Saturday, October 31, 2015

Top Veterinary Articles of the Week: Cleaning Wounds, Top Liver Poisons, and more ...

Hydrogen Peroxide Is NOT For Cleaning Pet Wounds
Jason Nicholas, BVetMed/Preventive Vet

When I was little, we always got our wounds treated with peroxide. I remember because of all that foaming. It also stung. It seemed everybody was using that, included nurses, such as when my brother badly scraped his elbow on a vacation.

As I grew up, I stopped falling and had no scrapes to worry about any more. Sharing my life with dogs now, minor wounds is something I have to deal with every now and then again. Using hydrogen peroxide would never cross my mind simply because it hurts. I went to find out what else I could use that wouldn't sting and settled on betadine solution for most things. Many people still using hydrogen peroxide on their dogs' wounds.

I do have hydrogen peroxide in my dog first-aid kit but not for cleaning wounds but in case we needed to induce vomiting or if our dogs got skunked.

If you're using hydrogen peroxide for wounds, don't. Not only it stings but it also damages tissues.

What many people don’t realize is that the bubbling you see when you add hydrogen peroxide to a cut isn’t just an indication that the peroxide is killing the bacteria present, it’s also an indication that the peroxide is killing the very cells that the body is counting on to actually heal the wound! These cells are called fibroblasts, and they are truly crucial to proper wound healing.

Protect Your Dog From 4 Ultra-Scary Liver Poisons
Dr. Eric Barchas/dogster

Did you know what are the toxins most dangerous to your dog's liver? According to a recent veterinary journal, it is xylitol, sago palms, blue-green algae and death cap mushrooms.

Sago palm. Image Pet Poison Hepline

Most toxins make their way into your dog's body through their mouth. Dogs like to test the eatability of almost everything; some more than others. For Cookie, for most part, if it doesn't smell like meat she's not interested in it. However, that doesn't mean she didn't try a brownie or rocks.

The liver is the body's first responder to toxins and it does an amazing job of that. However, some toxins can cause catastrophic damage to the liver itself. The toxins listed here rank as the most dangerous to the liver.

Do read the article, learn about these toxins and keep your dog safe.

Top 5 poisons to induce emesis in the veterinary poisoned patient
Dr. Justine Lee, DVM, DACVECC, DABT/LinkedIn

This article is meant for veterinarians but I think it's interesting for anybody to read. If your dog ingests something bad, there is always the question of whether or not to induce vomiting. What determines whether making your dog throw up what they ingested depends on two things - what they ate/drank and when. It's really a tricky issue and I strongly recommend to not ever induce vomiting in your dog without talking to Pet Poison Helpline or your vet first.

The most common poisons dogs end up eating include cardiac medications, grapes and raising, xylitol, chocolate and rodenticides. The cardiac medications kind of surprised me, I wouldn't think they'd be so attractive. But it might be because of them being more likely to be lying around, perhaps.

We induced vomiting in Cookie once, when she found outside and ate a brownie. Not really because of the amount of chocolate for her size but because the question of whether or not it could have been a pot brownie. We didn't have a conclusive answer to that and we opted to err on the side of caution. But not after a discussion with a vet.

When a dog’s tail wound isn’t just a tail wound
Dr. Marty Becker/Dr. Marty Becker

Sometimes, when you hear hoofs, you do need to think zebras. Dr. Becker talks about a case of a dog who developed an ulcer near his tail, which was diagnosed as bacterial infection. He was put on antibiotics but there weren't helping. After a consultation with the University of Florida’s Small Animal Hospital emergency and critical care service, and several biopsies, it turned out that the dog was suffering from a rare, life-threatening tropical disease, pythiosis, also knows as the "swamp cancer."

Pythiosis is an umcommon and often fatal fungal infection caused by direct contact with contaminated water. It can affect the skin, lungs, brain, sinuses or digestive tract.

A correct diagnosis is always crucial to a successful treatment. If your dog's treatment isn't working, it can be because the diagnosis is wrong. Speak up, get a second opinion, look for an explanation.

Thursday, October 29, 2015

JD's Mast Cell Tumor Diagnostics, Strategy and Treatment

Recently, we found three bumps on JD. One of them was clearly a skin tag. The other two could not be identified by simply looking at them. Following the golden rule, we had them aspirated.

One of them turned out being a benign lipoma, the other, however, a mast cell tumor.

I had a basic idea what mast cell tumors are but I didn't feel it was enough now when we were actually dealing with one. I went on to do my research. One of the first things I did during that process was getting the Dog Cancer Survival Guide. It is written by Dr, Demian Dressler, DVM and Dr. Susan Ettinger, DVM, veterinary oncologist.

Dog Cancer Survival Guide covers full spectrum approach to canine cancer, combining state of the art modern medicine and holistic approach.

If I was going to tackle cancer of any kind, I was going to attack it from all sides.

When the lab results came back identifying one of the bumps as mast cell tumor, I know surgery was the next step.

If everything went just right, getting the cancer out could be all that was needed.

It was still very small (size of a smartie) and not angry-looking at all, just a little inconspicuous bump. We were shooting for a cure.

The main goal was removing all cancerous tissue.

Unfortunately, cancerous cells don't come with a big tag and they don't come confined strictly to the lump itself. Getting clean margins, which means removing ALL of the cancerous cells, was going to be tricky. The rule is to cut out 2cm of tissue all around the tumor. On the tarsus, where JD's tumor was, there is very little of any tissue. If we couldn't get clear margins, we'd have to consider following radiation therapy.

We had a big debate on getting clean margins versus being able to close the wound.

Both I and our vet felt that clean margins, if possible, are the main goal, even if it meant having to do a skin graft to close.

Notes from the vet in response to my questions: "For margins, we need 2 cm around laterally and one fascial plane down. This will not be a problem. I may need to do a lateral releasing incision, but I'll have a better idea at surgery. We can also use flaps or grafts.

We will know about local radiation after the histology comes back, but at the size it is now I seriously doubt we will need radiation therapy.

