Vet Blog
11/02/09
 A few days ago a very nice woman brought her Miniature Schnauzer to my office. The dog had been acting agitated for several days. He seemed reluctant to sit down, but when he finally was seated the dog had a tendency to rub his hind end on the floor.
A thorough general physical examination was unremarkable (unremarkable is how veterinarians say normal–we can’t actually say normal because the word normal, according to some malpractice insurance providers, implies things that can be very dangerous if we have missed something subtle).
The symptoms were consistent with an anal gland problem. If you never have heard of anal glands, consider yourself lucky. You may want to stop reading now in order to preserve your innocence.
The anal glands are bulbs located adjacent to the anus. The bulbs are connected to the anus by ducts. The glands produce a fluid with a unique odor. It smells like a combination of rotting fish, feces, and tear gas.
Cats and dogs have anal glands. Skunks do too–the glands are modified in skunks and are responsible for skunks’ unique smell.
The anal glands normally empty when a cat or dog defecates. In some instances, however, this does not happen as it should. The result is anal glands that are impacted and distended. Animals with impacted anal glands often drag their rear ends along the ground.
Impacted anal glands are treated by manual expression. The most effective means of manually expressing anal glands involves inserting a finger into the animal’s rectum and massaging the accumulated fluid out of the glands.
This is what I proposed for my patient whose hind end was so uncomfortable.
The owner accepted my proposal. However, she declined to accept my recommendation that the procedure be performed in a section of the hospital where only employees were present. She asked to be present while her dog’s anal glands were expressed.
Palpation of the glands revealed that they were both markedly distended. Both glands were expressed with ease. A large amount of fluid was released.
As the smell of the fluid filled the room, the owner of the Miniature Schnauzer soon was ill at ease. She complained of light headedness and dizziness. She asked to sit down. She retched and nearly vomited.
The nurse and I escorted her to some fresh air. She rapidly recovered. I blame myself for not warning her vehemently enough that anal gland fluid smells really bad.
After enough time one becomes inured to the smell of anal glands. To the uninitiated, however, it can be overpowering.
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10/27/09
 Cody is an adorable two-year-old Lab/Beagle cross who saw me at the emergency clinic on Sunday. He clearly is a very well loved family pet.
Friday was Cody’s second birthday and on that night the family threw him a birthday party. Twenty-five people attended. Many of them were children. All of them brought gifts for Cody. Most of the gifts were edible.
During the party Cody received and immediately devoured several rawhides, pig’s ears, and sundry other dog treats. He also took the opportunity to hoover up any human food that was dropped during the party. His owner mentioned that one partygoer accidentally dropped an entire hamburger on the floor. Cody wolfed it down as the crowd sang Happy Birthday.
As the owner recounted this story I thought to myself that this massive amount of dietary indiscretion sounded like a good way for a dog to contract pancreatitis. Pancreatitis is a life-threatening inflammation of an organ (the pancreas) that is involved in the digestion of food. I began to get worried about Cody.
The owner’s story continued. The party ended uneventfully and everyone went to bed. The next morning (Saturday) Cody woke up feeling awful. He could barely move. He had no appetite (which, the owner assured me, was most extraordinary for Cody).
The owner was not very worried initially. But by Sunday afternoon Cody’s condition still had not improved. He refused to eat, and he still was extremely lethargic. He therefore wound up in my office.
When I examined Cody I was troubled. He was very lethargic. His abdomen was bloated and painful. He was extremely dehydrated. I recommended hospitalization and tests to rule out a serious problem such as pancreatitis or a foreign object (such as an undigested fragment of food) in his intestines.
Cody seemed to feel better after he was re-hydrated. And I was happy to see his test results. He tested negative for pancreatitis and other serious metabolic disturbances. His X-rays were not consistent with a foreign object in his intestinal tract.
However, the X-rays did show a very large amount of food in Cody’s stomach. This was most extraordinary in a dog who hadn’t eaten for two days. And it led to a diagnosis in the case–the best possible diagnosis considering the circumstances. Cody appeared to be suffering from a resolving case of glutton’s remorse (term coined by my friend Reading Maley).
Canine glutton’s remorse occurs when a dog overeats in the extreme. The stomach becomes massively and painfully distended, and the dog feels markedly ill for several days as the food slowly passes out of the stomach and through the intestines. The condition is painful and rarely triggers a life-threatening condition called bloat. However, most young dogs make it through episodes of glutton’s remorse unscathed. In my experience the condition is most common in Labs and Beagles (remember that Cody is a Lab/Beagle cross).
