Tuesday, December 27, 2011

Is it Okay for My Cat to be an Outside Pet?

By Patrick Miles, DVM
One of the questions we ask when a cat presents to the hospital is whether they are indoor only, outdoor only or both. A few clients over the years have become defensive or felt guilty over this issue. The simple answer to the above question is yes. Your cat is your pet and your responsibility. There is not one lifestyle that is perfect for every home. Some cats are not good indoor companions due to behavior issues, allergies, house soiling, etc. There are situations in which owners felt pressured to keep their cats indoor by friends, family, adoption agencies, and veterinary professionals. We will often recommend a cat that has been ill or recovering from a surgery become an indoor pet during recovery to reduce complications risks.  However, it still is an owner’s choice to allow their cat to live an outdoor life once healed.
As a veterinarian, the lifestyle of a cat can play an important role in addressing an illness. If a cat lives indoors, it can be much easier to develop a diagnostic and therapeutic plan simply because the possibilities causing an illness tend to be more limited. For instance, patients that present sick that live outside may not be able to answer whether there has been any trauma, vomiting, diarrhea, cough, straining to urinate, blood in stools, etc.  Problems that arise with indoor cats tend to be found earlier simply because of the more intimate proximity, i.e. it’s easy to know if your cat has been vomiting when you accidently step in it or find it on the couch.
Risks for outdoor cats can be extensive. The risk for trauma from vehicles, dogs, other cats, raccoons and other wildlife tend to be more obvious. Infectious diseases are more common due to exposure to other cats.  Feline leukemia and Feline AIDS are more common due to bite wounds from infected cats. They may ingest unknown toxins, things that can cause vomiting and diarrhea, etc. The list of risks can be extensive. Subjectively, outdoor cats tend to have a shorter lifespan than indoor cats.
When we ask this question, it is not to judge your decision on your pet’s lifestyle. It is to help develop and focus the approach to an illness. We may advise additional diagnostic testing for a specific problem based on the lifestyle, thus increasing the financial obligation. The issue is really one of understanding and accepting the increased risk of illness or trauma.

Monday, December 5, 2011

When Repeating Diagnostics Makes Sense

By Beth Davidow, DVM DACVECC 

Many times clients will ask why we are repeating a test.  It does seem that if you have just had blood work done recently, things shouldn’t be that different.  However, when an animal is sick, things can change dramatically over a period of hours.  The following case is a good example.

A seven and a half-year-old pointer was referred to our ICU for care of a suspected reaction to a chemotherapy drug.  A review of his case showed that the dog had a skin lump that turned out to be an atypical form of a cancer called lymphoma.  (Lymphoma is a cancer of lymph nodes and lymphatics and doesn’t usually show up as a skin nodule.)  Initial screening showed no evidence of the cancer anywhere else.  The dog had been given a chemotherapy drug three weeks prior to presentation.  The tumor shrank dramatically in size and he seemed to feel well.  Many chemotherapy drugs can suppress the body’s infection fighting cells, the white blood cells, and this did happen seven days after the drug was given.  The dog was put on antibiotics and seemed to be fine.  However, three weeks after the drug was given, the dog acutely started having vomiting, diarrhea and was severely weak.  He had a fever and a borderline low white blood cell count.  Bloodwork, radiographs and ultrasound were done and no evidence was seen of any new cancer.  It was assumed that he had an infection secondary to having the low white blood cell count.

When the dog arrived at ACCES, he was dehydrated, weak and had a fever.  He had been started on IV fluids, antibiotics and anti-nausea medications at the regular veterinarian and those treatments were continued.  However, at 10:00 pm he was still febrile and now couldn’t stand up.  A blood glucose (blood sugar) was rechecked and had fallen to a dangerously low level. He was given IV glucose and was much brighter.

Why did the blood glucose fall in only 12 hours?  Normally dogs can maintain their blood sugar in a normal range even if they aren’t eating.  In the face of overwhelming infection, sometimes the bacteria are “stealing” the glucose and blood values will fall quickly.  Sometimes, if the body’s normal stress mechanisms aren’t working, it can also fall.  Sometimes, tumors can also “steal’ glucose but we hadn’t found any new cancer.  Our working hypothesis was that we still weren’t on top of the infection.  We started an additional antibiotic.

Over the next 24 hours, the glucose stayed normal and the fever resolved but the dog was still very depressed and wouldn’t eat.  The next morning, 48 hours after the initial illness started, small pinpoint bruises were noted on the skin.  This can be a sign that the clotting system isn’t working.  We checked the clotting blood values and found that the platelets, small particles in the blood that make the initial clot, were now very low, even though they had been OK the day before.  A full complete blood count was sent to the lab.  A falling platelet count can also be a sign of infection or emerging cancer but the fever was under control.  What was happening?

In the afternoon, we had our answer.  The complete blood count, which had only normal blood cells 48 hours before, now showed cancer cells in the blood.  The cancer, despite being gone from the skin, had lodged in the bone marrow and in a 48 hour period and multiplied fast enough to be found in the blood stream.  The dropping glucose and platelets were not from a chemotherapy reaction or from infection but from the emerging cancer we couldn’t yet see.

Thus, repeating the same tests several times allowed us to diagnose the reemerging cancer quickly.  It was a lesson of how rapidly things can change in the body. 

Monday, November 28, 2011

Watch the Litter Box!

