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

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.

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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!

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

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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.

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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.

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

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

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

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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.

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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.

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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.

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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.

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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.

 

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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.

 

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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

 

Aquaponic Gardening

Aquaponic Gardening…….another hobby

 

October 2, 2014

 

From the desk of Dr. Voorheis

 

At the beginning of this year, I said that most of he blog would be about veterinary medicine and every once in a while I would write something a bit more personal for good measure. This week, it’s personal. I’d like to take you all on a gardening and science adventure and tell you all about one of my favorite hobbies….Aquaponic gardening! 

I have always been a gardener. Going back to being a kid in a rural setting, there were always spring and summer gardens. I’ve carried that through my adult life as well. There is nothing quite like home grown vegetables. They actually have flavor because they ripen naturally as opposed to being ripened by exposure to ethylene gas. They still have vibrant flavor as opposed to those selected for toughness of skin and even ripening so they can be picked by automated machines.  As much as I don’t want to sound like someone yearning for the “good ole days”, vegetables used to taste better than they do now, especially tomatoes. Yet I have also had my share of frustration with my traditional gardens. Tilling the soil and pulling weeds is not exactly how I want to spend my  precious time off. Although I will admit to some satisfaction from digging in the dirt, it is not nearly as much fun as I might romanticize it to be. In all honesty, I can gear up to working in the soil only a few times a year. It’s not much fun to have to maintain my backyard garden week in and week out. Really, the time just isn’t there.

I also like to tinker on things, build things. So when I found out a little bit about aquaponics, I thought it sounded pretty darn cool. “Doc – Aqua what?”  Aquaponics is a food production system that combines conventional aquaculture (raising aquatic animals such as fish, crayfish, or prawns in tanks) with hydroponics (cultivating plants in water) in a symbiotic environment. With aquaculture (think most of the fish that we eat or buy in the grocery store), fish are raised in large tanks in a closed system. The waste products of these fish in an intense grow system require that at least 10% of the water needs to be removed and exchanged every day. If the waste products from the fish are not addressed on a daily basis, waste products accumulate and the water becomes toxic and the fish die. A tremendous amount of monitoring has to happen in these tanks where fish are raised for food.  Aquaculture is a very water intensive process. It doesn’t sound attractive to an environment that is in the middle of a drought. 

Hydroponics is the raising of plants in media (soil free, i.e. rocks or hydroton) being fed a nutrient solution (water + needed nutrients) tailored to the requirements of the plant species.

As with aquaculture, hydroponic operations need to carefully monitor the water environment to ensure the highest yield. 

In an aquaponic system, water from an aquaculture system is fed to a hydroponic system where the by-products are broken down by nitrogen-fixing bacteria into nitrates and nitrites. The nitrates are utilized by plants as nutrients. The nitrites are further broken into nitrates by other bacteria. The water is then drained and re circulated back to the fish, oxygenated and void of its toxic nitrogenous waste. There is no need to remove water from the system.

In brief, by combining the two systems, they complement one another perfectly. Fish produce the nutrients that the plants need, bacteria in the grow beds remove the nutrients that kill the fish, and oxygen levels are maintained by the cycling of the water through a natural system similar to that found in nature.

A few years ago, I decided to try this aquaponic thing. Mostly I didn’t know what I was doing, but I read and researched as much as I could on the subject. I found out I would need a few grow beds, a large tank of water for the fish (275 gallons), and a sump tank (also 275 gallons). For a backyard gardener raising fish, I learned tilapia were probably the most resilient fish when it comes to temperature fluctuations and other screw ups by the farmer.  Believe me when I say I screwed things up more than once and tilapia are a very resilient fish.

 

Aqua1

I built 3 grow beds (3’ x 6’ x 1’). I then lined them with pond liner. I put a large pump in a “sump” tank (a large IBC tote cut to hold 275 gallons of water. I used another IBC tote as a fish tank. Water is pumped continuously to the fish tank and to the grow beds. When the grow bed fills, the water is returned to the sump tank by means of a “Bell Siphon” pictured above.

Aqua2

My pumps (there are two) because of distances of grow beds to sump tank, are powered by solar energy (in fact my whole house is but that is another subject).

Aqua3

The sump tank as it initially filled.

 Aqua4

This picture is one of the grow beds a month into the first growth cycle. The grow media is “expanded shale”. It takes about a month, of plants only, for the water to complete the nitrogen cycle. Cycling is really shorthand for the establishment of a biofilter where the nitrogen cycle can take place within your system. The nitrogen cycle is the ongoing process in which bacteria convert ammonia and nitrites into food that your plants can consume. That food is nitrates.