If indeed we need further therapy, radiation is by far the best choice, no question.

The grading system is entirely up to the histologist, but most do either the new system or both. We will be sampling the local lymph node (popliteal) and taking 3 view radiographs (left, right and v/d) of the chest, and an ultrasound of the abdomen. They always include mitotic index in addition to margin evaluation and staging. Many will include literature on prognosis, but generally if the grade comes back greater than 2, or a suspicious 2, then I forward the case to an oncologist. They would be the ones directing the radiation regardless.

You could add turmeric, and possibly a stasis breaker formulation - I would like to see the histology first.

I do want to tell you that based on experience, distal limb cutaneous mast cells growths are by in large, MCT 1, unless they are left for years and years. This one is nice and small, and we are getting it off early. So I don't want you to worry too much until we know for sure what we are dealing with. JD needs our good energy right now! :)

Oh, and I will be pre-medicating with diphenhydramine (antihistamine) before the surgery."

Having to do a skin graft ended up being the case - skin was taken from JD's shoulder and sutured on the wound. Then the removed tissue was sent to the lab.

We did indeed achieve clean margins.

Even though JD looked like after a motorcycle accident, having a chunk of skin taken from his shoulder and implanted onto the would on his leg, even though it all looked very nasty and unhappy, and even though it's still healing, I believe that getting clean margins was well worth it, particularly as it turned out being grade I tumor, for which complete excision can be all the treatment needed to achieve cure.

All the cancer was removed.

JD also got x-rays, ultrasound and a lymph node aspirate to see whether there were any further signs of cancer other than the lump itself. All this was done before the actual surgery because if it was found that it has spread, we might not have attempted the surgery in the first place. All of that looked clean.

We are done for now.

We got it all out, it was grade I and mitotic index was 0. Of course, we'll keep checking for any future bumps and continue semi-annual wellness checks.

Related articles:
It's That Time of the Year Again: Annual Wellness Exam and JD's Bumps 
JD's Biopsy Results Revealed Mast Cell Tumor: You Don't Know What the Bump Is Unless You Look at the Cells
See Something Do Something Cancer
JD's Mast Cell Tumor: Surgery and Pathology Report 

Symptoms to Watch for in Your Dog: What Is that Bump?

Further reading:
The Oncologist’s thoughts on mast cell tumors 
Diagnosing mast cell tumors
Mast cell tumor treatment: surgery and radiation
All about Mast Cell Tumor Grade
Beyond Mast Cell Tumor Grade: Other Prognostic Factors

Canine Mast Cell Tumours: New Grading, New Treatments

Tuesday, October 27, 2015

Taking Care of JD's Wounds

Is it a guy thing to be horrible about being sick or about their wounds? It's certainly a guy thing with men and as far as I can tell boy dogs are no better.

Boys make horrible patients.

Jasmine had a number of major surgeries and taking care of her incisions was a walk in the park. Not that she never tried licking them but watching her and reasoning with her was good enough. With my working at home and being a light sleeper, she never needed the cone of shame. When she started licking, I'd come up to her and she'd leave it alone. She seemed to understand when I explained why she needed to leave it alone.

Even when Cookie had the porcupine quill in her footsie, she could be convinced to leave it alone and when she cut her paw pad on a glass she was amazingly good about that. We only bandaged it when she was going outside and could take the bandage off when she was at home.

The girls always understood when we were trying to take care of them.

JD is an obsessive licker on a good day. He doesn't have any allergies or any other good reason for it anybody could be able to determine. Normally, that isn't a big deal, other than having everything drenched by his saliva. I wish he took up stamp collecting instead. Or something.

Once he hurt his foot a little bit on a picky weed and next thing we knew he chewed a hole in his pad. When he hurt his leg and had a bit of an infection, he would lick it until he'd cry in pain and yet wouldn't stop. That's JD.

Now he has a long incision on his chest where the skin for his graft was harvested and the wound after the mast cell tumor removal.

Talking about good times ...

Of course, he was furnished by a stylish soft cone. And, of course, because the wound is way down on his leg, he can still reach it. In fact, he somehow manages insert the foot right into the cone. So a cone of shame was a total bust. We still put it on him for the night to protect at least the chest but otherwise is useless.

None of the topicals to stop licking worked either.

During the day, to protect the chest incision, he wears a t-shirt. On the foot we put a sock. Even with the cone on, the sock becomes drenched, no matter how we watch him. All you need to do is blink. Short of putting an astronaut helmet on him, I don't think there is anything that would work. We tried a few other things but it's just a nuisance for him and doesn't stop him from doing what he's gonna do anyway.

Miraculously, in spite of his best efforts, his wounds are healing.

For his chest incision, we revived Jasmine's vet's idea of using Preparation H. He recommended that for one of Jasmine's incisions that didn't want to heal as fast as it should after her knee surgery. He said that it works wonders and does a much better job at that than its original intent.

So that's what we put on that one. The problem is that quite a chunk of skin was removed and the remaining skin was pulled to close. There has been quite a bit of tension in that area trying to pull things apart. JD's stitches had to say in for longer than typical 10 days for that reason.

Right now, though, most of the incision looks healed and there is only one small spot still feeling the tension. Overall it looks like he might be able to get the stitches out on Monday.

This is what the graft looked like originally.
Not much left of it now.
I don't think much of the graft on the leg is going to make it.

However, at least it functioned as a "living bandage," covering the wound for the time being. Because of all the puckering in the particular area, most of the stitches came apart and the remnant of the graft is just sitting in the middle as a pirate patch.

The vet saw it regularly and feels it's doing as well as it's going to.

The good news is that it's filling in with new tissue and there isn't much of a hole there at all now.

The tissue is still raw at spots but that's not a surprise given the challenges it faces all the time. I hasn't gotten infected, which is a miracle, and there was never any dying tissue stink to it either. It's nasty but healthy.

Manuka honey is saving JD's ass.

