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Virtual Vet Newsletter

Here are tips from the Virtual Vet Newsletter.   This is a free web-based newsletter which we highly recommend.  Instructions on how to subscribe are included after the article.

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BITE WOUND CARE

A TAD BIT MORE ON FOOT PAD CARE

Just a quick follow-up on the dry foot pads discussion. One of our readers suggested using Bag Balm, which was originally sold to soften the teats and udders of cows. Since it works great on hands and other dry skin areas in people, it is widely available now. Another reader commented on my suggesting a small test area before general use of hand/body lotions. A friend of hers used it on her dog and had an allergic reaction. Simple petroleum jelly is generally a safe bet. Please remember that those foot pads are for protection, so don't try to make them baby soft.

OK, now on to today's major topic....

BITE WOUNDS

Bite wounds are some of the most common traumas that a veterinarian sees. Usually the bite is caused by another animal of the same species fighting with the victim over a female in heat, or territory. Both dogs and cats engage in this behavior but in the cat the damage is usually not as obvious to owner. Biting cats tend to bite down and hang on, whereas dogs are more likely to bite repeatedly. Also, cats have more needle-like teeth that puncture rather than tear.

Cats can also inflict puncture wounds with their claws, something dogs don't use in fighting. The net result is that veterinarians don't usually see cats right after a fight. Generally, it's a few days later when the infection really gets going under the skin and a boil or abscess is seen by the owner. 

Dogs, because of the nature of their wounds, require more immediate repairs. Abscesses do form in dogs, but not nearly with the frequency we see them in cats. Often the first sign of a bite wound encountered in a fight is a gaping hole which discharges a nasty, bloody pus in large quantities. This can be quite upsetting to an owner, much more so than it seems to bother the cat, who often seems rather unconcerned about the whole thing. Cats have fairly loose skin, which helps in a fight when the opponent chomps down, but does allow the spread of infected material under the skin. The body's natural response to introduced foreign bacteria is to produce large numbers of a specialized white blood cells, the neutrophils, which are designed to kill off invading organisms. The result of this great cellular battle is rather large amounts of fluid, often called pus, that  builds up under the skin until the pressure and necrosis of the overlying skin results in its exit to the outside, forming this aforementioned gaping hole in the cat's skin.

Sounds and looks nasty, but in reality it is quite functional because it rids the body of this vast deposit of dead neutrophils and bacteria and permits healing to the underlying tissues to proceed. Often in homeless cats, which, of course, go untreated, this results in large deposits of scar tissue where the body fills in this damaged tissue in a process known as granulation. That's why old and intact tomcats frequently have large heads...it's due to the large amount of scar tissue because that's where most of the bite and claw wounds occur when toms fight over queens and territory.

Pets, however, do get veterinary care. What your veterinarian will try to accomplish is to clean out the remaining abscessed material and keep the exit wound open to allow an additional fluids to drain while healing occurs from the inside first and the skin last. Sometimes clipping the hair around the wound is necessary to allow the skin to heal without excessive amounts of scar tissue forming. Antibiotics may be necessary, depending upon how the pet's body is dealing with the infection.

Occasionally, a small rubber drain tube may be sutured into the wound for a few days to allow the drainage to occur. Once the infection is under control and the drain is no longer needed, the skin suture is snipped and the drain pulled out. This removal is essentially painless to the pet and no anesthesia or analgesia is required for the procedure. Depending upon the individual pet, hospitalization during the period the drain is in place may be suggested because the pet may need a mild tranquilizer to keep them from chewing on or removing the drain prematurely.

In cases where the damage is more severe, surgical debridement (removal of dead or dying tissue) may be necessary. In these cases, surgical anesthesia will be required and hospitalization generally required for a few days. Fortunately for all concerned, treatment this extreme is not common.. 

For minor bite wounds that have resulted in ruptured abscesses you may be able to treat your pet at home. You will usually require some help to hold the cat during the procedure described below, so the first thing is to find someone who knows how to hold a struggling cat with out causing damage to either human or cat. Good luck in finding such an individual!

For abscesses:

Using a mild soap and warm water, gently clean the affected area. This will enable you to better assess the extent of the wounds and reduce the chance of additional wound contamination. If the wound is open and draining, try gently flushing it out with either warm water or sterile saline solution (like that used for contact lenses, if available). That's it. Don't try to cover it because your pet is only going to tear at the bandages anyway, possibly causing more damage. If it is in an area that can't be reached by the pet (hah!) you might get away with bandaging it, but I doubt that it will make much difference in healing anyway. The goal is to have healing occur from the inside out, so you will likely have to remove the scab over the abscess itself every day for at least 3 or 4 days.

Don't worry if your pet licks the wound. Such licking appears to be comforting and even the raspy tongue of a cat is unlikely to cause further injury. If healing appears to be progressing well, that all you need to do. If not, your family veterinarian is there to assist you. 

Please be sure to neuter your pet. By doing so you will reduce such injuries in the future and also do your part to reduce the needless slaughter of millions of homeless dogs and cats every year.

That's it for today.

Peace,
Denis

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MORE ON PAIN IN PETS 

Today I'd like to re-open a subject that we discussed about a year ago, pain in animals. A question from two subscribers concerning the post-surgical analgesia that was provided for their cat was so pertinent that I thought I'd share it with all our readers.

