Birthing difficulty

Once upon a time, when the world was young, I had a ranch practice in northern Montana.  It was a wonderful time and place for a young man.  Streams were filled with trout, pheasants were in every field, ducks in all the ponds, and every rancher had lovely daughters.  But delivering calves was my livelihood.  Laboring cows taught me a lesson germane to today’s small animal practice.  If a fetus is not positioned in the birth canal it will not be born, nor will the dam strain to deliver it.  The problem is uterine inertia for the uterus will not constrict and start the fetus into the pelvis.  In most cases intravenous administration of calcium will correct the problem.  The uterus can then constrict placing the fetus where it can be expelled normally.  But not always!

            Jessica, a four pound Maltese female had delivered one pup.  Then everything stopped!  For an hour she did not deliver any more pups.  Didn’t even try!  And yet her belly was still distended.  She remained pregnant.  I could palpate a pup out of position in the anterior abdomen.  This seemed to be typical uterine interia so I injected calcium and sent her home.  Often these cases will deliver a pup during the car ride home but not this time, nor during the ensuing hour.  She had to be returned for a caesarian section.  One has to get fetuses out of the abdomen or they will die, start to decompose in the abdomen, and the rotten material will kill the dam.  On reexamination the pup had not been moved.  It was no nearer to the pelvis then when the dog was initially examined.  During surgery I found the wall of the uterus surrounding the remaining pup had ruptured spilling the pup into the abdominal cavity and making it impossible for the pup to be properly positioned.  Why the rupture occurred I don’t know.  Perhaps it was due to incoordination of uterine contractions.  Both pup and mom survived surgery.

            Rarely did I find a cow with uterine rupture and the calf lying free in the abdominal cavity.  If one did surgery in time the cow might live but usually the calf was dead.

"Photo Attributed to S. Fulljames via flickr.com

Urinary blockage in a cat

Jack was in last week.  He needed vaccinations and his teeth cleaned.  I hadn’t seen him for a while, but for an old cat, he’s 18 now, he was sleek and vigorous.

     He wasn’t always this way.  One cold winter evening five years ago his owner brought him to me.  She thought he was dead but wanted to be certain.  At the time he was an indoor-outdoor cat and had been missing for several days.  When he came home his owner found his lifeless body on her back porch.  As she gently laid him on the exam table a quick glance convinced me it was time for condolences.  As the comforting words formed in my mind I saw just the slightest hint of a movement of his chest.  Could it be he was still alive?  If so, there surely wasn’t any time so spare.  The examination was hasty.  His heart was beating slowly and the pulse was so weak I could barely feel it.  There were no eye reflexes.  Body temperature was so low the mercury didn’t budge from the bulb.  His belly held a clue; the bladder was grossly distended with urine.  Quickly I performed a cystocentesis and drained the bladder of thick brownish urine.  He had feline urologic syndrome.  The urethra was plugged with exudates and crystals so he couldn’t void.  Metabolic waste products had backed up and accumulated in his blood and he had gone into a coma.  A blood sample showed an extremely high level of urea, confirming that he had uremic poisoning, complicating his condition.

     Jack was catheterized so urine would flow freely.  Intravenous fluids were given to flush the poisons from his system and we put him on a heating pad to warm him.  Amazingly, in an hour he was stirring, six hours later he sat up on his sternum and in two days he went home.  Now in his waning years, he lives the good life indoors.  Perhaps, because it is so easy to become the caretaker of a cat some people view them as expendable.  But not his owner, he has been her valued friend for many years.  A relationship that has grown over time, especially since his close encounter with death.

A case of canine Pancreatitis

Wilbur is a 7-years-old French bull dog whose vomiting started a week ago. He cried when his abdomen was pressed and he had refused to eat for the past several days.  Also, water consumption had declined.

