Fear of the Unknown, or Fear of Saying ‘I Don’t Know’?
Originally, I was planning to write this blog about the current “mystery illness” that is popping up in random places around the United States. But when I sat down to research what I could, I kept getting stuck on the word “unknown.” It made me think about all that I haven’t figured out myself yet.
“I don’t know” is a phrase that you are likely to hear from me as your pet’s veterinarian. It is a phrase that I used to be terrified of saying when I first started practicing medicine over a decade ago.
I spent a lot of time (most of my 20s) and money (over six figures) learning everything about biology, chemistry, pharmacology, virology, physiology, anatomy (of multiple species, mind you!), really any animal-related “-ology” so I could avoid that very phrase.
Why I Say ‘I Don’t Know’
Now, with years of experience in the field, I frequently say “I don’t know” because I am so acutely aware that figuring out why an animal is sick (we call this a differential diagnosis) is often much harder than just making an animal feel better (we call this empiric therapy).
There are a few reasons why this is so:
- Answers often cost money. Even the best veterinarians can go only so far on a physical exam and asking good questions. Eventually we need test results, but this costs money—your money—and sometimes we don’t need an answer to find the treatment. We want to put your resources to the best use. If we use up the available budget to find answers, that may mean we have fewer resources to provide the care your pet needs.
- Answers often aren’t easy. One of the worst things that has ever happened to any medical professional is the show CSI. They always find the answer in a convenient hour (or 40 minutes if you’re paying for premium streaming). This is just not reality. Yes, sometimes tests to give you a precise answer, but a lot of times testing provides information and clues. Then I use my expensive degree to put all the pieces of the puzzle together.
- Answers often aren’t universal. This is what I mean when I say a pet “hasn’t read the textbook.” The same problem does not always manifest in the same way in every pet. (Not to put all the blame on cats, but it’s usually cats who haven’t read the textbook!) That can mean that even if we think we know what’s going on, we can get curveballs.
I know this may not instill a lot of confidence in what I and my colleagues do, but I say this because I want you to know that getting an answer isn’t my only goal. I want to help you and your pet in the best way possible. Often these goals are at odds with each other.
We Still Don’t Have an Answer
This brings me to the current “crisis” going on in veterinary medicine right now: the mystery respiratory illness that is affecting dogs. We still don’t have an answer as to what it is. It won’t be easy or cheap to figure out, but there are people working on it. As soon as we have verified information, we will let you know.
For now, we’re left with the general guidance of trying to keep your dog away from crowded canine events as much as possible (I will be boarding my own dog over the Christmas because that’s our only option), keeping them away from unhealthy dogs, and keeping up with the recommended respiratory vaccines like distemper, bordetella, and parainfluenza, and, for some dogs, influenza.
It’s hard accepting “we don’t know,” but to tell you anything more than that would be foolish. In all my years of practice, I would much rather say “I don’t know” than “I was wrong.”
—Dr. Alyssa Kritzman
Diabetes mellitus is a condition in which the body cannot properly produce or respond to the hormone insulin. Insulin regulates the amount of glucose (sugar) in the bloodstream and delivers glucose to the tissues of the body to use as energy. Diabetes results in elevated levels of glucose in the blood. The most common form of diabetes in cats is type 2 diabetes. In type 2 diabetes, glucose levels are high because cells in the body do not respond appropriately to insulin.
Diabetes is the second most common endocrine disease in cats. (The body’s endocrine system consists of several glands—in the case of diabetes, that gland is the pancreas—that make hormones, which are chemical messengers to control organs throughout the body.)
Cats are typically diagnosed with diabetes between the ages of 10 and 13 years. More cats are acquiring diabetes as the number of overweight or obese cats grows. The average cat that weighs 13 pounds or more has about four times the risk of developing diabetes as a smaller cat. Signs of diabetes can include increased thirst, increased urination, weight loss, and increased appetite.
When a cat is suspected of having diabetes, a veterinarian will perform blood and urine testing. Diabetes is indicated if blood testing shows an elevated glucose level (hyperglycemia) and urine testing shows evidence of glucose in the urine (glucosuria).
Because stress in cats can lead to both hyperglycemia and glucosuria, another confirmation test called fructosamine is usually done. Fructosamine concentration reflects the average glucose concentration for the past 1 to 2 weeks and is not impacted by stress. If this test comes back as elevated, the diagnosis of diabetes is confirmed.
Insulin is the treatment of choice for cats with diabetes. This typically requires twice daily administration. In addition, dietary management can be an important component of managing diabetes in cats. A high-protein/low-carbohydrate diet is recommended. Weight loss is also an important component of diabetic management in overweight cats. Weight loss, if attempted, should ideally be gradual, one-half percent to 1% of total body weight lost per week.
The goals of treatment are to maintain a healthy blood glucose, stop or control unintended weight loss, stop or control increased thirst and urination, and avoid hypoglycemia (low blood glucose).
Unlike dogs, cats can reach diabetic remission; these cats have near-normal blood glucose levels without receiving insulin or other blood-sugar–lowering medication. However, cats in diabetic remission require close monitoring to ensure that they do not relapse. Remission is not achievable in every diabetic cat.
