A few friendly reminders……..

My next blog entry was going to be about grain free diets, but let’s save that for next time.  This time around, a few reminders are in order.

 It’s been hot and the heat is here to stay, at least for the next several months. A reminder about heat and your pets is in order. It is truly heartbreaking to see video of a dog happy and healthy taken an hour before being presented at our hospital overheated and struggling to survive. Please don’t walk your dog’s during the heat of the day. Morning walks are best and need to be over and done by 10 am. This is especially true for brachycephalic breeds which are dog with “short pushed in muzzles” such as Bulldogs, Pugs, French Bulldogs, Boston’s, Boxers, Mastiff’s and American Bulldog’s. These are all breeds that are “at risk” for overheating quicker than other breeds.  Even the American Pit Bull Terrier is somewhat brachycephalic in skull type.  Another reason to get your walks done early in the day is the temperature of the asphalt.  As the day proceeds and heat builds, the asphalt our dogs walk on can become scorching hot.  Paw pads can burn very quickly and easily. Always have fresh water available for your dogs and cats. If you think your dog or cat is overheated, you can rinse them with cool water and bring them into the hospital for further treatment right away. This next sentence deserves to be in all capital letters! NO ICE BATHS FOR DOGS EXPERIENCING HEAT STROKE! If cool water is good, cold must be better? Wrong! Using Cold water or ice water to col a dog causes vasoconstriction of peripheral vessels which means it ends up trapping heat inside the body. Ice water is ok to drink but never submerge an animal in ice water.   

                                

 

For much more about heat and your animals, you can read one of my previous blogs:

http://wbanimalhospital.com/blog/heatstroke/

 The next important reminder is about Fleas. This past wet winter seems to have set up optimal conditions to have large numbers of fleas multiplying quickly. For our feline friends, this can mean severe flea allergies. We have also seen severe anemia from flea infestations. Fleas can also carry an organism that causes a hemolytic anemia in cats. In dogs, the most significant problem we see from fleas is a flea allergy which causes itching on the back half of the dog. We have multiple ways to control this problem. Revolution is a topical medication that is outstanding for flea control in both cats and dogs. Be sure to give the cat formula to cats and the dog formula to dogs as giving the wrong one to the wrong species can create severe medical issues. There is also an oral medication for dogs only called Simparica and it achieves terrific flea control. Flea medications can be adjusted to your specific pet’s needs. Ask your veterinarian which treatment plan is right for your pet.  For more detailed information about fleas and the issues they cause, you can read a blog I released back in 2014:

http://wbanimalhospital.com/blog/fleas-blood-sucking-vampires/

 

Now, about those pesky foxtails! In addition to fleas, this past wet winter has led to explosive growth of this annoying weed called foxtails. These are the plant awns that stick to your socks when you walk through a field. They are also a significant problem for our pets. I have removed many foxtails lately from cat patients who spend time outdoors. If you think getting one stuck in your sock sounds painful, think about these poor cats who get them stuck in their eyes! A foxtail in your conjunctiva is no picnic! In dogs, foxtails seem to like to get into ears and snuffed into noses. They can penetrate the oral cavity and cause abscesses in and around ears. They can be inhaled into lungs and cause serious and potentially fatal pneumonia and they can then migrate out of the lung, slide along the diaphragm and end up causing discospondylitis of the vertebra. The most common thing these pesky foxtails do is puncture a dog’s skin and cause abscesses in between the toes. Check your dog’s feet daily and remove plant material from in between the toes and the undersides of the feet.  

                                                              

And last but certainly not least is the subject of current identification for your pets. Summer is a time of vacations, fireworks and outdoor adventures. Lots of fun for the family but also a potentially dangerous time for your pets.  Your pets count on you to keep them safe and sound and one of the best ways to do that is to make sure they have been microchipped and always wear a collar and ID tag with current contact information.  A microchip is a quick, safe and cost-effective way to permanently identify your pets. Unlike a collar that may be torn off or become separated from your cat or dog, a microchip is permanent and can quickly identify your pet when scanned by animal control or a veterinarian. A microchip registered with current information is the quickest way to get your lost pets back home to your family. This 4th of July, we were able to reunite 4 dogs with their owners because of registered microchips that owners had purchased for their dogs. The dogs had all escaped their yards and were running loose because they had been frightened by fireworks.  But microchips aren’t just useful for the 4th of July. Many dogs and cats are lost because of people accidentally leaving gates or doors open.  Remember that a person cleaning a pool, doing yardwork or making repairs to your home doesn’t necessarily think about keeping gates and doors closed properly. A registered microchip and a collar with ID tags is a winning combination.  

                                  

 

Ok, next time I promise……..the trending grain free diet.

Until next time,

Dr. Voorheis

 

Canine Influenza – Can Dogs Get the FLU?

Canine Influenza – Can Dogs Get the FLU?

From the Desk of Dr. Dennis Voorheis

 

In my last blog entry, we talked about the pros and cons of our local dog parks and in that piece, I briefly touched upon the topic of canine influenza with the promise of a blog entry dedicated entirely to that subject. So, this time around, let’s chat about the possibility of “canine flu”. Our obvious starting point for this discussion would be “can dogs actually get the flu?”. The short answer is YES but as we all know, I’m not one to simply give a short answer and be done with it. The longer answer is an entire blog, and one that comes with recommendations about vaccination at the end. There are two influenza virus strains that affect dogs, H3N8 and H3N2. Both cause similar symptoms in dogs that are likewise similar to a host of other respiratory diseases.

Let’s begin with some background for a bit of base line knowledge. The Influenza A virus, which the H3N8 and H3N2 are subtypes of, can cause infection in many different mammalian species including humans and birds. It exists in multiple subtypes and these subtypes mutate and thus the need to get our human FLU shots every year. Canine Influenza Virus (CIV) was first identified in 2004 in a group of Greyhounds associated with Florida racetracks. The virus was identified as a genetic variant of the H3N8 equine influenza that gained the ability to infect dogs. The key change was an ability of H3N8 to move from dog to dog. The newer influenza virus, H3N2, is derived from an avian strain that gained the ability to infect dogs and is transmitted from dog to dog. It can rarely also affect cats. It was first reported in 2006 in South Korea and appeared in the Chicago area in 2015 where it caused a large outbreak. With both types of CIV, infected dogs shed virus for two days prior to symptoms.  With the H3N8 they continue to shed virus for 4 to 10 days after signs begin. Dogs infected with H3N2 shed virus for up to 24 days after signs begin even when they no longer appear sick. That is a significant amount of opportunity to spread the virus. So far, the affected outbreaks are limited and isolated and this is not an epidemic in Los Angeles County at this point in time.

 

 

The virus was first detected in California in March of 2015 in Orange County and then again in July of 2015. A vaccine first became available in November 2015. In March of 2017, CIV H3N2 was identified in dogs in Los Angeles County. A total of 50 dogs were exposed to the virus, including 35 sick animals. PCR testing confirmed H3N2 in 5 of those dogs, the remainder of the sick dogs were assumed to have H3N2 because they were in the same group of dogs and had the same signs.  Two dogs died, however they also had other unrelated illness that contributed to their deaths. The rest of the sick dogs have now recovered. There was another case out of the San Bernardino shelter that has been confirmed and isolated and no new cases have been confirmed.

Canine Influenza (CIV) usually causes mild to moderate disease in dogs. The signs are fever, coughing, sneezing, nasal discharge, lethargy, and loss of appetite. Some dogs have no symptoms at all. Some of the more severe and fatal cases have pneumonia. It is spread through direct contact with respiratory secretions from infected dogs and by contact with contaminated objects such as toys, bedding, leashes, collars, cages and floors. The virus can survive for 1 to 2 days on floors and cages.