 He was a very sick dog when brought to the hospital.   Several abnormalities of his serum chemistry profile suggested he might have acute pancreatitis, for the blood study showed dehydration, inflammation, and stress.  He was started on intravenous fluids to rehydrate him and sustain kidney function.  An overnight blood test confirmed the diagnosis of acute pancreatitis.  Next morning all food and water consumption was stopped and drugs were administered to depress stomach-acid production.   Acidic stomach contents passing into the small intestine can aggravate pancreatitis so it must be controlled.   Also, he was given a low dose of antibiotics as insurance against infection in the region of the pancreas.  Intravenous fluid therapy was altered to provide essential energy and protein building blocks to help with healing.  He was maintained on this program for two days.  Then, drugs were dispensed to prevent vomiting and continue reduced gastric acidity and he was sent home. Such treatment would permit him to eat and drink without aggravating the pancreatitis and still facilitate continued healing.  

Illness of a kitten

“Doctor Howard,” Robin called from the intensive care ward, “he ate, the kitty ate, a little.” 

Mrs. Andrews had found a dying kitten in the alley behind her home the previous day.  When she brought him to the hospital he was so weak he could not stand.  About four weeks old, he was mostly bones, frizzy fur, and fleas.  A Siamese, and quite handsome we thought, in spite of his wretchedness, with black outline of his eyes, nose, and mouth.  On closer examination we found the black markings were flea dirt.  There was no outward sign of infection other than the parasites, but the membranes of the mouth and eyes were almost white because he was so anemic.  I supposed the anemia was due to fleas draining his blood as they fed, which was partially correct.

            Our first order of care was to rid him of the fleas.  JoAnn, knowing the little fellow might be killed by routine flea treatment, dampened a piece of cotton with flea spray and gently rubbed the hair against the lay getting the chemical to the fleas but not on the kitten’s skin.  Then, with a flea comb she and Phyllis removed the poisoned pests.  This took more than an hour. 

            In the meantime, John found the kitten’s blood cells had hemoplasma organisms on them.  These bacteria, spread by fleas, sensitize blood cells which are then destroyed by the spleen faster than the bone marrow can replace them.  We had our diagnosis, but what to do?  While JoAnn bathed, dried and warmed the little tyke, we caught Tazz, the clinic cat, varmint control officer, and donor of blood for ailing kittens.  We transferred six milliliters of his blood into the kitten’s abdominal cavity so it would flow into his circulation giving him essential blood cells, protein and immune factors.  Then, just a tiny bit of antibiotic was injected to start controlling the hemoplamas.

            By this time it was getting late in the day so Robin fed him milk replacer with a dropper and put him to rest in a small cage with an insulated heating pad to warm him.  The next day he was able to stand and, as mentioned earlier, eat.  The day following he was released to Mrs. Andrews’ care with two more weeks of antibiotic treatment.  He recovered and grew to be a handsome cat.  Never cross or arrogant, he seemed to understand that he was in debt for his life.

            When you consider adding a new pet from any source to your household, you should realize that the new animal may be carrying a disease that can spread to resident animals.  To help avoid trouble be sure your existing pets are current on vaccinations, and regardless of how healthy it seems, have the new pet examined by your veterinarian before it is introduced to its new home as Mrs. Andrews did. 

A Big-Stinky Problem

“Doctor, my cat has a big, stinky problem!  Every-once-in-awhile she will leave a small, really foul-smelling spot somewhere in the house.  What is this and what can be done about it?”

            This problem is more common to dogs than cats, but it is the same in both species.  Animals have a gland on each side of the anus that secretes a smelly material thought to be used for marking territory as the animal defecates or rubs against the ground.  Sometimes these glands spill their contents spontaneously resulting in a spot somewhere in their surroundings and a nauseating odor.  Also, sometimes the glands become blocked this irritates the animal which tries to correct the problem by scooting across the floor.

            Permanent correction of the problem demands surgical removal of the glands by a veterinarian.  It takes a few days to a week for healing to occur and the dog or cat forever remains free of the problem.