Blood glucose curves are used to monitor response to insulin dosing. If a blood glucose curve is performed at home, pet owners measure the first blood glucose reading before the insulin injection. Then, they test every 2 to 4 hours until the next dose of insulin, depending on the type of insulin used. Performing curves at home eliminates the stress of coming to the clinic, which can affect the accuracy of the testing. Owners may need to perform a blood glucose curve several times to find the right dose for their cat.
One method of measuring glucose is by using a glucose meter calibrated for feline blood, such as a AlphaTRAK3. Another way is by using a continuous glucose monitor, such as a FreeStyle Libre. These monitors can be picked up at a human pharmacy and installed by a veterinarian or veterinary technician. Other important monitoring tests include serial bloodwork and urine testing. Your veterinarian will help determine the frequency at which these tests should be performed.
Monitoring your cat’s level of thirst and urination, weight, and appetite are important throughout treatment. These measures can give clues as to how well the diabetes is being managed. Unfortunately, monitoring response to treatment in diabetic cats can be frequent and expensive.
Complications of Diabetes
One complication of diabetes is diabetic ketoacidosis (DKA). This problem occurs when there is not enough insulin in the body to control the amount of glucose in the blood. DKA happens in uncontrolled diabetics. Without the proper amount of insulin in the body, glucose cannot be used as an energy source. Instead, the body breaks down fat, which produces ketone bodies. With high levels of ketones, the body becomes more acidic, which disrupts fluid and electrolyte balance. Left untreated, the resulting abnormal electrolyte balance may lead to abnormal heart rhythms and muscle function and death. Signs of DKA can include increased thirst or urination, lethargy, weakness, vomiting, increased respiratory rate, decreased appetite, and weight loss.
The other complication is hypoglycemia, or low blood sugar, which may arise when insulin therapy lowers the blood sugar significantly. Signs of hypoglycemia include weakness, lethargy, vomiting, lack of coordination, seizures, and coma. Hypoglycemia can be fatal if left untreated. A diabetic cat that shows any of these signs should be offered its regular food immediately. If the cat does not eat voluntarily, it should be given oral glucose in the form of honey, corn syrup, or dextrose gels and brought to a veterinarian immediately. However, if a cat is seizing or comatose, oral glucose methods should not be attempted.
If you’ve noticed changes to your cat’s eating and drinking habits as well as weight, please have them seen by a veterinarian for additional testing to be done as soon as possible.
By Jeanette Barragan, DVM
Con el verano acercándose, muchos de nosotros pensamos en el riesgo de las pulgas, garrapatas y parásitos intestinales pero no se olviden de los parásitos del corazón! El parásito del corazón es transmitido por los mosquitos y causa daño irreversible al corazón, las arterias, y los pulmones. No existe cura en los gatos y el tratamiento en los perros es costoso, doloroso, y toma un promedio de un año.
Muchos piensan que sus mascotas no están a riesgo de infección en Illinois como tenemos inviernos largos, pero solo se necesita una mordida de un mosquito que lleva el parásito para ser infectado. Aunque su mascota no salga de la casa, los mosquitos pueden entrar por las ventanas, garajes, puertas, etc.
Es importante realizar que la prevención no previene la exposición y aunque los medicamentos preventivos no matan al parásito adulto, se usan para prevenir la madurez de los gusanos. Si el medicamento preventivo se da sin prueba de diagnóstico y el perro está infectado, no solo se quedará infectado pero también puede causar reacción parecida a un shock. En casos inusuales, también puede resultar en fallecimiento de la mascota.
Los gusanos adultos parecen espagueti cocido y pueden llegar a 12 pulgadas. La carga parasitaria puede variar de 1 a 250 gusanos con un promedio en los perros de 15 gusanos! La severidad de los síntomas depende de la carga parasitaria, el nivel de actividad de la mascota, y cuánto tiempo ha estado infectado. Los síntomas más comunes son tos, dificultad para respirar, fatiga, falta de apetito, y pérdida de peso.
El mejor tratamiento es la prevención!
La buena noticia es que existen varios medicamentos preventivos para los perros y gatos! Se necesita una prueba negativa una vez al año (en los perros) para poder recetar el medicamento. Si su mascota no ha tomado la prevención del parásito del corazón de manera constante durante los últimos 12 meses, debería hacer una cita con su veterinario para hacer un análisis de sangre para comprobar un resultado negativo y poder recetar prevención. Hay varias formas de prevención y su veterinario le puede recomendar cual usar basada en su estilo de vida.
With summer approaching, many of us think about the risk of fleas, ticks, and intestinal worms. But don’t forget about heartworms! Heartworms are transmitted by mosquitoes and cause irreversible damage to the heart, arteries, and lungs. There is no cure in cats, and treatment in dogs is expensive, painful, and takes an average of one year.
Many think that their pets are not at risk of infection in Illinois since we have long winters, but it only takes one bite from a mosquito that carries the parasite to be infected. Even if your pet does not leave the house, mosquitoes can enter through windows, garages, doors, etc.
