Urolithiasis (bladder stones)

Meet "Miss Scarlet the Grange Dog". She came to visit us a few weeks ago with the complaint of not feeling well and having to urinate all the time. The only problem we could find on physical exam was a small amount of malodorous vaginal discharge. Since she had never been spayed, we had to consider that she might have pyometra (infection in the uterus). Surgery to remove her uterus and ovaries was scheduled, and antibiotics and pain medicines were started. When Miss Scarlet was anesthetized we were able to palpate her abdomen a little better. While she was awake, she kept her stomach muscles so tight that we could not effectively palpate. A very hard structure was felt in the caudal abdomen (towards her tail end) -- in the area of the bladder. Since there should not be any hard objects in this area, it was likely that she had, along with the infected uterus, a stone in her bladder. The medical term for this is urolithiasis.

Surgery consisted of opening the abdomen, cutting into the bladder and removing a large "rock", flushing the bladder and urethra, and then suturing the bladder closed. Next, the uterus and ovaries were removed because of her pyometra. All went well and Miss Scarlet was returned to her owner a new "lighter" dog.

This is a picture of the freshly removed stone.

This picture shows some objects for size reference. Scarlet is a 10# mixed breed terrier. As you can imagine from the size of the stone, there wasn't much room left in the bladder for urine. This reason, combined with the irritating nature of the stone, would make it so that Miss Scarlett felt like she had to urinate all the time. Add to this the irritation and discomfort from the uterus and you can understand why she didn't feel 100%.

Here are some examples of stones we have removed from other patients. Sometimes there is just one, sometimes there are hundreds -- like small gravel. These stones are very hard. Often the stones are passed out the urethra before they get large enough to cause trouble. If they are not passed they can irritate the lining of the bladder, cause bloody urine, and make the dog feel like it has to urinate often. The stone can also temporarily (or permanently) block the passage of urine, and when this happens, it is a medical emergency. Surgery must be performed immediately to remove the stone or stones so that the dog can urinate.

Crystal formation is enhanced in urine that is alkaline (has a basic pH), and is inhibited in urine that has more acidic pH. Diet is a big contributing factor to the pH of the urine. Meat based diets tend to make more acidic urine, and plant based diets make more alkaline urine. Bacteria, which like to grow in an alkaline pH, make by-products that also contribute to crystal formation. Bladder stones in dogs are sometimes found following cases of infection in the bladder (cystitis). The inflammation and bacterial by-products form debris in the bladder which provide a starting place (or nidus) for the crystals to begin forming. Once the crystals start, they can form onto each other and build and build until they make stones. So you can see that urine pH and bacterial infection go hand in hand with urolithiasis.

Not all stones are caused from inflammation, some dogs such as Dalmatians, produce bladder stones because they cannot metabolize certain substances well. In the case of some Dalmatians, they cannot metabolize uric acid and so they make uric acid stones. This type of stone formation can be possibly corrected or prevented with special diets. Other dogs, such as Schnauzers just seem predisposed to form stones for some unknown reason.

Bladder stones can look very impressive on a radiograph as shown above. This radiograph is not from Miss Scarlett, but of a dog that had the largest stone in the above stone comparison.
Can you see the more dense central portion of the stone? This could be a different type of stone within the larger stone. It is not unusual to have multiple types of stone within the bladder at the same time. It sure looks uncomfortable to me!

Welcome Kasey

We'd like to welcome Kasey to our team. Kasey was born and raised in Whitman County, where she and her husband continue to live and raise their children. Kasey has first hand experience with farm life and enjoys riding her horses and being with her dogs. She also has a pot-bellied pig living at her home, but she would tell you it belongs to her children.

Kasey is working in the mornings (and occasionally filling in for Penny in the afternoons). She replaced Jenny, as Jenny has quit to focus on to other important things in her life.

We hope you will give Kasey a warm welcome when next you visit our clinic.

Spinose Ear Tick

Blogging has been a little hit & miss lately. Sorry. It is not that we haven't been busy, or that there haven't been interesting cases, to the contrary. It seems like we've had a rash of crazy trauma cases, and those aren't the type of thing that lend themselves to blogging. It's not like you can ask an owner if you can stop and take picture of the bleeding, mangled dog before you begin treatment. And asking whether or not you can blog about their poor pet seems in bad taste. So, that's how it has been.


