need an emergency exploratory surgery you should expect to pay about $3,000. Most of us don't have this cash hanging out in our back pockets. BUT, should you find yourself in a similar predicament you should expect to add another zero to that estimate. And, we are talking about the same diagnosis, the same surgery, and the same treatment care. Not a bad deal when you compare it that way, is it?

This babies story..

As a follow up to my previous blog,"Taking A Stand And Facing Consequences," I thought I would share my attempt at putting my money where my mouth is.. So, I am including our written Jarrettsville Vet Financial Constraints Policy with everyone. Why am I doing this? Well, beside the persistent nagging yearning for transparency, I also feel that the existing system is met with great bitter frustration from people desperate to take care of their pets in need of immediate care they cannot afford to provide.

In our efforts to provide help to more people, AND never turn away a pet in need, Jarrettsville Vet has adopted the following payment protocol;

It is important to remember that when discussing a treatment plan with a client that every patient and every client should be treated the same. We provide an examination and an assessment for each case. Do not make any assumptions about any pet or client without discussing all possible options. One of the worst mistakes we can make is to deny care because we assume the client cannot, or will not pay for it.

Financial concerns can be discussed after the options are provided. We are assuming that people can’t or won’t pay and yet too many people internally/staff are complaining (or departing) because they are not paid enough. We need to stop expecting that people can’t or won’t pay and start treating everyone equally. Assumptions have no place here. Prepare for every option and adjust as they are accepted or declined.

Any client who has financial constraints should be given all options to allow us to help them with the care of their pet. To assist our clients in caring for their pets, and to remain aligned with our clinics mission of never denying care, we are enacting the follow new policies;

Every client is expected to pay the initial $50 exam fee. This is where we start and this is what we relay to clients calling in seeking an appointment for their pet. IF, they state that they cannot afford this, it is at the veterinarian’s discretion as to whether they are willing to waive the exam fee. If the vet declines to waive the fee we can reach out to the rescues. If no one is willing to help with this call me and I will take the case over. I will either see the pet pro bono, or authorize the JVC donation fund to pay for the exam.

After the exam the diagnostics need to be discussed. Every vet should become comfortable providing care with limited diagnostics. There is, in some cases, no other option. My goal for JVC is to provide care to our patients and to never turn away anyone in need. But, I am also most obligated to you, the staff. I will never ask you to do something you are not comfortable with, nor will I ask you to compromise or participate in something you don’t feel is right. If you feel caught in between call me and I will gladly help.

Our goal is to help our clients and their pets and we must do whatever we can to achieve this. We do not allow convenience euthanasia’s, walk-in euthanasia’s without prior DVM consent, and we should not allow them internally due to lack of resources.

If the client cannot afford the care needed or recommended for their pet, their options are as follows;
1. Seek care elsewhere if they choose to euthanize and we are unwilling to oblige.
2. Seek pro bono care elsewhere.
3. Continue services at JVC.

If they choose to stay with us and are unable to leave a deposit for the entire estimate, they are required to apply for CareCredit. CareCredit is the most expensive plan we offer, BUT, it guarantees payment to us. I ask for this because in many cases the client is not calling and is just telling us that they did not get approved. To provide this option we must make sure that the estimate is accurate. Also, please notify the client that they need to ask for the amount at the high end of the estimate. They are welcome to use our phone and we are happy to help them should they have any questions or concerns. A declined CareCredit fax must be submitted via fax to the clinic for us to offer the EBCS payment plan.

If CareCredit is declined EBCS can be offered. To be eligible for EBCS the client must leave a 30% deposit for the estimate.

Estimates must be accurate and must be given as a range. The client should ask for CareCredit at the high end, and will be given an EBCS payment plan for the high estimate. If the bill is lower we will shorten the payment period. All estimates need to be in writing and submitted in the chart. The client needs to sign the estimate and be given a copy.

If the client does not have the 30% to leave as a deposit they must either leave collateral OR go to a local pawn shop and provide the deposit. I am no longer going to accept no deposits being left. And, there are no exceptions. If you have a problem call me, or the hospital administrator and we will resolve it.

I am persistently trying to offer assistance and run the fine line between taking care of pets and the staff. If any staff members feel compelled to assist a client and/or a patient they are welcome to donate their time and services. I appreciate the generous compassionate dedication of all of the JVC team but we are consistently helping people who do not pay us back and do so at the expense of us collectively.

Every client needs to be given a daily update of their bill and every hospitalized patient is required to be paid in advance at the beginning of the time of services.

Lastly, no pet will be euthanized or allowed to be privately cremated without the bill being paid. If a bill is not paid, or transferred to me the vet who provided the services will be held responsible for the invoice. (I never ever want this to happen! I will gladly shoulder the responsibility so that no one else has to cover someone else’s bill!!)

