Dawg Business: It's Your Dog's Health!: August 2011

Tuesday, August 30, 2011

The Plot Thickens: Billy's Story (Part IV)

By Dr. Jonathan Mitelman and Barbara Kelly

Continued from Part 3

Where we left off: An inter-digital cyst had been found on Billy the large dachshund’s left front paw, adding to the problem of the badly infected right front paw. Out of nowhere came an unexpected bad response to medication.

The plot thickens …

After having a peculiar response to the combination steroid/antihistamine, Billy was left at VETSToronto for further assessment.

Dr. Mitelman: The pharmaceutical company was kind enough to authorize a thorough diagnostic work up including blood and urine tests, blood pressure, radiographs and ultrasound.

I'd hoped the tests would shed some light on Billy's unusual and prolonged reaction to the medication.

All of the tests returned normal results except for a mildly elevated level of one liver enzyme called alkaline phosphatase (ALP), derived from the bile ducts within the liver.

We could not ascribe any significance to it.

Notwithstanding that, the idiosyncratic reaction to the medication itself did not make sense. Sedative effects for over two days?

Perhaps Billy's liver couldn't metabolize or eliminate the drug properly?

Maybe the selective barrier surrounding the brain (the blood-brain-barrier) wasn't selective enough. This reaction was definitely a first for us.

Barbara: I was actually finding it hard to believe that my dog had a reaction that NO ONE had seen or heard of.

So I started doing my own research.

After all, we are a journalist's family. Unfortunately, I turned up nothing to the contrary.

Dr. Mitelman: Billy's leg licking, chewing and irritated armpits from presumably itchy skin was unrelenting. He was up in the wee hours of the morning, scratching, whining, catching his leg in his e collar while attempting to chew it.

Nothing the sleepless family tried offered any relief to him (or them).

We discussed our options. Barbara was reluctant to have Billy take steroids, a concern left over from side effects experienced by her first dachshund, Auggie. So we decided to try an over-the-counter antihistimine.

Barbara: Yes, and then we tried the antihistamine. I was comfortable with this as my husband and son took it to treat their allergic reactions to stings/insect bites. I actually had some at home.

I hoped this would give Billy some much need relief that night.

Dr. Mitelman: The veterinary drug book indicated this drug would be safe, particularly at the low dose prescribed. I haven't had or heard of any complications with it before, when given to dogs half Billy's weight, at this same dose.

Harmless. Right?

Wrong again. Several hours after the always trusting Billy accepted his medication, he changed. Dr. Jekyll and Mr. Hyde. He became delirious. Confused, wide eyed and agitated. Pacing in the house, back and forth.

Perhaps he indicated the urgency to urinate. As Barbara opened the door, out he darted, almost falling off the porch. Unresponsive to her calls, he darted into the street, confused. And then he froze. Barbara, visibly shaken, scooped him up and carried him back home.

Unbelievable.

Barbara: Billy's reaction to the antihistamine was frightening. Never again.

The only way to keep him safe that night was to crate him. He eventually stopped whining and thrashing about. By morning, eight hours later, he finally slept.

Unbelievable.

Dr. Mitelman: Pharmacologists were consulted again. An explanation called "hyperexcitation", at paradoxically low doses of the antihistamine, was offered.

This was a hard pill to swallow. The previous combination drug knocked him out, the current one over stimulated him. Where is this all coming from?

James Herriot, meet Sherlock Holmes.

Barbara: So we went on a search for possible sources bringing on Billy's unrelenting itching. What could he be reacting to? Dr. Mitelman and I started to dissect every aspect of our family's life. Shampoos, deodorants, cleaning products, dust mites. Our family life became an open book.

Somewhere in here we changed Billy's food to a kangaroo and oat formulation, used for sensitive skin issues. Billy loved it. But I was told it could take months to see the desired results. If it helped at all.

Late night emails, back and forth with ideas.

Dr. Mitelman, Billy and I really didn't need to sleep, did we?

Dr. Mitelman: In addition to the stresses revolving around Billy's physical and mental state, Barbara had her hands full with those of her own.

Her aging mother, in the advanced stages of dementia, required intensive care, beyond what the nursing home had to offer. A certain end was coming and Barbara was faced with challenging decisions. The stress and responsibilities placed on Barbara were immense. You could see it in her eyes and hear it in her voice.

Fortunately, she was surrounded by caring people and her strong will and determination helped her forge on.

Barbara: Dr. Mitelman, Jonathan, was an amazing support during my mother's difficult last months. I will always remember this and be grateful.

Billy could not be left alone so Dr. Mitelman arranged for me to leave him at VETSToronto, any time of the day or night.

Billy continued to show us more and more peculiar behaviors. We knew we had to continue our search for some answers.

Dr. Mitelman: Little astonishment to our readers, more surprises lay ahead.

***

Dr. Jonathan Mitelman, DVM, graduated from the Ontario Veterinary College in 2002. After graduation he joined the staff at the Kingston Road Animal Hospital in Toronto, becoming a partner with clinic founder Dr. Morris Samson in 2005. Together they formed VETSToronto, the Emergency Service Trauma Network in 2009.

Dr Mitelman's interests are in orthopaedic and soft tissue surgery, ophthalmology, and cardiology. He is experienced with the endoscope/laparoscope, ultrasound, slit biomicroscope, and CO2 surgical laser. He is married and has a daughter, son, and three cats.

***

The Kingston Road Animal Hospital, and its founder Dr. Morris Samson, are celebrating the clinic's 25th anniversary this year. VETSToronto, the veterinary emergency trauma service, is housed in this location in the Beach area of Toronto.

The hospital is a full service emergency/after hours/critical care facility that provides around the clock care. There is a doctor on site 24/7/365. Owners Dr. Samson and Dr. Mitelman oversee all cases, providing continuity of care.