The above described symptoms are seen every day by veterinarians in Los Angeles County.

They comprise a group of diseases bunched into one of two common terms, upper respiratory disease or kennel cough. Most of the time, diagnostics such as PCR testing to determine a cause of a runny nose or cough, are not performed. The “sicker” dogs are usually the dogs that get more diagnostics performed on them. If you suspect that your dog may have these signs and may have been exposed, please call for an appointment to see one of our veterinarians. Please let the front office know at the time of making the appointment that you think the dog may have an infectious cough, sneeze or upper respiratory issue. At the time of your arrival, if it is not too hot, you may be asked to wait outside in your car until we can admit you. Alternatively, you may be brought in through a side entrance and placed immediately into an exam room to avoid cross contamination in the lobby area. Please do not wait in the lobby with a dog that you suspect may have an infectious upper respiratory issue as these can be highly contagious for other animals.

One of the advantages of being a “seasoned” veterinarian, is that I have been around long enough to have seen emerging viral diseases change the medical landscape. Parvo viral enteritis, feline immunodeficiency virus and influenza are just a few examples of how viral diseases can change the medical landscape we practice in. Frankly, I’d prefer not to be part of another viral epidemic like the one I was witness to in the late 70’s/early 80’s with the parvo virus. Due to the relatively brief period of time influenza lasts outside the body, it is unlikely to end up as significant a problem as the parvo virus is. However, the epidemic that hit Chicago in 2015 certainly was devastating and the potential exists that it could affect us in the same way. So far, we appear to have dodged a bullet so let’s hope it stays that way. Vaccination of at risk groups dogs is certainly the most “common sense” approach to prevention at this point.  

There are some reasonable recommendations that have resulted from the canine influenza topic which are being made by our public health veterinarians. There are groups of dogs that are “at risk” dogs. These are dogs that are in highly social situations such as:

  1. Dog shows
  2. Agility, obedience and other trials
  3. Dog Parks
  4. Doggy Day Care
  5. Boarding facilities
  6. Grooming facilities
  7. Any other group or activity where dogs are interacting with other large numbers of dogs with unknown exposure or vaccination histories.

The recommendation is that the dogs that are in these situations should be vaccinated against CIV. We have not yet made the vaccination a requirement to use our grooming or boarding facilities at WBAH, but that may very well change as we monitor what is happening at the county level. A second question that will come up is, “is it safe to vaccinate?” That answer is yes. The vaccine is a killed vaccine, given as a set of two shots, three weeks apart. It is my recommendation that if your dog participates in any of the above social activities, he/she be vaccinated against CIV. If you would like to discuss this topic in more detail, please schedule an appointment with one of our veterinarians and allow them to provide you with more detailed information.

Next up……. The trending grain free diet.

Until next time,

Dr. Voorheis

                                                            Dog Parks – Pros, Cons and Food for Thought

                                                                From the Desk of Dr. Dennis Voorheis

                                                                                          June 9, 2017

 

Many of our local cities, Whittier included, have developed dog parks as a place to take our four legged friends for some appropriate off leash play and socialization. It takes a great deal of time, effort and planning to develop these dog parks and bring them to fruition.  The dedicated individuals who make it happen deserve a rousing round of applause for their dedication to their community. Dog parks can be a terrific place to take your dog, offering both physical and mental benefits. Dogs are social creatures who require mental stimulation to be balanced and fulfilled. But dogs are not the only social creatures at the dog park, we are too! The human interaction with fellow dog owners creates a sense of community for us as well. You might say it’s a win-win.

You all know me by now and you realize there’s a “but” coming, right? Of course! My cautionary statement is this; be aware and informed and take some reasonable precautions to keep your dog safe.

There are some basics to consider before going to a dog park.  First, realize you are taking your dog into a group of dogs that neither of you know. This means they have unknown vaccination histories and unknown behavioral traits. As a veterinarian with 30+ years of experience, I will first discuss the unknown vaccination history and the corresponding medical risks.  

The potential for dogs to be exposed to common viral diseases at a dog park is moderate. To guard against any possible exposure, make sure your dog is current on his or her vaccinations. This would include DA2PP, Bordetella and Rabies vaccinations. I will address H3N2, the latest influenza virus, later in this blog.  

For those who have adopted a new puppy and can’t wait to show off the “cute factor” at the dog park, I caution you – don’t do it! Never bring your unvaccinated or incompletely vaccinated puppy to a dog park. It’s up to you to protect this young life from the dangers they face in the presence of the unknown. Your puppy’s vaccination series must be completed before taking your puppy to the dog park. This is something I believe in very strongly. The puppy vaccination series is made up of a total of 3 DA2PP, given roughly 8,12, and 16 weeks, two Bordetella vaccinations given at 8 and 12 weeks or 12 and 16 weeks and a Rabies shot, given at 12 weeks of age or 16 weeks of age. 

In our area the most common infectious, transmissible, non-parasitic diseases are Parvo viral enteritis, the upper respiratory diseases and Distemper. We don’t see as much Leptospirosis here as in other parts of the country but it is reported every year. You may ask “what about the new influenza disease I’ve heard about on the news?” At this point, we are not recommending the vaccination of every dog against this new flu strain. It is not a part of our core vaccination protocol at this point. We are, however, recommending it for at risk dogs. An at-risk dog is a dog that is exposed to “social situations” such as dog shows, agility trials, doggy day care, dog parks, grooming facilities and boarding situations. An entire blog is being devoted to influenza which is next in line to be published.   

Another part of the “unknown” at dog parks and other social situations is parasites.  Parasites can be lumped into two categories, external and internal. First, let’s address the external category. You’ll want to make sure the dog you take to the dog park has flea and tick control in place before you go. There are a host of good products that are used to prevent fleas and tick infestation. Oral products such as Simparica, Bravecto, Comfortis and Trifexus are excellent at killing adult fleas. Simparica and Bravecto are also excellent at killing ticks. Topical products such as Revolution also work very well. In my experience, products such as Advantage and Frontline are not quite as effective as they once were, however still offer some pretty good flea control.

 Internal parasites are things like worms which would include roundworms, hookworms, whipworms and tapeworms. They are all potentially present in greater numbers in dog parks than they may be in other areas. Single cell parasites such as giardia and coccidia can also be present in higher numbers at a dog park. Roundworms, hookworms and whipworms eggs are shed in the feces of infected dogs. Within a day or two, the eggs in those feces become infective larva. If other dogs come along and, as gross as it sounds, eat poop or eat the grass that the poop was on, they can easily become infected with worms. To cut down on this, dog parks have rules in place that say to pick up your dog’s poop and dispose of it immediately.  This is a good rule that makes a lot of sense. I encourage you to be responsible and pick up your dog’s waste and dispose of it as soon as you see it. Now, having said this, we all know that not everyone follows the rules and the chance of your dog encountering feces in a dog park is reasonably high. For that reason, dogs who are regular attendees at dog parks should have their stools examined for parasites 4 times each year. Better safe than sorry. Parasites can do some damage if left to their own devices, so it’s important to catch it early and address the issue.

Your water supply is another thing to consider while on a dog park outing. It’s a good idea to bring your own clean supply for your dog. Community water bowls can be walked through, urinated in or on and overrun with “doggy slobber” from unknown dogs in unknown states of health. You probably wouldn’t let your child drink from a community cup at school and this is the same premise. Keep it clean and sanitary.  

It’s also important to mention overheating. Summer is coming and it’s going to be hot. If you own a brachycephalic breed which is any dog with a squished in face such as pugs, Boston terriers, Boxers, French or English bulldogs etc., the best advice might be “don’t go”. This also applies to walks and any other activity where a dog can become overheated. These types of dogs overheat EASILY. The second-best advice is to go early in the morning while it is still cool or later in evening so the danger of overheating is minimized. Early signs of overheating include splayed tongue; the tongue is used to try to cool the dog and an overheated dog’s tongue will look very broad at its tip. Overheating can be fatal and it comes on quickly. I recently saw a dog that died from overheating while being taken to our hospital. It was heartbreaking to see video of the dog at a park and less than an hour later the dog was dead. It is worth repeating that overheating can be fatal and it comes on quickly. Prevention is key.