A examine and sniff the wound three times a day. A couple of days after the surgery I detected a slight, suspicious whiff of something. I contacted the vet, told her about it and asked whether it would make sense to use honey to help it heal and protect it from infection.

We cut the socks so it wouldn't go over JD's foot.
Both JD and Cookie don't do well having something foreign on the foot.
We use vet wrap to help hold the sock in place,
this is applied well above the actual wound.

She agreed so that's what we've been doing. We put some of the honey, one layer of light gauze and the sock over it. We do this three times a day. Just once we forgot to change it mid-day--it was the day we got JD's pathology results and got distracted and forgot all about that. When I was changing the bandage and checking it before bed time, it already started to have a light stink of old socks - starting infection!

By morning it was all fine and dandy again. But we do have to do this religiously three times a day, particularly given how wet the sock gets in the meantime.

Once daily we take everything off and leave it open to air. Which means somebody has to sit there with him to keep him from licking the entire time. We do that with after dinner movie.

To top it all off, JD does not like to cooperate.

He does what he can to avoid his wound care and it takes both of us to tend to it. Hubby has to keep him in place, otherwise I'd be chasing him with the bandages all over the place. Girls are so much easier! Always understood when one was taking care of them.

It's no fun for anybody but it's getting there.
Side note: hubby just said that I owe thanks to JD because he makes the girls look so good! Ha, good point I guess.
Hopefully JD can get the stitches on his chest out on Monday. No much of the stitches left on the leg, maybe three or four, the rest just came apart on its own. The wound is getting there too even though slowly. I wasn't used to tending to such gnarly-looking wounds but over time I figured out when it looks good, read looking as good as it can. It's probably going to take another week or two before that one is in good enough shape to be left alone.

JD has been under house arrest but I think next week we'll start taking him at least for one of the walks a day. On leash, and with some seriously heavy bandage to protect it but I think he should be ok to get out of the house. Cookie misses her play buddy. She's also concerned about him and tries to lick his wounds for him. We are telling her that he really doesn't need any help with that. SHE listens.

Did you ever have a hard time getting your dog's wound to heal?

Related articles:
It's That Time of the Year Again: Annual Wellness Exam and JD's Bumps 
JD's Biopsy Results Revealed Mast Cell Tumor: You Don't Know What the Bump Is Unless You Look at the Cells
See Something Do Something Cancer
JD's Mast Cell Tumor: Surgery and Pathology Report  
JD's Mast Cell Tumor Diagnostics, Strategy and Treatment 

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!

Saturday, October 24, 2015

Top Veterinary Articles of the Week: Wound Home Care, Veterinary Mistakes, and more ...

How to... Take Care of Minor Wounds at Home
Dr. Jennifer Coates/petMD

I still remember taking care of Cookie's cut paw pad. She was running through the bush and her foot found a piece of glass. The cut seemed pretty deep but it was Sunday. Because we were able to stop the bleeding we figured cut pad is not an emergency and we could take care of it at home.

This was a pretty deep cut but healing was progressing nicely without complications.

We did, successfully and I became an expert in bandaging very quickly. If it was a week day, we would have gone to the vet. If it was a bite wound, we would have definitely gone to the vet. Cookie's pad healed nicely and never got infected. But I was all over it like a stink on cheese.

Be a prudent judge of seriousness of the wound.

For minor wounds, see Dr. Coates suggestions for home care.

When Veterinarians Make Mistakes … Tales of an Inexact Science
Dr. Patty Khuly/Dolittler Blog

Anybody can make a mistake. Veterinarians as no exception. Sometimes because things are too hectic, sometimes from the best intentions, sometimes because the right answer isn't apparent at the time. Trust but test, is a saying in my old country (sounds much better in the original language). I learned to review all the labs, discuss things in detail, check medications properly ... I understand that even the best vet can make a mistake but I'd prefer if I could prevent it from happening to my dog [ever again]. So I do my best. And I know our vet and the staff do their best too.

Dr. Khully shares her clinical disaster.

Pet Cancer: Understanding Hemangiosarcoma in Dogs and Cats
Dr. Ann Hohenhaus/Vetstreet

Sarcoma is a malignant tumor of connective tissue. Hemangiosarcoma is a rapidly growing, aggressive cancer in the lining of blood vessels. It most likely occurs in the spleen, liver, heart and skin. It strikes like a lightning bolt. Everything might seem fine and then your dog collapses from internal bleeding.

My brother-in-law lost a dog to hemangiosarcoma in the spleen not long ago. She was quite ill before it got diagnosed, though. Her spleen was removed before it ruptured but it has already metastasized.

Chemotherapy for Dogs & Cats – Better Than You Think!
Dr. Christopher G. Byers/CriticalCareDVM

Seeing what chemotherapy does to people, there was a time when I would even think twice about saying no to chemotherapy for my dog. Jasmine's best friend, a Boxer, got a lymphoma and was started on chemotherapy. He didn't do well at all. The therapy was stopped and shortly after he was set free of his misery.

However, I've been following Dr. Sue Ettinger, a veterinary oncologist, for a long enough time now, I've learned otherwise. Chemo protocols for dogs are different than for humans and most dogs do not experience significant side effects. And when they do, a different protocol can be prescribed.

And the main point? If you say yes to chemotherapy, you didn't sell your soul. You're by no means obligated to continue with a treatment should you change your mind based on your dog's reaction to the treatment.

Today I would not discount the chemotherapy option without at least considering it.

Thursday, October 22, 2015

Primer on Tonsillitis

Written and reviewed by John A. Bukowski, DVM, MPH, PhD
and Susan E. Aiello, DVM, ELS

Dogs have two tonsils located in the back of the throat, where they act much like lymph nodes to combat throat infections.  

When the tonsils become inflamed, the condition is called tonsillitis.  It is most common in small breeds of dogs.

Tonsillitis can be caused by any infection or irritation of the mouth that allows bacteria to multiply and enter the throat.  

The most common cause is probably build up of bacterial tartar on the teeth and associated inflammation of the gums.  Most cases of tonsillitis are caused by an overgrowth of bacteria that are normally found in the mouth, which means that it is not usually contagious to other pets or people.

