Thursday, March 13, 2008

Acute Renal (Kidney) Failure in the Cat

Kidney failure is quite common in the cat. Most cats (something like 85%) of cats over the age of 12 years have some form of chronic kidney failure, although most owners don't know it until it's too late. It's not all their fault. The most common tests for kidney failure don't demonstrate a problem until 2/3 of the kidneys have been destroyed. Also, the owners are part of the reason for the problem....well, sort of. Well-fed, well-treated cats can live to be 18, 19, 20 or longer. Given that most estimate of cats in the wild are in the 3 year range, it should not be surprising that pets that live 15 years or more past their "wild" lifespan would begin to break down.
Since chronic kidney failure in the cat is a constant worry, veterinarians are always concerned about threats to a cat's kidneys. Whether we are concerned about medications, anesthesia or anti-freeze, how a cat's kidneys will handle the crisis is always a concern.
Which brings us to today's article: Acute intrinsic renal failure in cats: 32 cases (1997-2004), JAVMA, vol 232, No 5 728-732, by S. Worwag and C. E. Langston.
These two researchers studied the records of over 32 cats that presented to a referral hospital for kidney failure that came on suddenly. Most of the cases (18) were due to the ingestion of some toxin. Seventeen of the cats survived (53%), which is on par with humans and dogs. (This seems worrisome to me, the human hospital has way more tools than I have and still only 1/2 survive!) All of the cats that did not survive were not producing urine at the time of admission. And, an increase in potassium usually meant a decreased chance of survival.
This is bothersome to me. First, it means once a cat's kidneys shut down there may be very little I can do to get them working again. Second, at least in my neck of the woods, potassium is very rarely run on a routine blood panel at the veterinarian's office. The lesson here is to keep things that may be toxic to your cat locked away.

Wednesday, March 12, 2008

Toxic Pet food Update

Apparently, there has been a $3.1 million settlement in the Diamond Pet Food lawsuit. Details at:

Claims must be submitted by April 15, so you need to hurry.

So you want to be a veterinarian?

Here's your first step:

Most of the veterinarians who I met before I went to veterinary medical school were small animal veterinarians. Of course, I grew up in Rhode Island, so there weren't too many cows around. This is a good place to see what the other half of my profession does for a living.

Tuesday, March 11, 2008

Canine Heartworm Disease

I’ve seen the first mosquito! That’s means it’s time for dogs (and cats, and horses, and people!) to catch heartworm disease. No fear though, it’s my favorite diseases: one that I never should have to treat. Just 1 tablet per month, at a cost of $5-10 per month and you don’t have to worry about it. Ok, I put the cart before the horse. First, go here:

These guys will tell you everything you need to know about heartworm disease.

Now, go to your regular veterinarian and get the heartworm test, to make sure your dog is not already infected. Once you get your dog’s negative result you can start giving the pill once per month. That’s all you need to do!

What do you do if your dog is positive? That’s more complicated. I can tell you that dogs which are not yet showing signs have a very good prognosis, if you do it right. Let’s get on to the first myth, shall we?

Myth #1: I don’t need to get the expensive heartworm treatment, I can just put my dog on the prevention for 6 months and he’ll be heartworm free.

This myth has killed more dogs than I can count. The monthly prevention, when given for 6 months or more, will render the female worms sterile while shrinking both sexes, but not kill them. The worms can live for up to 2 years in this state. Since most of the current tests react to the proteins produced by fertile females, the test can be negative long before the worms are dead. To sum up: You give heart worm prevention for 6 months, you get a negative test, your dog still had heartworms for up to 1.5 years.

Myth#2: I don’t need to give heartworm prevention; I use a product that repels fleas, ticks and mosquitoes.

This has yet to be proven. And since 1 mosquito can transmit up to 10 heartworm larvae, I think you should err on the side of caution. How well does your citronella candle work?

Myth#3: My dog’s heart is fine, he can’t be that sick.

Heartworms are so named because that’s where they live. They actually cause most of their damage in the lungs. The heart “damage” is actually caused by high blood pressure in the lungs, which explains why much of the “damage” goes away when you kill off the worms.

Myth#4: Heartworm treatment is dangerous.

This is only partially true. Most of the time I hear this just because people don’t want to spend the money. Most of the dogs I treat do just fine. In fact, out of over 100 dogs I treated post-Katrina the only one that died came to me so sick we actually discussed euthanasia instead of even trying to treat her. She died within hours of the injection.

Heartworms are completely preventable, and the stuff is cheap. There is no reason for me to ever lose a dog to this disease.

Monday, March 10, 2008

International Health Certificates

Every couple of months I get an update on my malpractice insurance. The update comes with a summery of "closed cases", basically examples of cases gone wrong where someone has sued, or threatened to sue. It's always a fun read. Usually the cases fall into one of two categorizes: 1) "I waited 6 weeks to get my cat treated and now he's dead, someone has to pay", or 2) The veterinarian left some cow on the table to fix lunch and the cow died, now someone has to pay". I read them as a reminder to make sure I answer all peoples questions. (Something like 85% of all malpractice lawsuits result from miscommunication)

However, this month's capsule was different. We all write health certificates for pets traveling to different states and there is a HUGE gap between what the certificate says and what most clients believe the certificate says. Here in Tennessee the certificate states, "the animal is free of communicable disease". Notice, it does not say that the pet is "healthy". Theoretically, I could write a certificate for travel to a dog with a broken leg, but not to a dog with fleas. Veterinarians who misunderstand what these certificates mean get sued all the time. I know of one lawsuit where a veterinarian wrote a health certificate for a dog with skin problems only to have the family receiving the dog come down with ring worm. Not good.

Back to the capsules: there were 4 different lawsuits filed over dogs that were brought to different countries with incorrect health certificates. This is clearly the veterinarians fault, but since a lawsuit does nothing to get your pet out of 6 months( that's right, 6 months!) of quarantine, I'm posting the link to the US Governments website to help guide you.

I would also strongly recommend that you check with the country you plan to travel to, in order to make sure you have the most recent information.

Sunday, March 9, 2008

How often should I vaccinate my dog?

I was going to summarize this article, but I think it's better if you just read it yourself.

Most current veterinarians wish we could vaccinate less, but we were hindered. First, none of the products on the market were labeled for 3 year cycles. This meant that we exposed ourselves to tremendous liability if we used the vaccine against label directions. Second, while we strongly suspected the vaccine was good for more than 1 year, there was no scientific evidence supporting the increased time between vaccinations. And lastly, the old guys in town were telling everybody that if we didn't vaccinate every year the dogs would die a horrible death and it would be all our fault.

But now we have a choice. Major veterinary organizations have changed their recommendations to better reflect the current information.

Now, this is not an excuse to NEVER vaccinate your dog, or to skip the annual exam. Dogs die from Canine distemper every day. I've seen it and it's not pretty. Plus, since your dog or cat can't talk to you, an annual physical is important. And I would go to any doctor who just gave me my shots and turned me out the door.