The nursing staff administered an enema to Cody in order to help keep everything moving through his system. I expect him to make a complete recovery. And I imagine that he never again will party as hard as he did on Friday night.
Photo: Feed me. Please. By Mzelle Laure.
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10/20/09
 A most remarkable and unnecessary case was at the emergency hospital over the weekend. If a human being had wound up injured in the manner described below he would have been a laughingstock.
Of course, in this case the dog was not at all to blame. His owners, on the other hand, could use a healthy injection of common sense.
The dog was a young, active large individual. He liked to run. The owners were more sedentary in nature. Recognizing that their pet needed exercise, they took him to a quiet road and set him free. They then followed behind in their car.
They followed too closely. The dog became tired and slowed down. Can you guess what happened next?
Fortunately, although the dog was injured when his owners struck him with the car, the injuries were not life-threatening. Pain killers, antibiotics, wound care, and nasal oxygen support were all that he needed.
But I am amazed that his owners failed to foresee the likely consequences of their way of exercising the dog. I worry about that dog’s future.
Photo: Blix demonstrates safe dog-car interaction. His risk of injury is minimal.
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10/12/09
 The other day I was at Costco. En route to the checkout line I passed an enormous display of plants for sale. The display consisted entirely of sago palms. (This article discusses cycad sago palms, not true sago palms.)
As I walked to the checkout line I thought to myself that there were enough plants in the display to kill half of the dogs and cats in San Francisco.
Sago palms are beautiful and common house plants. Sadly, few people realize that they are deadly.
Every part of the common sago palm is toxic. The plants are palatable to cats and dogs. Both may suffer liver failure after ingesting the plant. Remarkably few people realize this, and countless loving pet owners unknowingly place their animals at risk by keeping these attractive plants in their homes or gardens.
 Today I saw a cat who was in serious trouble. He was in the prime of life. He was an indoor-only cat. He appeared to be in perfect health. Unfortunately, his face was covered in lily pollen. A conversation with the owner confirmed my worst fears. The cat had chewed on stargazer lilies.
Stargazer lilies are staples of many bouquets. They are beautiful. They also are deadly. Cats especially are at risk. Lilies, especially stargazer lilies, may cause irreversible kidney failure in pets.
If you have pets, please don’t allow these two deadly beauties into your house. Nothing good can come of it.
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10/02/09
 Like most vets who practice in northern California, I treat stoned dogs on a regular basis.
Dogs most often suffer marijuana toxicity after consuming cookies or brownies made with marijuana. However, some dogs consume baggies of the dried plant or even entire plants growing in the ground.
The term marijuana toxicity somewhat overstates the effect of the drug on dogs (and, rarely, cats). Death from exposure to marijuana is almost unheard of.
However, pets that are exposed to marijuana commonly experience non-life-threatening adverse reactions. In short, they are prone to bad trips. Although I doubt stoned pets worry that their friends secretly make fun of them or that the police can read their minds, stoned pets frequently suffer from extreme agitation, disorientation, and an inability to walk. They may urinate or defecate on themselves. Conversely, they may refuse or be unable to void their bladder or bowels. They may suffer from severe tremors that can resemble seizures. And, they frequently vomit (which places them at risk of inhaling stomach matter–a dangerous situation).
Pets that have been exposed to marijuana should see a vet. And that is where the fun begins for me.
There are two types of people who bring stoned dogs to me: those who are forthright about what has happened, and those who deny it.
When a client tells me that his pet is suffering from marijuana intoxication, I generally am able to address the matter with ease. I usually recommend hospitalization for observation. Fluids and sedatives and may be administered. If the pet ingested marijuana recently, I may induce vomiting to remove the remaining drug from its stomach. Then, the clients and I joke about how we’ll put the dog in a cozy cage with a lava lamp and play Dark Side of the Moon until the effects of the drug wear off.
However, many owners of stoned dogs deny that their dog has had access to marijuana. In some cases, they did not know that their teenage child had pot in the house. In others, they worry (wrongly) that my staff will contact the police if they confess to possession of an illegal substance.
