Archive for the ‘Veterinary Diagnostic Procedures’ Category

Murphy and Ruska

September 5, 2011

I refer to my last week at work as the “Murphy and Ruska Show” in honor of two delightful patients who arrived at my doorstep one day apart, each with a life-threatening disorder called pneumothorax. “Pneumo” means air and “thorax” refers to the chest cavity, so “pneumothorax” is air within the chest cavity.  If you’re scratching your head wondering, “Isn’t there supposed to be air in the chest cavity?” here’s what you need to know.  While the lungs are air-filled, the space surrounding the lungs, known as the pleural space, is normally devoid of air.  Pneumothorax refers to the accumulation of air with the pleural space. In order to understand how a pneumothorax causes difficulty breathing, it helps to think of the chest cavity as an empty barrel into which the lung lobes expand as they inflate (like balloons filling with air).  The lungs readily inflate with minimal effort because negative pressure (a vacuum effect) normally exists within the pleural space.  Fill the pleural space with air and the negative pressure is disrupted resulting in more effort required for lung expansion.  Make sense?

Murphy and Ruska were both observed by their families to experience an abrupt onset of labored breathing. Murphy also became subdued, a marked deviation from his normal wiggly-waggly Labrador self and he was unwilling to lie down.  Clever Murphy figured out that lying down makes labored breathing even more of a struggle.  In addition to working extra hard to breathe the normally ravenous Ruska refused her breakfast, a sure sign that this sweet Shepherd was off her game.

Normal Chest

The two most common causes of pneumothorax are penetrating chest cavity wounds that allow external air to enter the pleural space and leakage of air from the surface of a diseased or injured lung lobe.  Pneumothorax is readily diagnosed with a chest x-ray.  Have a look at the accompanying normal and abnormal x-ray images. In both views, the dogs are lying on their sides with their head end to the left and their tail end to the right.  You can see the spines at the top of the images.  Note the heart, the whitish round structure in the middle of the chest cavity. Air shows up black on an x-ray. Now notice how much more black (air) there is surrounding the heart in the pneumothorax image compared to the normal chest. Makes you want to become a radiologist, eh!

Pneumothorax

Murphy and Ruska were referred to me to figure out why they had leaky lung lobes.  The most common cause of pneumothorax is a blunt blow to the chest cavity (hit-by-car trauma is classic) forceful enough to tear a lung lobe and allow leakage of air into the pleural space. Ruska and Murphy were both closely supervised with no known trauma history.  Computed tomography (CT scanning) is my test of choice for solving the mystery of the leaky lung lobe. Murphy’s scan revealed multiple small blisters (aka, blebs or bullae) on his lung lobe surfaces.  Just as in people with this abnormality the blisters are thin-walled and capable of spontaneous rupture allowing air to leak into the pleural space. Fortunately, as was the case with Murphy, most lung blisters are self-sealing within a few days. Worse case scenario, a stubborn leaker can be surgically sealed. Murphy’s family has been forewarned that his multiple blebs will likely mean multiple penumothorax episodes.  They know what to be watching for and will return with Murphy any time, day or night, should his labored breathing recur. Murphy is now home, happy as can be with instructions to be a couch potato for the next two weeks with hopes of avoiding disruption of the body’s “bandaid” on his leaky lung blister.

Ruska’s CT scan documented a small walled off abscess on the surface of one lung lobe.  Given the time of year and where Ruska lives and plays, I’d be willing to bet my first born child that a foxtail plant awn is living within that abscess.  Fortunately, Ruska’s lung lobe leak resolved itself, and the pros and cons of surgically exploring the site versus long-term antibiotic therapy (foxtails shuttle bacteria wherever they migrate) were discussed and are still being considered.  I should be hearing back from Ruska’s mom sometime this week.  For now, this big girl is back home and, like her friend Murphy, she is doing her best to be a cooperative couch potato (easier for a Shepherd than a Lab!).

Our emergency room vets are used to seeing pneumothorax patients because hit-by-car trauma is so prevalent.  As a small animal internist I rarely see them, yet here were two within one week! (I suspect the third is on its way.)  Have you or a loved one (human or canine) experienced a pneumothorax?  Please do tell.