It is important to realize that prevention does not prevent exposure. Although preventative medications do not kill the adult parasite, they are used to prevent the worms from maturing. If the preventative medication is given without a diagnostic test when the dog is already infected, the dog will not only stay infected but the medication can also lead to a shock-like reaction. In rare cases, it can also result in the death of the pet.
Adult worms look like cooked spaghetti and can grow to 12 inches. The parasite load can range from 1 to 250 worms, with an average of 15 worms in dogs! The severity of the symptoms depends on the parasitic load, the pet’s activity level, and how long they have been infected. The most common symptoms of a heartworm infection are cough, shortness of breath, fatigue, lack of appetite, and weight loss.
The best treatment is prevention!
The good news is that there are several preventative medications for dogs and cats! A negative test is needed once a year (in dogs) before the drug can be prescribed. If your pet has not been on heartworm prevention consistently for the past 12 months, you should make an appointment with your veterinarian for a blood test to confirm a negative result so prevention can be prescribed. There are various forms of prevention, and your vet can recommend which one to use based on your lifestyle.
– Dr. Ana Valbuena
With Chicago’s changing weather, who knows what season we’re currently in right now? And with the season change comes … seasonal allergies, or just allergies in general.
That’s the tricky part that we veterinarians face. We have to investigate and determine what type of allergies your pet is experiencing, and if it is truly allergies versus something else.
As many of you may know, just like people get allergies, so do pets. The signs, however, can be a little different. Many times your pet will show signs of scratching, biting, chewing, and rubbing certain areas of their bodies. You can even see redness, inflammation, fur loss, and, in severe cases, open, infected wounds.
There are many components to allergies, and getting a detailed history from you during the initial vet visit is very important. So although it may seem like an interrogation in the exam room, this is when we are putting all of the puzzle pieces together in our head and thinking of the best diagnostic tests and treatment options for your pet. Each pet is different, and treatment varies on a case-by-case basis.
“My cat doesn’t go outside.” “My dog isn’t around other dogs.” “I’ve never seen any fleas on my pet.”
Just because you don’t see them, doesn’t mean they’re not there. Did you know that 1 female flea can lay between 20 and 50 eggs a day?
At times, the only evidence we have to suspect that there are fleas present is flea dirt, which is basically flea feces. Areas that can be affected by fleas include the tail base, neck region, and belly, although fleas can be found anywhere on the body.
A flea allergy is caused by the saliva of the flea itself. All it takes is a few bites to see clinical signs. Fleas can survive at a wide range of temperatures, so it is important to have your pet on flea and tick preventatives year-round to avoid flea allergy dermatitis. Read more about fleas.
Pets can also have hypersensitivities to certain foods. Although potential allergens can include the food dye, carbohydrates, or preservatives, often it’s the protein source that is the culprit. A food allergy is diagnosed based on a detailed history and, most importantly, a strict food trial.
A food trial consists of feeding your pet a hydrolyzed diet or novel protein for a minimum of 8 weeks. This diet is very strict, and it is important that you only feed the novel protein or hydrolyzed diet. You must not feed any additional foods or treats. Keep in mind that many medications and monthly preventatives can be flavored so you must monitor closely what you are feeding and giving your pet. If after the trial period your pet is symptom free, a food challenge is performed. This consists of introducing the previously fed diet and watching for signs of itching or scratching. More details regarding a food trial can be discussed with your veterinarian. Read more about food allergies.
Seasonal vs Environmental Allergies
These can get tricky and hard to diagnose so, as previously mentioned, a thorough history becomes very important. We must investigate if there is any pattern to the clinical signs. Are the signs happening when it is warmer out vs colder? Do the signs show up after walks or after visiting certain areas, like a park or forest preserve? Every detail matters, so it is important to reach out to your veterinarian when your pet starts experiencing signs of excessive itching, scratching, licking, fur thinning, etc.
Treatment for Allergies
Treatment varies on a case-by-case basis. Ultimately, we want to control your pet’s clinical signs but also make your pet comfortable and clear of any secondary infections. Contact your local veterinarian when you start seeing any of the previously mentioned clinical signs.
There are several allergy medications to try. Each pet is different, and sometimes it can take some trial and error to find what works best for your pet, whether that is a single medication or a combination of medications. Allergy medications come in oral, injectable, and topical formats. Your veterinarian will determine which one suits you and your pet’s lifestyle.
Is It Even Allergies?
Although fur loss, fur thinning, over-grooming, and biting can be signs of allergies, these can also be signs of stress, especially in cats. Fur thinning and fur loss can even be signs of endocrine diseases, such as hyperthyroidism or hypothyroidism.
If your pet is experiencing any of the clinical signs mentioned throughout this post, please reach out to your veterinarian so they can determine the best diagnostic test and treatment options for your pet. You and your veterinarian form a team that wants the best for your pet.