The question, from Vicki and Stephen, that re-opened this whole issue of post-surgical pain control, concerned their cat Zen, who had major surgery and was in severe pain following it. Vicki and Stephen had been assured that Zen would receive appropriate analgesia, but, although Zen was sent home wearing a Fentanyl patch, she seemed to be in extreme pain.  Vicki and Stephen wondered if Zen had been given sufficient and appropriate analgesia.

While dogs will often seek solace from the leader of the pack (you), cats in pain usually hide and move as little as possible. As with humans, the appetite is generally depressed in both species. Zen hid under the bed and essentially refused to eat.

The use of the Fentanyl skin patch is certainly indicated, although there is some doubt about its ability to control pain in all animals. The downside of fentanyl is that it takes from 6-48 hours for the maximum plasma concentrations to be reached, during which time pain relief is incomplete. One possible approach to this would be to apply the patch prior to surgery. It may also be administered intravenously, but it does have some serious drawbacks when administered in this fashion. Prolonged depression of the heart rate (bradycardia) may occur and the duration of analgesia is only about 20 minutes. While a continuous intravenous drip of fentanyl might offer continued analgesia, the close and constant monitoring of such post-surgical patients make this approach impractical in most cases.

A shift in thinking in veterinary medicine has been occurring in the last few years towards providing analgesia based on the severity of the trauma, either accidental or surgical, rather than on the symptoms of pain exhibited by the animal. One reason for this, in addition to the humanitarian ones, is that moderate to severe pain causes some pathophysiologic changes in the animal's system (eg. changes in blood pressure, potential shock, and hormonal irregularities). 

This approach bases the administration of analgesic drugs on the severity of the trauma and is routinely given without waiting for the signs of pain to become evident. The choice of drug and the dosages are adjusted on this basis. 

The concern that health care providers have in routinely giving analgesic drugs freely is that if the patient is critical, the drugs may worsen the patient's condition. So, you see, it is a delicate balance that one must achieve here. Personally, I agree that the pre-emptive approach is best, but only in cases of surgical trauma in normal, healthy animals. Trauma due to accidents, such as animal-automobile trauma, need to be evaluated on a case-by-case basis depending upon complicating factors, such as organ system damage, blood volume loss, and shock. During the recovery phase, analgesia certainly should be strongly considered. 

Another complicating factor is that many of the analgesic drugs are impractical unless they are administered intravenously on a frequent (sometimes continuous) basis. This means the pet must be hospitalized for some additional time following surgery. Please, remember that veterinarians are concerned about the cost to you and must balance that expense against what they would really like to do for the patient.  Human medicine has the luxury of insurance coverage that, in veterinary medicine, is rare, so please try to understand the dilemma facing your veterinarian. Frequently owners say "expense is no object" only because they never intend to pay the bill for pet care. You would not do that, I am sure, but too many others do it every day. 

Zen received oral Butorphinol on a follow-up visit to her veterinarian because Vicki and Stephen had reported signs of extreme pain at home following her release from the hospital. Vicki told me that it worked very well for Zen. I do not have any experience with oral administration of this drug and I am happy to pass on her experience with it for your information. 

That's it for this issue. Next time I'd like to go a little deeper into the background of why certain types of analgesic drugs work better than others in different types of pain. Since this is an evolving area of veterinary medicine, I'd like to be sure you are prepared if you have the occasion to discuss the issue with your family veterinarian.

Copyright 2000 Denis A. Bekaert, DVM.

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PAIN AND ANALGESIC DRUGS

Last week we re-opened the discussion on the use of analgesic drugs and I promised I'd go a little deeper into the subject this week. Today, we'll look at how these drugs relieve pain and why their differing mechanisms of action are important factors in choosing a suitable analgesic drug.

Before we start that discussion I'd like to clarify a point made last week. One of our subscribers, a veterinarian, reminded me that some animals are particularly sensitive to the pharmacologic action of analgesic drugs and may become depressed with what would be a normal dosage level. As with any drug, we must observe the pet's reaction to it and adjust our dosages in relation to balance it to the desired effect. My thanks to Dr. Connie Canode for this observation. 

In the past we veterinarians tended to regard pain as a protective mechanism that caused animals, including humans, to protect injured areas of the body and thereby reduce additional injuries to that area. With human patients we can tell them to avoid using injured tissues, but with pets it is not that simple. So, with that philosophy, we in veterinary medicine traditionally held that pain was a mechanism to control injured animals and avoid further damage. We all recognize that a pet in pain will generally lie quietly to avoid intensifying pain following surgery, thus avoiding post-surgical tissue damage caused by excessive movement.

But, as I pointed out in the last newsletter, our views are changing in regard to analgesic drugs following surgery. We have found that pain can cause further damage at the system and cellular levels and that, rather than being a protective mechanism, it delays healing. So, veterinarians are responding to this new understanding by prescribing and dispensing analgesic drugs in greater and greater numbers.

Let's look at how analgesic drugs work in preventing pain.

First, analgesic drugs do not eliminate pain stimuli, they act by blocking the perception of the pain in the brain. The injured tissue continues to send pain messages but they are not received by the brain. The receptors that recognize pain are known as nociceptors. The most potent class of the analgesic drugs used in veterinary medicine is the opioids, which are derivatives of opium. Examples of commonly used opioid analgesics are morphine, Buprenorphine, and Oxymorphone, all of which bind to specific opiate receptors in the central nervous system (CNS) to inhibit the reception of pain signals from injured tissues. The opioids are particularly indicated in cases of moderate to severe pain. While there are drawbacks to using the opioids in some types of trauma (eg. head or CNS injury), they are relatively minor when utilized by trained professionals. Opioids exert their effect by binding to specific opioid receptor sites in the CNS and thereby prevent the pain messages from the tissues from reaching the brain.