Anyway, last week we had a rather mundane "check dog ears" from the western part of the county. And this is what we found -- a spinose ear tick (Otobius megnini). The spinose ear tick can infest many warm blooded animals, but seems to prefer cows, horses, dogs, cats, and even humans. It can be a real problem in livestock, causing poor condition with heavily infested cattle. We have seen several of these ticks in the past few years, all from the relatively arid parts of Whitman county. In dogs, infestation of the spinose tick causes severe head shaking, pain, and digging at the ear. Severe oozing skin infections can result from the bite. Most people assume that there is just a grass seed or awn in the ear canal.


As it turns out, only the nymph and larval stages of this tick feed on blood. The adults apparently do not feed at all, and can live for up to 2 years. The feeding stages of this tick like to crawl into ears, especially deep into the horizontal canal and attach to the skin where they feed on blood and wax in the ear. The spinose ear tick can cause tick paralysis and can also spread diseases such as Q-fever, tularemia, Colorado tick fever, and Rocky Mountain spotted fever (although not necessarily in this area of the country). Treatment for infestation involves applying an acaricide solution (typically permethrin or amitraz) directly into the ear canal if the tick cannot be removed manually. In cattle, permethrin impregnated ear tags are helpful in prevention of infestation.

Kind of gives you the creeps, huh?

Palouse Empire Fair

Every September, for the past 23 years, Dr. McGraw has spent the week and weekend after Labor Day out at the Palouse Empire Fair. At first glance, this may seem like a dream job, but after you found out about the hours of service you might think otherwise. Dr. McGraw is on the fairgrounds from about 6:30 AM until the barns close at 10PM, but as you can see, Dr. McGraw takes this all in stride.

Most of the years that Dr. McGraw has served as the fair Veterinarian, he has also had children at the fair showing one animal or another: pigs, horses, bottle calves, sheep, and the occasional chicken. This year it was a black bummer lamb, and a beautiful red and white short-horn bottle calf.


Official duties for the fair Veterinarian include: checking in animals as they arrive at the fair to make sure they are healthy and free of infectious diseases, treating show animals that get sick while at the fair, and occasionally treating rodeo stock or rodeo contestant animals. Unofficial duties include: putting chicken eggs in the rabbit cages (much to the surprise of people in the rabbit barn), hiding prize ribbons where 4-H or FFA contestants cannot reach them (not very amusing to some people), and putting goose eggs in the pigeon cages (poor, poor pigeons!). Dr. McGraw can also be seen helping out in any barn that needs an extra hand, visiting people he only sees yearly at the fair, and perusing exhibits in the buildings.

The last day of the fair, Dr. McGraw organizes the "Ol' Fogies Fitting and Showing Contest." This is the 17th year he has served as the official organizer. The first year, the prize for winning the "Ol' Fogies" contest was a political campaign button with a pig's tail attached (never fear, the poor pig lost it's tail when another pig bit it off). The prize is currently an old women's bowling trophy. Needless to say, all the "ol' fogies" have a good time at the showing contest.

This year, the weather was fine and most of the animals were healthy at the fair. We like it that way. See you at the Palouse Empire Fair in 2010!

Cats, Bats, and Rabies

Awhile back, one of our client's cat brought home a bat, and she called me asking what they should do with the bat and if they should be worried about rabies. The cat, bat, and children were all in the back yard together, and whether or not the children touched the bat was unlikely, but uncertain. We get asked these questions often enough that I decided to write a post about cats, bats, and rabies and try to address these questions to the best of my ability.

1. What should you do if your pet catches a bat?
DO NOT touch the bat barehanded! This is very important. Put on thick leather gloves and put the bat in a container that can be disposed of. If you think any person may have been exposed to the bat --touched or bitten -- phone your county Health Department and tell them the situation, then phone your physician as well. If only your pet has been exposed to the bat, phone your veterinarian. The bat will need to be sent in to a laboratory for rabies testing. Most public health departments will send the bat off for testing (for free) if a human has been exposed, but not if only your pet has been exposed. If your pet has been exposed, the bat should still be sent off, but at your expense (around $40). It is important to know if the bat is infected with rabies or not.