Referrals from other hospitals are examined, stabilized and treated, then returned to their regular clinic. Follow ups are done with both the referring veterinarians and the pet's owners.

As a full service hospital we have the following:

on site ultrasound
on site endoscopy
laser and orthopedic surgery
emergency/critical care specialists, internal medicine specialists, and surgeons on call

Saturday, August 27, 2011

Don't Knock It Until You Tried It: Animal Chiropractic

The goals of having chiropractic adjustments can be as simple as having your animal feel and perform better, to resolving biomechanical problems, to helping heal extreme pain and paralysis.

Source: Dog Kinetics

Animal chiropractic? Really?

Well, until recently, I didn't know much about it either.

When I first read about it, as interesting as it sounded, I would have never consider it for my dog. Anecdotal evidence issue aside, in my mind, the word chiropractic stood for painful bone-crunching torture. I'd hesitate to put myself through something like that, let alone my precious baby.

But one can always learn something new.

Eight out of 10 dogs seem to find some type of instant relief from dog chiropractic therapy.

Source: Organic Pet Digest

Animal chiropractic is a very gentle procedure!

Well, it does sometimes hurt some when the chiropractor finds the spot. But how much pain might your dog be in constantly, without you even knowing?

When the sore area is found, your dog might react with a growl or "don't do that it hurts" response. This part is actually useful, as it helps to identify where the problem is. (Diagnostic points in Traditional Chinese Veterinary Medicine (TCVM) work much the same way.)

The adjustment itself consists of applying gentle pressure until things pop back into their rightful place.

Reading about animal chiropractic is one thing. Experiencing the results is another.

As Jasmine started going for her physical therapy, her vet included chiropractic as part of the process.

This often consists from a check up only. But sometimes misaligned areas are found and adjusted.

Jasmine is a very social and outgoing dog and she loves attention and petting. But sometimes she would get sensitive to touch in one area or another.

We guessed that she might be painful in that area but didn't really understand why, as there was nothing obvious to be found.

After she started seeing the physical therapist/chiropractor, things suddenly made sense. Every time she'd become sensitive to touch in a certain area, some misalignment would be found.

The most dramatic result we witnessed was when one day Jasmine suddenly started limping on her rear leg terribly.

She wouldn't use the leg at all! Not even laying down or getting up!

It looked worse than when she tore her cruciate ligament! At that time we already new that the knee surgery failing that long after it has healed was not likely at all.

What was going on? Another muscle or tendon injury?

We took Jasmine to her physical therapist right away. She checked her out and found a major hot spot on the spine right at a hip area. As she applied steady pressure, suddenly we could actually hear the pop!

And that was that. Still little sore that night, Jasmine's was walking fine the next day!

Same thing happened with her recent limp on front left leg.

Three hot spots at the shoulder area were found and adjusted. The next day the limp was gone.

And those are just the things that are easily visible.

Because of Jasmine's high activity level, she is perfectly able to tweak her spine here and there. I can't even imagine what her life would be like without the benefit of the chiropractic adjustment.

It also puts many things into a different light.

I read stories of highly reactive dogs who mellowed right out after getting chiropractic help. No wonder the'd be aggressive, with so much pain.

Today I believe that getting a chiropractic check-up should be part of the diagnostic arsenal, whether your dog is visibly suffering pain or just being more grumpy or aggressive than they should. Particularly with a sudden onset.

No harm in that. While it might not always be the case, a chiropractic adjustment just might solve your dog's problem.

Yes, there are evidence-based practice veterinarians who frown on such hack as animal chiropractic. Ours is not one of them. He's, in fact, the one who introduced us to Jasmine's physical therapist.

I guess it's just one of those things where seeing is believing. For me, anyway.

Don't knock it until you tried it.

Does your dog see a chiropractor? Share your experience.

It's your dog's health,
Jana

Further reading:
Dog Chiropractic Basics
Dog Chiropractic Therapy: An Option for Your Dog?
What is Animal Chiropractic?
Veterinary chiropractic

Thursday, August 25, 2011

Vomiting in Dogs: Is He Actually Vomiting?

by Lorie Huston, DVM

Vomiting is a common occurrence in dogs and can be a major concern for their owners. There are many causes of vomiting and vomiting can range from being an isolated incident of very little concern to your dog’s health to being a major threat to his health and well-being.

But how do you determine the difference?

Firstly, you need to determine whether your dog is truly vomiting.

Is Vomiting Really Vomiting?

While vomiting is a very real symptom and one we see frequently in dogs, there are a few other instances that can cause symptoms that appear very similar while not actually being vomiting in reality.

In order to accurately diagnose the cause of a symptom or illness, we need to understand what we are seeing.

Let’s start by defining vomiting.

Vomiting is defined as the forceful expulsion of contents from the stomach.

The contents “thrown up” when your dog vomits may be anything that is in his stomach, including undigested or partially digested food, yellowish-colored bile-tinged fluid, or even foreign objects your dog has swallowed.

Vomiting is typically an active process and you will usually see your dog’s abdomen heaving as he vomits.

At the same time, your dog may be nauseous, in the same fashion that you probably feel nauseous when you are vomiting. Nausea may result in excessive salivation or drooling and it is possible that your dog may feel nauseous even if he is not actively vomiting.

Vomiting Versus Regurgitation

Vomiting must be differentiated from regurgitation.

Regurgitation is the term that is used to describe the expulsion of the contents of the mouth, pharynx or esophagus.

In other words, regurgitation involves “throwing up” food and other content that has not yet made its way to the stomach.

Regurgitation is a more passive process than vomiting.

There is no abdominal heaving involved. There may be a little gagging involved but basically undigested food will simply pass back up through your dog’s mouth when he regurgitates. In most cases, the regurgitated material will be undigested food and it may be covered with mucus.