I am including a list of pawn shops. I am also including their hours of operation. I feel very strongly that we are offering to help, willing to put our necks on the line to help them and they in turn need to also put a little skin in the game. Anyone who is unwilling, or unable to, provide a deposit can sign their pet over to a rescue and we will help that rescue get the care that pet needs. I know this might not always be fair, and I apologize for this, but that is life. I can offer to help care for your pet, I just have to expect that you will put your pets needs first and do what they need.

There are other options that I am exploring and hope to be able to offer soon. I have spoken with the founder of PetChance.org. A crowd funding site that helps people raise the needed funds to care for their pet in the darkest of hours and most desperate of times.

PetChance.org is a 501(c)(3) non-profit organization based in Massachusetts. The mission is to remove obstacles for pet owners so they have more opportunity to provide excellent medical care for their pets.

So, where do you stand?

What can you do?

Do you put your money where your mouth is?

Do you think, and act, and make miracles happen?

And when do you dare to live and think outside of the box?

I am a small animal practitioner in Northern Maryland. My goal is to help more pets. It is the reason I went to vet school and the reason I get up every morning to try again. I believe that miracles happen everyday, that amazing things are possible if you just dream, believe, and work to make them a reality.

If you have a pet question, seek better care for your pets and want to help other pet people, please join me at Pawbly.com. Pawbly is a free online social media platform built by pet people to help other pet people. It is free for everyone to use.

You can also find me at the clinic, Jarrettsville Vet, in Harford County Maryland. I am also on Twitter @FreePetAdvice.

Related Blogs;

What Can We Do To Help More Pets?

Burnt Out From Being Burned.

The Holes In The Safety Net

There are days when it is all I can do to just drag myself home. The days like today when I am arriving home after 9 pm after arriving at the clinic at 9 am. Today I skipped lunch, took no breaks, (I am not even sure I had a bathroom break), and now here it is after 9 pm and I am rushing to feed my kids, eat, and sleep. I repeat this day Monday through  Friday. Today was a mirror image of yesterday, and tomorrow will be the same. It is exhausting and it is sometimes brutal. But I have home. I always have home. It is where I seek refuge, solace and peace. Where I harbor the possessions that I hold dearest and closest to my heart, my pets, and my home becomes my salvation.

The days like today when I have been on my feet for over 12 hours, faced death, sad cases, miracles, possibilities, smiles and comfort from my clients who long ago transitioned into friends and people who challenge me over $10 for a nail trim they don't want to pay for, (for whatever ridiculous inane reason that I am unable to understand), preferring instead to spend a half hour of my demanding busy afternoon arguing. There are hard, long, often demanding days. There are days when being a vet isn't a source of pride it is a source of resentment, frustration, and pain.

To add insult to my injured sleep deprived self, I talked with a friend who balked at the idea that my education and work ethic get me to less than half of a six figured salary. He actually laughed at my paycheck. He makes seven figures, he works hard, he has 4 years of college, I have 12..there is sarcastic bitter comedic justice in this, except I have yet to find it.

When I got home last night I learned from Steve Dale's column that Dr. Yin had died a "sudden and unexpected death." She is a pillar of the foundation of the humane behavioral advances we veterinarians have made in the last 20 years. As soon as I read her reps addition to her Facebook page I knew her death had to be due to suicide. Without knowing her personally, I have been a long time fan of her work, and a follower of her blog. She is a veterinarian who I identify closely with. She was woman who through words, actions, blogs, stories, educating and endless tireless determination has helped pets she never met the world over live longer safer lives. She leaves behind a legacy with ripple effects far surpassing any of our lifetimes. Dr. Yin was a mentor an inspiration and a person I referred to often as I sought to educate and advise others.

On the day that Robbin Williams suicide news broke I was at a mentors Hall Of Fame induction party. She is a woman I have known for 25+ years. She has shaped the course of my life, has helped pick me up at my lowest most desperate moments and is now fighting for her own life against one of the most grave diagnoses possible. Her smile, her conviction and her determination were the antivenin to the despair of a superstar comic who always made us laugh. I was struck by the sudden tragic loss due to depression and desperate fleeing from a demon we could not see and the juxtaposition of the fight for yet one more day to live battling for every last moment of the fleeting days my friend has left to live with her 12 year old daughter. It is symbolic of the professional life I live. Always apposing forces and always unknown mysterious, fleeting, possible outcomes.

If you underestimate the plight of our profession take a spin down Google lane and search "highest suicide rate by profession." You will be provided with the frightening statistics of suicide being the highest in healthcare, among those veterinarians.

Why? Well, from the depths of my soul I will say that I believe it is due to the overwhelming stress we internalize, the pressures we feel powerless to resolve alone, and the pervasive garble we tout everyday in order to keep clients happy, not lay guilt or blame on their feet and the massive tragic decisions we are asked to execute daily. We are asked and expected to treat life as a gift if the checkbook and client are able and willing, and end a treatable healthy life if the whim of society deems it necessary. We also have all of the tools and an experts bag of experience in ending life quickly, quietly and permanently whether that be ours, or others.