 Aqua5

This is another grow bed about a month into the first cycle with strawberries and cilantro. I have grown the following vegetables and herbs with significant success:

 

  1. Tomatoes – all types
  2. Swiss chard
  3. Onions – yellow and white
  4. Garlic
  5. Basil
  6. Cilantro
  7. Parsley
  8. Brocolli
  9. Cauflower
  10. Peppers – all types
  11. Strawberries
  12. mint
  13. rosemary
  14. Romaine lettuce
  15. leaf lettuce
  16. spinachMy current winter crop is an entire grow bed devoted to lettuce. I also have basil, peppers, and cauliflower started for fall. Tomatoes are still producing too. I’ve got a number of different herbs growing as well. Less success with squash and cucumbers… I still grow those in dirt.Aqua6

    One of the end products was these fish. They were harvested at a BBQ at my house over Labor Day weekend. It was fun because anyone who wanted fish literally had to catch their own fish! These tilapia were about 14 to 15 inches in length and weighed over a pound each.

    I enjoy my aquaponic garden a great deal. I undertook the project because it was challenging, fun, and I wanted to learn more about a different way to garden. It has also given me a lot to think about. I will now jump into some uncharted waters. Whether or not   you think “Global Warming” is real, or that our climate is changing, it is undeniable that we are suffering a significant drought here in the West. It seems rather evident to me that it makes sense to pursue gardening and farming practices that conserve water, and certainly aquaponics uses a fraction of the water of traditional agriculture practices without using any fertilizers or pesticides. This is sustainable gardening at its best.  In some countries of the world, for example Australia, aquaponics has huge support on the government level and on the individual level because of the opportunity to produce a significant amount of food using smaller space and less water. I believe that eventually aquaponic gardening will take off in popularity, simply because it makes sense and it works.

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

     

    Dr. Voorheis

Kennel Cough And Other Canine Cooties

Kennel Cough and other Canine Cooties

 

From the Desk of Dr. Voorheis

 

September 4, 2014

 

 

The timeliness of this week’s blog is certainly no coincidence. Some of you are already aware of the recent events at Boulevard Grooming and Boarding (the facility behind us that we operate) but for those of you who aren’t, this blog will explain in detail what took place, why it happened and what we did to resolve the situation. It’s important that you all hear this from the horse’s mouth so that details are clear and concise and stories do not evolve with inaccurate facts. Recently, at Boulevard Grooming and Boarding, a number of dogs showed signs of upper respiratory disease. It is not at all uncommon in boarding facilities to have this happen to the occasional dog, but in this circumstance there were more than we (Drs. Voorheis and Throgmorton) were comfortable with. So, PCR testing (DNA) was done on 4 of the dogs and that revealed the reason for the coughing to be a viral disease there was no vaccination against, Pneumovirus. The boarding facility was shut down for a week and all surfaces thoroughly disinfected. Disinfection in both the boarding and hospital facilities is done daily, but what happened during that week was a deep cleaning the likes of which were beyond impressive. I must share with all of you that this has never once happened in the 30+ years that I have been at WBAH. We have never had to shut the boarding facility down.  This decision was inconvenient for clients who had made plans to board their dogs but easily understandable from the point of view of safety for their animals and the other animals scheduled to board. This was absolutely the right decision for us to make. Having said that, we do realize it caused a great deal of annoyance and for that we are truly apologetic. Please know that we will always make the right decision for the health and safety of your animals. They are our absolute first priority.  

Every dark cloud has a silver lining, right? Our silver lining is that this unexpected situation enabled us to review our vaccination policy for boarding and grooming animals even though this “episode” was caused by an organism that there is no vaccination for. We decided to look at diseases that are generally more common and that we do have vaccinations for. Due to the amnestic response (immune memory), dogs who had previously received a booster against bordetella were “ok’d” to get that booster on entering the facility. This policy has now changed. We are now requiring that the bordetella booster to be given one week prior to boarding/grooming. This gives them their absolute best protection against illness. The goal is to prevent any further preventable situations.

As outlined above, it is clear that this episode was caused by a viral infection that there is no vaccination against. It is worth reiterating that there is risk involved when you take your dog to a grooming/boarding facility. There is risk involved when you take your dog to any place where numbers of dogs have gathered. I guess you can say life is a risk. I would ask any client to consider a number of things before making a decision to groom or board their dog. Are vaccinations current? Is my dog coughing now, or recently had a cough? Upper respiratory organisms can be shed for a month following infection. If your dog is recently recovering from an upper respiratory infection, don’t groom or board it. Does your pet have increased risk factors such as existing cardiovascular disease or lung disease? That pet may not be an ideal candidate for boarding. Is your pet on chemotherapy for cancer? This too may not be an ideal candidate for boarding.