Dogs with tonsillitis tend to gag, as if something is in the throat, or to make exaggerated swallowing motions.  

Some dogs lick their lips repeatedly.  Most dogs with tonsillitis are reluctant to eat because swallowing is painful.  They may be hungry and go to their food bowl but then eat nothing or very little.  Activity level may be decreased, although tonsillitis does not usually cause a fever.

Tonsillitis is diagnosed by signs of infection and examination of the inflamed and enlarged tonsils in the back of the throat.  The tonsils are hidden in pouches, so they are difficult to see in healthy dogs.  In tonsillitis, the red and inflamed tonsils often “pop out” and can be seen by your veterinarian during an examination of the mouth.

Treatment involves antibiotics to combat the infection, followed by therapy to remove the source of infection.  

For example, a dental cleaning may be needed to remove built-up tartar and calculus.  Tonsillectomy is recommended only when the infection does not respond well to treatment, or if the condition recurs frequently.

Tuesday, October 20, 2015

JD's Mast Cell Tumor: Surgery and Pathology Report

JD had his mast cell tumor removed on last week. Everything went well and I will go into more details on all his procedures next Thursday. Since then we were tending to his surgical sites and waiting for the pathology report.

The pathology report came today.

That is much faster than we expected, which is great. Who likes waiting for these things?

JD's ultrasound and x-rays didn't show anything suspicious.

There are no signs of any lesions, metastasis, enlarged lymph nodes or anything else of concern. His blood work also looked good. Quite good for an old guy.

The pathology on the removed tissue confirmed the mass was indeed a mast cell tumor. Then there are a lot of details followed by the important bit.

Excision is complete.

We had quite a debate how to remove enough tissue from an area where there really isn't any. We had a discussion about the importance of being able to close the incision versus getting clean margins. The area on the tarsus is tricky because there is very little to work with.

We decided that getting clean margins is more important than being able to close easily. It resulted in JD needing getting a skin graft from his chest to close but it was worth it.

We got clean margins.

It wasn't so tricky taking out enough skin around the tumor but it was tricky to find enough to remove below it, between the tumor and the bone. The vet took out two layers of connective tissue below, which was as deep as she could have gone.

There was less than 1 mm of tumor-free tissue at that margin. But it was tumor free. Th closest margin was 7 mm and the other margins were all over 1 cm (out of 6 sections examined).

The other finding of concern was the grade of the tumor.

Microscopic findings: Grade 1, low-grade mast cell tumor.

Low grade mast cell tumors are usually well-behaved and  taking them out is the end of them.

So that is all great news.

This is the best case scenario.

Home run. Now we just need to make sure that JD's incisions heal and we are good.

Related articles:
It's That Time of the Year Again: Annual Wellness Exam and JD's Bumps 
JD's Biopsy Results Revealed Mast Cell Tumor: You Don't Know What the Bump Is Unless You Look at the Cells
See Something Do Something Cancer

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!

Sunday, October 18, 2015

Can Peanut Butter Kill Your Dog?

If you haven't heard this one yet, listen up!

Peanut butter can make a delicious treat and dogs love it. I myself give it to our dogs sometimes. Until recently it was a perfectly safe thing to do.

New peanut butter products are now on the market that contain xylitol!

The list of peanut and nut butters containing xylitol seems to be rising. Xylitol is very toxic to dogs even in small quantities.
"Ingestion of as little as 0.1 gram (g) of xylitol per kilogram (kg) of body weight (0.1 g/kg) can cause a rapid and dangerous drop in a dog’s blood sugar (a condition called “hypoglycemia”). Hypoglycemia can show as staggering, appearing disoriented, collapse, weakness, and seizures. Just slightly more than that, approx. 0.5 g/kg xylitol ingestion, can lead to debilitating, and sadly often deadly, destruction of a dog’s liver cells." ~Preventive Vet

Beware and read labels carefully.

Related articles:
What Happens In The Dog’s Body: Xylitol Poisoning
What Is Xylitol Poisoning in Dogs? Ask Boomer! 
Xylitol And The Basset Hound 
Poppa’s Orbit(-al) Adventure
Keep Chewing Gum Away From Your Dog!

Further reading:
Is Peanut Butter Safe For Dogs? Please Beware – Some Could Be Deadly!

Saturday, October 17, 2015

Top Veterinary Articles of the Week: Pre-Anesthetic Testing, More on Skin Masses, and more ...

Pre-Anesthetic Testing – Is It Really Necessary?
Dr. Christopher G. Byers/CriticalCareDVM

I remember that back when we were taking Jasmine to be spayed, pre-op blood test was offered as optional. It was extra money and to us that was an important criteria. We debated it a lot but at the end we just had to go with what was better and safer for Jasmine—getting the testing done. I would never subject my dog to anesthesia without pre-anesthetic testing.

Just recently I shared a story of Jack and how pre-op testing saved his life.

What does pre-anesthetic testing involve? Medical history, physical examination, blood panel and urinalysis. Coagulation profile and electrocardiography might be indicated. If your vet ever offers this as optional, don't even think twice just say yes. In fact, insist that it is done.

What Makes One Skin Mass Cancerous and Another Non-Cancerous?
Dr. Patrick Mahaney/petMD

That is a timely question for us, since just over a week ago we had two bumps we found on JD aspirated—one of them turned out being a lipoma but the other a mast cell tumor. JD had it removed on Thursday.

Not all lumps are cancerous but some of them are!

Read Dr. Patrick's article about his dog Cardiff who not only recently had surgery for cancer in his abdomen but also some of his skin masses turned out cancerous as well. Cardiff had total of nine masses, six of which were cancerous. Biopsies revealed that Cardiff had the following masses - sebaceous adenoma, nodular sebaceous gland hyperplasia, epidermal and superficial follicular hyperplasia, fibroadnexal hamartoma, plasmacytoma and malignant melanoma. Don't ever assume that just because you know what one mass on your dog is, that the other is going to be same. They weren't the same on JD and they certainly weren't the same on Cardiff.