2. What should you do if you simply find a bat laying in your yard or in your house in broad daylight?
The same applies as above. DO NOT touch it with your bare hands. If it is outside, just let it be and see if after 10 minutes or so it has gone elsewhere. The problem lies in the fact that most bats that are found in broad daylight are ill, and some of them may be ill with rabies. If the bat is still there and you have children or animals, it is best to dispose of the bat as indicated above. You may want to call your veterinarian or public health official first.

3. What is the big deal with rabies anyway?
Rabies is a virus that is spread via saliva from the bite of a rabid animal. The virus travels through the nervous system, and once it reaches the brain it is deadly. The incubation period for rabies is quite variable among mammals and depends partly on how far the virus has to travel before it reaches the brain. So for example, if a rabid dog bit your face or a bat bit your cat's face, the virus wouldn't have very far to travel before it reached the brain. However, if you were bitten on the toe, the virus would have a long way to travel via the peripheral nerves to the brain. Incubation periods in dogs and cats range from 2 weeks to 6 months (but average 3-6 weeks). In the U.S. rabies is not the huge problem that it is in many parts of the world, but still-- infection with rabies without treatment is deadly --that's the BIG deal.

Image of dog with "furious" rabies

4. What animals can carry rabies?
Any warm-blooded animal can be infected with the rabies virus and thus spread it. In our area of the country we have no terrestrial rabies -- that is to say, no animals that live on the ground are endemic for rabies. In the northwest, our primary source of rabies is bats, and the rabies viruses isolated from infected terrestrial animals have all been found to have originated from bats. In the southwest and mid-west the main sources of rabies is skunk and fox, and in the east and northeast the main source is raccoons.

5. What are the symptoms you might see if your pet was infected with rabies?
The first stage of the disease is the "prodromal phase". In this phase your pet may show anxiety, nervousness, or apprehension and may do a lot of hiding. A fever may be noted especially in cats. Your pet may be irritable and try to bite, or it may be docile and friendly if it is normally aggressive. The second stage is the "furious phase". In this phase your pet may be hypersensitive to auditory and visual stimuli, may become restless and roam more, and may be irritable and vicious. The final stage is the "dumb or paralytic phase". In this phase the nerves that go the head and throat are affected causing the jaw to drop and the animal to be unable to swallow -- thus the stereotypical drooling and foaming. The animal may be thirsty but unable to drink, that is why another term for rabies is hydrophobia. An animal may exhibit some or all of these symptoms. Death is inevitable once symptoms are observed. A VERY few people have survived, and there are anecdotal accounts of dogs surviving.

Image of dogs with "dumb" rabies

6. How is rabies diagnosed?
The only way that we have of diagnosing rabies at this point is submission of brain tissue for microscopic inspection, so unfortunately euthanasia is a must for diagnosis.

7. Are all bats infected with rabies?
No, not all bats are infected with rabies. In fact, only about 10% of bats that are submitted for rabies testing are positive. That means that the percentage of rabies positive bats in the wild is probably much less, because normally you wouldn't find a bat just hanging around where you or your pet could catch it unless it were sick (possibly with rabies). However, if it was me or my child, I would not play the guessing game. I would presume a bat was rabies positive until proven otherwise.

8. What is the best way to prevent rabies infection?
Vaccination. Vaccination of pets is the only way you can help to prevent your exposure to rabies. That and steering clear of any wild animals that are acting suspiciously. Dog and cat vaccination protocols are strictly regulated: First vaccine at or after 16 weeks followed by a booster at one year. Then another booster every three years (at least in our good state of Washington). You should have your cat and dog vaccinated for rabies even if it is strictly indoors, because bats can come into a house through the smallest opening. Also, if your dog were to ever bite a person (heaven forbid), up-to-date rabies vaccination will be important to help keep your pet from being euthanized. There are also a rabies vaccine for people -- veterinarians are required to be vaccinated against rabies since they may be more likely to come in contact with a rabid animal than the average person.