By Patrick Miles, DVM

Personally, cleaning the litter box is not one of my favorite chores.  I’ve tried self cleaning boxes and bribing my children.  I have not attempted to train the cats to use the toilet simply because something seems “wrong” about having to share the bathroom with your pet.  Though I’ve heard clients say it works quite well!
However, there is a lot to watch out for with your cat’s use of the litter box.  Houses with multiple cats can be an additional challenge, but can still help to uncover underlying illness in your pet.  Cleaning the litter box on at least a once daily frequency is typically recommended.  The frequency of use, whether there is more or less urine, diarrhea, mucous, blood in urine or stools, all may indicate a developing problem.  Cats that have urinary tract infections or other urinary problems may have an increased urgency and frequency in their use of the box.  Blood or an abnormal odor may be noted in the urine indicating infection, or in some cases complications from diabetes.  Some people are able to detect the smell of “ketones”, which indicate possible complications due to diabetes mellitus.  The amount of urine produced may be decreased if a male cat is developing a urethral obstruction, or increased if diabetes mellitus is present. 
The color and consistency of stools can also help determine the source of problems.  Chronic diarrhea in general may be due to problems involving the small bowel versus the large bowel/ colon.  Small bowel disorders often tend to be larger amounts (cow-pie), may have a dark, tarry consistency if blood is present, and frequency may be normal or increased.  Weight loss tends to be more profound with small bowel disorders.  Large bowel disorders tend to be smaller in volume, increased frequency, mucous and straining may be present, and have visible red (frank) blood.
Though the litter box is not the most enjoyable aspect of cat ownership, attention to its contents and use may be valuable in detecting emerging problems.

Friday, November 18, 2011

Salmon Poisoning in Dogs – Potential Danger in the Pacific Northwest

By Patrick Miles, DVM

Salmon Poisoning is a unique disease in dogs that is really only found in the Pacific Northwest.  The term “Salmon Poisoning” is somewhat misleading, as the disease is not a true poisoning and not a problem from the fish meat itself.  Salmon poisoning is actually an infection found in dogs that occur through a complex life cycle involving a bacteria (Neorickettsia helminthoeca), a fluke parasite (Nanophyetus salmincola), a snail (Oxytrema silicula), certain fish, and dogs.  The infection is caused by a small bacterial organism that lives in a fluke parasite. The fluke lives only in one known species of snail found in the Pacific Northwest coastal freshwaters.  The flukes mature within the snail, and when released, infect fish that spawn in fresh water.  The fish involved spend part of their life in salt water (salmon, certain trout, steelhead, and one species of salamander).   The bacteria cause no known illness in the fish.  Dogs become infected after eating raw fish harboring the fluke, which carries the bacteria.  Once in the dog intestinal tract, the bacteria are released causing infection.  The bacteria do not affect cats.
Signs of infection occur approximately one (1) week later.  Vomiting, diarrhea, fever, and enlarged lymph nodes are often found.  In my experience, the diarrhea is very orange(pumpkin) in color.  The disease can be life threatening if left untreated.  Diagnosis can be based on finding evidence of the fluke eggs on a fecal examination, or finding the bacterial organism on aspiration of the lymph nodes.  Therapy involves addressing hydration, nausea, anti-parasitic medication for the fluke, and antibiotics for the bacteria.  The antibiotic used is not one chosen for other causes of vomiting and diarrhea so the diet history is very important in diagnosis.
ACCES Renton has seen an increased number of cases over last year, which likely has to do with our proximity to salmon runs along the Green and Cedar Rivers.  Cases likely fluctuate based on the size of the salmon run, temperature of the river, seasonality of the salmon migrations, and other local factors that may encourage the growth of the fluke or snails.
 We had one case in which crows or seagulls left salmon carcasses in the yard of a dog with no other exposure to salmon.  In another instance, two dogs drank water from a cooler that held salmon, but did not actually eat any salmon.  Another case was from feeding smoked, uncooked salmon to a family pet.  (Cooking kills the disease causing organism.)  This is often where the confusion regarding a poisoning/toxicity comes from.  It is often thought that the salmon has “gone bad” and is releasing toxins like what one would see with conditions such as botulism, food poisoning from E. coli, or salmonella toxicity.  Though vomiting a diarrhea may occur due to ingestion of decaying, rotting salmon, “Salmon Poisoning” is a specific disease that occurs from specific bacteria, which may not be carried by every salmon, in all locations. 
Raw or undercooked salmon should not be fed to dogs.  If your dog, develops severe vomiting or diarrhea they should always be evaluated by a veterinarian.  Always give your veterinarian a thorough diet and travel history as this helps pinpoint what the cause of illness may be. 