No matter how many masses your dog might have, aspirate every single one of them.

11 Most Embarrasing Pet Potty Stories
Laura Cross/Vetstreet

This clearly isn't medical; I didn't find any more medical articles I'd want to include. So on a lighter note, see if any of these sound familiar.

Thursday, October 15, 2015

Blog the Change: See Something Do Something Cancer

I know there are a lot of issues to be addressed but today I decided to highlight Dr. Sue Ettinger's See Something Do Something: Why Wait Aspirate campaign.

Sometimes it's the littlest things that can make a big difference in your dog's life. Finding a bump and aspirating it instead of watching and waiting. Don't ever let anybody talk you into watching cancer grow. Aspirating a bump is so easy and quick, why not just do it?

Thank you so much to Tracie Hotchner, Dog Film Festival and VCA Animal Hospitals for helping me with the PSA on See Something Do Something Cancer. Join us at the 1st annual Dog Film Festival in NYC on Oct. 3rd to seem amazing films about our canine companions. (Tix are on sale now!!) #whywaitaspirate
Posted by Dr Sue Cancer Vet on Saturday, September 12, 2015

JD is just on his way home from his mast cell removal surgery.

He had two little bumps. Small enough and innocent enough looking they would have made great candidates for the watch and see approach. But I've been following Dr. Sue long enough now, we decided to aspirate them. If they were harmless, then we'd know. If they were not, then we could do something.

At first sight, they looked harmless. One looked like a lipoma and the other looked like a cyst. Even looking at the slides, after the fine needle aspirate, one looked like a lipoma and the other like a cyst.

One of them is a lipoma. One of them turned out being a mast cell tumor.

If we left it to just watch it, we'd be watching cancer grow and eventually metastasize. Does that sound like a good plan? Not at all.

This way we got it out and there is a good chance that's all that it will take and we'll never hear of it again. Very often, taking care of masses while they are small, surgery is all it takes.

JD is resting on the couch now, crying for the girls he fell in love at the hospital.

Thunderstorm! Powers out! Time to cuddle with patients!
Posted by Walden Animal Hospital on Thursday, October 15, 2015

We will still have to wait for lab results on the removed tissue and other labs. We're hoping for good news both regarding clean margins and grade.

If you find a mass on your dog, don't wait, aspirate.

Because you don't know what the bump really is unless somebody looks at the actual cells.

Related articles:
It's That Time of the Year Again: Annual Wellness Exam and JD's Bumps 
JD's Biopsy Results Revealed Mast Cell Tumor: You Don't Know What the Bump Is Unless You Look at the Cells 

Tuesday, October 13, 2015

JD's Biopsy Results Revealed Mast Cell Tumor: You Don't Know What the Bump Is Unless You Look at the Cells

We found three bumps on JD which we had checked out last week. One of them, looking like a skin tag, is a skin tag. We had the other two aspirated because no matter how much you stare at or play with a bump, you cannot tell what it is by doing that.

One of JD's bumps was preliminarily thought to be a lipoma and the other one probably a cyst. JD is another example why you want to biopsy every bump you find, no matter how little and how innocent it might look.

The biopsy results came back this morning.

The bump on his thigh is indeed a lipoma as thought. There were no suspicious findings on that one. The other one, however, is not a cyst after all.

The bump on JD's tarsus is a mast cell tumor.

Tiny, innocent-looking little thing. Not at all the typical lesion you'd expect to see. Yet not so innocent after all. Mast cell tumors can indeed look like anything or look like nothing much at all.

What is a mast cell tumor?

A mast cell tumor (MTC) is cancer of specialized, histamine-releasing immune cells found in connective tissue - mast cells. MTCs account for up to 20% of skin tumors in dogs. If we're lucky, surgery can be all the treatment needed. The biopsy result says that the cells show mild atypia.

JD is perfectly happy and doesn't know he should be worried about something.

The upside is that JD's tumor is very tiny and now we know what is is. 

JD is scheduled for surgery on Friday. Then another biopsy and staging of the tumor. Surgery is the treatment of choice for MCT, and often the only treatment needed.

I'm a bit concerned about the location because where it is there isn't much surrounding tissue to remove at all. Will we be able to get clean margins? Ideally, two centimeters of tissue should ideally be removed all around. But there isn't much of all around there. We may or may not have to follow the surgery with radiation therapy. For now, we're going to get it out and see what else needs to be done.

JD's bump isn't the only example of why it is important to aspirate each and every bump.

I was following what I believed was the best thing to do but at times I wondered whether I was being overzealous. But clearly, I was not.

Don't wait, aspirate.

Related articles:
Primer On Mast Cell Tumors In Dogs 
Symptoms to Watch for in Your Dog: What Is that Bump? 
What Is Cytology And When You Might Need One For Your Dog?

It's That Time of the Year Again: Annual Wellness Exam and JD's Bumps
Bad Dog: JD's Garbage Gut And Diarrhea 
Grocery Bag Is Not An Open Buffet: What Was In JD's Vomit 
JD's Leg Injury And Hip Dysplasia
JD's Injury And Bad Hip Update

Further reading:
The Oncologist’s thoughts on mast cell tumors 
Diagnosing mast cell tumors
Mast cell tumor treatment: surgery and radiation
All about Mast Cell Tumor Grade
Beyond Mast Cell Tumor Grade: Other Prognostic Factors

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!

Sunday, October 11, 2015

A Reflection on a Year of Working with Our New Vet

Wow, it's already been over a year since we moved to Jasmine's ranch and started working with our new vet. One thing life taught me is that there are awesome vets out there but not all vets out there are awesome. Our past experiences had been mixed to say the least.

Having finally had a great vet I was quite stressed about having to look for a new one.

I've put a lot of time into researching the vets and veterinary hospitals at our new location before I finally made my choice. Of course, things can look great on paper and reality might be different. Once I selected our vet, first thing we did once we arrived was to make an introductory appointment. Everything went great and our choice was sealed for the time being.