Whatever the reason, when this happens, it makes the dog’s visit much more intense and costly. Marijuana toxicity can clinically resemble many other more serious problems. Ingestion of snail bait, pesticides, and many household chemicals can lead to symptoms that are initially indistinguishable from the ingestion of marijuana. These toxins are much more deadly, so I must perform significant testing and aggressive medical management to address the worst case scenario.
The moral of the story is simple. If you know that your pet is suffering from marijuana ingestion, your best bet generally is to tell the vet what’s happening.
If you are not comfortable discussing what has happened with your vet, try the following line. I have heard it dozens of times. Say, “I think my roommate may have some marijuana in the house, and the dog might have gotten into it.”
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09/21/09
 Yesterday was yet another busy shift at the emergency clinic. Thankfully, no cats paid the ultimate price for going outside. However, several cats suffered consequences linked to their outdoor lifestyles. Their owners’ bank accounts took huge and completely unnecessary hits as well. Sunday night treatment does not come cheap.
Yesterday we had a run of grass blades in the nose. Many cats enjoy chewing on grass. However, if they gag, cough or vomit as they are trying to swallow a blade of grass the plant matter can pass into the sinuses and lodge there.
Cats with grass blades in their noses most often sneeze violently. If the blade is lodged deeper in the sinuses and throat they may cough, gag, or make snorting noises.
Looking up a cat’s nose is a big pain in the end of the veterinarian that is opposite his nose. General anesthesia is required. In the absence of a rare and expensive instrument called a rhinoscope (very few non-specialists have access to this instrument), vets are forced to use awkward tools to work in a small space (the nasal passages and pharynx, or back of the throat). It can be very frustrating.
Three cats came to the hospital yesterday displaying symptoms of nasal or pharyngeal foreign bodies. By 11:00 pm, three grass blades had been removed successfully. One of the cats suffered severe swelling in the back of the throat, but I expect him to make a complete recovery within a few days.
The owners’ bank accounts, on the other hand, may take a month or two to get well.
Note: it is possible for indoor cats to suffer from nasal or pharyngeal foreign bodies after chewing on “kitty grass”. However, this is very uncommon. Also, kitty grass tends to be softer and much less irritating than most grasses encountered outdoors.
Addendum: yet another reason to keep your cat inside! Feline leukemia virus. The disease is essentially unheard of among indoor cats.
Photo: playing with fire! I hope the owners have saved their money.
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09/16/09
 People who let their cats go outside are funding my future retirement. Nonetheless, I wish everyone would keep their cats inside.
This morning I finished a series of overnight shifts at an emergency hospital near San Francisco. I saw a dozen cats. Only one of them was an indoor-only individual. She was a fifteen-year-old with kidney failure. Her syndrome occurred naturally due to old age.
Every other cat I saw during the last two nights didn’t need to be there. They all suffered consequences of going outside. One suffered the most serious consequence of all.
The outside world is a dangerous place for cats, regardless of age or experience. In my years as a vet, I cannot count the times I have heard someone say something like, “Fluffy has been going outside for ten years and this is the first time he ever got into trouble.” Let me reassure you that when Fluffy finally does get into trouble, the results can be disastrous.
In my career I have treated innumerable cats who have been in fights with other cats. These fights lead to abscesses and feline AIDS. Cats are hit by cars, trucks, bicycles, and trains. I have treated cats that have been attacked by raccoons, bobcats, mountain lions, dogs, coyotes and hawks. I have seen cats suffer hypothermia after being caught outside in thunderstorms. These cats may be so weak that maggots infest their wet fur and infected skin. I have treated cats that fell from trees, cliffs, and ledges. Cats are brought to my office after suffering deliberate abuse at the hands of deranged psychopaths. Outdoor cats frequently are shot with BB guns. They may be kicked, twirled by their tails, or thrown long distances. Twice I have treated cats who were deliberately wrapped in duct tape.
Indoor cats do not suffer these maladies. Every one of these common yet horrible problems is preventable if you keep your cat inside.
As I mentioned, of the dozen cats I saw in the last two nights only one had a problem that was unavoidable.
Ten of the cats I treated had been in fights with other cats, leading to abscesses and lacerations. These cats will survive, although they are at risk of feline AIDS. Their owners shelled out thousands of dollars to my bosses.
One cat, however, broke my heart. If you already keep your cat indoors, I recommend that you stop reading now. What follows is graphic.
If you believe that your cat is “happier outside”, or if you think that going outside is “natural”, or if you think that your cat’s life will not be complete unless he goes outside, or if you think that nothing bad will ever happen to your cat, please read on.