Respiratory Symptoms and Vomiting

Another scenario that may be mistaken for vomiting can happen when a dog is experiencing respiratory symptoms and is coughing up respiratory secretions.

This can usually be differentiated from true vomiting by the presence of other respiratory symptoms such as coughing, gagging, wheezing and/or difficulty breathing. When coughing up respiratory secretions, the “thrown up” material is likely to be white and frothy in appearance.

Diagnosing the Cause

Naturally, if any of these symptoms are occurring for your dog on a regular basis, it’s time to visit your veterinarian.

With a thorough physical examination and good history of your dog’s physical symptoms, it is usually possible to determine whether your dog is truly vomiting or experiencing some other health issue.

Bringing a sample of the material your dog is “throwing up” can help determine whether the material is made up of stomach contents if you are uncertain.

Because of the acidic nature of the stomach, stomach contents will have a pH value that is much more acidic than that of regurgitated food or other materials. The pH value can easily be measured.

The list of possible causes for true vomiting is much different than the things that can cause regurgitation.

Similarly, if your dog is experiencing respiratory issues rather than gastrointestinal issues, the differential list changes dramatically.

Once it has been determined that your dog is truly vomiting instead of regurgitating, a diagnostic plan can be pursued to find the cause and a treatment plan can be chosen to resolve your dog’s illness.

***

Lorie Huston has been practicing veterinary medicine for over 20 years. Besides a successful career in a busy small animal hospital in Providence, RI, Lorie is also a successful freelance writer specializing in pet care and pet health topics.

Currently, she is the feature writer for the Pet Care section at Suite101.com and the National Pet Health Examiner at Examiner.com. Lorie also publishes her own blog, The Pet Health Care Gazette and manages an increasingly popular facebook page, The Voice of Pet Care.

Articles by Dr. Huston:
Lyme Is Lame (Pun Intended)
The Ticking Bomb
Don't Let Heartworm Become A Heartbreak!
Summer Perils: Blue-green Algae
Your Dog And Leptospirosis
Canine Parvovirus
Canine Distemper Virus
Why Is My Dog So Itchy? Top 5 Causes Of Itching In Dogs
Vaccination Concerns and Potential Side Effects
Natural Flea Control for Dogs

Related articles:
What's In The Urine? (Part I)
What's In The Urine? (Part II: Urinalysis)
Excessive Drinking
Bad Odor
Excessive Panting
Bad Breath (Halitosis)
Where There Is Smoke, There Is Fire: A Symptom Is Your Friend!
When Is It An Emergency?

Tuesday, August 23, 2011

What Is Going On With Billy's Skin? Billy's Story (Part III)

by Dr. Jonathan Mitelman, DVM and Barbara Kelly

Continued from Part 2

Where we left off: An inter-digital cyst had been found on Billy the large dachshund’s left front paw, adding to the problem of the badly infected right front paw.

Dr. Mitelman: The good news is that Billy's front right paw was steadily improving. Islands of alopecic skin were steadily shrinking.

What hadn't changed was his desire to lick and chew the leg.

But who could blame him? He did, however, tolerate the daily handling, medication, rinses and that still ever-present e collar well.

We brought the inter-digital cyst on the front left paw under control.

Then, wouldn't you know it, Billy diverted his attention to his rear legs.

Without the e collar (and even at times with it on) he would lick and chew. If given the opportunity to do so for long enough, he would probably chew his paws to the bone.

What brought this on?

Back at the hospital, Billy was examined. Again. There was a tiny red bump on the webbed skin between the toes of his right hind leg.

What came first?

Did the bump induce the licking or did the licking induce the skin lesion? Was this related to the right fore leg and if so, how?

Barbara: We were amazed to see the infection in the right front paw healing so well. At the same time we were distressed that the dog was so itchy. And the appearance of the sores on all of his other legs meant that we were now doing daily cleanings/treatments on all four paws.

It was crazy-making time for all of us. What was causing this? New floor cleaner or laundry soap? Something in the grass? What had changed? It was always in our thoughts and the topic of every dinner conversation.

Dr. Mitelman: We were on a hunt for answers. Barbara recalled that Billy had some warts (or papillomas) removed from the right side of his body at the other clinic.

Now the right front and back paws. The asymmetry piqued her curiosity and worries further.

(Billy wouldn't mind the middle name Dexter, right?)

It was time to consult with senior veterinarians. It was pointed out that the skin beneath Billy's armpits was also moist, dark, hairless and had a slight yeast odor. Another skin issue.

The path was now turning towards allergies.

But to what? And why now after all these years free from medical problems, save for a bout of intervertebral disc herniation in 2008 (that is for another blog).

A collective decision was made to treat the symptoms and get the itch under control. A routine medication consisted of a tablet containing both an anti-histamine and a steroid.

"This will take the itch away and make him more comfortable," I reassured Barbara. "Have him take two pills tonight, and call me in the morning.”

Barbara: I certainly did call the clinic in the morning. But not with the message everyone was expecting.

Billy, a normally exuberant, tail wagging bundle of energy, fell into a deep sleep shortly after taking the new medication. My first reaction was, "good, we will all get some sleep tonight".

My relief turned to panic when, 12 hours later, I could not wake the dog!

I called the clinic and the doctor on duty advised me to bring him in.

Billy became a little more active en route, but had a groggy appearance and was simply not himself. When the doctor commented on how calm Billy was, I knew something was wrong. This vet had never seen my very boisterous dog before.

Blood work was done. Everything looked fine, except Billy was a little dehydrated.
I was allowed to take him home with instructions to call with any changes.

Billy went back to sleep. After eating. I knew that was a good sign. I emailed Dr. Mitelman and spent the day listening to Billy snore.

Dr. Mitelman: I got Barbara's message late in the day after attending an out of town meeting. I checked with the clinic and called Barbara. We would monitor the situation through the night.

On the bright side, he wasn't chewing. He was, however, a zombie.