Tuesday, November 15, 2011

Diabetes in Our Companion Animals – An Overview

By Alan Schreiner, DVM, DACVIM

As many of you already know, our four-legged friends are susceptible to some of the same diseases that affect us. One of those diseases is diabetes mellitus or high blood sugar. In animals as in people, diabetes mellitus occurs when the body is not producing enough insulin or because the cells in the body cannot respond to the insulin produced. Insulin is a protein made by the pancreas that helps keep the sugar in the blood within a narrow range.  Like people, animals with diabetes mellitus are classified into two categories: Type 1 diabetics are insulin-dependent and require injections of insulin while Type 2 diabetics are characterized by having insulin resistance and can be insulin-dependent or non-insulin dependent. Both Type 1 and Type 2 diabetics are recognized in dogs and cats.
Occurrences in Cats vs. Dogs
Non-insulin dependent diabetes mellitus (NIDDM) is more frequently recognized in cats than in dogs and accounts for as many as 30-50% of diabetic cats. One big difference between cats and people is the phenomenon of transient diabetes mellitus. Transient diabetes can be seen in approximately 20% of our diabetic cats. These cats will appear to have insulin-dependent diabetes mellitus (IDDM) initially, then revert to a normal state, not requiring any insulin therapy and have normal blood sugar levels. These patients can then swing back to IDDM. This phenomenon can occur multiple times during the cat’s life as a diabetic.
People always want to know if their pet is at risk for developing diabetes mellitus. No one can predict which pets will develop diabetes, but in general we see occurrences in dogs that are four to 14 years-old with a peak between seven to nine years-of-age. In dogs, females are about twice as likely to develop diabetes as males are. Any breed can develop diabetes mellitus, but the breeds that are commonly seen are Miniature Poodles, Cairn Terriers, Dachshunds, Miniature Schnauzers and Beagles.
As for cats, they are typically older than six years-of-age, but diabetes mellitus can show up at any age. The neutered male cat is predominantly seen verses the spayed female cat and there are no apparent breed predispositions reported.
Signs and Symptoms: Diagnosing the Diabetic Pet
The signs and symptoms seen by most pet owners are very similar to what people experience; an increase in water consumption and urination frequency and an increase in appetite but accompanied by weight loss. One way to think of diabetes mellitus is starvation in the face of plenty.
When a dog or cat is presented to their veterinarian for any of these signs or combination of symptoms, the doctor will order some diagnostic tests. These tests usually include a complete blood count (CBC), a chemistry panel, in cats a thyroid level, and a urinalysis (UA). The classic results will show elevation of sugar (otherwise known as glucose) in both the blood and the urine. Other abnormalities may also be present, such as signs of infection on the CBC, elevation of liver enzymes is common, and ketones maybe noted in the urine. A urine culture should always be done because of the high incidence of concurrent urinary tract infections. Additional diagnostic test may be ordered based on physical exam findings, results of the blood work, or previous medical problems.
Treatment and Next Steps
In most animal patients, successful treatment is centered around an ongoing schedule of  insulin injections. Persistence of signs and the development of chronic complications are directly correlated with the severity and duration of the high blood sugar levels. The goals of therapy are to limit blood sugar fluctuations and maintain nearly normal sugar levels to help minimize signs and symptoms. This can be accomplished through proper insulin administration, diet and exercise.  In addition, avoiding or controlling current inflammation, infections, and hormonal changes (intact males and females) is important for maintaining good blood sugar control. Although, we attempt to keep the blood sugar from rising too high, we must also guard against the development of low blood sugar which can be a serious and potentially fatal complication of therapy.
As in people, our four-legged patients can develop, over time, complications associated with diabetes mellitus. In dogs, cataracts are a common complication and cats can develop nerve problems in their legs just like people. Bacterial infections, especially in the urinary tract, are also common and urine cultures are done periodically to monitor for their development.
It is recommended that the treatment be monitored regularly by the veterinarian with blood glucose curves, fructosamine levels, and sometimes glycosylated hemoglobin levels checked. The blood glucose curve is done to monitor the effect of the insulin on the blood sugar levels. The curve is usually done in the veterinarian’s office during the course of a day. Blood samples are taken every few hours throughout the day and the readings are used to create a graph. This graph helps the veterinarian decide if the insulin is adequately controlling the blood sugar level. If not, then changes are made to the insulin dose or type. If a change is made, then the patient’s body will take about seven to 10 days to adjust to the new regime. Another blood glucose curve will be scheduled to recheck the effects of the change.
The other two tests, fructosamine and glycosylated hemoglobin, are used to obtain an average blood glucose level over different periods of time. These tests are helpful in detecting deteriorating blood glucose control, thus allowing intervention before a problem develops.
Identified early, Diabetes Mellitus in dogs and cats can be successfully managed through the right nutrition, exercise, and, if necessary, regular insulin injections.  While there is no cure for the disease, proper managed care can help the pet live a happy, active life. Your veterinarian is an essential partner to this care and can give advice on the best preventative and management programs.
To learn more about the diabetic pet, please visit

Monday, November 7, 2011

Grapes and Raisins – Deadly to Dogs

By Beth Davidow, DVM DACVECC

A gorgeous, full of life five-year old male Australian Shepherd narrowly avoided dying last month. His case is offered as a follow-up to last week’s blog post on toxic dangers to pets. It reminds us all of the potential, deadly dangers that await our pets in our every day food.

Roadie, the Australian Shepherd, had spent the weekend with some friends while his owner was on a trip. During that weekend, Roadie ended up feasting on ripe grapes from a vine in the friend’s yard. Initially, Roadie’s caretakers were not concerned with what he had eaten as their own dog had eaten grapes in the past without problem. However, by Monday, Roadie had become ill and started vomiting.

As Roadie’s condition worsened, his owners took him to their regular veterinarian on Tuesday where Roadie was diagnosed with severe damage to his kidneys. By Wednesday night, his kidneys were much worse and Roadie was referred by his vet to the ACCES ICU for monitored, round-the-clock care. By Thursday, Roadie’s kidneys were barely functioning. Unable to produce urine, all the toxic waste products normally eliminated from the kidneys, were accumulating in his blood stream. Roadie was in such a severe state that dialysis treatment was discussed. After much thought, the owner decided to continue with the current medical treatment.

Through aggressive medications, the ACCES ICU team was finally able to increase the amount of urine Roadie’s kidneys were making. Roadie was then supported with IV fluids while his kidneys healed. It was a close call, but after 10 days in the ACCES ICU Roadie was finally able to go home.

Pet owners should be aware that both grapes and raisins can cause kidney failure in dogs. Unfortunately, the mechanism of action is not known. For awhile, it was hypothesized that it was pesticides sprayed on commercial grapes, but this kidney failure has now been seen in dogs eating untreated grapes. Another proposed theory is that the toxin that affects the kidneys is from fungus that is on some grapes and not others. It is an odd toxicity in that there does appear to be some dogs more prone to the toxins than others. In this case, one dog had eaten off the grape vine for a long time with no signs but the Aussie was severely affected.