I received a request from the AVMA a few weeks ago asking me to fill out a questionnaire to help assess and understand the stress and depression that has become a palpable undercurrent of hushed whimpers and obituaries. I didn't compete it. I don't feel that the intent is genuine and I don't believe that the answers come from above. I think the help and support comes from each other, from our families, our colleagues, and our community. It is a product of our profession fracturing from the pressures of being unrealistic with where our passions, our purpose, and our place in society. We are struggling to maintain a way of life we cannot afford, we are drowning in debt, we are losing ourselves, and seeking peace in the most tragic places.

I have written about compassion fatigue. I have lived it, and I continue to live it everyday. I understand the fragility of life. The circuitous maze that this profession and life present and I am grateful for the safe supportive net that I am able to fall into daily. I am a soldier among the army of a profession who needs help, who finds little, and who believes that salvation and peace lie at the end.

Me and Lorie Blog Paws 2013

Tonight I also learned of the death of Dr. Lorie Huston. She is the author and creator of the Pet Health Care Gazette. When I began blogging she was the benchmark. The person who proved to me that there was an audience and a need for help in the online community. She was another kind, bright light whose words are prolific and timeless. She helped when others closed doors, and she was a smiling beacon of what I always believed a vet was cast to be, she was a compassionate generous caring soul.

I miss you ladies, you were both a pillar of support an inspiration and the guide for many a pet parent the world over. You touched lives you never knew and you brought pride to a profession who struggles to find caring and compassion in the minutes of the routine drudgery of a hard demanding profession.

My blog on compassion fatigue can be found here.

My shoulder, my ear and my support for my fellow animal friends lie here, in these words, in my heart, and in the foundation of what we are about, we are about healing and helping. Email me, call me, find me, you are never alone and you are the oxygen of our patients, our clients and our calling.

For those of you who feel sad, alone, and afraid of the demons that haunt your soul please hear me. You are never alone, your life matters, and you make a difference. There are miracles we never understand but yet they exist and they happen, you just have to breath and believe, that's all. Keep breathing and keep believing.

(Authors note..this is fraught with gramatical mistakes, I am sure. I remain unable to change the tense from is,, to was,, in many cases. I am unable to proof read clearly, and I am, as many of us are, stuck in that place of accepting that a life has ended and there is now a "was" instead of a "she is..") 

Bloody Urine. What to do when it's your cat's?

Cameron

The cosmos is sending me a flurry of bloody urine kids recently. As Sherlock Holmes would say, "There has to be a reason?" I guess without being able to put my finger on it I am left to deduce that is just the universe begging me to put another blog out for others to benefit from. (After 5 pets I got the message and got my butt to the desk to type this).

There are two ways these cases present at the clinic.

1. Due to the lack of an opposable thumb your cat is unable to grab a marker and write on the walls "Need a little assistance here!" and so they are left with the next best way to inform you of their plight by peeing on your clothes, your bed, the carpet, or whatever place that isn't the one you provided. After the anger passes you notice that there is a pink tinge to the urine and you think, "Huh? maybe Fluffy is trying to tell me something?"
2. Your cat seems to have developed a special affinity for the litter box and is repeatedly posturing to urinate/defecate, or you hear screams, moans, whimpers from the box as they are straining to take care of business.

To cement my point;

Your cat is only NOT GOING IN THE BOX, BECAUSE THEY NEED YOUR HELP.

They are not mad at you, they do not harbor spite, regret, ill-will, or any tiny yearning for you to look at them with disapproval, disappointment, disgust, or the most popular reason cats are sent to shelter/ purgatory/death.

Every cat with abnormal or inappropriate urination, (or even acting oddly in any way shape or form), warrants a trip to the vet.

Every vet has seen a cat die from a urinary blockage. A blocked cat is, in almost all cases, a treatable, reversible condition that if treated early enough can be completely cured.

Which leads us to discussing;

What are the urinary health clues to look for;

1. Any cat appearing to have difficulty passing urine,
2. Licking at the genitals,
3. Frequently visiting the litter box,
4. Producing small amounts of urine,
5. Any change in color to the urine, (Even absence of color denotes a possible medical problem),
6. Foul smelling urine,
7. Not using the litter box, (going outside of the box),
8. Painful belly,
9. Distended belly,
10. Reluctant to move,
11. Lethargic,
12. History of urinary tract infections, urinary blockage, crystals in the urine, etc.

Cameron snuggles with his mom.

My opening line to any and every urinary tract patient, suspected or otherwise, is the same. It is a simple and time proven dialogue.