We have found that by anticipating the body's response to trauma in terms of pain and giving the analgesic drugs before the pain messages begin, we can actually reduce the dosages of analgesics necessary to control pain. This means there is less chance of encountering side effects of the drugs which could complicate the recovery processes. Consequently, your veterinarian must base the type, the dosage and the frequency of analgesic given, on the degree of pain expected from the particular surgical procedure.

If we wait until signs of pain are present we have at least two potential complications. First, the pathophysiologic changes, such as histamine release, blood pressure changes, or inflammatory responses, may create additional clinical problems. Secondly, the dosages of analgesics are likely to be much higher than if they were given prior to the appearance of pain in the animal. Additionally, signs of pain may not be evident in the pet because, in the wild an animal showing pain would signal potential predators and scavenger species that an injury has weakened the animal.

The bottom line here is that it would seem that there is every reason to insist that, at least for elective surgery, your veterinarian should strongly consider the administration of analgesic drugs prior to surgery. If accidental trauma has caused a painful injury, once the animal is stabilized, analgesia should be the next consideration. There may well be exceptions to this priority, but as a rule of thumb, they will be the exceptions, not the rule. 

Sometimes the analgesia provided will be a local anesthesia, or in the case of minor pain heat or cold packs. It is not necessary, nor even desirable, to drug the entire animal for a localized source of pain. This is especially true in the case of minor pain. 

(c)Copyright Denis A. Bekaert, DVM 2000

Today's quote

From time to time I come across a quote or joke that I find particularly funny. I'd like to share these bits of humor with you as they occur. This probably will not be a regular feature, unless I receive input from our subscribers with similar material. If we get enough, I'll try to get it into most issues. This feature will not replace our regular material, just supplement it. Besides, a laugh is good medicine.

Women and cats will do as they please and men and dogs should relax and get used to the idea.

Robert A. Heinlein

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HOW TO COPE WITH A PET EMERGENCY

It happens to all of us at one time or another, the unexpected pet emergency. Sometimes it's easily solved and no permanent harm results; other times it can be really serious, even fatal. Often, what separates the two is just how prepared we are beforehand. Now, while things are calm and Rover or Fluffy are napping peacefully, might be a good time to think about just what we might need in such a situation. When an emergency occurs, calm and rational thought are sometimes difficult to find.

Let's first consider just what type of emergencies we are likely to see. Then we'll make a list of what would be a good kit to have available.

Trauma is often due to contact with a moving automobile. If not immediately fatal, lacerations and broken bones often result. Immediate immobilization and/or protection of fractures pending professional attention will often greatly minimize further damage. Please remember that even gentle Fido or Pussywillow may bite or scratch you badly as you try to help them, not because they don't love you, but because they are reverting back to primal reactions to injury and pain. So, please be careful. Applying a cloth muzzle is a good first step, unless the injury is to the head or jaws. Shock often accompanies fractures and lacerations, so try to get professional attention as soon a possible. In the meantime, try to keep the pet warm.

Lacerations range in severity from a cut footpad to a life-threatening wound, so naturally how you deal with them also varies. Minor wounds can be cleaned out with hydrogen peroxide or simple soap and water. Application of an antibiotic cream such as Neosporin will help avoid bacterial infection. Protective bandages are often indicated, mostly just to keep the wound edges together and to prevent gross contamination from the environment. This is particularly true since, unlike yourself, you can't ensure that your pet will try to keep it clean. In fact, especially with cats, having them leave the bandages alone is a major feat!

Minor cuts can be treated at home, but often it will be necessary to have your family veterinarian evaluate the wound and suture it. Wounds resulting from fights, particularly in cats, are often left at least partially open to allow healing to occur from the inside out and to allow drainage to occur. If this is not done, frequently abscesses develop. Your veterinarian might put a temporary rubber drain in place until healing is well along. But all of this is beyond what you will be attempting at home in an emergency, so let's get back to our original subject...sorry I strayed so far!

Poisoning is another home emergency that requires immediate transport to professional assistance. While you can't do much to treat the poisoning at home, you can play an important role in your pet's chances of recovery by bringing the original container that housed the poison, if possible, with you. With that information, your veterinarian can institute effective and appropriate treatment much more quickly. Obviously, sometimes you will not know what your pet ingested, but if you do, bring the container.

Now let's see what you might want to have in your pet's home emergency kit.

  1. Hydrogen peroxide, easily obtained at your local drugstore for less than a dollar a pint.
  2. A selection of roller gauzes, ranging in size from 1 to 4 inches wide.
  3. A tube of Neosporin, or similar antibiotic cream designed for minor wound treatment.
  4. Cotton balls make great protective cushions and disposable pads for cleaning up injuries.
  5. Light wooden splints that can be taped in place to keep fractures from moving.
  6. A selection of adhesive tapes ranging in size from 1 to 6 inches in width.
  7. Scissors, with rounded tips if possible. Bandage scissors are best.
  8. Tweezers for removing splinters or pieces of glass from paws.
  9. Rectal thermometer.
  10. A plastic syringe for giving liquid oral medications. Don't attach the needle, just use the syringe itself. If local laws make it difficult to obtain a 5-10cc syringe, ask your family veterinarian for assistance.
  11. A small plastic or metal toolbox makes a handy container for transport and keeps everything clean and together. You might want to add a small handbook on dealing with pet emergencies to your kit. Check with your veterinarian or pet store for potential titles. 
  12. I hope you never need to use this information, but if you do, I hope it helps both you and your pet deal with an emergency. 