The lowest amounts recorded to cause kidney injury are 0.1 ounce per kilogram of body weight of raisins or 0.7 ounces per kilogram of body weight of grapes.

If your pet gets into a quantity of raisins or grapes over these amounts, call your veterinarian immediately. Inducing vomiting and aggressive intravenous fluids for 24 hours can often prevent the development of signs. Most deaths from these foods occurred when treatment was delayed.

Other foods that can be toxic to pets include chocolate, onions, bread dough and macadamia nuts. Always talk to your veterinarian first before offering your pet any human food.

If your pet gets acutely sick, always let your veterinarian know about any foods that they might have had access to that would be out of the ordinary.

Friday, November 4, 2011

Sadie Finds Her Way Home – When Microchips Do Their Job

We have all heard the tales of a lost pet making an amazing journey back home after having been missing for months on end. ACCES is happy to share a similar tale a little more close to home; that of Sadie the cat.

An older female cat had been seen hanging around a Capital Hill neighborhood for several months. One day, she was discovered to be not walking, and it was presumed that she had been hit by a car. The Good Samaritan who found her presented her to the ACCES Seattle emergency hospital for care where she she was found to be in shock and to have a broken pelvis.

It is important to note that when a stray animal without a collar arrives at ACCES the first thing that is done is scan them for a microchip. Luckily, the injured cat had a microchip and we were able to quickly find the owner’s contact information. We soon learned that the cat’s name was Sadie and she had been missing for four (4) months! The owners were thrilled Sadie was found and authorized the surgery Sadie needed to fix her pelvis.

Sadie is now doing well and is happy to be back with her people. Her story reminds us all of the importance of microchips. A microchip should be considered for any pet; outdoor, especially, or indoor. One never knows when a pet may get out of the yard or house and get lost.  In Sadie’s case, she had traveled more than five (5) miles (see map below).

All local shelters and many veterinary hospitals have microchip scanners on-hand. If you find a lost pet, bring them in to one of these locations. Who knows. You may unite a long lost pet with its owners.

Sadie's Journey

Thursday, November 3, 2011

Toxic Household Items - What to Avoid to Keep Your Pet Safe

By Beth Guerra, DVM

Dogs and cats eat many of the same things we do but they metabolize both foods and drugs differently than humans. Cats, in particular, have different metabolic pathways in their livers, which mean that some drugs that are safe for people or dogs are very dangerous for them. Following are five (5) common items which can be potentially deadly to your pet.

1) Pain Medications: The most common toxicity we see at the emergency clinic is the ingestion of non-steroidal anti-inflammatory pain medications. These pain medications include ibuprofen, naproxen, Tylenol, and the veterinary drugs carprofen and deramaxx. Tylenol cannot be metabolized correctly by cats so even one (1) adult tablet is enough to result in death if ingested by a cat. Dogs are more tolerant, but an overdose can lead to severe anemia and liver damage. Ibuprofen, especially the brand name Advil, tastes sweet on the outside so dogs may eat through the bottle or especially through plastic bags. Carprofen, or Rimadyl, comes as a chewable tablet for dogs. Unfortunately, it tastes good so it is easy to give. However, I have seen dogs chew through child proof containers and eat the full contents. (Important – Always keep ALL medications, even those prescribed for your pet, in child proof containers, up high and out of reach.)

2) Lilies: The most dangerous plant toxicity we see is exposure of cats to lilies. I wish that more florists and nurseries knew this and could help get the word out. Members of species Liliaceae including Easter lilies (Lilium longiflorum), Tiger lilies (Lilium tigerinum), Japanese showy lily (Lilium speciosum), Stargazer lily (Lilium orientalis) and daylily species (Hemerocallis demortieri and fulva) all contain an unknown compound that if ingested can lead to acute kidney shutdown. The toxin, which has not been identified, concentrates in the pollen and flowers so if a cat gets pollen on their fur and then grooms, they are at risk of the toxicity. Many cats will have moderate vomiting within hours of ingestion and can have fulminant kidney failure within two to three days if not treated. Treatment for exposure includes inducing vomiting, giving activated charcoal and two to three days of intravenous fluids to prevent kidney damage. (Important – We strongly recommend not keeping lilies in any house where a cat lives.)

3) Sugar Free Gum: Dogs cannot metabolize the xylitol that is in many sugar free gums. The ingested xylitol can cause a severe drop in the blood sugar which can lead to seizures and even death. In addition, in large ingestions, liver failure is a risk. The amount of xylitol in sugar free gums is variable so without knowing the type, it is hard to know how many pieces could lead to clinical signs. If xylitol is one of the first ingredients, one to two pieces can be enough to cause a problem in a small dog. (Important – Keep sugar free gum out of the reach of dogs and/or considering buying gum with lower xylitol content.)

4) Grapes and Raisins: In 2001, the National Animal Poison Center, reported that they had consulted on 10 cases of cats and dogs who had eaten either grapes or raisins who then developed kidney failure. Much work has been done but we still don’t know why this occurs in some animals. It does not appear to be related to fertilizers or other chemicals and it does appear some animals may be more susceptible than others. In a 2005 study of 43 dogs and cats with kidney issues secondary to grape or raisin ingestion, dosages as little as 0.1 oz/kg raisins and 0.7 oz/kg of grapes resulted in the signs. (Important – We do not recommend feeding your pets grapes or raisins. Contact your veterinarian if your pet eats a large quantity.)