Best wishes for good health,

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

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

The Elephant in the Middle of the Exam Room

August 1, 2011

My dual career as an author and a practicing veterinarian provides me with a unique vantage point. Not only am I privy to the issues my veterinary colleagues are stewing about, I also receive a plethora of emails from my readers candidly venting about their experiences as consumers of veterinary medicine.  It’s rare that those on both sides of the exam room table are growling about the same issue, but these days this is certainly the case.

See if you can identify the elephant in the exam room based on the following data that has appeared in current veterinary news feeds along with quotes from recent correspondences with my readers:

– The number of pet visits to veterinary hospitals is dramatically decreasing (DVM Newsmagazine, June 2011), and a special session was held at this year’s conference of the American Veterinary Medical Association to explore ways to increase public awareness about the importance of annual checkups for pets.

– “In my opinion, most of the decline in veterinary visits is primarily due to the bad economy. If you are barely scraping by, you are certainly not going to the vet for a very pricey annual exam, especially if your pet seems fine.”

– While pet spending is up, the market isn’t growing fast enough to support the number of new veterinarians entering the veterinary profession. (DVM Newsmagazine, June 2011) Veterinarian supply is growing faster than pet owner demand. (The Bayer Veterinary Care Usage Study 2011)

– “Sadly there are some veterinarians who see hospitalization fees as a revenue stream and do not inform clients that no one will be supervising the pet they recommend be hospitalized. While one tends to like to think of their vet as a kind, caring person and many are, some are more business than heart.”

– Eighty-nine percent of current veterinary school graduates have student debt.  The average student loan debt of students graduating in 2010 from veterinary school was $133,873 (15% have debt in excess of $200,000) and the average starting salary was $48,674. (Veterinary Information Network News Service, January 4, 2011)

– “My question is why most vets feel the need to worry about money instead of worrying about taking care of the pets.”

– Although the number of households in the United States with cats is increasing, the number of feline visits to veterinary hospitals is decreasing. (Banfield Pet Hospital® State of Pet Health 2011 Report)

– “I’d love to take each of my cats in for dental cleaning on a regular basis and I have two cats that desperately need attention now. For me, it’s a matter of costs. Vets continue to increase their charges and there’s no break for multiple pets. Dental disease is a precursor for renal failure in cats and yet it’s so expensive for cleaning – yet alone extracting any teeth. Then blood work is usually advisable to be on the safe side. It’s a small fortune when you leave the vet’s office for ONE pet. Next you’ve got the cost associated with monthly flea control. You have to draw the line somewhere and hope for the best.”

– Fifty-four percent of cat owners and 47% of dog owners report that they would take their pet to the veterinary hospital more often if each visit were less expensive. (The Bayer Veterinary Care Usage Study 2011)

– “I am not saying veterinarians can’t charge a reasonable fee for their services, but most people can’t afford $300+ bills every time they step into a clinic, per pet, per year, and that is for the healthy ones who are coming in for regular yearly checkups and not for other medical concerns that require medications, further diagnostics, overnight stays, dental cleaning, blood work etc.”

– Fifty three percent of clients believe that veterinary clinic costs are usually much higher than expected. (The Bayer Veterinary Care Usage Study 2011)

– “I am sick and tired of the way veterinarians financially take advantage of people who are emotionally upset about their pets.”

– Twenty-four percent of pet owners believe that routine checkups are unnecessary and 36% believe that vaccinations are the main reason to take their overtly healthy pet in for an office visit. (The Bayer Veterinary Care Usage Study 2011)

– “We have a lot of price gouging going on here at local vets. A dental cleaning has gone from $75 to $300 and up at many places. A lot of the clinics are buying high tech equipment and passing overhead costs on us so they really shouldn’t complain when clients come for less visits.”

Have you identified the common thread amongst these comments and statistics?  No doubt in my mind that the “gripe du jour” is the “M word.”  Perhaps it is more accurate to say that the real issue is too little money.

This blog is not intended to create or perpetuate harsh judgments. Please hear me when I say that I know that not every veterinarian or every person who brings their pet to see the vet is thinking primarily about money.  Clearly, however, money matters are on the minds of many, in fact more so than I’ve witnessed throughout my thirty year career.   Never before have I observed colleagues declare bankruptcy.  Never before have I spent so much time in the exam room trying to help folks figure out how to do more with less.

