Is it seizures? Nope, just a bad case of fleas!

I currently have the sweetest old kitty in my hospital for rabies quarantine. Here's how that came to be...

When a dog or cat bites a person and that animal is not current on its rabies vaccination, that animal has to be quarantined for 10 days in an approved facility such as a veterinary hospital or animal shelter (at a considerable expense to the owner). During this time, the pet is examined three times by a veterinarian for any signs that it may indeed have rabies. If there are signs of rabies the person bitten will need to have preventative rabies treatment to save his or her life.

The cat in my hospital, Chatterly*, bit his owner during a "seizure" and I performed the first of his three rabies examinations early this week. I was particularly worried that this cat may indeed be rabid because he was having neurologic symptoms at home, so I questioned the owners closely. Turns out Chatterly has no recent vaccine history, he has been having "seizures" for some time, and although he was an indoor cat, he had escaped to the great outdoors during the previous summer for several weeks.

As I watched Chatterly walk around the exam room, I noticed him crouching strangely as if he were weak in the back legs. He was missing a bunch of hair on his back as well. When I touched his back, he began twitching uncontrollably and almost fell over -- a typical "seizure" for him. Chatterly was absolutely crawling with fleas!

I just about laughed out loud with joy and amazement (actually, I think I did laugh which was probably bewildering to the owner). Chatterly wasn't having seizures, he was itchy beyond belief! And that weird crouching? I haven't run any blood tests yet, but I suspect he's very anemic from blood loss (or possibly even feline infectious anemia)!

Legally, Chatterly still needed to be quarantined and examined for rabies, but first we cleaned him up and treated him for fleas. He and his feline companion at home will need a monthly flea treatment for at least three months in a row. The owners were instructed to wash all the bedding in hot water, vacuum all the carpets and furniture weekly for several months and consider using a flea bomb or spray as well.

The most shocking part of this story -- aside from a mild mannered senior cat biting his well-meaning owner because he was out of his mind itchy -- is that Chatterly is one of two patients I've seen this week with fleas.

In January.

In Wisconsin.

Chatterly probably has had fleas on him since his outdoor hiatus this summer. It is unclear how or when my other patient, a geriatric canine, acquired fleas. The point is that we Wisconsinites often become complacent in the winter about continuing flea and tick treatments on our pets. And we almost never think of it for our supposedly indoor only cats! Many veterinary dermatologists recommend year-round flea prevention for pets with allergies because a single flea bite can set off a horrible cycle of itching and infection. Chatterly is the second patient I've met who was so itchy he appeared to be having "seizures."

In general, if your pet is an allergy sufferer, you should keep him on year-round flea prevention. The same applies if your pet vacations with you in Florida and other warm climates. Those of you with a large rabbit or rodent population and pets that catch or munch them, should consider year-round flea prevention as well. In the end, it's cheaper and easier than the complications associated with itchy, infested pets!


* Name has been changed to protect privacy.

A Graphic Reminder on the Importance of Spaying Your Pet

Spay and Neuter. You've heard it all before. Let's review...

• You should spay (female) or neuter (male) your pet to avoid inadvertently increasing the homeless pet population. Nationwide there is an overload of unwanted pet animals. Humane shelters can't find homes for all the stray and surrendered dogs and cats out there already.  

• Your pet should be "fixed" to prevent unpleasant behavioral issues such urine marking, roaming, aggression, vocalization and "in heat" behaviors.  

• Spaying and neutering reduces or altogether eliminates certain dangerous medical conditions. Surgical removal of the testes, uterus and ovaries obviously means your pet will not develop cancer in these organs. Risk of mammary cancer (especially in dogs) is reduced dramatically with spaying before the onset of puberty. Life threatening uterine infections are a common preventable condition as well, and that's what I want to talk about today!