Aside from unknown vaccination history and medical risk, I mentioned unknown behavioral traits. I do not profess to be a qualified dog trainer or behaviorist, but I do feel I’ve had quite a bit of dog experience in my 30+ years as a veterinarian that may prove helpful regarding this dog park topic.

You’ll see all types of dogs and dog owners at a dog park. Most are responsible owners who are there with their sociable, dog friendly canine friends. However, there may also be a few “higher risk” pairs to watch out for. For instance, a dog who is in heat may cause quite a stir at a dog park and this can often lead to scuffles. Logically, you wouldn’t think an owner would take a dog in that state into a setting like a dog park, but it does happen. There may also be aggressive, dog selective or ill-behaved dogs that you’ll need to watch out for as well as owners who aren’t paying attention to their own dogs.  If your dog fits into one of these categories, a dog park is not an appropriate choice for them. Remember that not every dog owner has the same training regimen or disciplinary beliefs that you may have, so it can be a bit of a mixed bag when you walk through the gates of a dog park. As Forest Gump would say “you never know what you’re gonna get”.  The vast majority of dogs do play nice and in true pack animal fashion, they usually work things out themselves and enjoy playing together. There is always some risk of injury with a play session such as one dog jumping on another resulting in a back or leg injury. It’s best to keep an eye on your dog at all times and monitor their activity. Be able to immediately redirect them if you see something escalating.  

Most dog parks provide different fenced areas for small dogs and big dogs and it’s a good idea to keep your dog in the appropriate area with similar sized dogs.  Most dog parks also have an entry area, where you take your dog off leash before letting them go into the park. Dogs on leash should never go into the park as it creates an unbalanced energy and can lead to fighting.                                                      

I will mention that a couple of times each month, we treat dogs with bite wounds obtained at a dog park. Dynamics in a pack setting can change rapidly so it’s best to keep a watchful eye on your dog to monitor their behavior and the behavior of dogs they are interacting with. Lastly, people can be seriously injured trying to break up a dog fight. The solution is prevention. Unless you have been professionally trained to separate fighting dogs, I do not suggest you attempt this maneuver.   

So, am I an anti-dog park guy? Not at all. I took my own dog to a dog park on Sunday, but she is fully vaccinated, friendly with other dogs and on great flea and tick control (Simparica). Her stool is checked 4 times a year and I bring my own water supply and pick up her poop. Am I the only one that wonders which thing their dog likes more -visiting with other dogs or with the dog owners? I’ll never know the answer to that one!

 Next up, INFLUENZA VACCINES.

 Until next time,

 

Dr. Voorheis

   Calling all Superhero Dogs and Cats 

November 29, 2016 

From the Desk of Dr. Voorheis

Now that we are moved in to our fantastic new hospital and starting to settle a bit, I thought it was time to “revive” my blog efforts and a timelier topic there couldn’t be! Have you ever wondered what would happen if your dog or cat needed a blood transfusion? Did you even know that this is possible? Maybe you have been faced with this situation or perhaps you’ve known someone who has. It’s a serious crossroads in an animal’s life and when blood is needed to support an animal in dire need of transfusion, time is of the essence. So, I’ve decided that I would write this blog about blood transfusions and blood donation and provide some background about why we do transfusions and how they work. I’ll also be enlisting your help toward the end of this blog, so please stay tuned.

Most people are unaware that animals sometimes require blood transfusions. You might wonder why an animal would need blood, There are several instances where an animal would need blood or at least a component of blood. Component you ask? Well, blood is made up of several different components. We will talk about that next. For now, let’s talk about why an animal would need a blood transfusion.

blog-1

 

There are many indications for transfusion. The most common reason is anemia, which can be caused by many different factors, and yet many anemic animals do not need to be transfused. Factors to consider include the cause and chronicity of the anemia, quantity and rapidity of blood loss and existing co-illnesses. Now we need to talk about those components that make up “blood”. Blood is composed of Red Blood Cells (RBC), White Blood Cells (WBC), Platelets and a liquid called Plasma.

Depending on the patient’s need, transfusions may be FWB (fresh whole blood) or WB (whole blood). FWB has clotting factors and platelets that may be needed in a given situation. From time collected, FWB needs to be administered within 24 hours, or it is called WB. WB may be stored (refrigerated) for up to 35 days prior to use. We also use pRBC (packed red blood cells) instead of WB.

 

You’re probably familiar with the Red Cross and the blood donation drives that they do to collect for the human blood bank. You’ve probably heard about “blood type” and “being a match” for blood transfusions and even bone marrow donation. But does this apply to dogs and cats too? You bet! Under normal circumstances, we type and crossmatch our patients with our donors. So, is a dog’s blood different from a cat’s blood? Good question, and the answer is yes! Let’s talk about Canine and Feline blood groups.

blog-2

Blood groups are based on the presence of particular antigens on the surfaces of red cell membranes. At least a dozen blood group systems have been recognized but the three most important clinically are dog erythrocyte antigens (DEA) 1.1, 1.2, and 7. Dogs, unlike humans, do not have naturally occurring antibodies against blood group antigens. Therefore, they can only acquire them after receiving a transfusion or after pregnancy.  Transfusion reactions can occur if blood positive for DEA 1.1, 1.2 or 7 is transfused, so donor dogs should be negative for those antigens. However, in practice, clinically relevant acute hemolytic transfusion reactions are extremely rare in dogs. Transfusion of blood from a donor who has not been typed and has never been pregnant to a recipient, independent of their blood types is generally safe.

Blood groups in cats include type A, B, and AB. Cats tested in the United States have almost exclusively been type A. The prevalence of type B cats varies from region to region and among breeds. Breeds in which 15 to 30% of the cats are type B include Abyssinian, Birman, Himalayan, Persian, Scottish Fold, and Somali. Breeds in which more than 30% of cats are type B include British Shorthair, and the Devon Rex. Fatal transfusion reactions can occur in type B cats receiving type A blood. It is best if cats are typed and cross matched before being transfused.

blog-3

                                                  

 So why all this talk about blood transfusions? The answer is fairly simple. We need donors. Dog and cat donors. We need superhero cats and dogs who are ready, sometimes on short notice, to save another dog or cat ‘s life. Some of our clients have heard of an organization called Hemopet, which is a nonprofit blood bank and animal rescue in Garden Grove. When veterinarians need to buy blood from Hemopet, we are charged $400.00 which is not a very affordable option for our clients. So, what we are looking to do is to build a blood donor bank of our own. Our practice has always been so family oriented and our clients have always been so loyal and so considerate and gracious with each other, that we thought it would be a perfect match (pun intended)! In years past, we kept a couple of great dogs as transfusion dogs here at the hospital. They were treated as hospital pets and were walked daily, brushed, groomed and given lots and lots of TLC. One of the last of the donor dogs is currently living out her life with my crew in the Voorheis household. Chelsea has donated blood to dogs in need more than 100 times in her lifetime. At age 12 I think she has done enough and she’s been living with me for over a year. With our practice growing so rapidly, we need to be ready to serve our clients with a fresh blood supply when it’s needed.