The bottom line is: Educate your children not to touch a bat if they (or their pet) finds one and vaccinate your pets against rabies. Just last year a young boy and his dog were found playing with a bat in northern Whitman County. Luckily someone found them and captured the bat for testing because the bat was found to be positive for rabies. The little boy had to go through prophylactic treatment for rabies infection and the unvaccinated dog was euthanized.

One more bottom line: If there is any doubt as to whether a human has been exposed to a bat bite, err on the side of caution. Another tragic story from Washington State occurred about 15 years ago when a bat was found in the room of a young girl who was sleeping. No bite wounds were found on the girl so no further medical attention was sought. Unfortunately, about a month later the little girl died from rabies. The bat was dug up from the backyard and was positive for rabies. So sad.


Here is a collection of helpful links where you can learn more about bats, rabies, and such.
Living with Bats
Journal of the American Veterinary Medical Association --Rabies Survey 2007
CDC- Bats and Rabies
Whitman County Department of Public Health

(images courtesy of http://www.vaccineinformation.org/rabies/photos.asp)

Parvo Virus

In the past month or so, we have treated several cases of puppy parvo in the clinic. It seems that we cannot stress enough how important it is to get your puppy or dog properly vaccinated against parvo virus. This very common disease can quickly turn a happy, healthy dog into a sick or dead dog in just a few hours to days. The virus and disease is described well at the following site: {Canine_parvovirus} Usually, the first signs we see with parvo viral infection can easily be mistaken for a simple upset gastrointestinal tract --a little vomiting and the dog no longer wanting to play. This is usually followed in a day or two by diarrhea, and then bloody diarrhea. Unless the dog is treated quickly, death from dehydration and electrolyte imbalance can occur quickly.

Parvo virus is everywhere, and I mean EVERYWHERE. It is a very sturdy virus -- only reliably killed with a strong bleach solution. It can last in the ground or on other surfaces for years. You never know where your puppy may come in contact with it, and of course puppies are always sniffing, licking, chewing anything they can find. Take your unvaccinated puppy to a friend's house where several years ago another dog have parvo diarrhea all over the yard and unbeknownst to you, you just infected your puppy with parvo.



It is the saddest thing when a puppy comes in and is deathly ill with parvo. Sad because in most cases, the illness and possible death could have been avoided if the owner had been correctly informed about vaccination. Often the owner is mistaken told by a breeder that the 6-8 week old puppy has been vaccinated twice already and needs no further vaccination. Or, the owner mistakenly assumes that since the puppy has been vaccinated at least once by the breeder, then it is up-to-date. This is just not true.

How the vaccination works is a little complicated, so hang in with me. Puppies are born with some maternal antibodies already running around in their blood, and then they receive more antibody protection through the colostrum they nurse from the mother dog in the first 24hrs post birth. This maternal antibody protection, against myriads of diseases, lasts anywhere from 6-10 weeks of age depending on many factors. A vaccine stimulates the body to make their own antibodies (not passive antibodies from the mother) and memory to make more antibodies when challenged by a virus or bacteria. So, for the vaccine to work, there must be very little of the maternal antibodies left in the puppy, and as the age for this varies greatly from puppy to puppy -- we are stuck doing sort of a crap shoot when it comes to vaccinating puppies. To try to make sure that every puppy is adequately vaccinated, we need to cover both ends of the spectrum. Some puppies may run out of maternal antibody by 6-7 weeks while others will still be protected until 10-11 weeks. accomplish this at 8-10 weeks. And since most vaccines need at least two doses to be fully effective, we need to start vaccinating around 6-8 weeks and continue with boosters every 3-4 weeks until 14-16 weeks. So, there it is-- it all comes down to immunology -- not money sucking veterinarians trying to make a buck. We especially don't like to see sick and dying puppies in the clinic when we know it could have been prevented.