This week I was happy to post a 5-star review on our new vet hospital's Facebook page.

(I don't write bad reviews but good ones have to be earned.)

After a year working with her, I'm happy she's the one I chose.

Beside regular wellness exams, we've been working on specific issues such as Cookie's incontinence and elevated ALT. I think I know her well enough now. And I like her very much. She's competent, dedicated, constantly learning new things, open to alternative options, happy to discuss things with me, and has great bedside manners with our dogs.

We are on the same page about things.

She has all the qualities I loved in our vet down South.

Reflecting on the two got me thinking. I love that her and I are on the same page. But I do miss the numerous discussions we had with Jasmine's vet about things we disagreed on. His point of view was often different than mine. We'd argue our point, with mutual respect, until one of us became convinced. Sometimes he'd convince me, sometimes I'd convince him. We both had to put a lot of work into backing up our convictions.

Did our opposing convictions lead to better decisions?

I think most of the time they did. We'd both consider everything whether we agreed with it or not. And the best idea won. Are we missing out on better solutions by thinking the same way? Perhaps not. I always research everything to death and do my best to consider everything that is out there. And I am sure she does too. I ask everybody who's willing to answer. My goal is to always make the best decision possible. So I think we are okay.

If you and your vet don't agree on everything don't take it as a bad thing.

As long as you can have an open dialog, disagreement can foster better ideas. As long as your vet doesn't dismiss ideas without considering them fairly, having opposing opinions will make you both work harder on your decisions. And the patient wins in the process.

What do you think?

Are you and your vet on the same page? Did you disagree on some of the things? Who wins the argument and why? What do you think is better for your dog?

Related articles:
Looking For A New Veterinarian: Our List Of Questions
We Have Picked A Vet At Our New Location
We Have Met Our New Vet: She's A Keeper 
The Evolution Of My View Of Vets, the Universe and Everything 
Veterinarians Are People First
Finding Dr. Wonderful And Your Mutt's Mayo Clinic: Getting Started
Reasonable Expectations: The Ability to Discuss Your Internet Research With Your Vet

Saturday, October 10, 2015

Top Veterinary Articles of the Week: Fall Allergies Tips, Toxic Mushrooms, and more ...

Top 10 Holistic Tips For Managing Your Pet's Fall Allergies
Dr. Patrick Mahaney, VMD/petMD

Fall stirs up environmental allergens no matter where on the map you are. If you find your dog is suddenly sneezing, coughing, itching, loosing fur or having a discharge from their nose and eyes, this might be why. Is there anything you can do before reaching to medications? As it turns out, there is.

How well can your dog's body deal with environmental challenges depends on their overall health, their immune function, diet, degree of exposure and medications they might be on.

Read Dr. Patrick's top tips to holistically managing your dog's seasonal allergies.

Five Predictors of Canine Obesity
Dr. Nancy Kay, DVM/Spot Speaks

Yes, here we go again talking about canine obesity. And we'll keep talking about it until every dog is at their ideal weight. Why? Because obesity has a negative impact on their health, life span and quality of life. There is nothing good about obesity. Keeping your dog at optimal body condition is one of the best things you can ever do for them.

What are some predictors for canine obesity?
  • breed predisposition
  • blind adherence to feeding recommendations on dog food labels
  • one-size fits all treats
  • peer pressure from people who have long forgotten what a fit dog actually looks like
  • age of the owner
Knowledge is power. If you know what to watch for, you can be more successful keeping your dog fit. Read Dr. Kay's recommendations.

Can I give my dog Benadryl and if so, how much?
Jessica Vogelsang, DVM/petMD

What if your dog gets stung by a bee? Or breaks out in hives? Can you give Benadryl?

I used Benadryl when Cookie got stung by a bald-faced hornet and her muzzle got swollen a little bit. Whether it worked or not, the swelling started going down and I felt better thinking that I have helped. If the swelling kept getting worse, though, or Cookie started having difficulty breathing, we'd be on our way to the emergency vet.

We tried Benadryl when allergies were on the suspect list for Jasmine's episodes of pacing and panting. (It didn't do anything for that, btw).

I only use any medication when I'm sure it's safe and/or on recommendation of our vet.

Benadryl is generally safe antihistamine. It is, however contraindicated with some conditions such as glaucoma, high blood pressure or cardiovascular disease. Did you know that?

The standard dosage is 1mg/pound of body weight, 2-3 times a day.

When in the slightest doubt, call or see your vet instead.

Dogs and Mushrooms: Are They Poisonous?
Dr. Justine Lee, DVM/Pet Health Network

Fall is also the season for mushrooms. Back in my old country, people would get our early in the morning, grab their baskets and hit the woods. Mushrooming was one of the favorite Fall activities, at least back then. Some folks would come back empty handed, season mushroomers would return with full baskets no matter what. They had secret places the location of which they'd guard with their lives.

Mushrooms were a great Fall culinary addition. One thing about mushrooms, they are all edible, BUT SOME OF THEM ONLY ONCE.

Amanita muscaria.Pretty, isn't it? POISONOUS! Image wikipedia

Seasoned mushroomers would know they mushrooms and could pick and safely eat all kinds of weird looking ones. Weekend mushroomers stuck with the ones they knew for sure. But still, mushroom poisonings, real or assumed, were a frequent topic of comedies and dramas.

"There are thousands of mushrooms out there, but only about 100 types are poisonous."

But which ones are which? You can be quite sure your dog doesn't know the difference. Unless you really know your mushrooms, which I'm quite sure you don't, when your dog eats a mushroom, assume it's a poisonous one and act accordingly. It's just safer that way.

Read Dr. Lee's article to found out which mushrooms are most dangerous and what to do if you notice your dog eat a mushroom.

Spoiler: the answer is the same for all of them.

Thursday, October 8, 2015

What's in the Poop? (Part III)

Continued from part II

In the previous parts of our poop series we covered consistency and color. What else does one look at when examining a dog's poop? 