                                                                                             blog-4

So, I am trying to gauge interest in developing a team of donor dogs and cats. I’d like to have 50 dogs and 20 cats on our donor list. We would pay for getting your dog or cat’s blood typed. We would also pay for an in house CBC (Complete Blood Count) which tells us about your pet’s overall health. We wouldn’t call often, but we would like to know if there is any interest in having your dog or cat donate blood and be part of a special and select group that save lives. I would say the we would probably draw from 4 dogs every three weeks; with the dogs that had donated last being rotated to bottom of volunteer list. The dogs that donate q 3 weeks – their blood would be used as WB (whole blood donation) – the rest would be on a list that staff would call in the event we had need for FWB (fresh whole blood). This group of dogs and cats will receive recognition on our website and in the lobby with photographs. We are also creating bumper stickers for the pet parents of these special dogs and cats. Being a blood donor is a big deal and we know pet parents will be very proud to sport a bumper sticker that says “my dog/cat saves lives by donating blood to animals in need”.

A donor dog needs to be 70 lbs in size or greater and no more than 8 years old. A donor cat needs to be at least 10 lbs and no more than 8 years old. Cats would be typed as well at no charge and then a call for a WB unit donation would come once every 3 weeks if we had a group of say 20 cats. With those numbers, the chance of a call comes once a year.

So, who’s in? What do you think? Those who are interested can send an email to blooddonor@wbanimalhospital.com   with any questions you may have or to volunteer your dog or cat.

I’m looking forward to your feedback!

Until next time……….

Dr. Voorheis

Moving Day!

Moving day is upon us…or shall we say moving days? It’s time to begin packing up the hospital in anticipation for the move into our new hospital and we must admit that we are very excited! In an effort to keep all of our clients in the loop, we would like to provide a schedule of events so that everyone knows what to expect and can plan accordingly as much as possible. We do realize that emergencies happen and we will certainly do our best to accommodate our clients. Having said that, we need to adhere to this schedule as closely as possible to make the move successful and get back into a fully functional hospital environment as quickly as possible so that we are able to provide the exemplary level of service to which our clients have become accustomed. Here is our current plan of action:

Friday, September 16 –
We will see appointments until 12pm. Our equipment will begin to be moved into the new hospital on Friday morning. We will have limited phone service while our lines are transferred to the new hospital building. Our front desk will remain open until 6pm for food and medication pickups. Hospitalized patients will remain with us under the care of doctors and staff.

Saturday, September 17-

Appointments are not being scheduled for Saturday. We will have limited resources available. Our vaccine clinic will be available from 10am-5pm. Emergencies beyond our capability will be referred to one of two Emergency Hospitals:

Orange County Emergency Pet Clinic
3920 N Harbor Blvd (cross streets are Harbor & Imperial)
Fullerton, CA
714-441-2925

 

Emergency Pet Clinic of San Gabriel
3254 Santa Anita Ave ( I 10 Freeway exit Santa Anita)
El Monte, CA
626-579-4550

Sunday, September 18
We will do our best to be ready to see patients on Sunday. For now, we cannot be certain that this will be possible.

Monday, September 19-
Appointments will be seen on a limited basis during normal business hours.

Tuesday, September 20-
Back to business as usual.

We would like to thank you for your patience, flexibility and understanding this weekend during our move. This will be a major undertaking and we will do our level best to get back to normal as quickly as possible. We sincerely appreciate your patience over the past year with our construction and parking challenges. Your trust and loyalty mean the world to us and we certainly couldn’t have realized this vision without all of you!

We look forward to welcoming you all to our beautiful new hospital!

 

 

Dr. Gary Throgmorton. DVM

Dr. Dennis Voorheis, DVM, CCRT

Every picture tells a story

From the Desk of Dr. Voorheis

 June 8, 2016

 

For those of you who have missed my musings, I’d say an update is in order. There have been many changes since the last blog and I can imagine that everyone is quite curious about the new hospital building. I’ll start with this – the last 4 years have been a bit of a blur.

In July of 2012, we started the process of planning a new hospital. Then came 2013 which was spent researching options, hiring an architect, developing plans and obtaining financing. In 2014, the process of approval and learning patience (ha!) began. When I first wrote about the new hospital in January of 2014, I actually thought that construction would begin in 2014. As you know, that didn’t happen. The process of building a new hospital takes longer and is so much more involved than I ever imagined it would be. I’ve learned a tremendous amount about planning, construction, financial requirements and setbacks but I’ve come through the other side of the tunnel with a great feeling of pride and accomplishment. I’m very excited to welcome you all to the new hospital. We are hoping that will happen mid July, so it’s close.

Now for the fun stuff, the pictures. They say that pictures tell a story and are worth a thousand words, so I thought I would share the picture history with all of you. The photo below illustrates construction that began with destruction. The bringing down of the boarding and grooming facility along with some of the other outbuildings was our first step.

nbpic1

nbpic2

This is a situation where pictures say more than words. Bringing down the old boarding/grooming building and having a demolition crew on site was a unique experience. Then came a different crew to prepare for and pour the foundation. So you may be wondering what was going on up front while all of this was taking place. To be honest, it was a juggling act and we were crowded. We merged the grooming business into the hospital building and placed a trailer alongside the existing hospital to facilitate grooming. As you are also no doubt aware, we lost a great deal of parking. That statement deserves some special attention. Parking got tricky and challenging. That’s an understatement, right? We hired a valet service to assist our clients with parking challenges. It was the best solution for a tough issue. We had to quickly figure out how to remain a fully functional hospital while undergoing this chaos. We have managed to do so because of an amazing staff that has put up with the stress, the noise and  the loss of parking. We have managed to do so because of amazing clients who have been understanding and patient with us and for all of you we are truly grateful. THANK YOU!

nbpic3

Oh and by the way, we took a little time to have a wedding. My beautiful daughter Grace got married in September!

nbpic5

 

nbpic7

The pad that the building will sit on was compacted, measured, tested by engineers and then compacted some more. Next, they did the layout where the plumbing, sewer and electrical will be placed. Next came the pouring of the concrete.

nbpic8

nbpic9

The obligatory signing of our names in concrete. We are obviously rookies. We signed in a spot where the wood foundation will cover up our names. Oh well, we know where they are.

nbpic10

Here we were on the last day of November 2015. This thing is going to be big.

nbpic11

Below is a picture two weeks later – framers move fast. December 15 2015

nbpic21

 

The picture below is approximately a month after the one above.

nbpic13

 

nbpic14

At this point, I stopped referring to the structure as the new building and started to refer to it as the new hospital. Every evening I would walk through and envision how the new hospital would flow. How will patients be moved? What will flow be like for in-patients and for outpatients? That discussion and training for current staff begins with a focus on both optimizing patient care and the animal and client experience in the new hospital. The pictures below focus on the outside of the new hospital and just how far we have come in the past two months. There are just as many changes on the inside.

nbpic15

 

nnpic16

 

nbpic17

Sometime in mid-July, all patient care will be transferred to the new hospital. We are in the home stretch. After we have moved in, we will then undertake the final phase of our new digs which will include demolition of the old hospital, and building of a new parking lot. This last phase will also be challenging as there will be no onsite parking. The valet staff will move the cars off site. You will be able to drive up and drop off and then your vehicle will be taken off site to a secure lot located around the corner at the Sprinkler Fitter’s Union.

I hope you enjoyed the update and pictures. Next up…. How I spent the last year earning that certificate. Yes, I am now very proud to say that I am a Certified Canine Rehabilitation Therapist (CCRT). The canine rehabilitation unit (think physical therapy for dogs) will offer treadmill therapy, underwater treadmill therapy, laser therapy, hands on stretching and massage, joint mobilization, and strategic exercises. I soon will be joined as a CCRT by Dr. Casida, who joined our practice last year.

 

Once we are up and running in the new hospital, we will be offering tours to all of you. Please feel free to talk to your friends and bring them along as well. We are very proud of our new hospital and we can’t wait to show it to the world! If you would like to be added to the mailing list and get updates specifically about the tours, please send us a quick note at tour@wbanimalhospital.com.