– Dr. Angelica Calderon
Comezón de la mascota
Con el clima cambiante de Chicago, quién sabe en qué temporada estamos ahora. Y con el cambio de clima llegan… las alergias. Esa es la parte difícil a la que nos enfrentamos los veterinarios. Tenemos que investigar y determinar qué tipo de alergias está teniendo su mascota y si realmente se trata de alergias o de otra cosa.
Como muchos de ustedes saben, al igual que nosotros podemos tener alergias, las mascotas también pueden hacerlo. Sin embargo, nuestros signos pueden ser un poco diferentes. Muchas veces su mascota puede mostrar signos de rascarse, morderse, y masticar ciertas áreas de su cuerpo. Incluso se puede ver enrojecimiento, inflamación, pérdida de pelo y, en casos graves, heridas abiertas infectadas.
Las alergias tienen muchos componentes y es muy importante obtener un historial detallado durante la visita inicial al veterinario. Entonces, aunque pueda parecer un interrogatorio en la sala de examen, al mismo tiempo estamos juntando todas las piezas del rompecabezas en nuestra cabeza y pensando en las mejores pruebas de diagnóstico y opciones de tratamiento para su mascota, ya que cada mascota es diferente y puede variar según el caso.
Alergia a las pulgas
“Mi gato no sale”, “Mi perro no está con otros perros”, “Nunca he visto pulgas en mi mascota”. Que no los veas no significa que no estén ahí. ¿Sabías que una pulga hembra puede poner aproximadamente de 20 a 50 huevos por día? A veces, la única evidencia que tenemos para sospechar que hay pulgas presentes es la suciedad de pulgas, que es básicamente heces de pulgas. Las áreas que pueden verse afectadas por las pulgas incluyen la base de la cola, la región del cuello y el vientre; aunque se pueden encontrar en cualquier parte del cuerpo. Una alergia a las pulgas es causada por la saliva de la pulga y nada más se necesita algunas picaduras para ver los signos clínicos. Las pulgas pueden sobrevivir en un amplio rango de temperaturas, por lo que es importante que su mascota tome medicamentos preventivos contra pulgas y garrapatas durante todo el año para evitar la dermatitis alérgica por pulgas. Leer más sobre pulgas.
Alergia a la comida
Las mascotas también pueden tener hipersensibilidad a ciertos alimentos. Aunque los alérgenos potenciales pueden incluir colorantes alimentarios, carbohidratos o conservantes; lo más común es la proteína que es la culpable. Una alergia alimentaria se diagnostica en base a un historial detallado y una prueba alimentaria estricta. Una prueba de alimentación consiste en alimentar a tu mascota con una dieta hidrolizada o proteína novedosa durante un mínimo de 8 semanas. Esta dieta es muy estricta y es importante que solo le des la dieta proteica o hidrolizada novedosa. No debe alimentar con alimentos adicionales. Tenga en cuenta que muchos medicamentos y preventivos mensuales pueden tener sabor, por lo que debe controlar de cerca lo que alimenta y le da a su mascota. Si tu mascota está asintomática, se realiza un reto alimentario que consiste en introducir la dieta alimentada previamente y vigilar si presenta signos de picor o rascado. Se pueden discutir más detalles sobre una prueba de alimentos con su veterinario. Leer más sobre alergias alimentarias.
Alergias Estacionales y Ambientales
Estos pueden volverse complicados y difíciles de diagnosticar, por lo que como se mencionó anteriormente, un historial completo y detallado se vuelve muy importante. Debemos investigar si existe algún patrón en los signos clínicos. ¿Están ocurriendo los signos cuando hace más calor que cuando hace más frío? ¿Aparecen los signos después de caminatas o después de visitar ciertas áreas como un parque o una reserva forestal? Cada detalle es importante por lo que es importante comunicarse con su veterinario cuando su mascota comience a enseñar signos de picazón excesiva, rascado, lamido, adelgazamiento del pelaje, etc.
Tratamiento para Alergias
El tratamiento varía según el caso. Queremos controlar los signos clínicos de sus mascotas, pero también hacer que su mascota se sienta cómoda y libre de infecciones secundarias. Esto significa comunicarse con su veterinario local cuando comience a ver cualquiera de los signos clínicos mencionados anteriormente. Hay varios medicamentos para la alergia para probar, sin embargo, cada mascota es diferente y, a veces, puede tomar un poco de prueba y error para finalmente encontrar lo que funciona mejor para su mascota. Qué puede significar un solo medicamento o una combinación de diferentes medicamentos. En cuanto a los medicamentos, hay varias opciones orales para probar, así como opciones inyectables y opciones tópicas. Su veterinario determinará cuál se adapta mejor a usted y al estilo de vida de su mascota.
¿Es incluso alergias?
Aunque la pérdida de pelaje, el adelgazamiento del pelaje, el aseo excesivo y las mordeduras pueden ser signos de alergias; estos también pueden ser signos de estrés, principalmente en gatos. El adelgazamiento y la pérdida de pelo pueden incluso ser signos de varias enfermedades endocrinas como el hipertiroidismo o el hipotiroidismo.