What’s in the coating?

Healthy poop should not have any coating on it.

Sometimes you’ll find stool that is  covered by a slimy substance - mucus. Mucus is produced in the intestine to lubricate and protect the gut lining but normally it isn’t noticeable on feces.

Mucosal surfaces in the gut are part of the immune system, designed to detect and kill pathogenic organisms that may be trying to make their way through the gut lining.

When the large intestine isn’t happy and battling  parasites, bacterial overgrowth, food allergy or intolerance, or even tumors (basically anything that irritates or inflames the gut wall), it can result in an increased production of mucus, which then becomes apparent on the stool. Even stress can cause mucus-coated stools.

One or two slimy stools don't warrant rushing to a vet. 

However, if this becomes a regular occurrence, or it is combined with other symptoms such as diarrhea, vomiting or abdominal pain, the situation in the gut has gotten out of control and it’s important to have your dog seen by a vet.

What’s in the content?

Just like with vomit, the contents of your dog stools can sometimes provide an inkling as to what may have upset your dog’s digestive system.

Pieces of plastic, toys and other non-food items, tell you that your dog ate stuff that was not intended to be eaten, which could be behind the problem. One question left unanswered, however,  is whether all the foreign material has passed or some still remains within the digestive tract.

If you find bits of undigested food, it’s either a reflection on the food or your dog’s ability to digest what they eat. 

Things like pieces of raw carrots can appear in the stools in more or less pristine shape. Dogs are not designed to digest chunks of raw vegetables. Once I tried giving my dog a freeze dried raw food with chickpeas in it. Chickpeas are nutritious and seemed like a good ingredient. However, the chickpea grit came out exactly the same as it went in. Clearly, there wasn’t much nutritional benefit to be gained from feeding something that just goes through unchanged.

If food that dogs should normally digest well comes out untouched, then you have a serious problem on your hands.

If your dog's stools look greasy, you might be looking at a condition that prevents the intestinal tract from absorbing nutrients normally (malabsorption).

What’s in the smell?

Poop does not smell like roses. It's supposed to be stinky. But some abnormal smells are an indication of a problem.

Food-like, or smelling of sour milk — suggests rapid transit, malabsorption and/or irritation of the bowel; it can be a sign of overfeeding, particularly in puppies

Putrid smelling — suggests possible intestinal infection

Rancid smell — might indicate improper digestion

One bad poop, no bad poop

Bad poops happen, particularly since dogs tend to eat all kinds of things some of which are not meant to be eaten. If my dogs get a bad poop, I watch for other signs of a problem such as changes in appetite, drinking, vomiting, lethargy or anything else that seems off. If the dogs look fine and the next poop is the way it should be, I just file the event in the back of my mind (and in Cookie's case on her chart).

If it develops into diarrhea, I generally give it 24 hours to resolve. If it doesn't, or if it becomes severe, or accompanied by other signs mentioned above, I see a vet.

There are a number of things that affect stool quality and diet is definitely one of them. In an otherwise healthy dog, it can even be as simple as determining the right amount of dietary fiber for that individual. This can be quite a balancing act, particularly in large breed dogs. But before you make any assumptions and start playing with your dog’s diet, see a vet to make sure you KNOW what you're dealing with.

Don’t forget the sample

Your vet can get a lot more information from your dog’s poop than you ever could. Not only do they evaluate all the above aspects, they can further analyze it and take a detailed look at what’s in the poop that is hidden from view. (a microscopic fecal analysis)

If you have any concerns, bring a poop sample with you.

Just like with urine sample, the fresher the better.

As always, understanding what poop should or should not look like is important to knowing when you should see a vet. If you do notice consistent abnormalities, see your vet sooner rather than later. It might save you headaches down the road.

Related articles:
What’s in the Poop? (Part I - Consistency) 
What’s in the Poop? (Part II - Color)

A Tale of Many Tails—and What Came Out From Underneath Stories from My Diary-rrhea (part I)
Acute Small Intestinal Diarrhea
Acute Large Intestinal Diarrhea (Acute Colitis)
Chronic Large Intestinal Diarrhea
Chronic Small Intestinal Diarrhea

Veterinarians Answer: 10 Main Symptoms To Watch For In Your Dog 
Symptoms: Recognition, Acknowledgement And Denial 
When Is It An Emergency? 
Don't Panic, Don't Panic: Know What Your Job Is   

Excessive Panting
Excessive Drinking 
Changes in Urination/Urinary Accidents 
Changes in Behavior
Bad Odor 
Excessive Drooling  
What Can Your Dog's Gums And Tongue Tell You? 
Excessive Head Shaking 
Excessive Licking
Lumps and Bumps
What Is That Limp? 
Nose Bleeds (Epistaxis)
Symptoms to Watch for in Your Dog: Head Tilt 
Unexplained Weight Loss
Unexplained Weight Gain  
Loss Of Appetite  
Fever (Pyrexia)
What Happens in a Dog's Body with Severe Vomiting?
Gastroenteritis is when ...  

Tuesday, October 6, 2015

It's That Time of the Year Again: Annual Wellness Exam and JD's Bumps

We take our guys at least for one wellness exam a year; usually two. 

There is no particular rule when during the year this should be done but we typically choose Fall and Spring for the following reasons:
  • there is no risk of it being too hot or the weather being to dangerous for the trips
  • the allergens load starts getting lower in late Fall; Winter would be ideal
  • some of the tests make most sense being done in the Spring, such as heartworm testing or tick-borne diseases testing

This is how it's been working for us. Come Fall, we make our wellness exam appointment.

We didn't take any photos at the vet. The exam room is quite small so imagine two of us, the two guys,
a vet and a vet tech ... and somebody trying to take pictures? Not happening.

Normally, we get the physical exam, urinalysis, fecal analysis, and complete blood panel. This time, all we ended up with was a physical exam and we'll have to do the labs some time in the near future. Things weren't working out right for doing the labs:
  • we could only get an appointment with OUR vet at the end of the day, which means in order to have fresh urine it couldn't be first morning sample and there was no way we could have fasted blood that late in the day with our guys
  • both pups decided to go poop in a thick bush where we just could not find it

Best laid plans, right?