My goal in presenting this information is to create some understanding about what’s going on in the minds of individuals on both sides of the exam room table.  Blame this money mess state of mind on the diseased economy, veterinary competition, or the expense of going to veterinary school.  Whatever the causes, there is an awful lot of emotion tangled up in the financial aspects of providing and receiving veterinary health care these days.

What are your thoughts? Let’s talk about it and in doing so we will be able to kick that big ole’ elephant out of the middle of the exam room!

Best wishes for good health,

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

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

The Cost of Caring

June 20, 2011

The news would have us believe that the recession is over and unemployment is declining, but I’ve got to tell you, I’ve not yet seen even a glimmer of this in my professional life.  The majority of my clients remain hard pressed to pay for the diagnostic testing and care that would be ideal for their sick pets in spite of the fact that we lowered many of the fees at my hospital approximately one year ago.  Fortunately, for most of my patients, I can offer multiple medical options rather than just one.  For example, many folks these days choose the less expensive route of empirical therapy (providing treatment without certainty of what the underlying medical issue is) rather than performing diagnostic testing.  Within the limitations dictated by cost constraints, I try to do what’s best for my patient while also trying to assuage the guilt that most clients in this situation experience.  They love their pets dearly, but face the reality of having to settle for something that would not normally be their first choice.

When appropriate, I provide my client with a list of organizations that provide financial assistance for veterinary care costs.  Trust me, these wonderful organizations have been deluged by requests over the last few years.  Yet they still manage to pull through for some of my clients.  Many provide financial help for any type of veterinary care while others set specific criteria.  For example, they might provide assistance only for pets with cancer or only for service dogs.  None of them provide urgent funding- invariably there is an application process.  If you are interested in having a look at these wonderful organizations, I invite you to visit my website. Click on “Resources” found in the red horizontal main menu and then scroll down to “Financial Assistance for Veterinary Care.”  A sure sign of the times is that this is the most frequently visited page on my website!

For those of you with  young healthy animals (devoid of any preexisting medical conditions) I encourage you to consider purchasing a pet health insurance policy.  For an annual premium cost of $300-$400 you will have the peace of mind of knowing that you will be reimbursed approximately 80% of future out of pocket veterinary expenses.  The key is in choosing your insurance provider wisely.  Some reimburse exactly as you would hope while others come up with all kinds of crazy loopholes.  Visit my website for a list of questions to ask insurance providers that will help you separate the good guys from the bad.  Click on “Resources” found in the red horizontal main menu and scroll down to “Pet Health Insurance.”  My book Speaking for Spot provides a comprehensive resource for learning all you need to know about pet health insurance.

Have these tough economic times influenced how you provide medical care for your pets?  If you feel comfortable sharing your story, I welcome hearing it.  If you know of any organizations (not already on my list) that provide assistance for veterinary care, please give me a shout out.  I would love to include them.

Best wishes for good health,

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

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

It’s foxtail season, again!

May 31, 2011

Photo © Margaret Birkhaeuser

 The emergency room docs I work with are  busy pulling foxtails out of eyes, ears, noses, and throats as well as from in between toes.  Such activity reminds me that it is once again time to blog about these pesky bristly plant awns that grow in abundance where I live in California.  In fact they are reported in most every state west of the Mississippi.  For more information about foxtails and the ways they wreak havoc, please read the blog I wrote right about this time last year.  

This year I’d like to tell you about a new way to prevent foxtails from finding their way into their favorite canine orifices (eyes, ears, nose, and mouth). Check out the OutFox Field Guard™ (www.outfoxfieldguard.com), the brainchild of a clever woman named Margaret Birkhaeuser. I suspect her invention was born as a result of multiple foxtail related trips to the veterinary hospital.  Have a look at Margaret’s site and you will see dogs modeling their mesh bonnets along with a video demonstrating the ease of attaching and detaching the device from a dog’s collar.  Believe it or not, dogs can drink and even carry toys in their mouths while wearing them!  A few of my clients who have purchased the product are completely sold on their investment.  