Billy slept well into the next day. A consult with the pharmacolgist was done. He couldn't offer an explanation for Billy's idiosyncratic response to the medication. This was a drug reaction with unexpected signs and of a lengthy duration.

On Monday, the drug company who manufactured the medication was called. They were willing to help since Billy's reaction was a first for them in well over 20 years of manufacturing and distributing the drug throughout North America.

The company graciously offered to cover the costs of blood tests, radiographs and ultrasounds in order to elucidate any cause and/or effect.

Barbara: Billy was himself again by Monday. Almost 48 hours of deep sleep. Dr Mitelman examined him and everything seemed fine. Tail wagging and happy again. I left Billy at the clinic for the tests requested by the drug company to be done.

I was looking forward to the answers I hope we would have.

Dr. Mitelman: Foreshadowing at its best, this was just the first drug in the line of medications to induce reactions in Billy. And to confuse and confound us.

***

Dr. Jonathan Mitelman, DVM, graduated from the Ontario Veterinary College in 2002. After graduation he joined the staff at the Kingston Road Animal Hospital in Toronto, becoming a partner with clinic founder Dr. Morris Samson in 2005. Together they formed VETSToronto, the Emergency Service Trauma Network in 2009.

Dr Mitelman's interests are in orthopaedic and soft tissue surgery, ophthalmology, and cardiology. He is experienced with the endoscope/laparoscope, ultrasound, slit biomicroscope, and CO2 surgical laser. He is married and has a daughter, son, and three cats.

***

The Kingston Road Animal Hospital, and its founder Dr. Morris Samson, are celebrating the clinic's 25th anniversary this year. VETSToronto, the veterinary emergency trauma service, is housed in this location in the Beach area of Toronto.

The hospital is a full service emergency/after hours/critical care facility that provides around the clock care. There is a doctor on site 24/7/365. Owners Dr. Samson and Dr. Mitelman oversee all cases, providing continuity of care.

Referrals from other hospitals are examined, stabilized and treated, then returned to their regular clinic. Follow ups are done with both the referring veterinarians and the pet's owners.

As a full service hospital we have the following:

on site ultrasound
on site endoscopy
laser and orthopedic surgery
emergency/critical care specialists, internal medicine specialists, and surgeons on call

Saturday, August 20, 2011

Canine Massage: Every Dog ‘Kneads’ It”

by Susan E. Davis, PT

Massage has always been a “cornerstone” treatment for physical therapists.

It is one of the first courses a PT student takes when beginning their professional coursework.

The benefits of massage to human beings having various medical conditions has been acknowledged for decades and is now being utilized more in the animal world. The benefits dogs receive from massage are many of the same benefits that humans do such as decreased tension, pain and inflammation, increased blood flow and healing, decreased swelling and reducing fibrous adhesions.

And you can never underestimate those non-tangible benefits of the healing touch that calm, sooth and allow the body to heal itself.

The technical definition of massage is “soft tissue manipulation or mobilization” and involves moving the hands along the skin and moving the underlying tissues, directed toward a specific purpose, aimed at achieving a physiological and psychological change.

In animals it is generally done in direction of hair or coat, but sometimes done in the direction of the heart.

There are 4 basic types of massage:

1. Effleurage or Stroking: which utilize gliding motions using the therapist’s palm and fingers.

This technique is excellent for removal of swelling and increased lymph drainage. It improves circulation and produces a “flushing out” effect. Bear in mind that the weather plays a role in affecting the soft tissues. When the barometric pressure in the atmosphere is low, tissues tend to swell and become more tender.

If your dog is arthritic you may notice their symptoms seem worse on low barometer/humid/damp days and better in dry or high barometric conditions. Massage can be used to combat the uncontrollable effects that the weather has on your dog. Therapists may be likely to use this type of massage technique for swollen, tender tissues.

2. Petrissage: kneading, compression, and skin rolling using thumbs and fingers.

This technique is best for soft tissue tension, commonly referred to as “spasm” or “guarding” and nodules, etc. They form from repeated strain, injury and micro trauma that cause muscle tightening.

This tightening is the body’s natural reaction to trauma, shifting from a relaxed to a protective mode. If the tightened, protective mode continues for very long without relief, the muscle becomes overused and fatigued, and changes start to occur within the cells.

Within skeletal muscle cells are protein molecules called actin and myosin. These are small filaments that are organized into units of muscle tissue called sarcomeres .In turn, they are arranged in series, overlapping each other, like a ratchet system. This is the mechanics behind muscle contraction.

Upon injury with muscle guarding and spasm, the cells simply start to run out of energy, they secrete excess protein and the sarcomeres tighten upon each other (think of those bright colored little woven Chinese torture tubes you may have played with as a kid, where you insert your fingers on each end and as you pull apart the tube gets tighter and tighter.)

Mild to moderate tightening that can be relieved by applying gentle pressure is called “guarding”. Harder tightening that tends to feel very hard and worsens with pressure is “spasm”. Guarding and spasm usually occur in an entire muscle belly and it can’t relax without intervention.

Small concentrated formations of tightness can occur within the muscle called “nodules” or knots. They can also be called “trigger” or stress points.

So, how to cure this problem?

From a physiological standpoint you want to flush out the excess protein and elongate the sarcomeres. This can be accomplished by the use of physical modalities like heat or cold, ultrasound or laser, massage, stretching and muscle length rebalancing. The muscle also needs rest.

This is why it sometimes seems to take longer to heal a muscle injury than a broken bone!

A bone can fairly readily be rested through casts and splints, but muscles can be “flexed” even with restricted movement from a cast or sling, via isometric contractions. In severe instances medication may be needed such as muscle relaxers, injections or dry needling techniques.