Until next time………………

 

Dr. Voorheis

 

 

 

 

 

 

 

 

When hot is TOO HOT!

When hot is TOO HOT!

June 18, 2015

From the desk of Dr. Voorheis

As I sat and thought of what topic to write about next, I went outside to put my feet in the pool because I was hot. Devine inspiration struck and I thought I would write about heat stroke in dogs and cats. You may remember seeing something on the news recently about a Boxer suffering from heat stroke up in Runyon Canyon. The owner had taken the dog out for a hike in the heat of the late morning and the Boxer was unable to keep up in high temperatures. First aid was rendered to the dog by LA County Fire who was thankfully nearby at the time.  Heat stroke in animals is very serious. You see, they do not have the same ability that you and I have to self cool. They cannot sweat.

Heat stroke is defined as a body temperature between 106 and 109, which results in thermal injury to tissues. Our bodies are not made to reach those temperatures, and bad things happen to tissues when those temperatures are reached. As we move into the summer, it is appropriate to talk about heat stroke because we see it quite a bit. Every year that I have been a veterinarian, I have seen cases of heat stroke. What are the risk factors for heat stroke? Any breed prone to upper airway obstruction, for example brachycephalic breeds (Pugs, French Bulldogs, Bulldogs, American Bulldogs, Boston Terriers, Pit Bulls, Boxers, and Mastiffs etc) or the breeds prone to laryngeal paralysis (Labrador Retrievers, Golden Retrievers and others). Obesity is also a risk factor. Dogs and cats confined in non-ventilated areas, deprived of water or shade, subjected to forced heat (such as dryers after bathing), locked in cars etc. I’ve had cats crawl into clothes dryers. One of the more common presenting scenarios is the brachycephalic breed that is taken for a run in the late morning to early afternoon. The owner not realizing his dog cannot cool himself. I’ve seen the same scenario with a lab being taken for a run during the day, with owner not realizing that the loud breathing his dog has prevents him from cooling.

                 http://cdn.carrington.edu/wp-content/uploads/2014/07/signsofoverheating.jpg

So how does this happen? How do we normally keep cool? To put it simply, thermoregulation is controlled by the brain (thermoregulatory center is in the anterior hypothalamus). Core body temperature is kept mostly constant in the normal dog and cat, under usual temperature fluctuations. Elevated ambient temperatures stimulate panting, drooling of saliva and vasodilation which cool the body by evaporation and radiation.  In people, I would have added sweating as a major means of keeping cool. We sweat, the sweat cools on our skin, and it’s one of our ways to keep cool. Dogs and cats don’t sweat. The sweat glands are only found on the nasal planum and the foot pads. This is not enough to keep cool.

Abnormal ambient temperature and humidity make it difficult for the normal means of temperature control to function. Translation: Hot, humid weather is the worst for dogs and cats.

In the early stages of heat stroke, cardiac output increases due to peripheral vasodilation and decreased vascular resistance.  As hyperthermia progresses, blood pools in the blood vessels supplying the GI tract and other abdominal organs, this causes a decrease in blood returning to the heart, a decreased circulating blood volume resulting in LOW BLOOD PRESSURE. Cardiac output declines, decreasing further circulating blood volume, the heat loss that was happening through radiation and convection fails and heat stroke worsens.

Initially, as dogs or cats pant, they develop something called respiratory alkalosis which means they blow off carbon dioxide and their body pH elevates. Then with the hypotension that develops, they develop metabolic acidosis. The bottom line is fluctuations in body pH that are dangerous require life saving intervention. As temperatures elevate, body proteins denature (break down), the enzymatic reactions that are essential for life stop happening and tissue death ensues (this is called necrosis).

All of that is happening at a cellular level. At the organ level, we see acute renal failure from direct thermal damage and from poor renal blood flow. Muscles breakdown and those large muscle proteins contribute to acute renal failure. In the gastrointestinal tract, direct thermal damage happens to the cells lining the gut and from poor GI blood flow – these cells rapidly die, resulting in hemorrhagic diarrhea. The toxins that are present in the gut and the bacteria that live in the gut cross into the bloodstream and cause sepsis, endotoxemia and SIRS (sudden inflammatory response syndrome). The brain swells and infarction (stroke) occurs. The same damage described above as happening in the kidneys and gut also happens in the liver and the heart. Bottom line – there isn’t an organ that heatstroke doesn’t affect negatively. That is why there is more than a 50% death rate from heatstroke in dogs and cats.

                     http://www.popalockofjacksonville.com/wp-content/uploads/2014/05/dog-hot-car-safety.jpg

Treatment is cooling; cool water in a tub or garden hose, then transport to hospital. If hospital is close, just transport. Cool water is better than ice water. Treatment is IV fluids, colloids, plasma, and treating individuals as their signs dictate. The prognosis is usually guarded.

Prevention is easier than treatment. Be aware if you have a high risk dog or cat and take extra precautions. I’m gonna jump on my soap box here. If your dog is obese, work on weight loss. If you walk your dog (and you should) do so before 9 am in the summer time. If we are having hot humid weather, take precautions. Provide access to shade and water. Owners of brachycephalic breeds – these lovable dogs walk around at risk every day. It does not take much for them to overheat. So keep them thin and keep them cool. Owners of older labs, goldens and other large breed dogs should take the same precautions. If they are “loud breathers” walking around the house, there is a good chance they have laryngeal paralysis. Talk to one of us about laryngeal paralysis. These guys don’t cool well either. It goes without saying (but I will say it). Don’t leave your dog or cat in the car. Not even for a few minutes. You will live to regret it. They might not live through it. Don’t mean to scare you too much… but this is very real. We all see it on the news every summer and all over the internet and social media. Be aware and take precautions. They depend on you for their safety and well being. As always, if you have questions or concerns about your critters, we are here to help. Never hesitate to give us a call.

Until next time,

Dr. Voorheis

Diabetes

Is your dog or cat too “sweet”?

June 4, 2015

From the desk of Dr. Dennis Voorheis

The last medical blog that I wrote back in October was on the pancreas. My discussion in that blog was the exocrine pancreas. I also mentioned in that blog that the pancreas had an endocrine function as well. The endocrine function is what we will talk about today. Put into more concise terms, we will be talking about Diabetes Mellitus which is an endocrine disorder. In thinking about how to address this topic, I have decided to take a new approach this week and speak as if you were in my exam room presenting me with a dog or cat who was exhibiting symptoms that would lead me to think “possible Diabetic”.

Endocrine is defined as “secreting into the blood or lymph”. When an organ secretes a chemical into the blood, that chemical is referred to in general terms as a hormone. There are several hormones that the pancreas secretes, but this blog will focus on insulin. Diabetes mellitus a disorder of carbohydrate, fat and protein metabolism caused by an absolute or relative insulin deficiency.

The dog or cat that presents to me in an exam room does not come in with a sign over his forehead that says, “Hi! I’ve got Diabetes Mellitus”.  Veterinarians get hints of what may be wrong through taking a thorough history. I will hear things like “Due to the heat he is now drinking more and now he is urinating in the house. He must be getting old and forgetting to ask to go outside”. The owner’s presenting complaint only has a vague reference to thirst and a presenting complaint with urinating inside. This is something that may be perceived as a behavior problem by an owner. Other times, the dog’s signs will have progressed to noticeable weight loss and increased thirst. Since there are a number of other conditions that can come in with identical signs, the veterinarian will recommend baseline lab work.  This will often include a urinalysis and a general blood profile.