Photo © Margaret Birkhaeuser

If your dog has been a foxtail repeat offender I strongly encourage you to consider the OutFox Field Guard™.  Not only is it a great insurance policy to protect your dog’s health, think about the money you’ll save by eliminating trips to the vet clinic during foxtail season.  

Photo © Margaret Birkhaeuser

Has your dog been a repeat offender?  Please share your story.  

Best wishes for good health,   

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

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Price Shopping: To Be Avoided at All Costs

December 13, 2010

I recently exchanged emails with a woman who was feeling frustrated while searching for a new veterinarian.  Her search included some “fee shopping” and she was disgruntled to find that some vets had the nerve to mark up lab fees more than others.  She wrote to me to find out how she might gain access to the fees charged by commercial veterinary laboratories so she could figure out how much mark up each veterinarian applied. She mentioned that she’d found one vet she really liked, but she was “out of the running” because her office charged double the lab fees (exact same test) as two others she’d investigated.

Here’s how I responded.  I encouraged my email buddy to consider reasons why fees are not uniform from hospital to hospital. In some cases, laboratory testing is run “in house” requiring on site technician time and costs involved in maintaining equipment.  Certainly charges to the client for this should be higher. The expertise a veterinary specialist brings to interpreting laboratory test results may be greater than that of a general practitioner.  Shouldn’t a client pay more for this? Additionally, every clinic must pay its overhead to continue to provide good service, and the more “bells and whistles” the hospital has, the higher that overhead will be.  For example, if the hospital employs sophisticated equipment to monitor anesthesia, that’s a really good thing, right?  Chances are, the fees for surgery there will be higher in order to cover the costs of this advanced level of care.

I went on to explain that I truly discourage people from price shopping when it comes to veterinary care unless it is an absolutely necessity.  A sweet six-month-old Labrador is currently being treated at my hospital because she sustained a horrific thermal burn all along her back from a faulty heating pad used during her surgery at a low cost spay/neuter clinic. This has necessitated major reconstructive surgery over her back- a tremendous price to pay both in terms of money and what this poor dog is going through. By the end of our email thread my correspondent seemed convinced- she told me that she’d decided to use the vet she really liked in spite of more expensive lab tests. Hurray!

Now, I’m not completely naïve when it comes to how our current economy is influencing delivery of veterinary health care.  I realize that for many folks, price shopping has become a financial necessity.  When this is the case, I encourage the following:

-Do your best to avoid sacrificing quality of medical care.  The old cliché, “You get what you pay for,” is often true.  Be thorough in your investigation: don’t make up your mind based on brief over-the-telephone price quotes.  Visit the clinic, tour the facility, and meet the staff to feel confident this is a place you and your pet will feel comfortable.

-Watch for “hidden” fees.  Some clinics may offer an extremely reasonable quote for a surgical procedure, but then charge additional fees for the initial office visit or for post-surgical necessities like removing stitches.

-Keep in mind the potential for complications.  If a significant complication occurs due to substandard care (such as occurred with the Labrador mentioned above) you will end up spending a great deal more money treating it, not to mention associated emotional energy, than you would have spent at the better more expensive clinic to begin with.

When you chose your veterinarian, how did fees enter into your decision-making?  If so, how did things turn out? I’d love to hear about your experience.

Now here’s wishing you and your loved ones (including those who are furry or feathered) for a peaceful and healthy holiday season.   

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller. 

Free holiday gift wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).

Axel

July 25, 2010

Rarely do dogs show their true colors during a veterinary hospital visit.  Outgoing dogs may become timid, gentle dogs sometimes growl or nip, and normally obedient dogs frequently feign deafness (one of the reasons I rarely request anything from my patients before offering them a treat-being tolerant of me and what I’m doing with them is a trick in and of itself). This out of character behavior is why it’s always so fun for me to catch a glimpse of my patients’ genuine personalities when in their “own element.”  Never has this been truer than with Axel, a five-year-old Belgian Malinois.  Not only is Axel a beloved family member, he is also an employee of the Sonoma County Sheriff’s Department.  He and his best buddy Sheriff Adrian Mancilla have been partners for approximately two years.  I first met Axel approximately nine months ago when he was a 50 pound dog living in what should have been a 65 pound body. Adrian reported that, although Axel’s appetite and enthusiasm seemed normal, he had been vomiting a few times weekly.  Diagnostic tests revealed that the cause of Axel’s vomiting and dramatic weight loss was inflammatory bowel disease, a syndrome in which noncancerous inflammatory cells infiltrate the lining of the intestines. 