So some time soon we'll take the guys in early in the morning to get all these things; a vet technician can draw the blood. Just as well, because we want to include the new kidney function test (SDMA) and apparently there might be certain things that need to be done to provide the blood for this the way the lab wants it and since it will be the hospital's first time getting this test, they have to find out what the requirements are.

Testing non-fasted blood can skew the results and show things that don't reflect actual workings of the body which is what is the purpose of checking the blood in the first place.

Before the trip I made a list of all concerns and questions I had for the vet.

I find that making a list and checking it twice comes in quite handy. That way you can go over all of it with your vet and not forget anything.

We only had a few minor concerns (of course, if they were major concerns we wouldn't have waited for the wellness exam), and a list of bumps we found on JD.

One of the bumps is a skin tag, which we just wanted to confirm that's what it was.

The other two bumps were more of a concern.

They aren't very large and not angry at all; just bumps under the skin. However, they'd been there for couple of months now (at least that's when we first found them) and not going away. One on the back of his thigh and one on the "shin" of the hind left leg. It's not attached to the bone, otherwise we'd gone in right away too.

The vet examined the bumps and marked them on chart so we start a map of where, when and which bumps were found and what their size was.

Interesting thing is that both bumps felt the same to me but to the vet one felt soft and one hard. (Well, I'm not one to squeeze things very hard.)

While they appeared the same to me, they are not the same at all.

I was hoping for fatty tumors (lipomas). The vet felt that the on on the thigh likely is indeed a lipoma but the one on the shin is not.

Because one of the bumps is larger than a pea (the other one is a bit smaller, more like a smartie) and they have been there for long enough, we had them both aspirated. The vet did fine needle aspirate (FNA) and a core sample.

Why wait?! Aspirate. Check out my blog for a preview of my cancer awareness program with VCA Animal Hospitals.
Posted by See Something Do Something Cancer on Sunday, June 15, 2014

I got to take a look at the slides.

The cells taken from the bump on the thigh looked very shiny, oil like. That's what the vet would expect cells taken from a lipoma to look like. Which surprised me because I always thought it would be more like lard type of thing. Funny how we picture things.

The smear from the other lump looked matte. The vet feels the other bump is an infundibular cyst because when probed it oozed liquid. I'm down with a cyst.

The skin tag is a skin tag. We didn't aspirate that one.

While we're still waiting for the lab results, I'm hopeful that one of them is indeed a lipoma and the other a cyst.

Both guys are at ideal body score condition 3/5.

That is what we strive for, even though I was under the impression that we kept JD below that because of his hips. Hubby, on the other hand, was worried that JD is too skinny.

Either way, JD is doing quite well, though he did respond to palpation over TCVM pressure points for hip pain. We are considering adding some turmeric to his supplements.

His muscles are good, except some slight muscle wasting over his glutes, from the way he compensates for the hips. We discussed exercises for him to strenghten them up some.

Other than that, everything is looking good, blood, urine and fecal testing pending.

From The End Of A Lead Line To Casa Jasmine: Meet Cookie, Our New Adoptee
And So It Begins Again(?) Our First Health-Related Heart Attack With Cookie 
I Didn't Know I Could Fly: Why Cookie Wears A Harness Instead Of A Collar
C.E.T. Oral Hygiene Chews For Dogs CAN Be A Choking Hazzard 
Our First Health-Related Heart Attack With Cookie: The Knee Or The Foot? 
Creative Solutions And An Incidental Product Review
Too Young For Pot: Cookie's Snack With A Side Of Hydrogen Peroxide  
Taming Of The Wild Beast: Cookie's Transition To Civilization  
Staying On Top Of The Ears: Cookie Is Not Impressed  
Putting The Easy Back Into Walking
Cookie's Ears Are Still Not Happy 
The Threat Of The Bulge Is Always Lurking 
Today Is Cookie's Three-Months Adoptoversary  
Cookie Meets The Electric Horse Fence And Her First Chiropractic Adjustment  
Why Examine Your Dog's Vomit? 
Why Is That Leg Still Not Happy? Cookie's Leg Keeps Getting Sore 
Cookie Too Is Insured With Trupanion
Does Being Insured Mean Being Covered? Our First Claim With Trupanion
Is Cookie's Leg Finally Getting Better?
Is Cookie Going To Be Another Medical Challenge Or Are We Looking To Closely? 
The Project That Is Cookie: Pancreatitis Up Close And Personal  
Pancreatitis: Cookie’s Blood Work   
Another Belly Upset: Pancreatitis Again Or Not?  
Happy Birthday, Cookie 
Incontinence? Cookie's Mysterious Leaks 
Who's Training Whom? Stick And Treat 
Don't Just Stand There, Do Something? Cookie's Mysterious Bumps 
Cookie's Mysterious Bumps Update
One Vomit, No Vomit 
Happy One-Year Adoptoversary, Cookie!
Cookie's Leaks Are Back: Garden Variety Incontinence Or Not?
Cookie's Leaks Update 
Don't Panic, Don't Panic: Know What Your Job Is 
The Continuing Saga Of Cookie's Leeks: Trying Chiropractic Approach 
Cookie's Minor Eye Irritation
Regular Wellness Exam: Cookie's ALT Was Elevated 
Cookie's Plantar Paw Pad Injury 
How Far To Take It When The Dog Isn't Sick?
Cookie Has Tapeworm Infection 
Cookie's Elevated ALT: The Ultrasound and Cytology  
Cookie's ALT Update
The Importance of Observation: Cookie's Chiropractic Adjustment
Sometimes You Don't Even Know What You're Looking at: Cookie's Scary "We Have No Idea What that Was" 
Living with an Incontinent Dog 
Summer Dangers: Cookie Gets Stung by a Bald-faced Hornet 

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!