Si su mascota enseña alguno de los signos clínicos mencionados en esta publicación, comuníquese con su veterinario para que pueda determinar las mejores opciones de prueba de diagnóstico y tratamiento para su mascota. Somos un equipo y queremos lo mejor para tu mascota.
– Dr. Angelica Calderon
Osteoarthritis in pets is often thought of as a geriatric pet disease that warrants treatment when our pets are obviously painful and experiencing lameness. However, osteoarthritis often starts younger than you might expect, and pain may be present even before lameness is apparent.
Let’s start with what osteoarthritis is: it’s the most common form of arthritis and it is characterized by painful inflammation and degeneration of one or more joints. Over time, it can lead to bone-on-bone contact.
Many factors contribute to the disease process, including overweight or obesity, abnormal joint development, past injury or orthopedic surgery, and how a pet is built.
In dogs, early signs of this disease can include:
- restlessness or irritability,
- frequent position changes during rest,
- not as fast getting up or sitting down,
- weight shifting while standing,
- less interest in activity or play, and
- hesitation before walking, sitting, or climbing stairs.
Eventually, a dog may begin to limp, to experience stiffness when walking, and to have difficulty going up or down stairs and jumping up or down.
In cats, osteoarthritis may look like a reduction in play, grooming, socializing, and appetite, with increases in hiding and sleeping and changes in urination/defecation habits. Cats can also have trouble jumping up/down, climbing up or down stairs, running, and chasing objects.
Because this disease is painful and progressive, early diagnosis and treatment are important for long-term pain management and slowing the progression of the disease. Treatment includes a combination of pain medication, weight loss or maintenance, dietary changes, environmental modification, and exercise.
If you feel your pet may be showing signs of osteoarthritis, our clinic can share additional resources on how to know if your pet has this disease and talk with you about treatment options.
– Dr. Jeanette Barragan
After two long years of this pandemic, we still do not know much about pets and SARS-CoV-2 (COVID-19), but over the last few months I have learned a lot. I am writing this blog as I am isolated in my basement with COVID-19. I am thankful for the protection I have received from vaccines as I am only experiencing very mild signs.
I hope to tell you what I have learned working firsthand with the first Illinois COVID positive dog over the past few months. According to the USDA there have only been 39 Polymerase chain reaction (PCR) positive dogs within the United States. The first dog in Illinois confirmed to be positive was a patient at Medical District Veterinary Clinic and was first tested in January 2022. He was positive on PCR, and viral sequencing information was obtained at the National Veterinary Services Laboratories in Ames, Iowa.
Since that time, I have had multiple other patients that are presumptive positives. A presumptive positive is when there is detection on a PCR test, but it is not confirmed positive with either virus sequencing or evidence of virus neutralizing antibodies. Obtaining sequencing data is challenging, most likely because the dogs have low viral load and very mild clinical signs.
- USDA case definitions: SARS-CoV-2-case-definition.pdf (usda.gov)
- USDA Confirmed cases SAR CoV-2 in US: https://www.aphis.usda.gov/aphis/dashboards/tableau/sars-dashboard
- CDC Animal guidelines: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html#:~:text=The%20virus%20can%20spread%20from,pets%2C%20livestock%2C%20and%20wildlife.
We believe that transmission to pets is from contact with a positive human within the household. Transmission from pets to humans is considered extremely low. Due to the risk of transmission to pets, the CDC recommend avoiding close contact with pets if you are ill. The occurrence of severe illness in pets is rare, but transmission is possible. Pets presumed positive should remain isolated from other pets until clinical signs have resolved.
It is important to remember this is a human pandemic. We know that by comparing the large number of human cases of COVID 19 and the very few cases documented in pets.
I truly believe that most pets do not acquire the virus. If they do, they are typically asymptomatic or have very mild symptoms. The clinical signs I observed in these presumptive positive cases were upper respiratory signs: nasal congestion, sneezing, reverse sneezing, and gag-like cough. These signs were odd and did not fit with classic tracheobronchitis (canine cough). When I examined these dogs, they did not cough when I touched their neck to palpate their trachea, which is the typical response during a physical exam when the patient has classic canine cough.
We have seen patients with clinical signs suspected to be secondary to SARS-CoV-2 in the past 2 to 4 weeks.
Unfortunately, there is no approved or documented treatment for COVID in dogs or cats, but in most cases, they do not need treatment. For those pets with more severe clinical signs, I have found that corticosteroids seem to provide the most relief. The brachycephalic breeds seem to have more nasal congestion and difficulty breathing. In these pets, I have started anti-inflammatory doses of steroids and they seem to respond well.
In a few of these cases, chronic rhinitis (irritation/swelling of the mucous membrane in the nose) and sneezing has lasted for weeks to months. Home care for pets is similar to home care for most human COVID-19 cases. The virus needs to run its course. Be sure your pets continue to eat and drink. You can also put the pets in the bathroom with the shower running; the warm humid air can be soothing for the upper airway.
SARS-CoV-2 testing is not widely available for dogs or cats, but most large veterinary laboratories are offering PCR testing. Antibody testing is not widely available at present. If you feel you dog or cat has signs of SARS-CoV-2 after exposure to an infected person, I recommend contacting your veterinarian.