© Susannah Kay 2010

Fortunately Axel has responded beautifully to a combination of medication and a novel protein diet.  He’s regained his missing 15 pounds and is back in full force on the force!  I recently had the thrill of witnessing this first hand while attending a competition for law enforcement dogs from all over California.  The first leg of the competition was basic obedience, followed by a rather daunting agility course including elements such as ten-foot vertical fence. Axel was a superstar and endeared himself to the spectators when, upon being released from the last agility element, he literally jumped into Adrian’s arms for a bear hug- his reward for a job well done!  

The “box search” was the third phase of the competition. Multiple closed containers resembling large trash dumpsters were scattered around a field. Only one contained a person sitting silently.  The challenge for the dog was to use his nose to identify the occupied box and then alert his partner in the shortest time possible.  Most of the dogs cruised the field checking out multiple containers before honing in on the correct one.  Not Axel- he apparently picked up the scent before Adrian released him and made a beeline (with the winning time) to the occupied box.    

© Susannah Kay 2010

The “protection phase” of the competition was the grand finale.  The dogs were required to pursue and subdue several “agitators.”  In the process, they were challenged to ignore a “dummy agitator,” jump through a screen of spraying water while in pursuit, and voluntarily release their hold on one agitator in order to subdue a second agitator (who happened to be attacking the dog’s partner).  Only a few dogs were successful with all three challenges and, you guessed it- Axel was one of them. 

© Susannah Kay 2010

Not only did Axel win the box search and protection phase of the competition, he won the entire competition’s top dog honors, known as the Maverick Award.  I feel enormously proud for Adrian and Axel. What a team- they share an indescribable bond whether on and off duty.  I felt privileged to watch them compete, and it was so thrilling to watch my patient doing exactly what his body and personality were designed to do- something I could never have fully imagined in the confines of my hospital exam room. 

p.s. Something only a veterinarian would notice- Axel was the only neutered dog in the competition, yet he was the top performer.  Hmm, food for thought…………… 

How does your dog’s behavior in a veterinary hospital setting compare to his behavior in his own surroundings?

Now, here’s wishing you and your four-legged best friend a most enjoyable and safe summer! 

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook     

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.

Those Frustrating Foxtails

May 18, 2010

My littlest dog Nellie came in the house tonight sneezing.  Any other time of year and I would be unconcerned, but in late spring and early summer an abrupt onset of sneezing after being outdoors is a “foxtail in the nose alarm bell”.  I’ll be watching Nellie like a hawk for the rest of the evening. Any crinkling of her nose, ongoing sneezing, or bloody nose and she’ll be my first patient tomorrow morning. 

If you are unfamiliar with foxtails, count your blessings! These pesky, bristly plant awns grow in abundance throughout California and are reported in most every state west of the Mississippi.  Once the plant heads dry, they become hell bent on finding their way into dogs’ noses, ears, eyes, mouths, and just about every other orifice.  They can dive deep into a dog’s nostril or ear canal (beyond sight) in the blink of an eye. And a foxtail camouflaged under a layer of hair can readily burrow through the skin (a favorite hiding place is between toes).  Foxtails can wind up virtually anywhere in the body and associated symptoms vary based on location.  For example, a foxtail within the ear canal causes head shaking, under the skin a draining tract, or within the lung labored breathing and coughing.  Not only is the dog’s body incapable of degrading or decomposing foxtails, these plant awns are barbed in such a way that they can only move in a “forward” direction.  Unless caught early, they and the bacteria they carry either become walled off to form an abscess or migrate through the body causing infection and tissue damage.  Once foxtails have moved internally, they become the proverbial needle in a haystack- notoriously difficult to find and remove. 