5) Rising Bread Dough: Dogs will occasionally eat an entire loaf of bread dough when it is rising. Bread dough in the stomach will ferment and release alcohol due to the heat in the stomach. Dogs have been seen with both bloated stomachs and with signs of severe alcohol intoxication. Treatment involves inducing vomiting if caught early or sometimes instilling ice water in the stomach to stop the fermentation process if they are too weak to vomit safely. (Important – Keep bread dough out of the reach of “counter surfing” dogs.)
It is wise to keep phone numbers for National Animal Poison Center and your local emergency clinic close to your phone. Always call if your pet eats something out of the ordinary.

Tuesday, August 30, 2011

Meet Matilda

By Beth Guerra, DVM
During my first week at ACCES, a stray bedraggled poodle came in through the ER. She had been found roaming the streets injured and a Good Samaritan contacted Seattle Animal Control to pick her up. She was initially assessed at another animal hospital before being transferred to our clinic to treat her injuries. She had no microchip or other identification, and after 3 days no owner had been found.
I was on a receiving shift when she came through the door. She was dirty, covered in fleas, and had bandages on both forelimbs. She was extremely shy and not making eye contact. The left forelimb had a degloving wound over the paw and wrist, but when I unwrapped the right forelimb, I was in for a shock. The limb was hanging at an odd angle, indicating a fracture, and the tissue was missing right down to the bone. The area was covered in dirt and fur. Although she was obviously in great pain, she tolerated an exam with no protests.
It must be said that I have a thing for small dogs, especially poodles. Our childhood dog growing up was a poodle, as was the dog my mom had before she married my dad. I already had one dog, a yorkie mix that I rescued from a shelter in Chicago, but my fiancé and I had just discussed getting a second dog to keep him company. We were planning on visiting the local shelter, and then this poodle landed in my lap.
That first day, we gave her some pain medications, antibiotics, and started her on IV fluids. X-rays confirmed that the limb was shattered and the joint was a mess. Extensive surgery would be needed to fix the limb. I got her set up in the ICU for the night, but after I left, I couldn’t stop thinking about her. I am quite an impulsive person, and I knew she would be our second dog.
The next day, I came in to find a technician sitting in her cage trying to hand feed her some kibble. She saw me and gave a wag of her tail, just a rhythmic thumping of the very end. The tech seemed surprised as she had given no other show of emotion so far. I immediately decided her name would be Matilda (I have no idea where it came from) and called Seattle Animal Control to inform them I would adopt her and assume responsibility for her medical care. I consulted with our surgeon about the wounds that day. There were two options; fuse the joint and repair the missing skin with a graft, or amputate the limb. For me, the decision was an easy one.
Three days after her right forelimb was amputated, I was brushing my teeth after a swing shift and she was following me around the house. It was 3am and I had no lights on. I heard a jingle and a series of thumps, and looked around to find she had descended a flight of stairs to chase after our cats. Then she came right back up the stairs without hesitating.
Since then, Matilda has been unstoppable. She jumps onto the bed with much more ease than our 4 legged dog. She goes for two mile runs without tiring. She uses her remaining forelimb to scratch at the door, or my leg, or whack our other dog on the head. We even have sweaters with one sleeve removed to accommodate her new form. When we are on walks, people often ask what happened to her leg. We make up stories that she was in a skiing accident or victim of a shark attack while surfing. People are surprised that she gets around so well, given that approximately 70% of a dog’s weight is carried on the forelimbs. She has adapted to life as a 3 legged canine. I realize that not everyone would make the same decision, but I do use Matilda as an example for my clients who may be faced with the same difficult decision.
If you are faced with having to decide whether an amputation will be the best decision for your pet, there is also a really useful website -

Wednesday, August 17, 2011

An Unlikely but Deadly Hazard-Vitamin D

By Beth Davidow, DVM DACVECC
The benefits of Vitamin D have been much in the news. Vitamin D is that funny vitamin that is produced in your skin after exposure to the sun, specifically ultraviolet B light.  Vitamin D from your skin is converted to the hormone calcitriol which regulates the calcium and phosphorus balance in your body.  Lack of Vitamin D can lead to rickets in children, a problem where the bones become overly brittle, don’t grow normally or deform. Lack of vitamin D is also a risk factor for osteoporosis in adults.  These diseases are why milk is supplemented with Vitamin D. 
Vitamin D’s recent newsworthiness has come from observational studies that have suggested that low Vitamin D may increase the risk of certain neurologic diseases such as multiple sclerosis, Alzheimer’s, and Parkinson’s.  In addition, low vitamin D levels may be a risk factor for some cancers and peripheral artery disease. Increased daily intake levels were recently recommended by the Institutes of Health leading many people, especially in locales with low sunlight, to start taking Vitamin D supplements
            Although a certain amount of a vitamin will improve your health, too much can lead to toxicity.  Daisy Mae, a 5yr female Basset hound cross, found her owner’s very concentrated liquid vitamin D supplement and drank the content of the bottle.  Daily recommended Vitamin D is about 600 IU for a child.  Daisy Mae drank about 1.2 million IU!  While normal Vitamin D will maintain the right amount of calcium and phosphorus for normal bone growth and strength, toxic levels of Vitamin D can lead to calcification of tissues other than bone.  In addition, the increased calcium and phosphorus in the blood can lead to acute insults to the kidney and possibly renal failure.
            The ASPCA National Animal Poison Center was consulted as soon as Daisy Mae presented to ACCES and they recommended aggressive treatment to try to prevent calcification of her tissues.  Daisy Mae was made to vomit and then given activated charcoal to try to bind up any of the vitamin D still left in her intestinal tract.  She was also given an intravenous lipid infusion.  This is a newer treatment for toxins that are fat soluble to try to pull the toxin out of the tissues.  She was also placed on IV fluids to try to flush any accumulating calcium out of her kidneys.
            However, after 24 hours, Daisy Mae’s calcium and phosphorus had both risen to higher than normal levels.  We then started furosemide, a medication to make her urinate more and to increase the calcium being excreted and a steroid.  The calcium and phosphorus stayed high so we then gave a medication called pamidronate.
            Despite all these treatments, Daisy Mae’s calcium and phosphorus remained stubbornly high for 10 days in ICU!  Finally, levels fell back to normal. Luckily, Daisy Mae never felt sick and the treatments were able to protect her from any adverse effects on her kidneys.
            Animals can get a similar toxicity from a Vitamin D type ointment called Calcipotriene, marked as Dovonex®, which is used to treat psoriasis.  Even as little as 1.25 teaspoons can cause problems in a dog.           
The lesson from Daisy Mae is to remember that even supplements and vitamins can be dangerous.  If your pet gets into a medication or supplement, contact your veterinarian, your local emergency veterinarian, or the ASPCA National Animal Poison Center as soon as possible.  Without treatment in this case, permanent renal damage could have occurred. Luckily, Daisy Mae is now home and doing great.