                                                http://ts1.mm.bing.net/th?&id=JN.2/i7lcrvB/5WSK0k6rG9uQ&w=300&h=300&c=0&pid=1.9&rs=0&p=0

 

The uncomplicated diabetic dog will have an elevated blood sugar, certainly greater than 250 mg/dl and the dog will be “spilling” sugar into the urine (something that happens when the blood sugar increases above 180 mg/dl). The dog’s urine will be checked for concurrent urinary tract infection. This is common. Warm, sugar filled solution is a great place to grow bacteria, the sugar being a nifty source of “food” for the bacteria.

The complicated diabetic is sick. This dog will require hospitalization with intensive fluid and electrolyte management. It may have developed a condition called diabetic ketoacidosis (DKA) which can be fatal. DKA develops as a compensatory mechanism, when sugar is not available to cells as an energy source the body turns to breaking down fat. The result is a product called ketones. Excessive ketones cause the body’s pH to decrease (this is called acidosis) and that triggers several negative cascading events. Insulin therapy (injections) is a key to treatment along with numerous other supportive measures. These animals can be saved but often survival depends on when we diagnose them and also on the presence of other complicating diseases such as pancreatitis, vacuolar hepatopathy, or hepatic lipidosis.

Not every dog or cat with an elevated blood sugar has diabetes mellitus. The degree of elevation is considered. Mild elevation may be dismissed or rechecked. In addition, the clinician will evaluate if other signs are present.  Below is a list of conditions that will cause the blood sugar to elevate.

Causes of Hyperglycemia in Dogs and Cats

Diabetes mellitus

Hyperadrenocorticism (Cushing’s Disease)

Stress, aggression, excitement, nervousness and fright (more cats than dogs)

Acromegaly (Cat)

Postprandial (within 2 hours of eating)

Diestrus (in heat)(female dogs)

Pancreatitis

Pheochromocytoma (dogs)

Some pancreatic cancers

Renal insufficiency

Head trauma

Drug therapy (glucocorticoids, (cortisones)

progesterone, megestrol acetate

dextrose containing iv fluids

parenteral nutrition solutions

 

The most common cause of diabetes mellitus in dogs is the loss of insulin secreting ability by pancreatic islet cells through presumed immune-mediated destruction of pancreatic beta cells. Huh? Here comes the in depth explanation of Diabetes Mellitus. Dogs are almost always insulin dependent. In cats, diabetes is caused by both an absolute insulin deficiency (type 1) and a relative insulin deficiency and insulin resistance (type 2). Type 2 diabetes is characterized by inadequate or delayed insulin secretion relative to the needs of the patient. Some of these cats can be managed without insulin.

 

        http://ts1.mm.bing.net/th?&id=JN.UTY2gpuzbGzcQNcV5ImsIQ&w=300&h=300&c=0&pid=1.9&rs=0&p=0             http://ts1.mm.bing.net/th?&id=JN.rcrllNVjx98NWndlrapj6Q&w=300&h=300&c=0&pid=1.9&rs=0&p=0

 

Absolute or relative insulin deficiency results in accelerated tissue breakdown, an impaired ability to maintain carbohydrate, lipid and protein metabolism and subsequent insulin resistance. This gives us weight loss which is one of the cardinal signs of diabetes mellitus. Lack of insulin and insulin resistance results in persistent hyperglycemia of sufficient severity which overloads the kidney’s ability to reabsorb glucose and therefore glucose spills into the urine. When glucose spills into the urine, it pulls water with it which is called an osmotic diuresis. When this occurs two more, of the cardinal signs of diabetes are formed. Those being increased urination and a compensatory increased thirst. Turns out, there is an insulin dependent glucose mediation satiation signal in the brain. It’s lost when there is no insulin so polyphagia (ravenous appetite) comes about. Therefore, there are four common signs to the diabetic dog or cat. They are weight loss, increased urination, increased thirst, and increased appetite.

In dogs, we diagnose diabetes mellitus more in females than males. Certain breeds such as Samoyeds, Tibetan Terriers, Cairn Terriers, Poodles, Dachshunds, Miniature Schnauzers, Beagles, Golden Retrievers and Chocolate Labs are over represented.

In cats, one of the early signs is obesity. Your obese cat is at a higher risk to develop diabetes than a thin cat. Here’s a tip before a cat gets obese or if you have an obese cat that has not developed diabetes yet. Consider feeding the Hill’s prescription diet “Metabolic” I think this is simply the best food available for cats.  I could write an entire blog on the proper feeding of cats. Simply put, for years we have “fed cats wrong” and a growing body of evidence is changing how we feed cats. There is a blog coming on this topic alone.

As mentioned before, literally all dogs with diabetes have insulin dependent diabetes. There is essentially no insulin being produced. It is thought there are multiple causes of diabetes in the dog. Genetics play a role as do infection, insulin antagonistic diseases and drugs, obesity, immune-mediated insulitis and pancreatitis. The bottom line is the pancreatic cell, the beta cell that produces insulin, no longer functions. No insulin means blood sugars rise and the blood sugar cannot be transported into cells that need it The high blood sugar spills into the urine because it surpasses the renal threshold and once in the urine it has an osmotic effect drawing water with it and  the increased urination and thirst occur. Cells are essentially starving and this is when weight loss occurs. A condition called ketoacidosis also develops. As I mentioned, ketones are by products of fat metabolism. The body breaks down fat to try to use as an energy source. Ketoacidosis is a life threatening metabolic condition that is beyond the scope of this blog but simply put a deficiency of insulin leads to breakdown of fat which leads to increased free fatty acids available to the liver and that promotes ketogenesis. As ketones accumulate in the blood, the body’s buffering system becomes overwhelmed and metabolic acidosis develops.

 

                             http://4.bp.blogspot.com/-s_335m3ClpA/UZD-wCeKk5I/AAAAAAAAAEc/E_MZ7so0xUI/s1600/1-s2.0-S0049384811006487-gr2.jpg

Treatment and treatment goals

With Diabetes In people, treatment goals are a bit different than in the dog and they depend on whether that person is a type 2 diabetic or a type 1 diabetic. It is not the aim of this blog to get into a discussion of the diabetic person or his/her treatment. It is helpful to discuss why treatments are different for the insulin dependent dog and cat vs an insulin dependent person.

The insulin dependent person is often on long acting insulin that maintains the blood sugar in a reasonably low level. Then at mealtime, the person will measure blood sugars and give themselves (by injection) a short acting or fast acting insulin. This is all done to keep blood sugar as normal as possible throughout the day. This does not even take into account other delivery devices that have been developed for people. The difficulties of measuring blood sugars at home on our pets should be self evident. Many times I have had clients willing too, and wanting to measure their animal’s blood sugars at home but unfortunately it just is not practical and almost never successful.

In the insulin dependent dog and cat, insulin injections are given, generally twice daily. Different types of insulin are used depending on the individual cat or dog. In cats, we usually recommend an insulin type called glargine (brand name Lantus), and in dogs we usually recommend an insulin type called NPH or PZI. The type of insulin used, is chosen by the length of time it is effective which is something determined by a blood glucose curve. Blood glucose curves are a series of glucose measurements that are made every 2 hours to plot glucose levels and determine if the chosen dose is effective. Changes in insulin dosage are then made based on glucose level as measured throughout the day. Alternatively, some choose to measure a solitary blood sample, measuring serum fructosamine concentrations. Fructosamines are glycated proteins that result from an irreversible, nonenzymatic, insulin dependent binding of glucose to serum proteins. The extent of this glycosylation is directly related to the blood glucose concentrations. This is a similar test (but not the same) as glycosylated hemoglobin, which is a test run in people to determine the average blood sugar over about a 3 month period of time. Glycosylated hemoglobins can be run in dogs and cats but the test costs about double the fructosamine cost with not much benefit in information obtained.