If you are a client at Medical District Veterinary Clinic, feel free to reach out to me and I may be able to assist in testing as I am collaborating with Dr. Ying Fang, a virologist, at the University of Illinois College of Veterinary Medicine.
– Dr. Drew Sullivan
For many people, the doctor’s office can be a scary place. So it is no surprise that many pets view going to the vet with a similar fear.
Our clinic truly believes in Fear Free practices. Our goal is to limit your pet’s stress and fear and make visits with us as pleasant as possible. There are various ways that we do this, which I would like to share with you.
Treats, Teats, and More Treats!
During your pet’s visit you will notice that we like to offer treats. We have biscuits, cheese, peanut butter – like a candy store for dogs and cats! This is not only because we think your pet is adorable and we want to spoil them, but this is also a main way we like to bond with them.
Imagine if you are at the doctor and you are anxiously waiting, and then the doctor walks in and immediately offers you your favorite treat (for me, that would be some delicious baked goods) and socializes with you. You would likely feel much calmer and connected to them. This is the equivalent of what we do with your pets.
Although we have lots of treats, if you have a dog or cat that is pickier with food, please feel free to bring whatever your pet likes best. This is not uncommon, as I have seen many patients that would eat only one food.
We encourage owners to offer treats as well during visits to help make the entire experience as positive as possible. We joke that visits go best when our patients come hungry, so you may want to consider bringing your pet to see us with an empty stomach so there is plenty of space for treats!
Getting on Their Level
We want our patients to feel comfortable, so we often will sit on the ground with them. We hope that by sitting on their level they feel less intimidated and fearful, and that they see us as their “friend.” I have noticed that when I sit on the ground and spend time in the room before even beginning my exam, my patients generally seem more at ease.
Please do not feel obligated to sit with us, but if you would like to you are totally welcome!
Limit Stress from Other Pets
Many cats never leave the home except to go to the vet. They may be stressed by traveling before they even arrive.
The smells and sounds of dogs can be very scary for them, too, which is why we recently created a separate feline waiting room and exam rooms. We use all separate supplies, have tasty treats and fun toys, and have nice feline-friendly smells. In the months since we have started using this new space, I have noticed that cats overall seem much calmer and happier.
Dogs can be become upset from other pets as well. Some of the sweetest and most affectionate dogs that I have met do not get along well with other dogs. Being around other dogs is stressful for them. I personally have a dog-reactive dog, and while she loves people, other dogs make her highly anxious.
To reduce this anxiety, we have multiple tactics, such as choosing specific exam rooms and trying to limit time in the clinic and exam room, when other pets are a trigger for the patient. We also perform exams outside in an isolated area if needed.
Fear Free for Your Pet
Please let us know if your pet is reactive with other pets, or there are any other behavioral concerns, and we will work with you to formulate a plan for their visits.
I hope you can see how much we at Medical District Veterinary Clinic truly care about our amazing patients! We look forward to continuing to make their time with us as fun and enjoyable and fear free as possible!
Amber Slaughter, DVM
Well, it’s been 17 months of a global pandemic and it’s the middle of a hot (UN Climate report) summer. Though much has changed since March of 2018, dogs’ anal sac health dramatically has not. Partly because I’m tired, and partly because I answer questions about this about 20 times a day, I wanted to re-run a classic of yesteryear that takes us back to times more innocent, when a postage stamp only cost 50 cents and kids couldn’t get enough of this “texting” craze. Enjoy.
Most of us in the veterinary field face a horrible dilemma. The majority of our days are filled with details and particulars that are deemed rather unfit for discussion at the dinner table, any social gathering, and anywhere outside the professional confines of the clinic. It’s always fun to talk puppies and kittens, but a great deal of what we do during the day revolve around bodily fluids (blood, feces, urine, vomit), wounds, parasites, and the selected greatest and grossest hits of infection and disease.
Anything interesting happen at work today? Yes. Most of it was gross.
So, I’d like to discuss the grossest of all things for one moment. Please feel free to put away your chocolate custard, beef stew, and bean soup, for one moment, while we explore dog and cat anal sac disease.
Cats and dogs have anal sacs located near the periphery of the anus. These sacs excrete a liquid, often when animals defecate, that mixes into their stool and gives forth a particular and specific smell akin to a garbage bag filled with a rotting animal that has been soaked in plague juice.
At times, though, the ducts that excrete the anal sac fluid can become blocked, forcing the sacs to become enlarged, uncomfortable, swollen, and irritated. Sometimes these sacs can become so blocked that they burst forth with a mixture of all of the aforementioned dinner-party unmentionables in one fell swoop. Other times they slowly leak out at convenient times and places such as Sunday morning at 5:13 a.m. on your pillow next to your head. Often, they don’t do anything but get bigger and more uncomfortable. There are times when severe stress and discomfort can cause animals to release their anal sacs all over (seemingly) everywhere in the world.