Copyright (C) Denis A. Bekaert, DVM - 1999-2000

PAIN IN PETS: 

Well, once again, I seem to have opened a subject that has created an ongoing controversy. This time it concerns pain medication in cats. Some of our readers tried to get additional information from their family veterinarians and were told that there were no analgesic drugs for use in cats. With humility, I beg to differ with my colleagues on this issue. So, today we will look a little closer into the subject of pain and pain medication for your pet. Next week we will continue with the second part of this controversial subject.

Cats are by nature very stoic and do not overtly exhibit signs of pain. Cat "owners" are well aware of the aloofness of our feline companions. They seldom exhibit emotions of any kind unless you are aware of their body language. By carefully observing body language we can begin to understand what in going on inside that aloof ball of fur.

Dogs, as I have said frequently in the past, are very different than cats. Dogs, unlike cats, are pack animals, and because of this, have a need to communicate their emotions to others of their group. Dogs will continually lick an irritated or itchy area, bite large areas of their body raw, and whine or howl when in pain. Cats, being mostly solitary hunters, have no real need to communicate discomfort to others of their species, nor to us. So how can we tell if our pet is in pain? Let's look at some signs, ie. body language, that will help us get the message.

Behaviors that may indicate pain would include some or all of the following:

  1. Changes in personality. A pet that is normally quiet and loving towards it owner and others suddenly becomes aggressive and may attempt to bite. Although much less common, the reverse is sometimes seen. In any case, it is an obvious change in attitude and personality. There are also diseases, particularly neurologic in origin, that may cause this type of behavior. Naturally, if you can see that the limb in fractured or pointed in an abnormal direction, you won't touch it at all. Unnecessary movement of a fractured bone not only will cause intense pain for your pet, but may also cause additional injury to surrounding tissues, nerves, and blood vessels. 
  2. Scratching, licking and biting of a particular&nbsppart of the body. Most often seen in dogs, although cats will sometimes lick one area of their fur so excessively that the hair and even the top layer of skin are removed. Mostly seen in allergic conditions, this behavior may indicate pain at a fairly superficial distance under the skin.
  3. Changes in hair coat appearance. This may be due to either as excessive grooming and/or licking or a cessation in normal grooming. Ill pets, not in particular pain, may also exhibit this behavior, so it is not a specific indication of pain.
  4. Changes in posture and gait. Just as you would not put weight on a painful joint or limb, your pet will be reluctant to use a limb that hurts. Careful palpation of the affected leg will help localize the problem area. Sometimes it is as simple as a cut foot pad or a stone wedged between the pads, other times it may be much more serious. By carefully examining your pet at home, you may avoid an unnecessary visit to your veterinarian. Obviously, you should have help in restraining your pet to avoid being bitten or scratched by a defensive animal. Gentle restraint by someone the animal trusts is the best approach.
  5. An animal with abdominal pain will often exhibit very tense muscles in this area. This is done to protect the point of pain from external forces that might cause additional pain. You should never attempt to palpate a tense abdomen. Not only are you likely to be injured by your pet but you may well cause added stress for your animal. Even trained professionals have some difficulty in such palpations as it is somewhat like trying to pick up a pin through a starched blanket.
  6. Decreased food and water consumption is not specific for pain, although it can often be seen in depressed animals. Certainly, animals in pain are commonly depressed. The problem here is that depression may be caused by a wide variety of things such as the owner going away for a few days, organic disease, parasites or simply an upset stomach. Taken with some of the other indicators we have been discussing, changes in food and water consumption can help you determine if you pet is in pain.
  7. Changes in sleep patterns. Animals in pain often do not sleep well because of an inability to find a comfortable position. They will seem restless and may try to sleep in unusual positions trying to find one that is less uncomfortable. Cats, who normally sleep a total of about 16 hours a day, may pace around, despite obvious exhaustion.
  8. Eyes may have dilated pupils and the animal does not appear to focus on anything. Often described as appearing to be looking off in the distance but really not seeing anything. Eyes may appear dull. In cats the nictitating membrane (the third eyelid) often partially covers the eye when depressed or in pain. Dogs do not exhibit this sign.
  9. Ears may be held in odd positions. Sometimes they will be held so that the pinna (outer ear) in pointing downward in normally erect eared dogs or in cats.
  10. Activity level is decreased. This is probably the most common sign of pain. Your pet will be reluctant to move and may make a grunting noise when arising from a down position. As with changes in sleep patterns, the animal seems restless.
  11. Changes in pulse and respiration. Generally both are increased, and in the case of chest pain, you may notice that the depth of each respiration is less than usual. This is often seen with fractured ribs or pulled intercostal muscles (muscles between the ribs). As with other signs, changes in pulse and respiration may but due to diseases as well as pain.

There are other, more subtle physiologic changes that your veterinarian will be able to detect, such as increased blood pressure, changes in electrolytes, body temperature, and others.

Perhaps we should stop for a moment and consider the positive aspects of pain. Now, I am not suggesting that we necessarily welcome pain, but at least we should recognize why the body registers pain. 

First, humans can be told to stay off a damaged joint or a recent surgical repair until the proper stage of the healing process, and generally we do just that. But try telling your pet not to run outside or jump on something in the same circumstances! Pain, then, is nature's way of telling animals to ease up a bit.