The overall treatment goal is to maintain the blood sugar in as near a normal range as can be safely done. Ultimately, the goals simplify down to:

  1. Are we controlling the excess water consumption?

  2. Can the pet “hold” it’s urine overnight

  3. Is the pet maintaining weight? That is, has the weight loss stopped?

Dr. Ed Feldman, probably the world’s foremost authority on diabetes in cats, has stated over and over that the 3 things listed on the above list are by far and away the most important things for owners and veterinarians to pay attention too.

Feeding your diabetic dog/cat

Turns out snacking on food all day long is not a good idea for diabetes control. Not for any species. It also turns out that there are diets that make it easier to maintain control. For my feline diabetic friends, I suggest to feed one of the following.

  1. Low carb/canned diet (<7% carbs)

  2. If we feed dry food then: Hill’s M/D

  3. EVO dry

  4. Purina D/M

For dogs I suggest:

  1. Many dogs can be maintained on the food they were on. They don’t need another or a different food in many cases. The way that food is offered changes. Feed twice a day. Do not let the food sit out for snacking purposes all day long.

  2. If the dog has smoldering pancreatitis – or a low grade pancreatitis. I change the food to Low Fat Hill’s I/D or Royal Canin GI low-fat.

  3. Wait Doc… I feed Hills W/D…. my answer is… if that is what you are feeding and your dog is doing well… keep feeding it.

The bottom line is to follow the advice of the veterinarian you are working with in regards to what to feed, what type and dosage of insulin to give and how often. In general, we suggest: Feed twice a day. 10 to 30 minutes post meal – give an insulin injection. But you may ask “What if my dog or cat didn’t eat all of his/her food? Do I change the dose of insulin?”  This one drives clients crazy and most veterinarians crazy too. The real answer is there is no absolute correct answer 100% of the time. I will remind you of a few things. Pay attention to how the animal is behaving. Is it behaving normally but just didn’t eat all of its food, or is it acting lethargic or ill? The animal is a diabetic even if it doesn’t eat all of its food. Blood sugars will continue to rise even if it doesn’t eat or doesn’t eat all of its food. I would encourage you to call if the cat/dog is not eating so we can have a discussion about amount of insulin to give.

Well, that’s all I have for today. I’m sure this discussion may have triggered some questions and I certainly welcome those in the comments section below. I enjoy the interaction and your feedback is certainly my biggest reward for my efforts in writing the blog. So please keep those comments coming.

 

Until next time,

Dr. Voorheis

Welcome to 2015 – Is the blog really back?

first blog 2015
Welcome to 2015 – Is the blog really back?

May 5, 2015

From the Desk of Dr. Voorheis

I began writing this chapter a few months ago while in sunny Florida. Life has a way of
redirecting you sometimes. The looming question today is “is the blog really coming back?”
I am going with “yes” and we shall see how it goes. I started 2014 with a promise of a blog. I
had even hoped for a blog a week, which morphed into every two weeks which in my typical
fashion was biting off a bit more than I could chew. Stop laughing! But, I was able to write
25 blogs last year which considering everything else that needed to get done wasn’t half
bad if I do say so myself. Yes, there was a drop off in the production of the blog during the
last quarter of the year, mostly due to the fact that in spite of my best efforts, demands on
my time with regard to the construction of our new hospital can be overwhelming at times.

The blog, much like everything else I am involved in, is a labor of love. Connecting with
clients is very important to me and I am going to attempt to do that again this year. I’m not
sure what a reasonable goal will be in terms of numbers of blogs, but I’m thinking of trying
to keep them a little shorter while still retaining the information that I believe you all deserve.
In my humble opinion, one of the most important things in my blogs is that I deliver to you
the most current and relevant information as I understand it. I also am a huge believer in
NOT “dumbing down” topics to the point of insulting your intelligence. One of my non WBAH
physician friends tells me they are instructed to communicate in writing at the 6th grade
level. My goal in writing is the same as it is in my exam room which is to make complex
topics understandable. My hope is that I accomplish that with my blog topics just as I would
in my exam room.

So where are we for 2015? What is happening with the new building? Is it a figment of my
imagination? I’ll answer all of that in this blog. We have a lot going on and it is all great stuff!

The new construction is coming. It really is. As I sit here today, I can say it should start
within the next few weeks. I must confess that I had no real concept of what it takes to build
a hospital. The details that go into the planning and permitting process and the number of
city and county departments that must sign off on all the details is just astounding. I just
thought, in my naiveté, that “we will draw this thing out, get some plans done up, hire a
contractor and the building gets built.” I was wrong. I was so very wrong. The detail and the
planning take time. Lots and lots of time. Many people have asked me if the city planning
and building departments are the reason it seems to go so slow. That has not been my
experience at all; in fact it has been quite the opposite. The City of Whittier, from the
planning department to the building department to the public works department has been
supportive and “in our corner” from the very beginning. In fact, when it seems like we have
been stuck; the city has shown an uncanny ability to think outside the box to get things
done. It has been “slow” because this is a slow process. I can now truly appreciate just how
much work goes into putting up a new hospital or any new building. Our final approval to
move forward happened at a city planning meeting back in October. I want to thank our
clients for showing up at the planning commission meeting. Your support was overwhelming
to all of us and truly appreciated beyond what words can say. The construction of the new
building will happen in phases. At this time we are in a process of dotting “I’s” and crossing
“T’s” on contracts and final building permit stuff. As I said, it is a SLOW process I suspect
that this will feel a whole lot like nothing is moving at all at first and then suddenly it will be in
full swing. Phase one, as you might imagine will consist of various demolition projects, none
of which will profoundly affect the current hospital. I should take this opportunity to reiterate
that the current hospital will be up and running at full strength during the demolition and
construction process. We will of course eventually have some parking challenges but rest
assured we already have a contingency plan in place to address that issue. More on that
later.

So you may be wondering why I would head off to Florida in the midst of all this planning
and such. Well, I can assure you it was no vacation!  I was in Florida for the most intense
continuing education I have had since becoming a veterinarian back in 19…..as I mumble
under my breath.  As many of you know, part of the new building will house an area for
Physical Rehabilitation (for your critters, not me). I was in Florida starting the process of
becoming a CCRT (Certified Canine Rehabilitation Therapist). There is far more involved in
rehabilitation then being able to push the button on an underwater treadmill or wave a laser
wand at an injury. Requirements prior to the course were to read major parts of 4 veterinary
medical textbooks (Canine Sports Medicine and Rehabilitation, Miller’s Canine Anatomy,
Small Animal Orthopedics and Fracture treatment and Fossum’s Small Animal Surgery).

There were also 10 videos to watch and take notes on, each over an hour in length. Then I
took an exam so I could actually go take the class. The class was 9 hours a day, with a
brown bag lunch x6 days. I came back with binders about 9 inches thick full of notes. And I
said binders, plural. It was so much fun; I went and completed my second week of intense
study in April. My third and final week of intensity will hopefully be in June. I am waitlisted
for that one. If not June, then November for sure. Oh, and did I mention that I will also be
spending 40 hours volunteering with someone who is already certified for some “hands on”
experience. Finally, I will take the certification exam.  So why all the fuss you ask? Rehab
medicine is a big deal and the road to certification is difficult because there is just so much
to it. So much to learn and know.  Any of you who see a DPT or a PT (Physical Therapist),
may want to give them a shout out. They have spent as much time getting their education
as the M.D. who sent you to them. Yup, 4 years of undergraduate and 4 years of post-
graduate training. They have board certification specialties too!

You will laugh at this one… I know I did. My daughter said to me, “Dad, I’m so proud you
are doing this at”…. then her voice trailed off. I said, “Do you mean at my age?” I told her I
work long shifts and I prefer to think that I am in the afternoon of my working shift (career).
The truth is, I’m in decent shape and I have never enjoyed veterinary medicine more than I
do right now. Bringing an emphasis on rehabilitation to WBAH is needed and appropriate.