Monday, August 1, 2011

Saving Lives: ACCES & The Seattle Humane Society Team up to give Tully a second chance at life

Recently, ACCES had the opportunity to work with the Seattle Humane Society to help a critically ill young dog. Tully, an approximately 2 year old, female Chihuahua was soon to be euthanized in an animal shelter in Los Angeles when the Seattle Humane Society agreed to care for her and find her a home. Tully arrived at the shelter in Bellevue emaciated, covered in fleas, and pregnant. Over the course of her first days in Seattle, Tully started having a hard time breathing until on the afternoon of Tuesday, June 14, it was clear that Tully’s condition was deteriorating. Hopeful that cause of Tully’s increased respiratory rate and effort was a fixable condition, the Humane Society referred Tully to ACCES for further diagnostic tests and care.
Tully was admitted by an emergency clinician, Dr. Julie March, and immediately radiographs were taken of Tully’s chest. The radiographs were diagnostic of a diaphragmatic hernia. The diaphragm is a musculotendinous partition that separates the chest from the abdomen. Loss of this separation allows the abdominal organs to enter the chest cavity and interfere with the lung’s ability to fill expand and ventilate normally.
The diaphragm is made up of a muscular portion that attaches to the ribs on both sides and a central tendinous region. The aorta, vena cava and other veins, esophagus, and lymphatic system pass through openings in the diaphragm. Hernias can be either congenital, in which one or both muscular portions of the diaphragm fails to develop or fails to fuse centrally, or traumatic, in which injury to the diaphragm can cause a tear in normally developed diaphragm. This is a common sequelae after dogs and cats get hit by cars.
Treatment of this condition requires surgery to repair or reconstruct the diaphragm. Complications can arise when the abdominal organs have been present in the thoracic cavity and have adhered to structures within the chest or to the chest wall. Or in congenital diaphragmatic hernias when abdominal organs develop within the chest and may not mechanically be reduced into the abdomen even with surgery.

Tully’s condition was complicated by the fact that she was pregnant. The puppies had mineralized skeletons but whether or not they were near term was yet unknown.  A decision was made to take Tully to emergency surgery to relieve the lung compression and repair the diaphragm. Since Tully was pregnant, it was also decided to perform a cesarian section to try to save the puppies since they would be unlikely to survive a long anesthetic procedure.
Tully was quickly anesthetized and taken to surgery.  Four puppies were retrieved and resuscitation of the puppies was initiated. Tully’s entire gastrointestinal tract, spleen, omentum and the majority of her liver had been pushed into her chest through a very large hole in the right side of her diaphragm. Her abdominal organs were replaced into her abdomen and closer inspection revealed the hernia to likely have been congenital.  It was necessary to also approach the diaphragm from her chest to get adequate access for repair. By advancing the diaphragm and part of the abdomimal wall forward and towards the left side, it was possible to close the hole in Tully’s diaphragm.
Tully had a rough recovery from anesthesia and struggled to reinflate her lungs and breath normally. She was treated with oxygen therapy overnight and by morning was breathing more comfortably. Unfortunately, Tully’s puppies did not survive. After several days of further supportive care, Tully returned to the Seattle Humane Society where she was put into foster care. Tully appears to be adapting well to her new home. We hope she finds a fantastic new family soon.

Tully is now waiting for her forever home in foster care.

Tully, fully recovered, is happy and healthy.

Wednesday, June 8, 2011

Disaster Sheltering for Companion Animals: It's never too late to be prepared

One of the lessons of Hurricane Katrina and other recent disasters is that people are reluctant to evacuate a dangerous area without their pets. When owners are not home during a disaster, they will often try to come back for their pets even at the risk of endangering their own lives. In the past, emergency responders have made little or no provision for evacuating animals with their owners, leading to conflicts at the site of the disaster and in shelters later on.