3. Tapotement: tapping, cupping, vibration and shaking using sides of hands, fist, or heel of hand.

It can include gentle squeezing and wringing. These techniques are used on more dense, thicker areas of muscle tissue such as the thigh and hip or buttock area. It is generally used to relax very tense areas and sometimes used over the ribcage in respiratory conditions.

4. Cross Friction or Transverse friction: for adhesions or scarring.

It uses the thumbs and index fingers perpendicularly across the direction of the fibers. It can be uncomfortable for your dog but usually yields fast and good results.

Who should do animal massage?

Veterinarians, Physical therapists, Massage Therapists and other health professionals who have received massage training and instructions.

Giving a proper massage requires study of animal anatomy, medical background and where/how to apply the various therapeutic techniques and maneuvers. It also takes practice. As a pet owner, your health care professional /Vet can show you some basics for your particular dog’s needs and issues.

Please understand that without prior basic instruction, massaging your dog can do more harm than good.

I have often been asked to give mini lessons to groups on animal massage but have declined the invitations for this very reason. In addition, you can never fool an animal and they really know when the hands touching them are trained or not.

The dog should be relaxed and trusting for the “healing touch” to have the best effect and they will not fully relax if they sense you are not prepared.

I cannot stress enough that a dog always knows “trained hands’. A trained practitioner should pay close attention and listen for the feedback dogs give.

When should massage be avoided?

During fever, shock, active bacterial or viral infections, distemper, neuralgia, fungal sin conditions, open wounds, conditions where there is acute and severe inflammation (need to wait a day or 2 for the inflammation to be less acute).

***

Susan E. Davis (Sue) is a licensed Physical Therapist with over 30 years of practice in the human field, who transitioned into the animal world after taking courses at the UT Canine Rehabilitation program. She is located in Red Bank, New Jersey.

For the last 3 years she has been providing PT services to dogs and other animals through her entity Joycare Onsite, LLC in pet’s homes and in vet clinics.

She also provides pro bono services each week to a shelter and sanctuary for neglected and abused animals. Sue is the proud “dog mommy” to Penelope, a miniature Dachshund with “attitude”. For more information see her website www.joycareonsite.com , or follow on Twitter @animalPTsue.

For further information:
Tallgrass Animal Acupressure and Massage Institute
National Board of Certification Animal Acupressure and Massage

Articles by Susan E. Davis:
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core

Thursday, August 18, 2011

What Acupuncture Did For Intervertebral Disk Disease (IVDD)

We had dabbled into Traditional Chinese Veterinary Medicine (TCVM)
when the conventional medicine failed to find either an answer nor a solution to some of Jasmine's health issues.

We tried food therapy, herbal therapy and acupuncture with very good results.

You might also remember Viva's story. Viva's spondylosis also responded very well to acupuncture.

As anecdotal as the evidence may be, dogs are benefiting from these treatments. What more does one need to know?

Here is an account of an experience of one of my dear friends, great veterinarian, Dr. Daniel Beatty, who just recently decided to explore this modality.

Canine Case of the Week: Bear and Cervical IVDD

by Dr. Daniel Beatty, DVM

Canine Case of the Week is Bear a special dog with Intervertebral Disk Disease in the cervical spine. What makes Bear special is that he is also a cancer patient, OK he is a good dog too!

Bear is one of my lucky patients that has been able to take advantage of the new information about acupuncture I have learned from the Chi Institute in my process to acupuncture certification.

Bear is a 10 year old neutered male black Lab. He was diagnosed with Osteosarcoma of the jaw in December 2010. The tumor was wrapped around his lower canine and it bled every time he ate. When it was discovered that it was cancer Bear underwent surgery to have the front third of his lower jaw removed. He recovered fine from the surgery and no longer had bleeding every time he ate.

Shortly after his jaw surgery he started limping on his left front leg.

Of course thinking the worse his owner brought him right away to a specialist and discovered that no, the cancer had not spread, but actually Bear had a strained tendon in his elbow. The specialist injected the elbow with corticosteroid and the limping improved. Unfortunately he developed a neck problem 2 weeks afterwards.

Bear has had issues with his neck for a long time.

He would be stiff and a little painful to the touch. His owner would give him aspirin and in a day he would bounce back, however this time was different. He did not bounce back and in fact became worse.

He could not turn his head to the left without being in pain.

Back to the vet Bear went. His cervical spine was radiographed and luckily no signs of cancer, but also no significant findings for a problem relating to his pain in the neck.

He was diagnosed with Cervical Intervertebral Disk Disease or Cervical IVDD.

An MRI could be done to confirm the diagnosis but with the expense, the fact that an MRI may not be as reliable as once thought for diagnosis of IVDD, the fact that Bear has gone through a lot already and most important the owner was not wishing to put Bear through another surgery and only wants him comfortable for how ever many months she has left with Bear, an MRI was not performed and

Bear was given typical conservative pain management pharmaceuticals – muscle relaxers and pain relievers.

He did this for a couple of months. It did not help enough and in May it became much worse. He could not raise his head comfortably and he was placed on more pain relievers.

In June when nothing else seemed to be helping Bear’s owner called me.

My first visit Bear was mildy depressed but still happy to visit. He could not raise his head very well, looked uncomfortable and certainly could not turn his head left. He was not sleeping well at night. He was very painful when touching his neck or trying to move his head.

I spent time massaging and doing chiropractic adjustments to help relieve some of his tension and pain.

I also prescribed Gabapentin for the neuropathic pain since none of the pain relievers he was on were seeming to help.

A week later I revisited and readjusted. He was improved. His pain was mostly gone but he still could not turn his head to the left.

The next week I revisited again and now he could turn his head about 50% to the left and still no pain. I adjusted him again and was happy with the progress.

However Bear had other plans with his new found reduction in pain.

The problem with giving a dog pain relievers, or doing modalities such as chiropractic or acupuncture is that they do relieve pain. The problem with relieving pain is that the area is still healing and can take 12 weeks to heal completely, but since there is no pain the dog will use the area like there is nothing wrong.