Owners complain about their dogs and cats “scooting” their back ends over the ground or that their pets are licking their back end obsessively. The clinical signs may be more vague and scary, especially for older animals who have not ever had this problem. We may find out animals straining to defecate (as the sacs block the exit of the anus), walking stiffly, uncomfortable, not interested in eating, and, in extreme cases, vomiting. I’ve seen some dogs become so affected that they scream in pain when touched and refuse to move. I’ve seen some cats stop eating or moving and refuse to go into the litter box.
Why does this happen? you ask (while not at the dinner table). There are a few common reasons:
• Anatomical irregularities that are uncontrollable: Some dogs and cats, for whatever reason, just don’t seem to have anal sacs or anal sac ducts in the right position to allow for easy release. We have seen puppies whose anal sacs fill up monthly and need help.
• An extended period when the animal’s feces are soft and unable to naturally press on the sacs to express them: When animals have parasites (such as Giardia) or chronic diarrhea due to dietary issues or underlying illnesses, we often are not thinking that during the whole of this period, their anal sacs are (metaphorically) laughing with power as they grow bigger.
• Infiltrative disease (such as cancer): This is not very common, though it can occur. The anal sacs become diseased and cancerous. It can happen in any dog, but one tends to see this more in spaniel breeds. It does not have a good prognosis, but this condition is rare. Very rare.
• Animals, especially as they get older, learn different postures to deal with changes in the body. I have seen so many cats and dogs with untreated back pain that have to posture differently to defecate, and because of this, do not seem to express their anal sacs with the same proud efficiency that they once did. As the anal sacs get worse, they become even more uncomfortable, the animals defecate less, develop chronic soft stool, and this glorious cycle continues until you have a cat or dog that is constipated and has horribly painful anal sacs.
What can you do about it?
First, express the anal sacs. This is not something one should just try at home. I am speaking for all citizens of earth, in general, by saying that you should not do this in your kitchen before the family wakes up. Partly, because the smells of putrid sub-par day-old fish byproduct mixed with armpits and feces will probably wake them up, but also I wonder if this aspect of your relationship with your pet is one you really want to explore. While some people do learn to do this at home with their animals, I personally will not do it at home on my animals. But it is possible.
Alternatively, we can express your animal’s anal sacs so you don’t have to watch, smell, see, and, in some tragic cases, taste. We have safe zones in the clinic where no one walks for fear of spraying anal sacs. Some groomers do this for you, but few do them to completion. Ask your groomer before you assume, and talk with us about how soon you should come back for a recheck. Sometimes the anal sacs can be so full and painful that sedation may be required.
Second, animals may need additional treatment, such as antibiotics or anti-inflammatories. Most bad cases of anal sacculits, anal sac impaction, or anal sac abscesses need medication and aggressive rechecks before they are not painful or affected. It’s not generally the case that medications alone will work.
Third, we must remove the cause. Are allergies causing chronic licking, which is causing the anal sacs to be inflamed? Is your animal’s diet not allowing for a normal stool texture? Do you need to add fiber to the diet? Is your dog anxious, and this anxiety manifests in back-end licking? Are there intestinal parasites present? Is there infiltrative disease? Is there a chronic infection? Is there another animal in the house that is over-grooming the affected animal? We need to fix this.
Fourth, sometimes the anal sacs need to be removed. It’s not a cheap therapy, and it is surgery. But sometimes after coming into the clinic every two weeks and having anal sac disease a constant part of their lives, some owners elect to remove them.
As a final note, most dog owners know or have heard of anal sac issues, but most cat people are thinking that this is not applicable. This problem affects many mammals. So I’m sorry to say that even the sweetest of felines has the foulest of anal sac scents. I’ve had a run, lately, of seemingly ill cats who magically became “new” cats after their anal sacs were expressed. And, for those who play with the skunks, beavers, and opossums of your neighborhood, though I’m sure you have more on your mind, also be aware. Humans have them too, but I will let you and your loved ones google that on your own on your non-work computer.
Read things from Canada, do anything related to Canada, enjoy the summer weather noticed when opening the windows after the scent of your animal’s anal sacs permeate the walls of your Chicago apartment.
Brett Grossman, DVM
Medical District Veterinary Clinic
Right now with the pandemic, I don’t think a day goes by when I’m not thinking about vaccines. Granted, a big part of my job is vaccinating your furry family members to help keep them healthy and maintain their legal status, but with most of us having “Moderna/Pfizer versus Johnson & Johnson” or “one- or two-shot protocols” swirling in our head, I’m hoping to review a little bit about vaccines and their importance while I take a break from working on my NCAA bracket.
What Is a Vaccine?
I’m sure this is common knowledge at this point, but as a reminder, a vaccine is a composite of either a dead or modified-live version of a virus or bacteria that you expose the body to so the immune system to be able to quickly build a response if or when exposed to the actual virus or bacteria in the future. (We will not worry about the newer mRNA vaccines, as at this time the veterinary field does not use them.) Using a sports analogy, you can think about vaccines as giving the immune system a little practice with a disease, so it will be ready for game day.
When Do You Booster Vaccines?