Start with a physical exam! Because if your cat is blocked you won't be able to get a urine sample, (as you are waiting your cat might be dying). If you see your pet straining, or producing small amounts of urine bring in a urine sample if or when possible.

Cameron arrived with his mom and a small pill bottle sample of red urine. Cameron had a history of urinary problems. His writing on the wall is peeing in the dirty laundry bin. Of great benefit to both all of the laundry was done and the urine was visibly bloody. Mom poured a sample into a bottle and headed to us for a visit.

It is worth mentioning that there are a few important things to discuss about urine samples;

1. The urine sample must be fresh. Get it to the vet as soon as possible. If you can't deliver it immediately place it in the refrigerator for storage. After 24 hours it should be thrown out.
2. If, and when possible, obtain and use the first morning urine sample. These are the most accurate when we are analyzing concentrating ability, (i.e. how well your kidneys are working).
3. Catch the sample midstream in a clean dry vessel. Last week a client delivered a sample that they had "scraped off the ground." We cannot separate dirt, mud, asphalt, cat litter (they do make sterile plastic litter for use in trying to get a urine sample from cats), or the dirt, bacteria and normal floor flora of your home. Don't waste your money analyzing a contaminated sample.
4. Urine samples are best analyzed in the clinic as soon as possible. Crystals and sediment is influenced by time delay, shipping and handling. 
5. Cystocentesis is the preferred method of collection in many cases. I know it sounds scary but veterinarians routinely use a needle and syringe to collect a urine sample from the bladder. 
6. An ultrasound can be invaluable at looking at the internal surface and contents of the bladder. It is also very helpful in obtaining a cystocentesis in a small bladder.
7. There are those urine samples that are so bloody they are difficult to assess for bacteria. If this is the case do a follow up urine sample as the color of the urine returns to clear or yellow.

Here's the thumb nail version of my bloody urine speech. Hematuria (blood in the urine) is a sign of a problem. The presence of blood DOES NOT diagnose infection. To diagnose a urinary tract infection you must have BOTH BACTERIA AND WHITE BLOOD CELLS in the urine. Sometimes we do see blood concurrently with infection, but often we do not. 

Hematuria

In veterinary medicine we do a very poor job of differentiating and diagnosing INFECTION VS INFLAMMATION. We skip a lot of important steps (often to save money), but we do so at the expense of our patients.

Inflammation will often cause blood to appear in the urine. 

There are a few things that influence urinary tract problems. They include; 

• Genetics. We can't change your genetics, so, we move on to..
• Exercise. There is a correlation to obesity and overall general health. Keep your pet at a healthy weight, trying to treat other diseases without addressing this is almost always futile, and ultimately costs your pet their quality of longevity.
• Diet. This is imperative to be talking about. Listen to your vet and keep your mind open to different foods that just might cure your cats urinary problem. Heck, in almost all urinary disease cases I believe the diet CAUSED the urinary issues. I suggest a high quality wet food with added water. I see most of the UTI cases eating cheap, poor quality dry cat food.
• Disease. Recurrent UTI's warrant further diagnostics. Look for things like diabetes, allergies, bladder stones, etc.

If you or I saw blood in our urine we would go to our doctor, provide a fresh urine sample that would be immediately checked with a urine dipstick. From the doctors office the sample would go to a lab where it would be grown in a petri dish to diagnose the type(s) of bacteria present AND the best antibiotics to treat that specific bacterial infection. This is called a culture and sensitivity. We often skip this test due to cost (about $100) and just provide antibiotic for two weeks.  

Without a C &S we guess what bug your pet has AND we guess which antibiotic is best to use AND we guess that we gave you enough to kill every bug. If the infection returns we don't know if we guessed any of these wrong. Guess less by doing a C & S.

A few  keys take home points:

1. A straining cat can be a blocked cat and THIS CAN BE FATAL QUICKLY. Get to the vet immediately.
2. Once you have one infection you are predisposed to others. Watch the size of the urine clumps in the litter box and encourage water intake. I love water fountains.
3. Talk about diet and change the diet if needed. You get what you pay for and you are what you eat. I don't quite know why but vets don't discuss enough about why these happen, how to best diagnose them, treat them, or avoid them. It is my goal to not have your pet suffer twice with the same affliction. This is only attainable by discussing your pet with your vet.
4. A cat not using the litter box is a cat begging for help. Not a reason to surrender, euthanize and NEVER EVER PUNISH A CAT. It is ineffective in all cases and will back fire on you every time.

Our last batch of summer 2014 babies up for adoption.

If you have a pet question or concern you can ask them for free at Pawbly.com. Pawbly is dedicated creating a place where people exchange pet care information to help pets lives across the globe.

If you want to talk to me about a pet care related item you can find me in person at the Jarrettsville Veterinary Center, in Jarrettsville Maryland.

You can also find me on Twitter @FreePetAdvice.