If the dog feels better and does something it should not it can re-injure the area and start the whole cascade of events all over.

That’s what Bear did!

He was happy feeling better and became excited one day. The owner knew that she needed to keep him calm and not do any activity with him, but Bear had other ideas and decide to play hard for a couple minutes and re-injured himself.

When I saw him we were back to square one!

He was in pain again and could not turn his head at all. We started over. I massaged and adjusted him and and was coming back the next week, after my trip to the Chi Institute.

Monday, after my course work at the Chi Institute I visited Bear He was out of pain but still could not move his head to the left.

I had some small needles that I usually use for horse legs.

I did some acupuncture for Bear’s neck and I have a laser machine and lasered a few acupuncture points as well.

The treatment lasted about 20 min. After the treatment was over, Bear got up shook all over and whined at the door. He went out, went to the bathroom, came back in and went right for his toy box. The owner and I were quick to tell him – OH NO. She told him to go lay down.

The owner and I could tell he was feeling very spunky and wanted to play.

He felt very good. So I went onto my soapbox and told her how he needed to rest and definitely needed to be confined and not allowed to play. The problem with acupuncture is that they feel too good and can re-injure themselves. All the while I was talking (preaching) Bear was laying with his right side against a wall, obviously upset that he was told he could not play, and at one point the owner and I looked at him and he looked back at us.

It only took a couple seconds for it to register that he was turning his head to the left to look straight back at us!

Here was a dog that had for months not been able to turn his head to the left and I thought I had made some big progress with the chiropractic treatments to get him to turn his head 50% of the way and now he was turning his head like nothing was ever wrong.

He had no pain and had full range of motion from one 20 min treatment of acupuncture!

Today I visited Bear and he is almost completely normal. He is off all the medications except for the Gabapentin which he has started weaning off. He has a little limp in his left front leg but his neck shows no sign of pain and has about 90% range of motion. I treated him with electroacupuncture today and will visit him again in two weeks.

I have a new found respect for acupuncture and will be incorporating it more and more in my treatment protocols.

I will be suggesting it to clients more frequently and eventually I can see that my practice will be a Traditional Chinese Veterinary Medicine (TCVM) practice using herbs and acupuncture with some chiropractic and physical therapy added. Thank you Bear for the excellent results that were way beyond my expectations. With more treatments I am hoping to help him with his elbow pain and extend his life comfortably despite living with an aggressive cancer.

***

Daniel Beatty, DVM is a wholistically minded veterinarian, with a love of giving out information to make the dog owner more knowledgable and able to handle any health issue with confidence.

Dr. Dan, as he is affectionately known is a 1996 graduate of the University of Illinois, College of Veterinary Medicine. He began his career as a large animal general practitioner in Princeton, Illinois.

While there, he completed advanced course work in animal chiropractics and became certified by the American Veterinary Chiropractic Association (AVCA). And that is where the start of the quest began.

Along with focusing on body mechanics and nutrition in dogs, he works on other health improvements such as reducing the number of vaccines and working with the dogs immune system through supplemental support and pathological issues using more alternative treatments in combination with conventional treatments to help my clients dogs improve their health and performance.

Check out Dr. Dan's Dog Kinetics blog or connect with him on Twitter or Facebook.

Related articles:
Acupuncture Is Not Voodoo
When Modern Medicine Doesn't Have The Answer: TCVM
The Theory Behind The Traditional Chinese Veterinary Medicine
What To Expect During A Traditional Chinese Veterinary Medicine Exam
Healing Your Dog With Food: More To Food Than Nutritional Value?
Why Integrative Veterinary Medicine?
Battling IMHA With Integrative Veterinary Medicine (part 1)
Battling IMHA With Integrative Veterinary Medicine (part 2)
Buddha Recovers From Third Degree Burns
The Many Faces Of Arthritis: Viva Has Spondylosis
Alternative Treatment Of Arthritis: Viva's Update

Tuesday, August 16, 2011

Life-threatening Infection Resolves; All Is Good? Billy's Story (Part II)

by Dr. Jonathan Mitelman, DVM and Barbara Kelly

Continued from Part 1

Story to this point: Billy, a large standard dachshund, had been left at VETSToronto in the hands of Dr. Mitelman. The dog had a life threatening infection in his front right paw that required immediate intervention.

"I just don't believe it," Barbara said, shaking her head in disbelief, acknowledging the gravity of the situation.

The infection, or deep pyoderma, as Dr. Mitelman described it, was so severe that Billy required hospitalization on intravenous antibiotics.

All of the hair had to go since layers of desiccated skin and dried pus needed to be cleared off.

Blood tests were taken to look for the spread of infection into the bloodstream. Radiographs of his leg were taken to look for penetration into deeper tissues.

Billy handled this process well. He seemed to enjoy the attention while the techs took care of the sore paw. He trotted around proudly sporting an intravenous line in one forelimb, the other forelimb shaved and his now ever-present Elizabethan collar.

Billy's leg improved.

After two days in hospital, the inflammation settled, and what remained were patches of fur sprouts amidst a bed of dry and healing flesh. It was uncertain how much skin would be regenerated, and how much would remain scar tissue.

Billy could not hold back the intense drive to lick his still painful wound.

Strong painkillers were prescribed to dull the pain from the irritated and upset nerve endings in his skin.

Billy was ready to go home.

Barbara: It was a rough two days while Billy was hospitalized, but the staff at VETSToronto gave us constant updates and took our frequent phone calls. They welcomed his dad Malcolm's unannounced midnight visit.

Our trust in Billy's caregivers grew.

When Dr. Mitelman explained the daily cleaning regime and aggressive antibiotic treatment plan, we realized the level of commitment that was required. Billy needed daily rechecks at the clinic. We were up to the challenge.