Injured animals in the wild depend upon pain to get them through the healing of traumas. Even the pain of arthritis fits in this category, because it reminds us to reduce the movement of already deteriorated joints.

Secondly, pain alerts the body that something is wrong. It might be as insignificant as a momentary pain in the side when we are running, or as critical as a fast growing internal tumor, but serves as a signal for attention.

Since are pets can't talk our language, we must be alert to the previously mentioned signs that signals pain. Next time we'll consider treatments to ease pain in our pets.

OK, now let's get back to the topic we were discussing last week, the detection of pain in your pets. In the last two issues I outlined some of the possible signs that might indicate discomfort. Naturally, most pets will not display all those symptoms, but most will display one or more if the pain is more than just transitory. I am planning on attending a national meeting in late February that will focus on pain in animals and analgesic drugs suitable for pets. Immediately following that I will devote at least one more issue on the newer findings and drugs. 

Before we consider drugs, let's look first on some things you can do at home to help relieve pain in your animals. Application of gentle heat often helps. A heating pad wrapped in a bath towel and kept at a fairly low setting may bring relief, especially to arthritic pain in older animals. Generally the best place for a heating pad is in the pet's bed where it can find the most comfortable position on the pad. 

Another method that may be effective in some cases is a gentle massage of the painful area. This is often difficult because your pet may not wish to have a painful area touched at all. Please be careful and slow in your approach to the painful area, otherwise you may upset your pet and receive an unintended injury yourself. Often you will have more success in cases of chronic arthritic pain than in acute pain and dogs are much more willing to have painful joints massaged than are cats. Please remember the important thing here is gentleness and slow movements. The heat from your hands along with gentle compression and relaxation of your hands may bring temporary relief to your pet.

Cold packs applied to the painful area may also be helpful, particularly if swelling and recent injury is evident. Pain sometimes occurs as a direct result of acute injury with swelling of the affected area and cold packs not only numb the area but also assist in reducing the tissue swelling. Naturally you should check with your family veterinarian if the swelling and pain do not markedly decrease in a few hours. 

The use of analgesic drugs in alleviating pain, particularly in cats, is highly controversial in veterinary medicine. Often drugs that are suitable for humans are highly toxic for pets because specific enzyme systems necessary to excrete the drug are not present in other species. Because of this, dosages are drastically different, even in cases where the drug might be effective. Pain is a very subjective thing; what is painful for me might be only mild discomfort for you. Add to this variability our inability to accurately detect the magnitude of pain in non-human species and we begin to understand the difficulty in establishing what is a safe, yet effective, analgesic drug in animals. This is why non-drug alternatives to pain management is the subject of much interest for veterinarians. 

Acupuncture and the use of magnetic fields to block pain signals have gained much respectability in medicine in the last decade. Magnetic fields hold great promise because they are not invasive and easy for the layperson to apply and manage after minimal instruction. I personally have had great success using magnets to control discomfort. The biggest problem today in the use of acupuncture and magnets for analgesia is overcoming our Western point of view which demands scientific proof for everything. Because these non-traditional approaches are difficult to measure, many in the medical professions, human and veterinary, have still been reluctant to try them.

I hope this series has been helpful to you in dealing with pain in your pets. I will compete this series following the meeting I spoke of earlier and bring you the latest information on the use of analgesic drugs in pets.

That's it for today. If you have a question you'd like to see answered here, please send it to me at: askvirtualvet@iname.com

WINTER WEATHER AND YOUR PETS

While Winter doesn't officially begin until the 22nd of December, that didn't keep the temperature around my house from dropping into the low twenties last night, and that reminded me that I wanted to discuss the care of your pets during the cold weather just around the corner. OK, I realize that those of our subscribers in the Southern Hemisphere are looking forward to Spring right now, but you lucky people can save this newsletter for six months!

Last week we discussed the toxicity of ethylene glycol antifreeze in pets. Today's issue will look at some additional hazards associated with the cold weather we can expect soon.

Nature provides our pets with natural insulation in the form of a denser haircoat during the winter months and also prompts the body to add to a layer of subcutaneous (just under the skin) fat layer which helps to retain body heat. This natural adaptation to cooler weather does not mean, however, that your pet is immune to the cold of winter. If you have an indoor pet, meeting this need is not difficult since you will want to increase the thermostat in your house to compensate for outdoor cold. Naturally, your outside pets do not have this luxury, so we must make some provisions to help them stay comfortable and healthy.

Depending upon the natural humidity in your home, increased water intake for your pet may be important during the months of indoor heating. Generally, this can be accomplished by keeping fresh water always available. As we have discussed in the past, fresh water means changing it at least two to three times a day. Naturally, outdoor pets have a continued need for fresh water too. During the coldest part of the winter, water bowls may freeze over, particularly at night. To avoid this, check with either garden shops or pet supply stores for electrically heated pet water bowls. The cost for a heated bowl should not be over twenty dollars. Your pet will really appreciate having water available even in the coldest weather. You might be surprised how quickly water in a bowl freezes over, since heat is usually lost from not only the surface, but also on all sides and often the bottom too.

Outdoor pets will have increased caloric needs too. Since the body loses more heat during cold weather, the pet's metabolism must increase to replace that lost heat. This, of course, means increased intake of food. Indoor pets do not need increased intake of food. 