Take the example of Emma Louise, an undeniably adorable Brittany Spaniel mix whose family told me that her favorite pastime is running through fields with her nose to the ground. They described her as a “foxtail magnet” having accumulated several in her ears and nose over the years.  I was asked  to  help figure out the cause of Emma Louise’s hunched back and straining to urinate. With abdominal ultrasound I discovered a gigantic abscess tucked up under Emma Louise’s spine, extending into her pelvic canal.  Given this girl’s history, I just knew there had to be a foxtail in there somewhere.  The question was, would we be able to find it?  

As is my medical tradition before launching a foxtail search, I recited a prayer to the “god of foxtails.” I then turned Emma Louise over to one of my surgical colleagues for exploratory surgery. After two hours of nail biting and a barrage of expletives originating from the O.R., I heard a shout of,   “Got it!”   The foxtail had been located and removed, and sweet little Emma Louise made a rapid and complete recovery.  Not finding the foxtail would have meant a lifetime of antibiotics to treat her foxtail induced infection. 

If you suspect your dog has a foxtail related issue, contact your veterinarian right away to find out what steps can be taken (at home or in the veterinary hospital) to rid your dog of this unwanted plant material.  Whenever possible, avoidance of foxtail exposure is the best and only foolproof prevention. If your dog does have access to foxtails, carefully comb through his or her haircoat a couple of times daily- checking ears and toes, too- to remove any that are embedded and poised to wreak havoc!  Have you and your dog experienced any foxtail nightmares?  If so, please share your story.

Best wishes to you and your four-legged family members for abundant good health, 

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.

Diarrhea Disclosures

April 2, 2010

A conversation earlier this week with one of my clients prompted this blog.  Jeanette, my client, and I debated whether or not her elderly and adorable shepherd mix named Jack had diarrhea.  I felt that Jack’s once daily, unformed bowel movement qualified as diarrhea (sorry if I am grossing you out here).  Jeanette’s thinking was that the term diarrhea should be reserved only for situations with increased frequency and urgency.  This got me to thinking about how many times I might be receiving inaccurate feedback to my standard question, “Have you observed any diarrhea?” I remember going round and round with one client who repeatedly answered “No” to this question.  When we discovered that, yes, her cat truly did have chronic diarrhea, she defended her responses by saying that it was her husband who always cleaned the litterbox (in truth, she had never “observed” any diarrhea!).

So, folks, here’s the scoop (no pun intended).  When a veterinarian asks if your dog or cat has been having diarrhea, please disclose any and all information about how his or her bowel movements appear abnormal.  Believe it or not, your description of stool appearance, number of bowel movements per day, urgency, and the presence or absence of blood, mucous, straining, and gassiness can provide your veterinarian with a wealth of useful information including whether the diarrhea is originating from the small (upper) or large (lower) intestine.

Boy oh boy is your veterinarian gonna get an earful next time he or she asks about your pet’s bowel movements! Please note, I purposefully refrained from including a photo with this blog.

Best wishes to you and your four-legged family members for abundant good health, 

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.

The Evil That Lurks in California

October 2, 2009

You’ve heard it in the news.  There’s the gazillion dollar budget deficit, declining academic test scores, state park closures, and never-ending heated discussion about gay marriage and illegal immigrants.  What you may not know is that there is something even more sinister lurking in California.  It is of the ilk that science fiction writers fantasize about- alien creatures that penetrate body cavities, migrate through tissues, and wreak havoc!

Take the recent case of Emma Louise, a darling four-year-old residing in northern California.  One minute she was a healthy, happy, go-lucky little girl.  The next minute she was writhing in pain.  Doctors could not figure out what was wrong.  Little did they know that an alien had invaded her being and poor little Emma Louise was incapable of describing the evil that lurked within…….

Hmm, as I write this I’m wondering if I’ve been denying in inner desire to write science fiction!  I met Emma Louise just a few days ago.  She came to me for a second opinion to try to figure out the cause of her abdominal discomfort. Emma Louise is undeniably adorable- part hound dog and part Brittany Spaniel- and there’s nothing she enjoys more than running through fields with her nose to the ground.  The problem is, the fields are loaded with foxtails- awful little bristly weeds that grow rampantly throughout California in the late spring and summer months.  They seem hell bent on finding their way into dogs’ noses, ears, eyes, mouths, and just about every other orifice.  Not only is the dog’s body incapable of degrading or decomposing them, the foxtails are barbed in such a way that they can only move in a “forward” direction.  Unless caught early, they can migrate through the body causing infection and tissue damage.  Once foxtails have moved internally, they are notoriously difficult to find- they become the proverbial needle in a haystack.