Bear in mind that in spite of significant efforts at cleanliness and disinfection, exposure can still take place. The best analogy is sending a child to school or taking an airline flight and then coming down with a cold or flu. “Cooties” are out there for humans and animals. They are airbourne and they attack. Some of them can be vaccinated against and some cannot. Your best defense is vaccinating against what you can and really think about any risk factors that your pet may have and let that guide your decision. This applies to any grooming or boarding facility you may consider as well as places like dog parks or other places where numerous dogs gather. 

So, let’s talk about what is behind all of this, medically speaking.  Canine Infectious Respiratory Disease Complex. Wow! That’s a mouth full.  Let’s talk about this disease, the body’s defense mechanisms, and our current understanding of the diseases involved. It turns out that “kennel cough” is not just one disease. The signs can be caused by a number of different organisms with different severity of signs and different treatments.

Let’s talk about the dog’s defenses against disease first. In the respiratory system, there are three levels of defense. The first level is the mechanical barrier level. Mechanical barriers are things like mucus, enzymes and the mucosa itself. These guys work to inhibit attachment and facilitate clearance of organisms in inspired air. Then there is the second level of defense, an immune response called the innate response. There are circulating white blood cells that move out of the blood into tissues. They recognize certain molecular patterns associated with pathogens. These cells types are phagocytic (engulfing) cells, neutrophils, basophils, mast cells, eosinophils, and natural killer cells (T-lymphocytes). They are what is called non-specific, so they do not have an “immunologic memory”. The third level of defense is an “Acquired Immune Response”. This has to do with lymphocyte development and memory. It is this level of immune response that we are stimulating when we vaccinate. We talked about some of this in my vaccination blog. That blog, at this point, would be an excellent one to go back and refer to.

 

  Dogresp                                                 

 

Allow me to give you a little more detail on the mechanical barrier. The majority of micro-organisms that we inhale every day are handled by anatomical or mechanical barriers. Bacteria, dust, viruses are suspended in inspired air. The conducting airways use turbulence and decreased velocity to accomplish filtering inspired air. This causes these particles to be directed onto mucus-covered walls where they can be easily cleared. These mechanical barriers include the complex turbinate structure of the nose, the changes in angle and direction of the pharynx and larynx, and the multiple branching pathways of the bronchi. In addition, the bronchi and trachea have things called mucociliary escalators. These are the cells that line these airways and are constantly moving to “escalate” the mucus out the bronchi and up the trachea where it can be cleared.

Now for a bit more detail on the innate immune system. That mucus I mentioned? Filled with host defense molecules, defensins, lysozyme, surfactant proteins; these have anti-microbial activity. These substances are secreted by the epithelial cells lining the airways into the mucus. Yes, it turns out someone other than Dr. Egon Spengler studies mucus! Anyone know who that is? Extra credit from me if you do! Anyway, the epithelial cells lining the airways have pattern recognition receptors. These both trigger and amplify the immune response to infection. Then there are patrolling white blood cells that are directed to where the immune response is occurring. These guys engulf the pathogens allowing them to be cleared by expectoration (coughing) or swallowing.

Last, but certainly not least, a little more information on adaptive/acquired immunity. At the same time the above is happening, mucociliary clearance is presenting the organisms to mucosa associated lymphoid tissue (MALT) or bronchial associated lymphoid tissue (BALT). This is lymphoid tissue either in nose, pharynx or nasopharynx (MALT) or trachea and bronchi (BALT). The MALT guys get to work producing an immunoglobulin (IgA). Mucosal antibodies work by immune exclusion or immune elimination. IgA works by immune exclusion. This prevents adherence of bacteria and viruses to epithelial surfaces. IgA is not bactericidal and is fairly short lived. BALT tissues produce IgG, these immunoglobulins are potent activators of destruction of the micro-oganisms by opsonization (the process by which a pathogen is marked by destruction by a phagocyte), and virus neutralization. These guys mediate the immune elimination of the infection by controlling an arm of the immune system called humoral immunity (IgG, IgM and IgE). They get activated if organisms evade IgA and gain access to tissues. They are bactericidal and they have long immunologic memory.  These are the cells that we activate when we give an injectable vaccination.

Now that you have some relevant information on the defense system, let’s talk about canine infectious respiratory disease (CIRD).  Canine infectious respiratory disease (CIRD) is also known as “Kennel Cough” or “Shipping Fever”.  These are a highly contagious group of infections that are spread through respiratory secretions. These secretions are aerosolized when an animal coughs or sneezes, thereby facilitating exposure especially where there are dogs gathered in moderate to large numbers such as dog parks, grooming and boarding facilities, pounds and shelters, rescues and veterinary hospitals. “Fomites” (inanimate objects such as tennis balls, rope toys etc) can be the source of infection as the organisms can survive on inanimate objects for over 48 hours. These pathogens colonize airway epithelium, the nasal cavity, larynx, trachea, the bronchi and bronchioles. They act to disrupt mucociliary clearance. This disruption or dysfunction allows further colonization by other viral and bacterial pathogens. There is a wide range of clinical presentations, from mild self-limiting disease to severe life-threatening disease, although that is fortunately rare.

For years, we have known that the primary agents of CIRD were either Bordetella Bronchiseptica + canine parainfluenza virus (CPV2) or Bordetella Bronchiseptica + canine adenovirus2. These agents can act by themselves or in combination with one another. This knowledge or paradigm is what most veterinarians practiced with for years and years. We know now there are many other causes for CIRD (canine infectious respiratory disease). A more complete list is below. Vaccination is not available for every organism on this list.

 

  • Bordetella
  • Canine Adenovirus type 2
  • Canine Parainfluenza virus type 2
  • Canine influenza virus
  • Canine respiratory corona virus
  • H1N1 influenza virus
  • Mycoplasma cynos
  • S.Equi zooepidemicus
  • canine pneumovirus
  • canine herpes virus
  • canine reovirus

 

So what does it look like when you dog is infected with one of these organisms? Signs relate to the degree of respiratory tract damage and range from non-existent to severe. In uncomplicated cases the cough is a dry hacking cough, followed by gagging or expectoration of mucus. Exercise, excitement and pressure of a collar all seem to stimulate cough. Severely affected animals may be inappetant (not interested in food), be lethargic and have trouble breathing. Fortunately, this group is uncommon. The vast majority of dogs with this presentation are treated as outpatients. Antibiotics are used for this group because many of these cases are infected with bacteria, or an organism that is responsive to antibiotic therapy. Cough suppressants may be used to treat these outpatient animals as well. Lastly we will also use bronchodilators to relieve bronchospasm.

There is a subset of dogs that present very ill, with pneumonia. These dogs are treated with IV antibiotics, supportive care including IV fluids, oxygen therapy, nebulization (a process in which antibiotics are put into a small amount of saline and aerosolized into the air the animal breaths. The highest risk dogs for this group are the very young, the very old or dogs with existing heart and lung disease. Animals who are undergoing chemotherapy for cancer would also be an at risk group as mentioned above.

 

Prevention 

Prevention can be broken into a couple of categories; risk reduction and vaccination.

Vaccination:

Studies done at the Western College of Veterinary Medicine, University of Saskatchewan, and published in the Journal of the American Veterinary Medical Association have given us the best information on how to protect dogs against Bordetella.

 

1. Puppies – who have never been vaccinated.

a. First vaccination – intranasal/oral vaccination

b. 4 weeks later – subcutaneous vaccination

 

Studies also showed that two subcutaneous vaccinations in puppies spaced 4 weeks apart were nearly as effective as “a” above.

 

2. Adult dogs – subcutaneous vaccination annually.

                  dogs1                dogs2

 

Risk reduction:

 Reducing risk is reducing exposure. This would mean don’t take your dog to dog parks, to dog shows, don’t board your dog at a boarding facility. Don’t take your dog to a grooming parlor. Don’t walk your dog through a pet supply store. The lobby of a veterinary hospital is also a place where exposure could take place. Of the list above, boarding is probably the highest risk. Why? Large populations of dogs, stressed because they are not at home, shedding organisms as outlined above and sharing a common air supply. Is the list above realistic? Absolutely not. We cannot have our animals live in a bubble anymore than we ourselves can live in a bubble. We can only educate ourselves and do things that attempt to reduce risk. As I have outlined above, even vaccinated and “protected” dogs can come down with signs of “kennel cough”. There is NOT a vaccination to protect against all organisms that can cause upper respiratory disease in the dog. Sad, but true.

I hope this blog has given you all some solid information and some things to think about. In closing, I want to thank a couple of people for this blog. First, John Barrier from Zoetis.  Zoetis is the pharmaceutical company that was formerly Pfizer Animal Health. John offered me the opportunity to have a two hour long sit down with Dr. Stephan Carey, a respiratory specialist who teaches at Michigan State University. The second person I’d like to thank is Dr. Carey himself. Dr. Carey was visiting the southland in late spring, and was gracious enough to give myself and 4 other veterinarians a couple of hours of his time (and his lecture notes). Most of this blog is a direct carryover of the information he shared. I believe he also shared that his young son was an avid Los Angeles Kings hockey fan. I’d say that young man had a good June.

 

Until next time,

 

Dr. Voorheis