A sweet, loving, and formerly beautiful 16-month-old cat was outside in a rural area near San Francisco. Somehow he made it home.
The cat’s owners thought that he had been caught in a trap, because his left front foot was missing. When I examined him, I came to a different conclusion: he had been hit by a car.
True, his left front foot was missing. Bones, tendons, and muscles were exposed at the stump. The site was bleeding profusely. But both rear legs had similar injuries. The owners hadn’t noticed this.
I suspect that the cat had been basking on his side on a road when a car ran over three of his four limbs.
Two nurses immediately placed an IV catheter into the cat’s only remaining leg–the right front. We gave him the maximum labeled dose of a narcotic painkiller. It didn’t touch him. We doubled down on the medicine, and he seemed to relax a bit.
I went into a private room to talk with the owner. She felt horrifically guilty. She knew that if she had kept her cat inside this would not have happened. In the end there was only one humane choice. We put the cat to sleep. It has been a long time since I have seen anyone cry that hard.
I apologize if this story offends you. But I would be very happy to go to my grave without ever seeing another case like this again. And it would be so easy, if only everyone would keep their cats inside.
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08/28/09
 When I was a child of 12, I started a venture that I believed would allow me to make money doing something I loved. I started a pet sitting business.
By many measures, my business was a success. I had fun, and pet owning folks in Boise, Idaho got to go on vacations. I don’t remember perfectly, but I suspect that my rates were very reasonable. I was a kid, after all, and I certainly didn’t get rich.
When I look back on those days now, I am amazed that I got through that time without a major catastrophe befalling one of my charges. Pet sitting is a risky business in the hands of a professional, let alone those of a child.
The overwhelming majority of pet sitters I have met are caring, responsible people and completely solid citizens. Yet a disproportionate number of sick animals are brought to me by pet sitters.
This phenomenon has nothing to do with the quality of care that the sitters offer. In most cases that care is excellent. Rather, it has to do with stress. Pets love their owners. When the owners go out of town, pets’ routines are upset. That is stressful. Stress can unmask pre-existing disease.
Consider a case I saw the other night. A very nice pet sitter was looking after her neighbor’s cat during a vacation. The owner had noticed the cat was excessively thirsty for a few weeks before the trip. She reported this to her neighbor and left town. As soon as she left the cat stopped eating, and the pet sitter wound up in my office at 10:00 pm.
I was very troubled by my exam findings. The cat was emaciated and dehydrated. It had very bad breath. Its coat was rough and unkempt. I suspected kidney failure.
To diagnose the problem definitively I would need to run tests. Depending on the outcome, hospitalization and intensive treatment might be necessary. The cat clearly was suffering intensely. If the test results showed seriously advanced disease, euthanasia might have been the best choice for the poor creature.
The owner was in Cancún. She had left no contact information. This placed the pet sitter in an incredibly awkward position.
The pet sitter would have to pay for the visit and any tests that were run and hope for reimbursement. She would have to make decisions regarding the cat’s care without any guidance from the owner.
The pet sitter agonized over the situation for over an hour. In the end she decided to forego tests. We administered fluids to the cat to treat dehydration, and she took the cat home. Her plan was to send a flurry of e-mails to the owner and hope for a response. I lost sleep that night worrying that the cat was suffering. I did not hear from the pet sitter again.
I can’t imagine that any pet owner wants to place their pet or their pet sitter in this sort of situation. But it happens all the time. Here are some steps you can take to help steer clear of the problems discussed above.
Get a checkup before your trip. If something seems wrong with your pet, don’t ignore it. It may turn into a crisis in your absence. Do your best to confirm that your pet is in good health before you leave town.
Provide contact information to your pet sitter. Leave a cell phone number, and answer it even if you’re on the beach. If you’re traveling to an area where you’ll be completely unreachable, designate someone local to make decisions in your absence, and put it in writing.
Make your wishes known. Talk to your pet sitter about how you want veterinary emergencies handled. Pick a pet sitter you trust, and leave your credit card number with him or her (along with a signed note allowing them to use the card and authorize medical treatments). Provide your vet’s office with the credit card information and a copy of the note to keep on record.
Pet sitting is a labor of love. Take the steps listed above and be kind to your pet sitter.
Photo: FlaviaC.
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08/11/09
 The other night I put a young skunk to sleep.