I have seen far too many unspayed dogs and cats presented for life threatening uterine infections. These animals are typically older and usually have never been bred. Recently, I was presented with a senior kitty who had had one litter of kittens years ago, but was so nervous at the vet she had never been spayed after an initial vaccination series. Now the owner noticed bloody discharge from the vulva. The kitty, Tina*, was not showing signs of a urinary tract infection such as frequently straining to pass small amounts of urine. The owner was certain Tina could not be pregnant, but she had not had normal heat behavior for some time. My physical examination confirmed that Tina had an open pyometra, or uterine infection.

A feline pyometra after surgery. An incision was made into
 one uterine horn to visualize (and smell!) the contents,
a mixture of blood, pus and bacteria.  

There are two types of pyometra. An "open" pyometra means the cervix is dilated and the infection can leak out somewhat. A "closed" pyometra means the cervix is tightly closed, and pus builds up inside the uterus without any outlet. Either type of pyometra is bad news and requires immediate aggressive action (nearly always surgery). However, a closed pyometra is often worse for several reasons. Veterinary intervention may be delayed with closed pyometra because it may be harder for owners to identify a problem with their pet. Aside from the foul discharge associated with open pyometra other symptoms of a pyometra are vague and sometimes subtle. A pet suffering from pyometra may have decreased appetite, vomiting, diarrhea or lethargy. A classic sign is drinking more water and urinating more, but this is again a non-specific symptom associated with many serious problems commonly seen in older pets. Because animals with closed pyometra are usually not presented to the veterinarian as early in the disease, these pets are usually much, much sicker when they finally are diagnosed. Tragically, some of these pets have a ruptured uterus and are septicemic with infection in their bloodstream by this point. Many owners elect humane euthanasia rather than pursue treatment.

Tina remained in intensive care on IV fluids after
 surgery to support her internal organ function during
recovery.

Fortunately for Tina, her cervix was open and her owner wasted no time seeking veterinary care. After running comprehensive blood work to identify if Tina had any other underlying diseases, she was hospitalized overnight on intravenous fluids and started on antibiotics. The next morning she had the surgery that I wish she'd had done years ago -- she was spayed. A pyometra spay is more complicated, more risky and more expensive than a spay on a young healthy animal for obvious reasons. The uterine horns are filled with pus. If the uterus ruptures (which is more likely when the cervix is closed and the uterus is like an over-inflated balloon ready to pop), there is horrible bacterial contamination of the entire abdomen! Plus the animal is often systemically very ill and so requires aggressive supportive care in the hospital before and after the surgery, and she may have a slow recovery at home.

The lesson here is prevention. As a veterinarian I hate seeing my clients struggle with the decision of whether to pursue costly treatment for their senior pet's pyometra or to euthanize her. I have seen numerous old dogs and cats go on to live many happy years after surgery for pyometra, so it is usually well worth the effort! Still it is cheaper and safer to spay your pet when she is young and healthy. Please avoid the heart-ache and financial burden that comes with waiting too long to spay.


* Name changed to respect owner privacy.

The Skinny on Intestinal Worms

One day last summer my fearless sister-in-law plucked a "slug" from her cat Izzie's bottom and sent me a video of the little bugger crawling around on her desktop. Sarah launched into a tangle of theories of where Izzie could have picked up a tiny slug. I suppressed a giggle. "Uh, Sarah, that's not a slug. That is a tapeworm."


Cats and dogs share our beds and kiss our babies. They also prey on rodents, scavenge dead animals, eat stool and lick their bottoms. Yep. It's gross. Limit the grossness by regularly giving your pet a dewormer. There are more types of wiggly intestinal worms than you probably care to imagine with different types of medicines necessary for each. Here's the low down!