Snug housing is also critical for the outdoor pet. By providing an enclosed space that will retain body heat, you will enable your pet to stay warm and snug through winter. Insulation, in the form of old blankets covered by a tarp will really help, too. Bedding, like a old blanket or two, or perhaps some discarded clothing, will prevent heat loss to the ground. Clothing you have worn and decided to throw out should not be washed since your pet will take comfort from your smells on the clothing. If you can hang a piece of plastic, canvas, or cloth over the entrance to the pet house, which is fastened only at the top, it will help prevent heat loss do to wind. Your pet can push this "door" aside to enter or leave the housing area.

One last thing. Just because it is cold outside, please don't neglect spending time with your outdoor pet. Going for a walk with you can be a real treat for your dog. Cats, particularly, often enjoy being picked up, stroked and scratched. By doing this, you are helping to reassure your pet that you are not ignoring them or make them feel excluded from your family. Remember, you are a significant part of their world. 

Spread a little love!
Copyright (c) Denis A. Bekaert, DVM, 1999

ETHYLENE GLYCOL (ANTIFREEZE) POISONING

For most of us, at least in the Northern Hemisphere, winter is fast approaching and it is time to check the antifreeze in our vehicles. Some of us will drain and refill the radiator, while others will add more to replace coolant that has been lost. So, what, you ask, does that have to do with our pets? Well, that is our subject for today!

Ethylene glycol is the most common antifreeze on the market today. It is used year-round to prevent both winter freezing and summer boil-over in vehicle cooling systems. Newer, less toxic products are available, but they are much less frequently used than the old standby, ethylene glycol. 

The problem for us is that ethylene glycol is very toxic for humans and animals. What makes this product so dangerous is that it is sweet tasting and the small amount that must be ingested for tragic results. The minimum lethal dose is cats is 1.4 ml/kg body weight; for dogs it is 4.4 ml/kg. That translates to about a teaspoon for a 10 pound cat. It is slightly less toxic in dogs, requiring about a bit more than an ounce of antifreeze for a 20 pound dog. Obviously, either species could lick up the toxic dose in a matter of seconds.

Many animals poisoned with ethylene glycol lap it up from the driveway when it is allowed to drain out of the radiator in preparation for changing the old antifreeze for new in the Fall or in the Spring. Since it is somewhat diluted with water in the radiator, it takes slightly more ingestion to reach the toxic dose this way, but exposure still only takes a matter of seconds to cause severe damage or death.

Ethylene glycol is quickly absorbed from the gastrointestinal tract, with peak levels occurring within hours of ingestion. About 50% of the chemical is excreted unchanged through the kidneys. This excreted portion does not cause damage. However, it is the rest of the ingested antifreeze that causes the damage when it is metabolized by the liver and kidney.  The products of these metabolic reactions cause significant metabolic acidosis and severe kidney tubule damage.

Metabolic acidosis is a complex situation that causes an entire host of changes in cell functions throughout the body. If untreated, it may lead to death rather quickly.

Kidney tubule damage causes a rapid build-up of toxic products in the blood and eventually irreversible kidney damage and shut down. This is fatal, too. 

The signs and symptoms of ethylene glycol ingestion include staggering, increased thirst, vomiting due to gastrointestinal irritation, knuckling over when trying to walk and a loss of the righting reflex.

Treatment success depends greatly upon the speed with which it is initiated. It is aimed at the prevention or at least reducing the amount of ethylene glycol metabolized by the liver and kidneys.

If you suspect your pet has ingested anti-freeze it is imperative that you get them to your family veterinarian as quickly as possible. In addition to reducing this conversion to kidney damaging metabolites, the fluid balance and acidosis will have to be quickly corrected to avoid further damage.

In terms of prevention, you might want to switch to the more environmentally friendly antifreezes without ethylene glycol. They may cost a bit more than the standard products, but the heartbreak avoided could be worth many times the price difference. Remember, though, that if your pet is allowed outdoors without supervision, the antifreeze your neighbors use may be just as important as what is in your car.

Copyright (c) Denis A. Bekaert, DVM, 1999

CANCER CHEMOTHERAPY IN PETS - Part 1

You have just been given what is perhaps the most feared diagnosis in people and pets, cancer. While at one time this almost always had a fatal outcome, advances in treatment, both surgical and medical, have dramatically increased the odds for complete remission, or at least a greatly prolonged quality life. There are, of course, some forms of cancer that do not have high success rates for any mode of treatment, but happily even these are becoming more rare every year as new chemotherapy drugs and treatment methods are developed.

Today we will be considering some of the more common questions that arise when owners are given that dreaded diagnosis of cancer. Cancers are generally more common with aging, although they do occur in the young but at a much lower rate. Because pets, like people, are living longer today due to better nutrition, advances in drug therapy, and improved availability of care, we are seeing many more cases of cancers than even twenty years ago.

Cancer is the most common natural cause of death in geriatric dogs and cats, accounting for almost half of such deaths. The good news about such statistics is that cancer is much more curable than many of the other serious diseases of geriatric patients, such as congestive heart failure, renal failure or diabetes mellitus. Of those types of cancers that can not be cured, we are much better able to manage the patient to minimize discomfort for extended periods and limit the rate of growth of cancerous tumors. Some types of tumors may be so slowed that death due to aging itself occurs before the cancer can be fatal.

One of the first things your family veterinarian will want to do after making a diagnosis of cancer is to biopsy the tumor if this is possible. Your pet will be anesthetized with an ultra-short acting agent and will not feel the biopsy needle. The biopsy site will be shaved and cleaned just as it would in the case of surgery, the sample obtained, and your pet can usually go home immediately. Biopsy is important because we can then establish the type of cells involved and the grade of the tumor. Most veterinarians will forward the biopsy sample to an experienced histopathologist for identification and grading.

