Pawcurious Vet Blog: Pet help, stories, and information with Dr. V

It’s the oddest thing. I can go 3 months without seeing a blocked cat or a glaucoma, and all of a sudden I will see three in one day. It always comes in waves. In yesterday’s case, we marked the start of foxtail season.

In our area, foxtails are one of the banes of a dog’s existence. They aren’t found everywhere, but in my neck of the woods they are ubiquitous. Foxtails are, essentially, grass awns. When they dry out, they turn into nasty little sticky bayonets that stick to a dog’s fur, and work their way into all sorts of places- toes, noses, eyes, ears, brains, gums, tonsils, you name it. It’s amazing how quickly the whole big thing can bury itself into skin once the end gets a hold, and it results in a lot of pain for the pet.

The first case I saw was a gorgeous little guy who was licking his paw and limping. Emmett happened to be at work that day too and got to meet his doppelganger:

Can you recognize which one is Emmett?

Warning: these pictures are a teeny bit gross.

So when we clipped this pup’s foot, this is what we saw:

Classic painful draining tract. Note that you cannot see anything coming out of it at all.

We anesthetize these guys, because we have to stick a sterile metal probe in the painful wound and fish around:

Ta daa! The one on the left is a standard looking foxtail, pulled from his fur. The two on his right came from that wound on his toe. Ouch.

Our alligator forceps got some major usage that day. After getting that foot cleaned up, I had to tackle a large lab who was having terrible sneezing fits so badly that he was bleeding out of his left nostril. I don’t have any photographs, but in order to get a good look up the nose I had to put the dog under general anesthesia and look around his sinuses with an otoscope. Sure enough, he also had not one but two of those nasty foxtails wedged in his nose. In his NOSE! Double ouch!

And because the day wouldn’t be complete without a hat trick, we had a little spaniel who was rubbing her ear voraciously and very painful. When I peeked in, this is what we found:

I don’t know why these insisted on travelling in pairs, but in all three cases they did. Those ugly looking awns had lodged all the way up to the pet’s eardrum, rupturing it in the process. I’m hurting just thinking about it.

The good news is, with a little finesse and a lot of drugs, we were able to get those ugly buggers out of each and every dog, much to their relief. We have a few patches of foxtails popping up in our backyard- I know what I’m going to be doing this weekend.

Conversation my receptionist had this afternoon with a caller:

“Oh, hi, um, well, I think my dogs had, um, sex…”

“OK….”

“And, um, well, they’re…sticky. Is that normal?”

“Um, sure. They can get sticky, I suppose.”

“Well, my wife says they are really sticky….hold on a minute…what, Gerturde?” talking in deep Eastern European accent “She says the dog’s entire back is really sticky. Like sap.”

“Well, sir, honestly, I’m not entirely sure what to think about that. Would you like to bring them in for an examination?”

“No, I was just wondering if it was normal.”

I don’t know about you all, but I’ve never considered post coital sap covering one’s back-regardless of species- as normal. I’ve spent all day trying to figure out exactly what was going on in that house, but after 5 minutes my head started to hurt so I gave up.

I had the unfortunate need to go to the emergency room this weekend with my 4 year old, thanks to a protracted Saturday night of vomiting that didn’t respond to any of the things I normally do to help at home.

My husband took her at 4 am, which is usually a pretty quiet time in the ER. Imagine his surprise to find the waiting area full- totally full- of groaning zombielike walking dead, all convinced they are dying of swine influenza. Granted, this is a real possibility, especially in our area, but man, could our kid have worse timing?

By 7 am, she still hadn’t been seen, so I went down to the hospital to trade places with my husband since I had had at least a couple hours of sleep. The nurses had taken pity on my daughter’s sad state and given her a room and an evaluation by the time I arrived. I waded through an even bigger throng of pathetic looking people, holding my breath, and found one unhappy 4 year old being hooked up to an IV line.

She had already had blood drawn, and I was just in time for the obligatory radiographs. A few things had yet to be done. The nurse told me, rather apologetically, that the doctor had done what he always did in these situations and ordered a full battery of tests, some I was OK with, others I was less so. Being the sole doctor with an army of patients queuing up, I understand that he didn’t have much time for lively debate on the topic, but I was sitting in that cubicle for hours and had nothing else to do except come up with my own treatment plan.

I told the nurse that I was not happy about test C, didn’t feel it was necessary and would ultimately be painful and traumatic more than helpful, and she agreed. “We” (gesturing to the other nurse) “tried to talk him out of it, but he has his way he likes to do things.” The doctor orders it, and the nurses and the parents have to actually deal with the painful part, so it’s no skin off his back, right? So I told her to decline it.