Tapeworm

• Tapeworms are a common small intestinal parasite in cats and dogs.
• Cats and dogs pick up tapeworms by eating infected fleas or rodents.
• Signs of infection are seeing tapeworm segments (e.g., grains of rice, sesame seeds or slugs!) in the stool or around the anus. A fecal float is rarely helpful in diagnosis unless the technician finds tapeworm segments in the stool sample.
• Some tapeworm species are contagious to people and can cause intestinal problems or dangerous neurological disease.
• It may be necessary to treat for flea infestation at the time of tapeworm diagnosis.
• Tapeworm dewormer is notoriously expensive and not included in most heartworm preventatives -- make sure you ask your veterinarian for advice on treating tapeworms.  

Whipworm

• Whipworms are a common cause of large bowel diarrhea in dogs.
• A heavy infestation can cause bloody stool, weight loss, anemia and dehydration.
• Whipworm infections are tough to diagnose on routine fecal floats because egg production is small, shedding is intermittent and the eggs don’t “float” well. Therefore, even with a negative fecal float, your veterinarian may still recommend aggressive deworming if suspicion is high.
• Whipworm eggs can remain hidden in the soil for up to 7 years! That means you must keep your dog on a monthly whipworm dewormer for a very long time to avoid reinfection.
• Whipworm dewormer is not found in most heartworm preventatives, but there are some that include it so ask your veterinarian.

Hookworm

• Hookworms are commonly found in dogs and cats.
• Hookworms feed on intestinal tissue causing blood loss and inflammation in the GI tract.
• Severe infection may lead to anemia, debilitation and even death, especially in young animals.
• Hookworms can infect people (Ewww!) by penetrating the skin or by being accidentally ingested. Infection in humans can cause an itchy rash or inflammation within internal organs.
• A routine fecal float performed by your veterinarian is used to diagnose hookworm infections.
• Many monthly heartworm preventatives also control hookworm infections, especially when used year-round. 

Roundworm

• Roundworms are the most common intestinal parasite of dogs and cats. Assume every puppy and kitten has a roundworm infestation even though worms are rarely seen in the stool. Some animals with very bad infections will pass "spaghetti-like" worms in the stool or vomit. 
• Adult worms live in the intestines depriving the host of nutrients. 
• Common signs may include diarrhea, weight loss, swollen abdomen, vomiting or no signs at all.
• Dogs and cats pick up roundworms from their mother or from infected feces. The potting soil in houseplants is a reported source of roundworm eggs for indoor-only felines! 
• Humans can accidentally ingest roundworm eggs. Infection in humans can cause blindness or organ damage (yikes!).
• Many heartworm preventatives are helpful in treating roundworms, but may need to be used year-round to be most effective.

Heartworm

• Not an intestinal worm, I know! Heartworms live in the heart and lungs of infected dogs and cats.
• Mosquitoes transmit immature heartworms from infected animals to healthy dogs and cats. Even "indoor only" dogs and cats are at risk...have you never been subjected to the whiny nighttime hum and nip of rogue indoor mosquitoes?
• Untreated, heartworm disease is fatal and treatment itself can have dangerous side effects. 
• In dogs, signs of infection may include coughing, difficulty breathing, sluggishness or no signs at all. Cats usually have signs of respiratory disease (similar to asthma), vomiting, lethargy or--you guessed it--no signs at all.
• Heartworm infection can be diagnosed with a simple blood test.
• Heartworm is easily prevented with a variety of safe medications that can be given orally or applied to the skin once a month. As discussed above, many heartworm preventatives do double duty as an intestinal dewormer and some also treat fleas! Your veterinarian can help you sort out the options.

The take home message is that parasites are almost never diagnosed by the naked eye. I hear it time and again: "My dog doesn't have worms. His poop looks normal." You will generally only see worms if your pet has tapeworms or has a really, really bad roundworm infestation! Next, almost all intestinal parasites require multiple courses of deworming medication to be effective. Like fleas, certain stages in the worm's life cycle are resistant to treatment, so you need to deliver the punch repeatedly! Finally, some parasites are contagious to people (especially children and immune-suppressed individuals) making preventative deworming that much more important in certain households.