The information from the biopsy, a through physical examination, radiographs, and appropriate laboratory tests will help your veterinarian determine the extent to which the tumor has spread prior to diagnosis. With this information we can give you a clearer picture of the prognosis and treatment possibilities. 

The laboratory testing is used to ensure that there are no undetected metabolic abnormalities that might interfere with the outcome of chemotherapy or modify the prognosis. Once your veterinarian has a more definite picture of what type of tumor we are dealing with and has discussed treatment possibilities with you, he or she will want to discuss the potential side effects you may see in your pet. Pain is common, often due to compression of internal organs and tissues by an expanding tumor, but it can be managed quite successfully. Pain management is important because it may cause additional, and unnecessary, stress for both pet and owner.

Next time we'll discuss additional concerns owners have about this common diagnosis, including cost factors, side effects of chemotherapy drugs, and other related issues. 

CANCER CHEMOTHERAPY IN PETS - Part 2

Today we'll continue by answering more of the most common questions veterinarians are asked when owners are considering chemotherapy for their pets.

Chemotherapy consists of giving drugs that are toxic to cancer cells. Generally, healthy, normal cells are not affected by the drugs. It is this specific site of action that makes chemotherapeutic drugs so valuable. The rate of success for chemotherapeutic drugs varies widely, based on the health of the patient, the cell type of the tumor, and the extent and location of the tumor.

Since chemotherapy drugs are so toxic to specific cell types, they may have some side effects that concern owners. The most frequent side effects seen are nausea, vomiting and diarrhea. Loss of appetite often occurs, and when it does, weight loss is common when coupled with vomiting and diarrhea. Depending on the chemical class of the drug used, skin and urine color may change. Although these side effects are relatively benign, they generally may be controlled by the administration of additional, non chemotherapeutic, drugs. Be sure to ask your family veterinarian about possible side effects so that if they occur you will understand what is happening.

Hair loss is not significant in most breeds, although poodles and cocker spaniels sometimes do lose significant amounts of haircoat. Cats may lose their facial whiskers, and in both species hair that is lost may grow back with different coloration. Usually when hair is lost during treatment, it will grow in again after the chemotherapy is finished.

Most chemotherapy is done on an out patient basis, although some drugs may require a few hours to administer. Many veterinary hospitals will allow you to stay with your pet during drug administration. Having a trusted friend nearby can sometimes reduce the stress on the pet.

Cost of chemotherapy varies widely, depending upon the agents used, the length of treatment, the weight of the animal and the route of administration required. Ask your veterinarian when the decision to use chemotherapy is reached for an estimate of the cost involved.

In conclusion, you should understand that although a diagnosis of cancer is reason for concern, it is no longer automatically fatal. Many pets, and people, have undergone chemotherapy and were able to live a full life once again. Certainly, these are powerful drugs and are never given unless absolutely required, but recent advances have made them safer than ever with fewer side effects than before.

As I mentioned in the last issue, we are seeing many more cases of cancer today because animals, and people, are living longer, into the time of life when cancers are much more frequent. I hope you never have to hear such a diagnosis, but if you do, remember, thousands of pets are alive today after having successfully recovered.

Copyright (c) Denis A. Bekaert, DVM 1999.

The Final Gift

The most difficult and painful decision in your relationship with your pet comes to most of us. As painful as it is to suddenly lose a pet to an accident, taking that mental and emotional leap when euthanasia becomes merciful is almost unbearable. While I can not make that painful decision for you, perhaps I can give some perspective which may ease that pain.

As a veterinarian, I have taken an oath to relieve suffering and to protect and comfort all animals, an oath I take very seriously. Veterinary medicine has made incredible advances in treatments, both surgical and medical, in the last fifty years. Today we can correct problems and treat infections successfully that only a few years ago were impossible. We can sometimes remove malignant tumors and use both chemotherapy and radiation to arrest others. Massive infections can be fought and often defeated; severe trauma can be reconstructed. But sometimes doing so is so painful and stressing to our beloved pets that it is not in their best interest to attempt such heroic measures.

And we still have not been able to defeat time and aging. There comes a time when all we can do is bow to the inevitability of the aging process. Oh, yes, we can ease the pain of arthritic joints, prescribe special diets to reduce the strain on failing organs, and even remove the misty, clouded vision caused by cataracts. Frequently these measures are indicated, especially in animals in otherwise reasonable health. 

Nutritional advances and diets are readily available for essentially all animals, particularly pets.  Sometimes a simple change in diet will prolong a comfortable life for months and even years. Analgesic medications for arthritis can be used for extended periods in many pets.

But, eventually, it will be time to consider that final act of love. It is a gift that only you have the power to give. Beloved pets, like people, should have the right to die with dignity and grace. In human medicine we can only use passive means, that is to say, not try to restart respiration or heart beats when they cease naturally. In veterinary medicine we have been given the greater responsibility towards our cherished four-legged friends, the responsibility to set  them free when unremitting pain and suffering sufficiently erode the dignity of life. When you and your family veterinarian have decided that no more can be done for your pet, then you must decide when to give this final gift of love to your faithful companion.

Veterinary euthanasia as practiced today is quite different than when I first began in the profession. Today, many veterinary practices have special euthanasia teams that have been especially trained to deal with this time of great emotional turmoil for the pet owners. My oldest daughter, Heather Anne, is on such a team and tells me what a great comfort it is for her to be able to help owners to make this difficult journey in the company of a sensitive and caring team of professionals. Love for animals transcends the overwhelming grief. 