Well, that got the doctor in the room. “Hi, mom,” he said, a slight, jittery guy like most ER doctors I’ve met seem to be, breezing in with his chart and his script. “So, you don’t want to do Test C?”

“No,” I replied. “You can get the same information by doing it with Test D, and I’d like to do that instead.”

“But blahblahblah,” he said, starting to use medical jargon.

“Yes, and blahdibladiblahblah,” I retorted, also using medical jargon.

This is when he blinked, I’m sure trying to decide if I just read a lot on the internet or what, and ultimately, I think, concluded I was a nurse. That is always the first assumption doctors make when talking to a female who knows medical words, and I don’t offer up an alternative explanation. Nurses are pretty stubborn and opinionated- and I mean that in a complimentary way- so it’s easier to let someone think that. He was too busy to argue, so he left.

We did Test D, which accomplished exactly what I figured it would, and after 9 hours of sitting around, we ended up with a diagnosis of “gastritis.” Which is medical for “stomachache.” Makes me long for my awful days in the veterinary ER, where the most I had to leave people waiting was maybe 2-3 hours on days we were understaffed to come to similar non-conclusions.

I saw the doctor one more time, right as he discharged us. “I’m giving you a prescription for Pepcid,” he said.

“Nope,” I replied. “Zofran.” And he did.

I’m not a pushy person, I swear it- but time and experience has made me realize in some situations you do have to question and argue, and I say this both as a patient and as a doctor who does get challenged at times. Either there is a good reason for what a doctor says or not; sometimes it’s just rote, sometimes it’s cover-your-butt practice, sometimes it’s convenience- but at the end of the day, you make the decisions; a doctor’s role is to help you make the right one.

Most of us animal lovers have been following the tragedy surrounding the death of 21 polo horses in Florida with great interest. The details just get worse the more we know, don’t they?

According to the latest report, the Venezuelan polo team was used to using Biodyl, a supplement that is available elsewhere, but not approved for use in the United States. So, they had a compounding pharmacy mix up a similar concoction- with this result.

Veterinarians use compounding pharmacies a lot- I’ve used the actual pharmacy in question. We use many, many medications in an “off-label” fashion, because most drugs simply are not approved for use in animals the way they are in people. When you have an unhappy cat who needs to take tapazole on a daily basis, having it compounded into a fish flavored syrup can be a lifesaver, literally. I have a patient, a 150 pound mastiff with Addison’s disease, who would be dead without compounding pharmacies- the owner cannot afford a $300 injection once a month, but can afford an oral medication that achieves the same goal, which is specially compounded for $70 a month.

There are a handful of compounding pharmacies, including the one in this case, who specifically cater to veterinarians. They are very familiar with the medications we use a lot. Most of the time when we use compounding pharmacies, it is in a straightforward capacity, taking already available drugs and making them in a different flavor, or a special dosage. Asking a compounding pharmacy to make up a medication that is not available in the States, however, is treading murkier water. It’s done, obviously. And when you ask a pharmacy to construct a medication from scratch that is not one they normally do, you, as the prescribing vet, are assuming the risk if it doesn’t work the way you wanted. The laws on this type of prescribing are somewhat murky, though with this incident I imagine it is going to be much more closely examined in the veterinary community.

No one has said yet if the compounding pharmacy made the medication incorrectly, or if the prescribing veterinarian gave them the wrong dosages to begin with.

Either way, not good.

I’m going to give you a sentence, and you have to picture it for me, OK?

“Today I took Fluffy to the veterinary acupuncturist.”

So what are you seeing? Some frizzy haired tank top wearing hippie haphazardly sticking insulin needles in your cat while waving catnip in front of her face, right? That’s what I was picturing when I heard some classmates talking about it in vet school. “Oh, you went to one of those vets,” we’d snicker, then go back to studying NSAID effects on renal perfusion.

I went on with this attitude until my anesthesia rotation in my senior year. Before me stood the chief of anesthesia, a guy whose entire career is based on pharmacological ways to mediate pain, and before him was a patient with chronic arthritis. “OK guys, get out of the room,” he said to us students. “I’m doing acupuncture on this dog.” We looked at each other incredulously. This vet was about as non-hippie looking as they come. Actually, he looked like Bill Gates with a British accent.

Intrigued, we asked him to give us a lecture on this befuddling thing, this sticking needles in random places. He sat down before us, and instead of talking about qi and spleens and energy, he showed us an article from the prestigious JAVMA medical journal, discussing in medical terms acupuncture’s proven ability to mediate pain.