Common Household Pain Relievers Could be Harmful to Your Pet

    This is an account of our lab technician John Whitehead’s astute observation.  An old cat had been sick for several days when it was brought to us for treatment.  When first examined I did not know what was wrong, with the cat but John, during the blood count, noticed microscopic bumps on red blood cells.  He identified the bumps as Heinz bodies a degenerative change of red blood cells caused by cats eating onions or being treated with Acetaminophen, the main ingredient in Tylenol, which is often used by people with headaches and other feel-bad conditions.  Heinz bodies results in anemia, illness, and even death.  When John told me of his findings he jogged my memory.  Two weeks earlier an article in a veterinary medical journal reported treating a cat with Acetaminophen poisoning by giving it acetylcysteine.  This was new information to me so right then I ordered an ounce of the chemical just in case it might be needed.

            To keep the cat alive, we had been treating it with intravenous fluids containing nutrients.  Although there was no precedent for doing so we dissolved some acetylcysteine in the intravenous fluids the cat was to receive the following two days.  That old cat gradually improved, recovered, and was sent home.

            A problem veterinarians encounter develops when an owner self-treats a puppy sick with parvovirus infection using Acetaminophen.  This stuff can and does kill pups by injuring the liver and results in sick pups that are difficult for veterinarians to diagnose and treat.  Use of Acetaminophen by owners who treat sick pups themselves may be one reason many of these people think that parvo pups die in spite of treatment.  Actually, most parvo pups survive if properly treated by a veterinarian.

 The point of the story is to urge you to not give sick animals human medicines.  If you do, be sure to tell your veterinarian so he can account for the drug’s toxicity while studying the pet’s illness and can treat it accordingly.

Treatment of Calicivirus Stomatitis in Cats

We have treated three cats in the past six weeks that had calicivirus stomatitis.  They all responded well to treatment, which may be encouraging news for other cats and their caring owners.  The first case was a six-year-old spayed female that lived out of doors.  She had been lethargic, not playing for five days, and eating very little.  Her temperature was normal but there were thick mucous masses on the surface of her eyes, no nasal discharge, but a large ulcer was on the middle of her tongue.  By the fourth day of treatment her eyes were clear, her appetite had returned and she was playing again.  But the tongue ulcer remained.  Treatment was stopped after seven days and the ulcer was healed by day 14.  With antibiotic-based treatment regimens recovery may take two weeks or more if it occurs at all.

            The second cat was very sick.  Temperature 105°.  His eyes were sealed closed with mucous, which also plugged the nostrils inhibiting breathing.  The cat drooled fetid saliva and there were extensive deep ulcers in the mouth.  He lived outdoors and could not eat because of illness and mouth pain.  With seven days of treatment he had almost recovered, drooling had stopped and he was eating.  Two days after treatment ceased clinical illness returned.  Treatment resumed but was limited to every other day. He now appears to have recovered but this may be transitory, dependent upon perpetual medication.   In my experience such dramatic response is unusual.  Most cases become chronic and severely emaciated, for the virus survives in the tissues.  The fact that this cat required prolonged treatment indicates the disease had already become chronic but the treatment limited extent of lesions and made the cat comfortable.  Only time will tell whether or not a cure has been affected. 

The third case was a cat with large open, raw lesions in the angle of the jaw at the rear of the mouth.  The lesions extended forward along the gums almost to the canine teeth.  This poor cat had been afflicted for several years.   In the past I had tried unsuccessfully to treat it with different regimens.   The cat had become quite thin, it could not chew its food, only swallow the kibbles whole.  With one week of treatment the cat was much livelier and crunching its kibbles.  One week without treatment and lassitude and difficulty eating had returned.  But, when treatment was resumed every other day the cat behaved normally again.  The condition is chronic in this cat and continuous low-levels or intermittent treatment may be required for life to control clinical disease.

 Treatment of these cases was the same, how levels of interferon once daily administered in the mouth.   Interferon is a small protein produced in virus infected cells.  It circulates through the body of the infected animal and inhibits virus development.   As a drug interferon is not generally considered an effective treatment against calicivirus infection.  For that matter, there is only one other effective treatment that I am aware of for this disease and it is experimental.  However, in my judgment, these three cats were benefited by interferon treatment.  Their symptoms diminished and their quality of life improved.