A couple more thoughts on parvo. It makes me cringe to see young puppies taken out and about to parks, the river, and other public places. Knowing what you now know about parvo and immunology, it should make you cringe too. You really shouldn't feel safe taking a young puppy to a public area until it has had at least 2 (or better yet 3) vaccinations for parvo. Also, just because you have an old dog, don't think that you don't have to worry about parvo any longer. An old dog that has not been vaccinated in a few years can be just as susceptible to parvo as a young unvaccinated puppy -- an aging body and other illnesses can make the immune system not as strong. Oh, and one more thing -- we recommend getting your vaccines from your veterinarian because you just don't know how the vaccines from the catalogues or feed store have been handled and stored. Vaccines are temperature sensitive and cannot be sure they have been kept cool. Our vaccines come on ice overnight from sources we trust -- if they are warm, we send them back. No sense taking risks.

A couple of good sites to visit about parvo:

http://www.avma.org/animal_health/brochures/canine_parvo/parvo_brochure.asp
http://en.wikipedia.org/wiki/Canine_parvovirus

Rattlesnake Vaccine

Did you know that there is a vaccine for dogs against the venom of this bad boy? That's right! We live in an area where there are [Western Rattlesnakes (Crotalis viridis)]. In our clinic we have been recommending vaccination against rattlesnake venom for 4 years now. Part of our clientele and their dogs live in areas of the county that are particularly prone to rattlesnakes. Every summer we usually see half a dozen dogs come in with snake bite. Typically a dog that has been bitten by a rattlesnake comes in and is pretty ill --swelling, pain, lethargy, fever, and infection -- are all symptoms. Most dogs will survive a bite if treated soon and appropriately. The most dangerous bites are to the head and neck as swelling is a big concern. However, if the dog has been vaccinated for the rattlesnake venom, these symptoms are MUCH less severe -- there may be a little swelling and pain, but less.


We have been offering this vaccine from [Red Rock Biologics] and we like how well it works. The protocol for vaccination is a two dose vaccination a month apart to begin with, then yearly (usually in the late spring when the snake are about to come out). It takes 4-6 weeks for the initial dose to be effective. I should point out that once your dog is vaccinated, you should still bring the dog in to the veterinarian after a snake bite, but the urgency of treatment is not so immediate. The amount of venom that is released during a bite varies greatly, and sometimes the bite is "dry" -- or no venom is released. However, the fangs of the snake often harbor bacteria and the wounds from the bite will become infected, and with the disruption of cells that the venom can cause, the infection can be bad. Thus, we usually put a dog on antibiotic therapy to offset the possible infection.

There is some controversy on the Internet about the efficacy of the vaccine and whether or not it is even necessary. All I can say is that at our clinic, we have noticed that it does help. And our clients that have dogs that get bitten repeatedly summer after summer notice the difference too. We have not observed any bad reactions to the vaccine itself in any of the dogs we have vaccinated. We do not recommend that every dog get vaccinated, only the dogs that live in areas where rattlesnakes are common and the likelihood of getting bitten is high.

Links:
For information on the vaccine --
http://www.redrockbiologics.com/risks.html

For information about Western Rattlesnakes:
http://www1.dnr.wa.gov/nhp/refdesk/herp/html/4crvi.html

A Calving Call

Last week, Dr. McGraw received a phone call from a frantic, crazy woman who said her first-time heifer was calving and that she (the heifer) had been up and down pushing for 1 1/2 hrs with nothing to show for it. So, Dr. McGraw made a quick trip home to placate the frantic, crazy woman and to check one of her (and his) cows. (Yes, the crazy woman, his wife -- a vet herself-- could have checked that heifer, but she didn't have any chains or calf-puller at her disposal, and besides that she likes to see her husband come home in the middle of the day--any excuse is a good excuse!)

"Luna" the cow had been off by herself all morning, getting up, laying down, trying to find a place to get away from all the strange pain and discomfort she had been feeling. I had been watching her carefully since this was her first time calving. I was sure she had been in active labor for 3 hrs and pushing for 1 1/2hrs, and I had not seen any evidence of the amniotic sack rupturing or any feet sticking out, I gave Dr. McGraw a call to see if he could come out and check her. She was a raised as a bottle calf so she is still very tame -- he was able to walk right up to her and check her.