After Katrina, federal law changed to require pets to be managed along with people in disasters.
  In October 6, 2006, Pets Evacuation, Transportation Standards Act (PETS) was passed. Many agencies now recognize this issue and have developed guidelines for accommodating pets during disasters.
Animal Critical Care & Emergency Services (ACCES) and the American Humane Association have teamed up to offer a course for community members to learn how to set up emergency sheltering for companion animals in the event of a disaster.  This course is primarily aimed  at those interested in the welfare of animals during or after a disaster, including professionals trained in disaster response, emergency medical services personnel, firefighters, animal shelter staff, animal control officers, veterinarians and veterinary technicians, animal handlers/trainers and Red Cross volunteers. The course will be held July 9-10, 2011 from 9a.m. to 5p.m. at ACCES Renton, located at 4208 Lind Ave SW in Renton, WA.  Tuition for the class is $135 and includes two days of lectures, a workbook, charts, illustrations and a certificate of completion. 
Register for the course by visiting:
While these changes will help all pet owners, it is ultimately up to owners to plan for their pets and themselves in a natural disaster.
Disasters can run the gambit from very personal to region-wide, so any plan needs to consider various levels of preparedness. A personal disaster such as a family illness or accident that takes you away from your home for more than a few hours and up to a few days requires planning. Other unforeseen emergencies could be icy or otherwise closed roads that prevent you from getting home, or a police road block that cordons off your neighborhood for many hours.
The Humane Society of the United States recommends the following actions to make sure your pets are taken care of when everyday events like these prevent you from taking care of your pets:
•Find a trusted neighbor and give them a key to your house or barn. Make sure this
person is comfortable and familiar with your pets.
•Make sure the neighbor knows your pets’ whereabouts and habits, so they will not have to waste precious time trying to find or catch them.
•Create a pet emergency/disaster kit and place it in a prominent place where your neighbor can find it (see kit checklist below).
•If the emergency involves evacuation, make sure the neighbor would be willing to take your pets and has access to the appropriate carriers and leashes. Plan to meet at a prearranged location.
•If you use a pet sitting service, they may be available to help, but discuss the possibility well in advance.
In your pet disaster kit, you should include:
•Food and water for at least five days for each pet, bowls and a manual can opener if you are packing canned pet food.
•Medications and medical records stored in a waterproof container and a first aid kit. A pet first aid book is also good to include.
•A cat litter box, litter, garbage bags to collect all pets’ waste, and litter scoop.
•Sturdy leashes, harnesses, and carriers to transport pets safely and to ensure that your pets can’t escape. Carriers should be large enough for the animal to stand comfortably, turn around and lie down. Your pet may have to stay in the carrier for hours at a time while you are away from home. Be sure to have a secure cage with no loose objects inside it to accommodate smaller pets. These may require blankets or towels for bedding and warmth, and other special items.
•Current photos and descriptions of your pets to help others identify them in case you and your pets become separated and to prove that they are yours.
•Pet beds and toys, if you can easily take them, to reduce stress.
•Information about your pets’ feeding schedules, medical conditions, behavior problems, and the name and number of your veterinarian in case you have to board your pets or place them in foster care.
Other useful items include newspapers, paper towels, plastic trash bags, grooming items and household bleach.
In a more regional disaster (in our area, earthquakes or severe winter storms and flooding), different considerations need to be addressed. Primary would be shelter for you and your pet either in place (your home) or after evacuation.
Most evacuation shelters will not allow animals except for service animals. In a disaster you will need to provide shelter for your pet. You should plan for this well ahead of any disaster. Call hotels outside the immediate area to see if they will take pets. Try and make a list of places you can go. Call animal shelters, boarding facilities and friends or family outside of the likely affected area. Make a contingency plan in case you are far from home when an evacuation order comes. A trusted friend or neighbor might be willing to evacuate your pets for you. It helps if that person is familiar with your pets (and likewise your pets comfortable with that person), has a key to your home, and knows where carriers and leashes will be. Arrange for a meeting place where you can take custody of them.
If at all possible, evacuate your pets with you. Don’t wait until the last minute. If you have warning of a disaster, evacuate, don’t wait for a mandatory evacuation. It will be more difficult to get where you need to go and your options will be limited if you wait until the last minute. If you leave your home without your pets even for a few hours, you may not be allowed back in to get them. It is better to err on the side of caution by moving your pets earlier, even if it turns out to have been unnecessary, if it might prevent difficulties in a disaster.
If you cannot evacuate, you need to make a safe environment in your home. Keep your pets confined or on leashes and close by. Do not let them wander; you may not be able to safely round them up if the worst happens. Set up a safe room in your house and store your disaster kit there. Make plans for your own well being and safety as well. You cannot help your pets if you are trapped, sick or injured. And keep communication available. A cell phone might work but ultimately a portable radio is necessary if all other communication is down.
After a disaster where significant area damage has occurred, keep your pets safe by restricting their movement by either confining them or keeping them on a leash. Do not allow them to roam. Familiar landmarks and smells may have been obliterated and they could become disoriented and lost. Toxic substances may have spilled. Dangerously damaged structures could collapse. There may be broken glass, splinters, nails, etc. lying around which are hazards for any species of pet.
Be patient with your animals (and with yourself). These are traumatic experiences for everyone and can lead to unpleasant behavioral changes. Try and return to as normal a routine as possible, as soon as possible. This will be comfort to everyone
Include as much information as possible on your pet tag. This includes a phone number where you are reachable day or night.
And finally, in any of these situations, positive identification for your pet is essential. If your pet gets lost or is sheltered somewhere, mixed in with other animals, a tag or microchip can help get your pets back to you.
With some foresight and planning, these unavoidable situations can be moderated and returning to a normal life can occur sooner for your entire family.
Resources:Humane Society of the United States (HSUS) (From which much of the information above is borrowed)
American Red Cross-