In order for a vaccine to work, the immune system needs enough exposure to build up long-term immunity. That means, when the body is exposed, it not only remembers the disease, but can build a defense quickly, before the disease causes significant illness. Sometimes you need more than one practice session to master that layup; it’s the same with the immune system. Some immune systems need more practice than others. This mostly pertains to puppies and kittens: their immune systems are less developed, so they require more practice than an older more “skilled” immune system.
Why Do Some Vaccines Last Longer Than Others?
It can get a little confusing to know how long each vaccine last for. Some vaccines, such as canine and feline distemper, can provide immunity for up to 3 years in most adult pets. Others (e.g., leptospirosis and feline leukemia) need boosters every year to maintain adequate immunity. This is because the immune system is better at remembering certain diseases than others. Some people will never forget how to shoot a free throw, but it will probably take a lot more practice to maintain that hook shot.
What Vaccines Should My Pet Have?
Ultimately, you should discuss this question with your vet. Recommendations will vary based on your pet’s lifestyle and geographical location. Here is what we currently recommend for the average dog and cat that live in Chicago:
Dogs: DAPP (Distemper virus, Adenovirus, Parvovirus, and Parainfluenza virus), Leptospirosis, Bordetella, and Rabies
Cats (indoor only): FVRCP (Feline Viral Rhinotracheitis, Calicivirus, and Panleukopenia) and Rabies
When they are current on these vaccines, your dogs’ and cats’ immune systems will be ready to fight and win on the big game day.
Let’s hope our Illini are ready to do the same! I-L-L
Alyssa Kritzman, DVM
What’s Your Diagnosis?
This is Chang Lu, a 10-year-old Shih Tzu. Chang Lu visited Medical District Veterinary Clinic in December with a history of straining to urinate, increased frequency of urination, and bloody urine.
During her exam she was trying to urinary every few minutes and was producing small, blood-tinged urine droplets each time. Initial diagnostics included urinalysis and X-rays. Her urine revealed significant bacteria and an overabundance of white blood cells. Below are her X-rays.
What is your diagnosis?
If you diagnosed Chang Lu with urinary tract infection and urinary bladder stones (urolithiasis), then you are correct. The large egg-shaped structures should not be there. Those are large urinary calculi (stones). Below I have notated the X-ray to point out various organs.
Urolithiasis (urinary bladder stones) are common in both dogs and cats. In people, most urinary stones originate in the kidneys, but in animals, more than 90% originate in the bladder, or lower urinary tract.
Urolithiasis (Urinary Bladder Stones)
Many factors, including genetic predisposition, can lead to bladder stones. Smaller breed dogs are at higher risk of developing urinary calculi (stones). Other predisposing factor include urinary tract infections, urine pH, urine mineral composition, and urine concentration.
When we see patients exhibiting the signs Chang Lu came in with (inappropriate urination, bloody urine, straining to urinate, increased frequency of urination), the most likely cause in dogs is a urinary tract infection and in cats is idiopathic (stress-induced) cystitis. In both species, however, it is important to rule out bladder stones, especially if urinary issues have been an ongoing problem for the pet.
To diagnose urinary bladder stones, veterinarians need to look inside the abdomen using X-rays and/or ultrasound. Seeing these stones is easier on X-rays than with ultrasound, and the number of stones can be more easily counted. Unfortunately, not all stones show up on X-rays, so ultrasound is needed to diagnose the non-radiopaque stones. Luckily, those that can’t be seen on X-ray are the much less common than those that can.
Treatment for Urinary Bladder Stones
Once stones have been diagnosed, treatment usually consists of a cystotomy (surgical removal of the stones) and treating the infection, if one is present. In some cases, prescription diets can be used to try to dissolve the stones. I personally have had great success with dissolution of stones in cats but very little to no success of dissolving stones with diet in dogs.
Chang Lu underwent a cystotomy, and two large stones were removed from her urinary bladder (see photo). At the time of surgery, we took a bacterial culture of her bladder, and the results showed that she had a resistant bacterial urinary tract infection. A resistant bacterial infection means the bacteria present in her bladder was resistant to most antibiotics, including the one she was initially prescribed. She was prescribed a new antibiotic in hopes the infection would be cleared.
How to Prevent Urinary Bladder Stones
Once stones have been diagnosed, it is very important to identify the type of stone to understand steps that can be taken to help prevent re-occurrence. After any cystotomy, the stones are sent to the University of Minnesota Urolith Laboratory, where the stones are evaluated. Knowing the mineral composition of the stone helps veterinarians determine the best way to prevent stones in the future. In many cases, pets are started on a long-term prescription diet to help alter their urine pH, encourage urine dilution, and limit the mineral components of the diet that lead to stone formation.
Chang Lu’s stones were determined to be 100% struvite stones, most likely secondary to her resistant bacterial infection. After she finished the course of new antibiotics, her urine was re-cultured, and the infection was completely cleared. Moving forward we will be screening her urine for infection every 3 to 6 months. She has also been switched to a prescription food designed to keep new stones from forming. Chang Lu is currently doing great and all her clinical signs have resolved.
– Dr. Drew Sullivan