The amniotic sac ruptured as he palpated and he was able to feel front feet and pull them out part way. When the sac ruptured, we could tell that the amniotic fluid was filled with {meconium} -- a sign that the calf was under stress. The calf was moving its feet though so we could tell it was still alive. Luna was trying hard to push with every contraction, but she wasn't getting very far even with help, so Dr. McGraw ran back to his truck to get the chains.

Notice the double wrap on the chains -- this helps alleviate any damage that the chains might cause on the legs when the calf is being pulled.

PULL!!!! HARD!!!! PUSH, LUNA, PUSH!!!!

No luck! Together, man and beast can only get the calf out as far as it's nose.

Time to get out the calf puller. Hang on there little calf!

A few contractions and a few ratchets on the calf puller and the calf is out. Yeah!
Ummmm.... the photographer forgot to take pictures while the calf was coming out. Sorry!

Hello little lady. So glad you could join us. Did you know that you are covered in poo?

Luna, meet your baby. Clean her up real good. This right here is the cause of all your discomfort and pain.

Enough cooing. Dr. McGraw has work to do. He checks to make sure all 4 quarters are opened up, and then he is back to the clinic. Thanks Dr. McGraw!

Within 10 minutes of being born, the calf is already trying to get up and find the milk bar. It amazes me everytime how quickly a calf goes from being in the water world of the womb to terra firma and walking on legs that have never stood before in just a matter of minutes.

Look at that calf go! Just hours later she is kicking up her heels. Would Luna have been able to have her calf on her own? Probably. Hopefully. But it would have been quite awhile later and the calf may not have faired so well had the labor gone on for much longer.

AVMA Convention

Last weekend, Dr. McGraw and myself attending the American Veterinary Medical Association (AVMA) Convention in Seattle at the Convention Center. As part of our quest as veterinarians to keep up with changing techniques, diseases, and pharmacology, we attend continuing education meetings every year. The AVMA is the national organization for veterinarians. The organization does more than just collect dues, it is a political base for lobbying for the profession and for animals.

As you can see in the above photo, the meetings were packed. Every lecture that we attended there was standing room only. We learned many new things, refreshed our memories on old things, and saw some vet school classmates. The meetings were nicely organized and the material was relevant to everyday practice -- I like continuing education that is ready to be applied when you walk out the door and into your practice.

Fly Control

Tis the season for flies -- flies feeding on your cattle, flies biting on your horses, and flies munching on your picnic. Flies are nasty and a nuisance, but why should you be concerned about controlling them on your livestock and horses? Let's make a list.

1. Flies spread diseases such as pink eye and upper respiratory viruses in cattle. Horse flies are reported to be one of the major vectors in the spread of Equine Infectious Anemia.
2. Flies lay eggs which turn into maggots in a wound or moist area on an animal. These maggots can cause major infections in the skin and deeper tissues if not treated.
3. Bot flies or heel flies lay eggs on the legs of cattle and horses that are ingested by the animals and then the larvae travel through the body causing damage and can eventually rupture out through the skin (makes you cringe). Another type of fly lays eggs that hatch and burrow into the skin causing "pigeon breast" in horses.
4. Flies bite the ventral thorax and abdomen of cattle and horses causing "summer sores." These are raw, irritated, and tender areas. Horses get bites in their ears causing them to be bloody and tender, and thus making them more head shy.
   
5. Bites from many flies causes generalized annoyance and decreased milk production in cattle.
6. Do we need to continue?
   

So what do we recommend for treating flies in cattle and horses? Well, our preferred fly control in cattle is Ultra Saber. It is a pour-on product that can last 1-3 months depending on the amount of precipitation that we get. We just treated our cows with it two weekends ago and they are fly-free right now. Great product and a great price (under a $1 per head).

For horses we recommend Equi-Spot. This product is also a pour-on type application that lasts 2-3 weeks depending on precipitation and sweating. This 3-pack costs under $10. Many people ask about fly sprays. They work OK, but you have to apply them daily for the best fly control.

Bottom-line, fly control is important not only for your picnic, but for your livestock and horses as well. Have a great 4th of July!