Apparently Emma Louise was a “foxtail magnet” having accumulated several in her ears and nose over the years.  Her current symptoms were different than any she’d experienced before- she appeared to have abdominal pain and was straining to urinate and have bowel movements.  Other than a mild fever and some abdominal splinting, her physical examination findings were unremarkable. I performed abdominal ultrasound and discovered a gigantic abscess tucked up under Emma Louise’s spine and extending back (towards her tail) into the pelvic canal.  Given this girl’s history, I just knew there had to be a foxtail somewhere in that huge abscess pocket.  The question was, would we be able to find it.

I prayed to the “god of foxtails” and turned Emma Louise over to one of my esteemed colleagues (a surgical specialist) for abdominal exploratory surgery. After approximately two hours of me biting my nails and some expletives heard in the operating room, there was a shout of “Hurray!” My colleague had located and removed the foxtail!  Now with some post-op exercise restriction and a course of antibiotics, Emma Louise will be good as new.  Not finding the foxtail would have meant lifelong antibiotics, unless the foxtail migratory course happened to exit the body.

Perhaps you’ve always wanted to experience the unique flavors and marvelous beauty of California.  After reading this, you might just have a change of heart- now that you know of the evil that lurks there!

Now, here’s wishing you and your four-legged family members much good health!

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine

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Getting More Bark for Your Buck

February 12, 2009

Today the human-animal bond is stronger than ever. Seemingly, the more tumultuous the world around us, the tighter we cling to our beloved pets. They soothe us with their predictability and unconditional love, and they consistently give in excess of what they receive. Imagine then, the heartache one feels when it’s necessary to cut back on a pet’s health care because of financial hardship.

Last week I worked with Joan and her ten-year-old Labrador, Rudy who still acts like a puppy. They are devoted to one another, and Joan has always done everything possible to care for her best buddy’s health. Rudy had been vomiting and not finishing his meals (keep in mind, most Labs would quit breathing before they quit eating). When I mentioned blood tests and X-rays, Joan began sobbing and expressed profound guilt and worry because she was unable to afford these diagnostics. Like so many others in this diseased economy Joan recently lost her job, depleted her financial reserves, and was in the midst of foreclosure. I gave Joan a big hug, told her how much I appreciated her candor, and reassured her that a diet change and medication to soothe Rudy’s stomach might be the solution. She will call me with an update next week.

If you are feeling a financial pinch (who isn’t these days), here are some things you can do to economize while still caring for your pet’s health.

-When talking with your vet, lay your financial cards on the table. Yes, this is difficult (talking “fleas” is one thing- having a candid conversation about your bank account is whole ‘nother ball game), but know that such discussion can open doors to options that make better financial sense. Rarely is there only one way to diagnose or treat a disease. You are entitled to an explanation of the risks and benefits of every single option, regardless of your financial status.

-Request a written cost estimate before services are provided. In no way does this reflect how much you love your pet; you are simply being fiscally responsible.

-Learn about all of your payment options.

-Consider investing in pet health insurance, especially if you are inclined to take the “do-everything-possible” approach.

-Don’t neglect the preventive care that could save you money in the long run. Administering heartworm preventive is less expensive for you (and safer for your dog) than treating heartworm infection.

What should one do if forced to contemplate euthanasia for a pet solely because of financial constraints? Before succumbing to such a drastic decision, I strongly encourage thoroughly investigating every other conceivable option. Consider coming up with a creative payment plan such as bartering services or goods, borrowing money from friends or relatives (borrowing from a bank might be a silly suggestion these days), contacting a dog rescue association, applying for a donation from a pet health assistance organization, or finding a new, financially capable guardian for your pet. Such exploration of options might just save a life and will do wonders for everyone’s peace of mind.

Please visit www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. SPEAKING FOR SPOT is available at Amazon.com, local bookstores, or your favorite online book seller.

Wishing you and your dog good health,

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine