Thursday, July 23, 2009

Senior cats and the silent killer

As most of you know, The Country Doctor has been home to Lucky the cat since he arrived at the clinic 9 years ago as a tiny 0.7 lb kitten. We like to tease him because as cats go, well, he doesn't have much of a personality. He really is kind of a cool cat to live at a clinic though. When he came to us, he had a badly deformed rear leg. His bad leg has always prevented him from jumping up on counters and the like. Also he has a cataract in one eye and I'm sure this messes up his depth perception so that he doesn't like to attempt to jump up on things. This is a really good thing for a cat that lives at a veterinary clinic since there is lots of "stuff" on the counters that should not be messed with by a cat. Unfortunately, this past week, Lucky was diagnosed with kidney disease. We are very early into the treatment and diagnosis so his prognosis is really unknown at this point. Kidney disease is never good, but if a cat has the chronic form of the disease, they usually do better than those with the acute form. It will be at least a week or maybe a few weeks until we can determine what form Lucky has. I'll keep you posted on Lucky's progress as time goes by.

Since the staff and I are personally involved with a cat with kidney disease, I thought this would be a good blog topic. Kidney disease in middle aged and older cats is probably the second most common disease we see (dental disease being #1). Unlike dental disease though, kidney disease is a true silent killer. Cats will have kidney disease for months or possibly a year or more before any symptoms are seen. In fact around 65% of the kidneys have to quit functioning before the very first symptom is visible and that would be a slight increase in thirst and an increase in the amount of urine produced. Not many owners will pick up the disease at this stage. In fact, I probably wouldn't pick it up in my own cats because it is so subtle. Next, when 75% of the kidneys quit functioning, the cat will finally have abnormal blood test results. Even at this stage, most cats will seem normal although some cats will start to show a little weight loss. As the disease gets worse, the cat will lose more weight, have a gradual loss of appetite and may start vomiting. All this time, most cats will still urinate more than normal. The poorly functioning kidneys in their failing attempt to get rid of waste products in the bloodstream will let more and more water escape from the kidneys and out of the body. Unable to keep up just by drinking more water, these cats are very slowly dehydrating themselves to death.

Like I said before, kidney disease is never good, but if caught early, this is one disease where a SIGNIFICANT impact can be made to the cat's quality and quantity of life. And I'm not talking heroic measures here (although kidney transplants are being regularly performed in cats in this country). I'm talking some VERY simple changes in the cat's life. But first, we must catch this disease in the early stages before the cat starts acting sick. Folks, this is why we stress the importance of yearly blood work in our older cat patients. In a moment I'll tell you why, if we catch this disease early, what a difference can be made. You will be stunned!!!!!!!!

When a cat is diagnosed with kidney disease, it will fall into one of four stages. Stage 1 is the earliest stage when the blood work is normal. We do not catch cats in this stage very often. Stage 2 are the cats with abnormal blood work, but are still feeling good. This is where we can do the most good. Stage 3 and 4 cats have a worse long term prognosis because their disease is further along, but we can often help most of these cats at least somewhat. Also cats that have lots of protein in their urine have a worse prognosis. Cats whose kidney blood tests get worse in the first few weeks have a worse prognosis. This points to the need to recheck blood work every month or so at the very beginning.

So here is where several different scientific studies of cats with kidney disease have had similar findings. If I diagnose a cat with chronic kidney disease and do nothing, the average amount of time until that cat will die is about 6 months. If the owner can get the cat to eat a veterinary prescription diet (which believe it or not is possible in 90% of cats and if an owner is persistent enough), the average amount of time until that cat will die is about 18 months and some studies have average survival times of over 2 years! That is extending life span by 3 times just by changing the diet. BUT we have to catch the disease early!!!!!!!!!!!!!!!!! One thing to note though is that there is really no benefit to changing to a veterinary kidney diet in a cat that does not have kidney disease. Diet is an important treatment for kidney disease, but it does not prevent the disease from starting in the first place. In addition to diet, there are other treatments available that have a major impact in both quality and quantity of life in a cat with kidney disease. You may read about subcutaneous fluids, blood pressure medicines, B vitamins, potassium supplements, hormonal treatments, phosphorus binders and stomach protectants to name a few. Not every medicine is appropriate for every patient, but if needed, they can make a big difference to an individual cat.

So meet Snow. Snow is a cat owned by our very own veterinary assistant Ashley. Snow was diagnosed with chronic kidney disease 4 years ago. He was started on Hills Prescription Feline k/d diet and a hormonal treatment calcitriol. Unfortunately, he developed side effects from the calcitriol so we just kept him on the kidney diet and monitored his blood work periodically. This year he started experiencing some occasional vomiting, but he has responded well to periodic administration of a small amount of Pepcid. Four years is longer than average, but it just goes to show how just a change of diet and then the later addition of just one medicine has made all the difference to Snow's life.

Wednesday, July 15, 2009

Is a puppy's life worth $24?

In this day and age, it is almost inconceivable to me that an 8 month old puppy could show up at the clinic with parvo, but it happened two days ago. And this is not a rare occurrence. Sometimes the owner is not aware of what parvo virus is, but more often than not, they tell stories of a relative's puppy or a friend's puppy or even a puppy they owned years ago that died of parvo.

So what is parvo virus? Well, it's a virus that showed up in the late 1970's and causes primarily severe vomiting and bloody diarrhea although the heart can be affected too mostly in young puppies. Sometimes owners will just find their puppy dead with little or no symptoms. Up to 90% of unvaccinated puppies and dogs will die if left untreated. Even with treatment, some dogs will die. Treatment can be expensive depending on how severely the disease attacks the puppy. I've seen treatment cost over $1000. This is a nasty virus! I have seen puppies die from this disease and it is horrible.

Enter the vaccine. Although no vaccine is 100% protective of a disease, I can honestly say that in my 23 years as a veterinarian, I have never seen a properly vaccinated dog get parvo. Oh I've heard about cases, but never actually had one myself. I have seen puppies that have received 1 or 2 vaccinations (but are not done with their entire series of vaccinations) get parvo virus. That is something that does happen sometimes and of no fault to either the owner of the puppy or the vaccine (there is a good scientific explanation why this happens, email me if you really want to know). So in a nutshell, there is a good vaccine and it needs to be used PROPERLY!

So this 8 month old puppy that had parvo had its "puppy shot". Hmmmmm? It had one shot before it was 4 months old. Not good enough. It bugs the heck out of me when a breeder sells an 8 week old puppy and tells the buyer that the puppy has had "all of its puppy shots". Well, yeah, it may have gotten a vaccination at 6 weeks old and that's all the shots it needs, uh, until it is 9-10 weeks old and then it needs another AND then another after that AND another after that. So I guess technically the breeder is correct in that the puppy has had all the shots it needs at that moment in time. They neglect to educate puppy buyers about the need for a complete series. Now, before the breeders out there get on my case, most breeders are very good about telling buyers about needed follow up shots, but you would be surprised how often this part is neglected.

About now, some of you may be asking, what about the $24? I'll get to that in a moment. I think everyone knows it costs more than $24 to take a puppy to the vet for 3 to 4 visits and get the proper vaccinations. I also hope that most people know there is way more value to the veterinary visit than just getting "shots". Oh let me count the ways...............
  • the physical exam (the most important part)
  • making sure the puppy gets vaccinated with the correct vaccine, the right number of times and the correct number of weeks apart. (all VERY important)
  • discussing what us veterinarians call "non-core" vaccinations, for example, Lyme Disease vaccination and Kennel Cough vaccination. Is it right for YOUR puppy or not?
  • counselling on keeping human family members safe from diseases that they can get from their puppy (zoonotic diseases, a favorite discussion of mine. more on this in a future blog)
  • counselling on behavioral issues (training, play biting, chewing, housebreaking, this list is nearly endless)
  • counselling on nutrition (obesity now affects between 40-60% of our pet population)
  • preventative health care for heartworms, fleas, roundworms, whipworms, hookworms, tapeworms, etc.
  • why microchipping is a good idea
  • information on pet health insurance (this is the future of veterinary health care as owners want more sophisticated diagnostics and treatments which all cost money)
  • spay/neuter counselling
  • care of the teeth (85% of pets will develop dental disease in their lifetime)

See there really is some value. Never ever be afraid to ask us questions. We don't have all the answers, but if we don't know, we usually know where to find the answers.

By now, you are all saying "would you PLEASE get to the part about the $24!". Ok, I will. You see, a parvo vaccine costs around $6 at the local feed mills. A 6 week old puppy will need a total of 4 vaccinations given once a month over the span of 4 months. $24. So if you want your puppy vaccinated in the most correct and safest way possible and have access to a professional that can answer a billion and one questions on pet health care, please have it vaccinated by a veterinarian. There is value there. But if you REALLY can't afford vet visits, spend the $6 a month for 4 months and then I won't see your 8 month old puppy showing up at my clinic with parvo. It just should not happen. End of sermon.

Thursday, July 9, 2009

In memory of Harlee

Harlee and his family have been coming to the clinic since 1997. Last month, Harlee died. On Thursday July 9th, I received a very special gift from a very special young lady. She drew this picture of her dog Harlee under the Rainbow Bridge. It touches my heart when children show such thoughtfulness and grace. The human-animal bond is indeed strong.

Just this side of heaven is a place called Rainbow Bridge
When an animal dies that has been especially close to someone here, that pet goes to Rainbow Bridge.
There are meadows and hills for all of our special friends so they can run and play together.
There is plenty of food and water and sunshine, and our friends are warm and comfortable.
All the animals who had been ill and old are restored to health and vigor; those who were hurt or maimed are made whole and strong again, just as we remember them in our dreams of days and times gone by.
The animals are happy and content, except for one small thing: they miss someone very special to them; who had to be left behind.
They all run and play together, but the day comes when one suddenly stops and looks into the distance.
The bright eyes are intent; the eager body quivers.
Suddenly he begins to break away from the group, flying over the green grass, his legs carrying him faster and faster.
YOU have been spotted, and when you and your special friend finally meet, you cling together in joyous reunion, never to be parted again.
The happy kisses rain upon your face; your hands again caress the beloved head, and you look once more into the trusting eyes of your pet, so long gone from your life but never absent from your heart.

Welcome to my blog

Hi everyone! Well, let's just get started. I am a small animal veterinarian in a small town in the far northeastern corner of Ohio. Yep, right up by Lake Erie in the land of "lake effect" snow. But I guess it's July and well, we won't have worry about that for another 3-4 months.

So why blog? As a primary care / family doctor for your furry "kids", my job involves a lot of preventitive heath care and education. If you ask me, reading articles on health care topics can get pretty darn boring at times. Enter the age of myspace, facebook, texting, twitter and of course blogging, Much more casual, fun and interactive than reading a piece of paper! And I get to write grammatically incorrect sentences too!

Which brings me to the goals here:

  • Give glimpses into the life of a small town veterinarian
  • Education on health care topics for your pet
  • Have fun!

Most of my inspiration for topics will come out of my day to day life, but if anyone has a topic of particular interest that they would like to know about, feel free to email me. Funny stories and comments are more than welcome.

Blog on!!!!!!!!!!!!!!!!!