Monday, May 23, 2011

Dog Bites are Preventable when Caution is Used

By Patrick Miles, DVM

May 15-21 was Dog Bite Prevention Week. According the AVMA, approximately 4.7 million people in this country are bitten by dogs every year.  Children are by far the most common victims.  800,000 Americans receive medical attention for dog bites each year.  Children are far more likely to be severely injured.  Approximately 400,000 receive medical attention every year, and an estimated 30,000 require reconstructive surgery.  Most dog bites affecting young children occur during everyday activities and while interacting with familiar dogs.
Working in the veterinary field, we certainly encounter dog bites to humans a number of times each year.  Many of the bites occur because the patient/dog is nervous, scared, or injured.  Despite all our training and experience, injuries still occur.
There are multiple factors involved when a dog bite occurs.  Responsible pet ownership is the biggest preventive measure.  It is imperative to not assume your dog will not bite.  There are so many situations that can occur that are outside the pet owner’s control.  Knowing the environment your dog is in helps to anticipate these situations. Most dog bites, in my experience, do not occur due to maliciousness, but are often spontaneous reactions. If your dog is a nervous dog, or has the propensity to bite, do not take them to high traffic areas.  Look into additional training or behavior modification. 
 As mentioned, children are the most at risk in the population.  Dogs can easily become nervous around a child who rushes up to a dog, is face to face, wants to hug or kiss the dog, etc.  A group of children may be playing, running, yelling and screaming which can excite some dogs and trigger a herding instinct. Or a young child may physically hurt a dog by pulling or tugging at the dog. Children often think that since their own dog is very friendly, that all dogs are friendly and will act similarly as their pet.
Another preventive measure to help control bites is to keep your dog on a leash around others or outside the home. However, a leash still won’t prevent a bite and should not give a false sense of security. I often see owners allowing their dogs to run off leash under the assumption that they know their dog.  However, you don’t know the other dog that is off leash and you don’t know that the person your dog approached is not going to react in a way to trigger a bite. We see a number of bites that occur when owners are trying to separate their dogs that have gotten into a fight.  We have also seen situations in which the person on the end of the leash was either too young or too small to be able to control the dog. 
Additionally, it is important how you act around unfamiliar dogs.  Warn your children not to approach an unfamiliar dog and to always ask owners if you can pet the dog before doing so.  If an unfamiliar dog approaches you off leash the AVMA advises to simply stop and stand still.  Do not yell, do not run, and do not try to pet the dog. Do not approach an injured animal, but call the local animal control agency.
If you are bitten by a dog, here is a checklist of things you should do as recommended by the AVMA:
  1. If the dog's owner is present, request proof of rabies vaccination, and get the owner's name and contact information.
  2. Clean bite wound with soap and water as soon as possible.
  3. Consult your doctor immediately or go to the emergency room if it's after office hours.
  4. Contact the dog's veterinarian to check vaccination records
  5. Contact the local animal control agency for additional information regarding local ordinances.  They may be able to enforce or impose fines if necessary
In general, dog bites will never go away but can be significantly reduced in following simple common sense steps. 

Monday, May 2, 2011

An ACCES Success Story: Sasha the Greyhound

By Jean Maixner, DVM
It was a typical drizzly and chilly February day when Mr. Rodgers saw his newly adopted greyhound companion Sasha hit by a careening car.  Mr. Rodgers rushed to Sasha’s side to find him weak and dazed, fighting for each breath.
Sasha was immediately taken to the Eastlake Veterinary hospital.   His gums were grey as he labored to breathe.  A quick radiograph revealed bleeding and bruised lungs.  Sasha had a tear in his lungs that released his breaths into his chest cavity.  Once in his chest cavity, the inhaled air could not escape, threatening Sasha’s life. The veterinarian worked quickly to remove the air and blood from his chest - with a needle and syringe he drew blood and air out, liters of air.  But even as the veterinarian drew air out, Sasha breathed more in, compressing his lungs so they couldn’t inflate.   Sasha was critical and needed 24 hour intensive care; he was transferred to Animal Critical Care and Emergency Services (ACCES).


Dr. Wassink and the ACCES team were ready for Sasha when he arrived. They quickly went to work and started him on oxygen support, while placing an IV catheter and checking his vital signs.  Dr. Wassink knew Sasha was going to need chest tubes to remove the accumulating air and fluid. The big dog was sedated; tubes were swiftly placed between his ribs and into the air and blood-filled chest cavity.  As the air and blood were suctioned off, Sasha was able to inflate his lungs and breathe.  There was a sigh of relief and smiles around the emergency room as everyone saw Sasha begin to take bigger and bigger breaths until he was breathing easier. 
However, the relief was short-lived as Sasha continued to bleed into his chest. He now needed a blood transfusion.  Dr. Wassink consulted with the ACCES Critical Care Specialist, Dr. Davidow, and they decided the best way to help Sasha was to auto-transfuse him.  They would collect the blood from his chest to further help his breathing, and then give the blood back to him as a blood transfusion.  The ACCES staff collected the blood and carefully transfused it back into him through his IV catheter. The auto-transfusion helped to stabilize Sasha that afternoon.

Sasha receiving an autotransfusion

Through the afternoon and night Sasha remained critical.  He stayed in ACCES’s ICU on oxygen support, while continuous suction was applied to his chest tubes to remove the excess air and blood, and he was constantly monitored by the ICU nurses and veterinarians.  By the next morning Sasha was more comfortable, but he still needed intensive care.  He was still anemic from bleeding into his chest cavity and was given a second blood transfusion, this time from an ACCES Blood Bank community donor.  Sasha was maintained on pain medication and watched closely.
Over the next 24 hours, Sasha’s lung tear started to seal, and less air could be removed from his chest cavity.  The continuous suction was disconnected.  His pain medication and sedation were gradually weaned down.  He started eating and drinking on his own, and began walking outside.  Two and a half days after his accident, Sasha was breathing well enough on his own that his chest tubes were removed. Today this big beautiful boy is home, enjoying life with his loving adopted family.