Help! I turned my back for 3 months and my dog got FAT!

EdGrrr the Athlete, 2007

EdGrrr, my 6-yr-old Labrador retriever, used to have the body of an athlete. No. Not just an athlete. A marathon runner. He was lean and mean. He had a lovely hourglass figure and was he ripped! Some people thought he was too skinny because, unfortunately, the breed standard for Labradors has been a somewhat thick and chunky variety of dog. While I battled baby bulge myself, I was so proud of my young lab's fitness and physique.

Then this summer, while I was building my vet clinic, EdGrrr went and got fat. And not just fat, but I-finally-weighed-him-on-my-clinic-scale twenty pounds fat! I'm not sure how I missed it, but now that he is chubby it has been a true challenge to whittle away the pounds.

EdGrrr the Tub, 2011

Although I have always measured my dogs' food and fed twice daily meals, avoided people food and shied away from regular treats, EdGrrr had plenty of help in the additional calorie department. His chummy personality and eager expression earned him a sandwich (or two) a day from members of the clinic work crews. Of course, I didn't learn this until after the work was done. To be fair, they played more fetch with him in three months than he's had in the previous three years.

I can't blame the workers entirely for the obesity-fueling excesses. EdGrrr, a farm dog through and through, finds calories in the darnedest places: a little grain from the feedlot steers here, a few compost heap veggies there, and a dead deer for dessert. I'm starting to feel like EdGrrr will foil my best efforts at dieting him no matter what I do.

So in spite of my failure at keeping my own dog at a healthy weight, here are some tips for your pet's diet:

1. Feed your pet distinct meals each day rather than keeping the bowl full. Many pets just can't resist another trip to the all-you-can-eat buffet. (Sound familiar?)
2. Use a true 8-ounce measuring cup to feed a precise amount of food as directed on your pet food bag (or by your veterinarian). The range on the pet food bag is often quite broad (such as "For a 40-60 lb dog feed 3-5 cups per day") so you will have to use your best judgement. Remember the amount is the total daily amount and you will have to divide that by the number of meals you feed a day.
3. If your pet is on a diet, make sure that you are feeding an amount meant for her ideal or goal weight, not her current weight.
4. Make sure chubby is on an adult maintenance diet (see Nutrition 101 for help selecting a pet food). "All life stages" foods are essentially puppy/kitten diets and won't help an obese-prone pet lose weight.
5. Watch the people food. It's really hard to gauge how many extra calories are being consumed by pets that lick the plates clean after dinner or receive tasty tidbits from Mom, Dad or human siblings throughout the day. Some types of people food are outright toxic for pets, so best to avoid it altogether.
6. Go easy on the treats. Of course you can still give treats. But your pet loves receiving a gift from you not the gift itself! So, if you can break that Milkbone biscuit (a doggie "candy bar" incidentally) into smaller pieces do it. Or choose a low calorie treat; the pet stores are full of them! In the really hard cases, you should eliminate treats and just offer a few pieces of your pet's daily allotment of kibble (chances are he won't know or care it's just his regular food).
7. Exercise. Enough said.
8. Once you've made one or more changes to your pet's diet you can weigh her periodically (say, once a month) to monitor progress. If your pet is small enough and you have a bathroom scale at home you can weigh her by holding her and then subtracting your own weight. For bigger animals you may need to schedule a weight check at your veterinary clinic (there probably won't be a charge for this...just ask!)
9. If your pet is not losing weight and you've really -- and I mean, really -- implemented the above tips religiously, please have a chat with your veterinarian. There are several treatable medical conditions that cause unrelenting obesity that can be diagnosed with a thorough examination and blood tests.

As 2012 dawns and I make my own New Year's resolutions to eat better and exercise more, I vow to get EdGrrr to a healthy weight as well. I may not have his full cooperation, but I do know that if I go out jogging he will be my willing companion. Then I can at least cross #7 off the list!

Have a wonderful New Year!