4 years later, I took a rigorous month-long course to learn acupuncture through the International Veterinary Acupuncture Society (IVAS). It was pretty crazy, if you’ve never been exposed to Traditional Chinese Medicine, and come from a Western oriented background. Learning Chinese medicine in a month is much like trying to learn, well, Chinese in a month. It’s a whole different way of thinking, but much like learning a new language, you’re still saying the same thing, just in a different way. Instead of “arthritic dysplastic hips,” for example, I might diagnose “kidney yang deficiency.”

We had some fantastic teachers; some were world renowned veterinary practitioners from China. Others, like Dr. March, were from right around the corner. He was president of IVAS at the time, and I was fortunate enough to shadow him to get some hands on time with animals.

I’m not sure what I expected Dr. March to look like, but he was pretty much the exact opposite. He is an equine practitioner, a well respected one. About 10 years ago, he heard from a client how much her horse had benefited from acupuncture and chiropractic adjustment, so he decided to give it a whirl. He looks like Danny Devito, a jovial, good-ole-boy, coverall wearing bundle of energy who drives a beat up pickup truck, and just so happens to know a hell of a lot about Eastern medicine. Because, he said, it works. And why not offer everything you can for your patients?

If he can believe in this stuff, I reasoned, anyone can. And I was right.

I haven’t had as many opportunities as I would like to practice my acupuncture- in my previous practice in emergency medicine, there wasn’t the time, and in my current place, I just don’t get a ton of clients who are, shall we say, open to the idea. But I do have a few brave souls, and they are all functioning better and with less medicine than they were before we started. It is so gratifying. I love it.

It’s been over a week since I started this food experiment, and I am ready with the first round of results.

Contestant Number One: Grandma Lucy’s Grain Free Freeze Dried Cat Food.

I picked this one to try first because it looked cool. Freeze dried cat food? Is that like astronaut food but for cats? The answer is, of course, yes, which makes it more interesting and fun than boring old kibble.

Ingredients: Chicken, Ocean White Fish, Potatoes, Flax, Carrots, Celery, Apples, Cranberry, Blueberry, Taurine, Vitamins and Minerals. So far, so good.

Let’s pour some into a bowl to examine it more closely.

Let’s see, hmmm, looks like Potato buds, mostly, with some airy crunchy striated meat like things hanging out on top.

I use paper bowls because although I like the idea of being eco-friendly, used wet food bowls (especially raw food bowls) gross me out so I have to be able to toss them afterwards. (I drive a hybrid to balance things out.)

Add an equal amount of warm water, and let sit for 3-5 minutes. At this point it still looks like Potato buds, or maybe toddler food. The nice thing about it is, it isn’t nearly as smelly as canned cat food, which makes me happy.

And 5 minutes later, we’re ready to rock:

Wait a minute…what’s missing…

Note to self: cover bowl while waiting for water to resorb. Someone liked the crunchy bits.

Day 1: Both cats ate it like gangbusters, as in, licked that bowl clean. Success! On day 2, both cats developed a pretty gnarly flatulence issue, but that resolved by the end of the week.

On day 5, the day after I finished my sample bag, declared it a success, and opened the non-returnable big bag, Callie decided she didn’t like it anymore. When I placed it on the floor, she looked at me with a raised eyebrow and a baleful expression, and left Apollo to the entire thing while she went inside to cough a hairball onto my pillow in protest.

By day 10, even Apollo was ambivalent. I put a bowl of it out this morning and when I came home this afternoon, it was mostly full (and these are cats who love all food.) I ended up giving them a can of Avoderm I had hanging around out of desperation and they attacked it like starving hyenas devouring a zebra.

Emmett likes it. Emmett is on a dry food strike but will eat the cats’ food, which the cats will not eat but they instead will happily nibble on Emmett’s leftover kibbles. There is just no winning. And now I have a $23.99 3 pound bag of fishy potato buds.

Verdict: I’m disappointed. I really wanted the cats to like this product. It’s easy to store and measure out any amount you need like kibble, with the dietary advantages of high water content once it’s rehydrated. The price was reasonable and the quality seemed good, but for whatever reason my cats decided within a few days they weren’t that excited about it. Their site does offer free samples, which is worth a try because it is a neat food- and maybe your pets will like it better than mine. If anyone has experience with this or another brand of freeze dried dog or cat food I’d love to hear it.

Next week: I’m tackling some pre-made raw food patties.