We, in turn, presented Dr. Mitelman with a challenge. We were due to leave for a vacation at a cottage in less than two weeks. We wanted to take Billy with us. He assured us he would prepare Billy, and us, for our much needed holiday.

Dr. Mitelman: There was no shortage of commitment and dedicated care for Billy's convalescence by the family. Armed with medications and topical disinfectants and cleaners, the Kellys continued the uphill battle at home. Some of the shampoos were such effective antiseptics that human hands required latex glove protection to prevent the handler's skin from drying out.

Wet, lather, rinse, pat dry. Wait, Billy's trying to lick again, put the ecollar back on.

Like a broken record, this protocol repeated two, even three times daily. And they always came for the daily at first, then every other day, rechecks.

Barbara: Days turned into weeks. We had a successful trip to the cottage. The staff fashioned a protective covering so Billy could walk on the beach.

Dr. Mitelman was always available for our never-ending questions and concerns. And we discovered a common coping mechanism for the stress of the situation: humour. Dr. Mitelman and our family had a similar, quirky, at times even dark, sense of humour.

Dr. Mitelman: Through all of this the family proved their stamina. So much so, they succeeded in washing Billy's paws without soaking the kitchen floor. Sort of. Restraining a wiggly dachshund while wearing rubber latex gloves is quite similar to wrestling with a greased pig. Except without the squealing. But cue in the splashing and water saturated clothing.

Wise to this, in one iteration, Malcolm stripped down to his undergarments and held fast to Billy on the floor while Barbara leaned over, latex gloves and all, to scrub Billy's leg. It wasn't a scene Patrick, their teenaged son, wanted to stumble upon. He stood on the threshold to the kitchen and stammered with incredulity, "What are YOU doing"?

Malcolm tilted his head and smiled, "We are washing Billy, wanna help"?

Patrick, grumbling under his breath, retreated to the safety of his bedroom.

Barbara: Thankfully, by mid-September, Billy's paw was much better. Still some small draining pockets but, to our delight, some hair was growing back.

Then one day I noticed blood all over the kitchen floor.

My heart sank. What had happened? To my surprise and relief, the blood was not coming from the injured paw.

Rather it was the left front paw that was bleeding.

The relief part was short-lived.

An immediate call to Dr. Mitelman's cell phone. Arrangements were made to meet at the clinic. Again after hours.

Upon examination Dr. Mitelman found a large inter digital cyst on Billy's left front paw.

We looked at each other in disbelief.

At that moment Dr. Mitelman and I both realized that Billy's skin problems were not limited to his sore right paw.

Our journey had just begun ...

To be continued ...

***

Dr. Jonathan Mitelman, DVM, graduated from the Ontario Veterinary College in 2002. After graduation he joined the staff at the Kingston Road Animal Hospital in Toronto, becoming a partner with clinic founder Dr. Morris Samson in 2005. Together they formed VETSToronto, the Emergency Service Trauma Network in 2009.

Dr Mitelman's interests are in orthopaedic and soft tissue surgery, ophthalmology, and cardiology. He is experienced with the endoscope/laparoscope, ultrasound, slit biomicroscope, and CO2 surgical laser. He is married and has a daughter, son, and three cats.

***

The Kingston Road Animal Hospital, and its founder Dr. Morris Samson, are celebrating the clinic's 25th anniversary this year. VETSToronto, the veterinary emergency trauma service, is housed in this location in the Beach area of Toronto.

The hospital is a full service emergency/after hours/critical care facility that provides around the clock care. There is a doctor on site 24/7/365. Owners Dr. Samson and Dr. Mitelman oversee all cases, providing continuity of care.

Referrals from other hospitals are examined, stabilized and treated, then returned to their regular clinic. Follow ups are done with both the referring veterinarians and the pet's owners.

As a full service hospital we have the following:

on site ultrasound
on site endoscopy
laser and orthopedic surgery
emergency/critical care specialists, internal medicine specialists, and surgeons on call

Saturday, August 13, 2011

Dog Versus Human Anatomy Facts

Have you ever wondered what anatomical differences there are between us and our dogs?

Enjoy there fun facts about dog anatomy created b Pet365 - a UK supplier of dog collars, leads and pet accessories. Click here to view the full post.

Thursday, August 11, 2011

Let There Be Water: Jasmine's Underwater Treadmill Session

Do you remember from my earlier article how Jasmine is convinced that she needs to help things along in order to get the tank filled? Here is a proof!

We first tried underwater treadmill for Jasmine's muscle injury.

After she was all recovered from both of her knee surgeries she suddenly started limping on her rear leg again.

At first we worried that her knee had gone bad again after all.

But it turned out being a muscle injury.

As much as that part was a good news, after some initial improvement the lameness wasn't going away.

NSAIDs are not an option for Jasmine and pain drugs didn't seem to had been making much difference. After some debate we decided to treat her injury with physical therapy.

While that particular injury was difficult to treat and it took a long time to resolve, underwater treadmill ranks high on our list of treatment options orthopedic issues.

Underwater treadmill at Jasmine's rehabilitation center, Woodcock Veterinary Services

We have returned to hydrotherapy after her latest problems, in conjunction with latest stem cell therapy, and decided to keep it up on maintenance basis.

You can't go wrong with underwater therapy, whether by itself, or in combination with other treatments.

The benefits of hydrotherapy are multifaceted.

The buoyancy reduces weight bearing strain. Gentle resistance improves muscle strenght. Water level and temperature can be controlled to achieve different goals. Find out more about How Water Is Used for Dog Physical Therapy.

Related articles:
Don’t Forget the Physical Therapy
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core
Underwater Treadmill
Keeping Your Dog’s Muscles Healthy and Strong
Arthritis? What Arthritis?