You may choose to either be with your pet at the end, or if that is more than you can bear, leave your special friend in the care of your family veterinarian for the gentle closing of a loving life. Talk to your veterinarian about the details if you would like to arrange to take your  pet home for burial. 

Do not ever think euthanasia is easy for your veterinarian. Dealing with sick and injured animals every day, we know how precious life is for both animals and people. We share in the joy of the special bond between pets and people and are grateful to be allowed to share in  this great bond of love. 

But we also know that it is that very love that enables the human to give the final great gift to a life-long friend. Just remember you are not alone, we grieve with you. If performing euthanasia ever becomes routine and it does not make me want to weep for both the pet and the owner, then I will find another profession. My conscience and the oath I took so long ago would not allow me to do otherwise. 

Copyright (c) Denis A. Bekaert, DVM, 1999.

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A QUESTION OF ENVIRONMENT: INSIDE OR OUT?

One of the questions I am frequently asked concerns the advisability of allowing inside cats to go outdoors. The justification goes something like this: "...well, domestic cats are really only small big cats, and since big cats live outdoors, why shouldn't Fluffy or Stripe be allowed to have that experience too...". Other themes involve not forcing the cat to use an unnatural thing like a litter box, or not being able to hunt, etc. The bottom line here is that some cat "owners" feel that they are depriving their pets of new and exciting experiences that can only be found outside the house.

Well, yes, you are depriving them of new and exciting experiences...like being chased, and possibly injured or killed by dogs; hit by cars because the cat has no experience with traffic, exposure to toxic chemicals; and, of course, diseases and parasites. You are not doing your cat any favors by allowing it to experience the great, and often quite dangerous, outdoors.

At this point I should tell you that we have about ten cats and that all of them are outdoor cats. I said "about ten" because they are very socialized cats and sometimes will move over to our neighbor's house for a month or so. Since they love cats too, our cats are always welcome there, especially since most are very clever mousers.

The difference here is that our cats are outdoor cats. They were born outside, were weaned outside and momma taught them all about the dangers they might experience. They are treated for fleas on a regular basis since that is one thing momma could not teach them to avoid.  We do have one cat we adopted that wants to be an inside cat, but even she panics when she gets in the house because suddenly she is in unfamiliar territory and facing unknown dangers. The other cats do not want to be inside at all, for the same reasons. When a normally indoor cat goes outside the same insecurity is suddenly thrust upon it. But outside the house, the dangers are real. Then, too, just being frightened might make kitty run off and into greater danger.

As far as the litter box is concerned, even the outside cats prefer it to digging in the dirt. They like it because it is easy to dig and cover in and also because it doesn't stick to their fur like dirt often does. A well cleaned litter box is one of your cats greatest pleasures. Please note I said "well cleaned" because a dirty litter box is very offensive to the cat's sensitive nose. The failure to keep it clean is the single most important reason that cats refuse to use it and go elsewhere in the house.

Another hazard for indoor cats, when they leave the safe confines of the house, include parasites, some of which we have discussed in previous issues.  Generally speaking, parasites are not fatal to otherwise healthy cats, but they can cause additional stress that may lead to disease from other organisms like viruses and bacteria. Besides, seeing a worm wriggling in the cat box is not the highlight of the day for most people!

More importantly, cats that hunt outdoors may expose humans to parasites that are quite dangerous in people, such as toxoplasmosis. Toxoplasmosis is so important that I'll cover that in much more detail in a future issue. Indoor cats that can not hunt outdoore unlikely to carry toxoplasma parasites unless they are able to catch and eat mice in the house. Naturally, when cats go outdoors they may be exposed to other cats that might be infectious for a wide variety of feline diseases. Many of these diseases have vaccines, but a number do not. So, the bottom line here is to keep your indoor cats indoor. Kitty does not need any of these "experiences" to be happy. And you don't need the heartbreak that goes with what may happen to your indoor cat outside.

Copyright (c) 1999, Denis A. Bekaert, DVM.

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BEAUTIFUL LILIES CAN KILL
Elaine Wexler-Mitchell, DVM

Annie died after eating Easter lilies. I dedicate this month's column to Mary Westrich's 3-year old cat in the hopes of preventing such tragedies.

Most cat owners have probably wished at some point their pets had not chewed, pawed or crawled into their house plants. Cats can make a mess of carefully arranged plants and flowers. Even worse, they might eat one that is toxic. Several species of lilies, including Easter lilies (Lilium, longiflorum), tiger lilies (Lilium lancifolium or Lilium tigrinum), rubrum (Lilium speciosum), and various day lilies (Hemerocallis), can kill cats.

Scientists have not precisely identified the toxic chemical in lilies and no antidote exists. Consumption of even small amounts of the plant can cause severe poisoning, so a veterinarian needs to start aggressive therapy as soon as possible. Kidney failure and death can result unless the cat receives treatment within 18 hours. The toxin destroys renal tubular epithelial cells (cells lining part of the kidney). Lilies do not seem to affect other species in this devastating way.

Annie arrived at her veterinary clinic seriously ill. The veterinarian diagnosed her with kidney failure but couldn't determine the cause. The doctor questioned Mary about Annie's exposure to toxins. The only new thing in the house Mary could think of was an Easter lily a friend had given her. The veterinarian did not think the lily could have caused the problem. Unfortunately, Annie's kidney disease was too advanced and she was euthanized. Several days later her veterinarian found an article on Easter lily toxicosis in cats.


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