The skunk was captured by San Francisco’s department of Animal Care and Control. It had been behaving erratically, staggering, and acting disoriented. Animal Care and Control did not have a veterinarian on duty at the time (it was the middle of the night), so the officer brought the skunk to the emergency hospital where I was working for euthanasia (the skunk’s condition was deemed to be beyond help).
The skunk’s likely diagnosis was canine distemper virus–the same virus that causes serious disease in dogs, wild canids, marine mammals, and African lions.
For the most part, diseases tend to be species specific. Dogs most often catch diseases from other dogs. Cats catch diseases from other cats. Humans catch diseases from other humans.
But there are exceptions. Rabies is the most famous exception. The virus can infect any mammal. Many parasitic worms can infest multiple species. Feline toxoplasmosis can infect humans, sea otters, and wild cats. Canine distemper virus can infect a variety of wild animals.
Fortunately, basic hygiene and vaccinations can protect your pet from many wildlife-borne diseases.
Pets who have minimal exposure to other members of their species (such as indoor cats and small dogs that rarely go out) may still be at risk for exposure to wildlife. Talk to your vet about these risks, and make life style and vaccination decisions accordingly.
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08/02/09
Dogs eat the strangest things.
Last night at the emergency hospital a nurse carried a five-year-old Terrier cross into the treatment room. She advised me matter-of-factly that the dog had consumed a fake breast three hours earlier.
 To prove her point, she showed me the box that the clients wisely decided to bring with their dog. One end of it was chewed. Inside was a plastic tray with two slots. One was empty. In the other slot was a stick-on silicone falsie, size B. Evidently the dog had eaten one and found himself sated.
I evaluated the piece of silicone, coated in polyurethane, that the dog had not consumed. Although it was non-toxic, there was little doubt that the other half of the pair ultimately would lodge in the intestines. The dog only weighed 15 pounds. Size B was too much for this guy to handle.
Three hours had passed since the dog’s indiscretion. If the breast was still in the dog’s stomach, it might be possible to eliminate it by making him vomit. However, if the fake breast had already passed into the intestines, then the dog would require surgery. In that case making him vomit would be pointless. After three hours, either was possible.
I considered the option of taking an X-ray to see if the breast’s location could be determined. But a technician took a sample X-ray of the non-ingested breast and it turned out to be invisible. X-rays would be useless in this case.
I decided that the best course of action would be to make the dog vomit. But first I would need to talk to the clients. Keeping a straight face during the encounter would not be easy.
One of the nurses offered a helpful suggestion. “Only look at her from the neck up.”
I entered the exam room where a bemused looking couple was waiting. I did my best to maintain eye contact.
We discussed the risks and benefits of inducing emesis in order to eliminate the, er, product from the dog’s digestive tract. The clients authorized the procedure.
I prefer to make dogs vomit by giving an intravenous injection of a drug called apomorphine. I am aware of only one use for the medicine. It causes vomiting. I do not understand why many bottles of the drug contain a warning that it may be habit forming.
While a nurse drew up the medication I offered the dog some canned food. Filling a dog’s stomach with food before he vomits causes the vomiting to be more productive. It is like priming a pump.
I, for one, would be too nervous to eat low-quality food in my doctor’s office. But the sort of dog who is silly enough to eat a fake breast generally doesn’t let such trivialities stand in the way of gluttony. Although he lost his appetite for fake breasts after one, he had saved room for a half can of junk food.
The nurses mainlined the apomorphine. In the course of 30 seconds, the dog transitioned from a happy, tail-wagging, breast eating, goofy mutt to a visibly nauseated creature. He retched and regurgitated a small amount of dog food. He then recovered.
This would not do. For this problem, the dog would have to go through gut wrenching, side splitting, eye popping vomiting. He had brought this upon himself. He needed more apomorphine.
The nurses gave another injection of the medicine. This time the floodgates opened. The dog vomited copious dog food, a moderate amount of grass, several small twigs, an ear plug, some yarn, and a fake breast, size B.
45 minutes later the dog was ready to go home.
I had to ask.
“Do you want the other, uh, product back?”
The clients graciously declined.
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A few days ago a very nice woman brought her Miniature Schnauzer to my office. The dog had been acting agitated for several days. He seemed reluctant to sit down, but when he finally was seated the dog had a tendency to rub his hind end on the floor.
You have questions. 