Meet Jasmine
I'm Still Standing! (Happy Birthday, Jasmine)
How Dogs Think (Well, Jasmine Anyway)
How The Oddysey Started: Jasmine's ACL Injury
Jasmine is Vet-Stem's poster child!
Rant About Quality Of Life Versus Quantity, And Differential Diagnoses
Jasmine Is Headed For Her Next Stem Cell Treatment
Jasmine's Stem Cells Are In

Tuesday, August 9, 2011

When A Small Sore Turns Into A Catastrophe: Billy's Story (Part I)

by Dr. Jonathan Mitelman, DVM and Barbara Kelly

This is the story of Billy, a nine year old standard dachshund.

There are many reasons that Billy is considered a "special" dog. He is a valued member of his family and loved by all he meets.

But, Billy has medical issues that make him unique as well: serious skin allergies, intolerance to certain foods and medications, and inflammatory bowel disease.

We never actually know how Billy will react to any treatment plan.

Dr. Jonathan Mitelman, of VETSToronto, at the Kingston Road Animal Hospital, is Billy's veterinarian. Two years ago he treated Billy as an emergency. Since then he has remained committed to Billy and his family through all of the ups and downs of what has turned out to be an incredible journey.

Barbara is Billy's dedicated owner. As committed as Dr. Mitelman is to Billy's cause, they work together to ensure the best health decisions are made.

We would like to share this story with you.

What started out as a one-time visit to an emergency hospital has grown into a two-year search for answers.

And in the process, Billy has brought us together as friends and families.

The first visit:

Dr. Mitelman: It was a rainy holiday Monday in August, and even if it wasn't raining it might as well have been. Barbara, Billy's mom, (known in the twitter world as @iambillysmom), knew something was amiss with her wiener dog.

Billy, the dachshund, is a red male of large stock. He was seen at her holistic-minded vet for an ongoing skin condition just two days previously, and now favoured his right foreleg, whining, and chewing it.

Oral supplements had been prescribed, a poultice and bandage applied, and she was directed it be left there for several days.

Something wasn't right. Didn't walk right. Didn't smell right. Didn't feel right.

Billy whined and tugged at his increasingly soggy bandage.

Where to seek veterinary care on a holiday Monday? Emergency referral hospitals in Central Toronto were a possibility, but not a good option for Barbara. Resorting to familiar habits, she reached for the Yellow Pages, dusted it off, and looked for other veterinary emergency hospitals.

She found VETSToronto at the Kingston Road Animal Hospital, close to home. Who needs a time consuming computer search when fingers can fly through paper media more quickly?

A worried Barbara called to announce her arrival and hurried in. She was welcomed by staff and promptly ushered into an examination room.

Enter the veterinarian, Dr. Eugene Alexeev.

Barbara shared the relevant history, and explained Billy was due to have his paw rechecked at their regular vet that week. "We just need the bandage replaced until our next appointment".

Dr. Eugene proceeded to remove the bandage. Billy was extremely agitated.

What Eugene found quite frankly shocked him. Third degree burns to the skin! Red flesh! Pus!

What happened here? What did they do? What was applied to this skin and then marinated beneath the bandage?

Eugene complied with the client's wishes, rinsed and dried the wound and applied the necessary dressing as requested.

"Please see your veterinarian tomorrow. I don't like how this looks. It is very infected," he said.

***

Barbara: When we saw the discharge seeping from Billy's bandage we knew he needed immediate medical attention. We had been taking Billy almost daily to our regular clinic for bandage changes, no one had warned us of this.

When Eugene removed the dressing we couldn't believe what we saw!

We hadn't actually seen it in about a week. The bandage changes had been done without us present.

How did such a small sore turn into this?

***

Dr. Mitelman: Dr. Alexeev said the first key was to stop the holistic medicine because it was not helping in this case. Dr. Alexeev's comment hit Barbara hard. How could this be true?

The proof was in the pudding. Or was it the green pus oozing from Billy's paw that helped her to her realization.

Barbara’s husband Malcolm went into their incumbent veterinary office for an appointment, but was told Billy couldn't be seen for two days. Billy's leg was worsening, so Barbara returned to Kingston Road Animal Hospital to see Dr. Alexeev for follow up and consultation.

Dr. Alexeev was scheduled for emergency shifts, so she was seen by Dr. Britteny Kyle, a new graduate.

Dr. Kyle proceeded to unravel the bandages, and frowned. She went to find one of the senior doctors.

"What was going on?" Barbara wondered.

Enter Drs. Samson and Mitelman, owners of the hospital.

To their astonished eyes, they were seeing a 3rd degree burn to nearly half of Billy's right foreleg!

Skin sloughed, and raw red flesh beneath. Dr. Mitelman left Dr. Samson to speak with Barbara and Malcolm.

Not knowing Billy's recent treatment history by the previous veterinarian, he asked Barbara bluntly, "What have you guys been doing?

What did he mean? Was he accusing Billy's owners of caregivers' neglect? “What do you mean us? We've done everything the other clinic told us to do".

Dr. Samson didn't beat around the bush.

The open flesh. The oozing septic wound. He's seen this before. It wasn't pretty.

"Look, if you don't treat this properly, he'll lose his leg. If this nasty infection has penetrated into the bloodstream, he'll die."

How did a small skin wound explode into such a catastrophe?

Dr. Samson called Dr. Mitelman to discuss treatment options with the family.

"I think I shocked them, you'll need to be more diplomatic than I was," Dr. Samson commented.

Barbara: We were faced with some difficult choices. Who would we trust? We couldn't take Billy back to the former clinic.

We had sought what we thought was proper care and look what happened.

But these were complete strangers.

My gut reaction told me that VETSToronto would do right by Billy. I was drawn to Dr. Mitelman and decided I would put Billy's life in his hands. This was one of the best decisions I had ever made.

To be continued ...

on site ultrasound
on site endoscopy
laser and orthopedic surgery
emergency/critical care specialists, internal medicine specialists, and surgeons on call