Porcupine Strikes Again!

This poor dog had a too-close encounter with a porcupine -- one of the more common reasons to see a dog at the clinic... (this and upset tummies). I thought we'd just share a few photos to show you what happens when you drop your dog off for quill removal.

After examination to assure us that the dog is in good enough health for anesthesia, we usually give the dog pre-anesthetic sedative and painkillers. A few minutes later, after the pre-anesthetics have taken affect, we will put your dog under general anesthesia.

As you can see in the above photo, there are often quills sticking all the way through the lip or tongue.... ouch!

Sometimes there are even quills so far back in the mouth that removal is a bit difficult.

Once your dog is fully anesthetized, here is how we remove the quills.... grab the shaft of the quill firmly with forceps, as close to the skin as possible, and PULL! Sometimes a dog will have so many quills that it will take 2-3 people working 20-30 minutes to pull all the quills. On quills that have broken off under the skin, we usually do not go in after (cut into the skin with a scalpel) because of the amount of trauma that would cause. Sometimes these quills will fester and become abscesses, sometimes they will just gradually disappear as the dog's body works to break them down.

Many quills later, and a bloody mess -- this dog is ready to wake up. We usually trim toe-nails and check the ears for foreign objects as well while the dog is still asleep. We usually send your dog home on oral antibiotics (and sometimes painkillers as well) because as you can imagine, those little quills are not the most sterile things in the world. You can expect the swelling in your dog's mouth and tongue to decrease quickly over the next couple of days.

Some questions we often get concerning porcupine quills:

1. Is a case of porcupine quills an emergency? Yes and no. How's that for an answer? Yes, we would recommend you bring your dog in as soon as possible if your dog's mouth/face is full of quills. The sooner the quills are pulled, the better: less infection, less broken quills, and less chance the quills will end up in the dog's paws or in your hands as well. If your dog has just a few quills not located in it's mouth, then it is not such an emergency and you do not need to call in the middle of the night for quill removal (hint hint).
2. I've always heard that porcupines throw their quills. Is this true? No, absolutely not. However, a porcupine is very good at flipping its tail around and when the tail makes contact, quills are left behind in the unsuspecting dog nose. Ouch!
3. Do you have to cut the end off a quill to let the air out before you pull it? No. That is an old wives tale. It is not necessary to deflate the quills before removal. However, you could cut the ends off after removal if you wanted to make a quill necklace. We'll give you the quills back -- no charge.
4. Can quills travel under the skin and through muscles? Yes. This can be especially troubling in cats as they tend to have pretty loose subcutaneous tissue. Luckily, cats and porcupines don't tend to have many interactions. We have seen the odd quill travel through tissues in the dog, especially so in quills that have lodged in the lower neck or shoulder (where the skin is loose). If there is a broken off quill in this area, we sometimes will incise over the quill and remove it just to lessen the chance of this.

I hope that answers some of your questions and provides you with a look behind the scenes of what happens when you bring your dog in for quill removal.

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!

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

Canine C-section

Meet Bailey. She is a 4 year old Blue Heeler. She is a miracle dog. About 3 weeks ago she was involved in an accident with a 4-wheeler and presented to us with paralysis of her hind legs. She was unable to move her legs and could feel no pain when we pinched her toes. We referred her on to WSU-CVM for possible surgery on her back. However, a few hours later, she was able to use her hind legs and proceeded to return to normal over the course of a few days. We have no answer as to her miraculous recovery, and neither does the veterinary college.

But that is not why Bailey is here today. Bailey has been in active labor for approximately 12 hrs now and has produced no puppies. It is time to make a decision. Considering the last time she whelped she had to have a c-section, the decision to cut again is unanimous. An ultrasound done at the veterinary college showed that the pups were doing well. We don't want to lose them by waiting longer.

Bailey was hooked to an EKG machine so she could be monitored for the duration of the procedure, anesthetized, and prepped for surgery. A dog's EKG looks similar to the picture you always see of a human pattern. The pattern you see in the above picture looks a little different because we are using an esophageal probe and not clip-on leads to measure the EKG. The dips in the pattern correspond with her respiration.

Bailey is covered with a sterile drape and an incision is made into the abdomen.

Bailey's owner has elected to go ahead and have her spayed during the process. You can see both horns of the uterus above --one puppy is in each horn. There can be many puppies in each horn, but Bailey only has two this time. The uterus with the puppies inside is clamped off and removed and the puppies are quickly taken out of the uterus.

The pups are cleaned up, evaluated, and stimulated to encourage breathing. They are a little sleepy because the anesthesia given to Bailey is also effecting them.

Bailey's abdomen is closed as quickly as possible so Bailey can begin to take care of her new family.

The pups get weighed-13oz each-- big girls! These are not small puppies, no wonder Baily was having troubles.

Within 10 minutes after being removed from the surgery table Bailey is sitting up proudly showing off her girls. All's well that ends well.

(All photos courtesy of J. Meek)