We have a large caseload of animals who will benefit from animal rehabilitation therapy. Pre
and post op orthopedic cases, neurologic cases, dog’s suffering from arthritis, cancer
patients, dog’s with sporting injuries and obese animals that can’t exercise just to name a
few. It is exciting to be able to bring this to our community.

On a more personal note, I’ll add this. I just told you that I am waitlisted for the June class. I
am waitlisted because that class had to be rescheduled from the original date in September.

Why? My daughter Grace who is so proud of me for doing this “at my age”, the Grace that
lives her name every single day, the Grace that owns her daddy’s heart…..Grace is getting
married! I am gaining a terrific son in law and I couldn’t be happier. Walking her down the
aisle outranks all else in my book. Well, if a critter needed emergency surgery we might
have an issue but aside from that…….. A class can be rescheduled!

So, the blog is back, and don’t worry… I haven’t forgotten that I left you all hanging… the
endocrine functions of the pancreas blog is coming. Thanks for continuing to read the blog
because I do enjoy writing it and I do enjoy getting your feedback as well.

Until Next time,

Dr. Voorheis

 

Pancreatitis

Pancreatitis

 

October 16, 2014

 

From the Desk of Dr. Voorheis

 

Ok, enough about growing vegetables in water tanks and hiking long distance to fulfill a lifelong dream. It was fun sharing those things with all of you but we’ve got veterinary medicine to talk about! And today we will dive into a timely topic here at WBAH, pancreatitis.

 

The pancreas is a complex gland that performs many vital functions in both a human body and in the body of our furry critter friends. Anatomically, it lies next to the greater curvature of the stomach and the portion of the small intestine called the duodenum. It performs both exocrine and endocrine functions. Endocrine function means it makes hormones. Many of you are familiar with one of the hormones the pancreas makes which is Insulin. If the pancreas stops making insulin, you become a type 1 diabetic. Type 1 diabetics are dependent on daily insulin injections. This is true for humans and animals alike. The pancreas makes other hormones as well such as glucagon, somatostatin and pancreatic polypeptide. These hormones are secreted by specific cells scattered in the pancreas called islet cells. The endocrine function of the pancreas will be the subject of another blog because there is so much to say on that subject. This blog will be a bit more compact and concentrate on exocrine function. Endocrine and exocrine functions are intertwined and work in tandem with each other. The close association of endocrine and exocrine cells in the pancreas allows them to coordinate digestion and metabolism which is a good thing. But it also means the two are linked together when things go wrong.

 

The exocrine function of the pancreas is to secrete digestive enzymes and bicarbonate.  These enzymes are produced by cells called the acini. The pancreas secretes all of the enzymes and enzyme precursors necessary for the digestion of proteins, fats, and carbohydrates. These are secreted as proenzymes and are converted to the active form once they reach the intestine. “Digestion” of the pancreas is prevented because these enzymes are secreted in the proenzyme form. Pancreatic lipase works to break down dietary triglycerides (fats) into substances that can be absorbed. Lipase needs bile salts in order to be activated. The bicarbonate is secreted because the digestive enzymes require an alkaline pH to work. Still with me?

Anatomically, the pancreas has ducts that serve to transport the digestive enzymes into the intestine. In the dog, there are usually two pancreatic ducts and in the cat there is usually one and it joins with the bile duct before entering the duodenum. In addition, the bile duct, transporting bile from the liver into the intestine, travels through the pancreas to reach the intestine.  In the normal animal, pancreatic secretion is triggered by the thought of food and the stomach filling with food, and most importantly by the presence of fat and protein in the small intestinal lumen.

Pancreatitis is the inflammation of the pancreas. It can be defined as acute pancreatitis and chronic pancreatitis. Acute pancreatitis is recognized more often in dogs and chronic pancreatitis recognized more often in cats. Think of pancreatitis as the disease that occurs when digestive enzymes that are meant to be “dumped in” to the intestinal lumen, instead are activated within the pancreas itself. Pancreatitis affects far more organ systems than just the pancreas too. The gastro-intestinal tract is affected; heart and lungs can be affected, the liver can be affected, and in severe cases we can see activation of the coagulation cascade. In cats, pancreatitis is often associated with inflammatory bowel disease and cholangitis and cholangiohepatitis which are liver diseases. It can be seen with any breed of dog or cat. In the dog, Miniature Schnauzers, Miniature Poodles and Cocker Spaniels are over-represented. In cats, it is seen more often in DSH (domestic short-haired) and Siamese. In the dog, they present with primarily GI tract signs. (Vomiting, anorexia). In the cat, the signs are vague, and non-specific. A painful abdomen is common in dogs. Sometimes we appreciate a painful abdomen in cats, but not always. Cats will often present with weight loss. Since is more often an acute disease with dogs, weight loss is not a common complaint. With the advancement of tests specific to diagnose pancreatitis in both dogs and cats, the diagnosis is achieved readily. The treatment can be both straight forward and challenging.

 pan1

So what causes pancreatitis? There are a number of causes. In the dog, it is often linked to ingestion of a high fat meal. However, it can be caused by pancreatic trauma, certain medications, pancreatic duct obstruction or high levels of blood calcium. In the cat, throw in certain infections such as toxoplasmosis, FIP and extensions of feline liver diseases and IBD (inflammatory bowel disease). There are sometimes when we diagnose pancreatitis and have no known reason or cause. By far the most common cause is feeding a high fat meal to a dog. Giving a dog the “table scraps” (the fat we don’t eat on our steak for example, or chicken skins) is often in the history of a dog with acute pancreatitis. Another reminder to not feed your dog table scraps.

We know we see a higher incidence of the disease in obese pets or in dogs that have concurrent disease such as Cushing’s disease or Diabetes Mellitus. As usual, dogs and cats don’t come in with a sign that says – my pancreas hurts, or better yet “I’ve got pancreatitis”. The symptoms they arrive with are identical to signs seen with a number of other disease conditions such as GI disease (gastritis, gastroenteritis, foreign body, gastric ulcers), liver diseases without jaundice, Addison’s disease, inflammatory kidney diseases, uterine infections, prostatitis and others. A careful history will eliminate some of these but xrays, laboratory work and ultrasound may be necessary to diagnose pancreatitis and eliminate these other diseases.

Pancreatitis in the dog is almost always managed in the hospital setting. These guys need aggressive IV fluid therapy and pain management. In addition, we use IV anti-emetic agents to help control the vomiting. Often these drugs are administered as a CRI (continuous rate infusion). We “rest” the pancreas. Not feeding the dogs for a 24 hour period of time. We will try to introduce safe foods as soon as possible. Depending on the severity of the disease, sometimes a J-tube is placed (a tube that by-passes the portion of the intestine the pancreas is adjacent too).  Some of these animals need extended hospitalization, most do not. Many of these dogs are managed long term by dietary fat restriction.

pan2 

Chronic pancreatitis is a far more challenging condition and is one that seems to affect our feline friends. Many of these cats have other associated conditions. These conditions need to be managed in order to manage the pancreatitis. Some, but not all, of these cats will respond to a low fat diet. Some, but not all, respond to the addition of pancreatic enzymes in their food. Some of these cats require potent anti-inflammatory medications to control both their pancreatitis and other associated conditions. These guys are treated on an individual basis, based on their specific needs. They are indeed a challenging group. It is not unusual for cats to also develop diabetes mellitus as a result of their chronic pancreatitis. I consider feline pancreatitis amongst the more challenging diseases I treat because of the difficulty and the chronic nature of the condition.

So much more can be said about Pancreatitis but I think this is a good place to stop so that I don’t send anyone into a state of crossed eyes and confusion.

Next blog in two weeks will be on Diabetes Mellitus. Until then…….

Dr. Voorheis