Archive for the ‘BVH’ Category

Lyme disease vs. “Blue Dot” disease

Wednesday, April 19th, 2017

I had two patients seen by another office recently for possible Lyme disease.  One was a little terrier dog who was feeling well, but her owner discovered an attached tick on her undercarriage, removed it, and noticed a ring of reddened skin around the attachment site.  Because the owner was concerned about the “bullseye” lesion of Lyme disease, off she and the terrier went to Hospital Big (it was a Saturday, my office is closed).  Lyme (and heartworm, Erhlichia, Anaplasma) test, doxycycline (antibiotic), and some other stuff (owner did not share an invoice with me):  $500.  Terrier (with no symptoms of Lyme disease) did well on a course of antibiotics.

Doggie number 2 (a fancy Italian breed)  was presented to Hospital Big, again on a Saturday, for extreme lameness, poor appetite, fever, and a mild ear infection.  Giardia test, exam, ear cleaning, ear potion, Lyme (etc.) test, NSAID, doxycycline, anti-nausea injection:  $555.67.  Fancy dog responded very well to treatment and made a full recovery.

Some highly opinionated thoughts on these two cases.  In the first case, the terrier simply had an attached tick–something that is dead common this time of year in Bucks County.  Even pets that are using great tick products (and there are now many great tick products), ticks may still attach before they become ex-ticks.  Ticks bites can result in a non-specific red circular rash, but dogs do not develop the erythema chronica migrans that humans do with exposure to the Lyme organism (Borrelia burgdorferi).  So when a client brings a dog to my office with an attached tick and accompanying rash, I will tell the owner that this is a perfectly normal and perfectly innocent lesion, and that absolutely no treatment of any sort is required.  Someone ought to have told the owner that, IMO.  Instead, hundreds of dollars was spent on a nothingburger of misplaced worry on the part of the dog’s very caring owner.  Dogs are, BTW, extremely resistant to symptomatic Lyme disease–only a small fraction of infected dogs will develop any problem related to their infection, in contrast to humans, who are highly vulnerable to symptomatic Lyme disease (although many only develop the pathonognomic erythema chronica migrans rash).  Incidentally, cats, deer, sheep–lots of species are completely immune to Lyme disease despite ease of becoming infected with the causative organism).  My office has stopped using the 4-way diagnostic Heartworm/Lyme/Ehrlichia/Anaplasma test for routine HW screening because of the very common Lyme positive results in perfectly normal dogs.  And treating “blue dot” positive “Lyme disease” is not safer in any way than not treating.  There is absolutely no evidence that feeding antibiotics to dogs with blue dots and no symptoms does anything helpful (other than to pharmacy revenues).

The second dog, our Italian friend, is quite a different story.  He was very sick (his owner told me she thought he was dying) and had several of the classic symptoms of canine Lyme disease.  Fever, dramatic lameness (we sometimes call them fracture lame–as bad as a broken bone), poor appetite.  For this patient, Lyme testing is clearly indicated, and quite reasonably antibiotics, too.  Pain relief–definitely.  Some of these dogs are in need of NSAID and tramadol (an opiate analog).  For this patient, full credit for the medical approach and a very happy outcome for the dog (and owners).

Screening for infectious diseases sometimes produces results that are worrying but not relevant to the patient and its symptoms.  There is considerable science/epidemiology around the use of tests for screening vs. sick patient diagnosis.  In general, tests perform better (they are more accurate) when disease-appropriate symptoms or risk factors are present, and perform considerably more poorly when they are absent.  This is a fact of almost all tests, though it sometimes frustrates dog owners who insist that their dog was “diagnosed with Lyme disease” (or something else) absent a single symptom of said disease.  I would call that “Blue Dot” disease, an incurable though expensive condition brought on by inappropriate testing.

 

http://www.VeterinaryPartner.com/Content.plx?P=A&A=1588

Lost and Found (by Lisa)

Thursday, December 19th, 2013
P1020523

“Idaho”

Christmas came early for one very special kitten.

It must have been fate that I left my apartment early to get to my job at Bridgewater Veterinary Hospital; if I had not left at that time, I don’t think this story would have the happy ending that it does.  I was walking along a very busy street at about 7:55am when I thought I heard a cat meowing sadly.   I stopped walking and took off my ear buds to listen more intently.  I heard such a plaintive cry that I turned instinctively towards where I thought the sad voice was coming from.  There, across the street by some bushes, was a small striped kitty, mewling pathetically at me.  As we made eye contact, this little kitty started walking towards me and right into the street.  My only thought was that this poor thing was going to be hit by a car, so I broke eye contact hoping that the cat would not try to get to me.  Then I could cross the street and see about helping the little guy out. However, the cat had other ideas.  He darted right out into traffic, trying to get to me.  He narrowly missed being hit by a couple of cars. I will be forever thankful that the drivers had such good reflexes & applied their brakes in time!  This scared little kitty skittered back onto his side of the road and hid under a shrub.  Once the cars passed, I crossed the street to see if the kitty would come to me.  No sooner did I squat down, that the kitten peaked out from under the shrub, saw me squatting down, and raced over & leapt into my lap.  The purring this kitten was doing was non-stop; he was rubbing his face against my face, snuggling his head into my chest, kneading my lap and coat.  Kitty was very cold – it must have been about 30 degrees – and he was so very happy to have a warm lap to snuggle into and the human contact he was so clearly craving.

So here I am, with a strange kitty on my lap, on the side of a super busy road.  While snuggling the kitty to my chest with my one arm, I called my amazing practice manager, Ann, who was already at our hospital.  I briefly described what happened and she dropped everything she was doing, grabbed a spare cat carrier, and jumped in her car to come to our rescue.  The entire time this kitty was just purring away and rubbing my face, licking me and clearly showing his thanks for being rescued on this very cold morning!

Ann arrives, we get the kitty into the carrier, and we go to work.  Once there, we take our new foundling into our warm and cozy cat ward, get the kitty, who Ann has nicknamed “Gabriel”  (we can’t keep calling him ‘kitty’ after all), into his new roomy crate with some fleece blankets to snuggle in.  We can tell that even though “Gabriel” was very cold and hungry, he must have been someone’s beloved pet as he was just such a sweet little man.  Once “Gabriel” was settled in, we pulled out our universal microchip scanner and scanned our little guest.  We cannot describe how thrilled we were to find a microchip number!  Now we just needed to look up the number and hope that the owner’s kept the information accurate.

We went to AAHA’s universal microchip site (www.petmicrochiplookup.org) and that let us know that this little guy was microchipped with a 24 PetWatch microchip (www.24petwatch.com). Knowing that they have representatives manning their phones 24 hours a day/7 days a week, we immediately called them.  I spoke to a very helpful lady there named Jennifer, who looked up the number we gave her.

Thankfully, this kitty had current information! Jennifer was able to give us the name of our guest, Idaho, as well as his owner’s name, address, and phone number. She even went so far as to call the owner, hoping to connect us directly, and then e-mailed the owner when she had to leave a voicemail with our hospital’s information.

Within 10 minutes, we received a phone call from one very relieved and extremely happy owner!  She just received an e-mail from 24 PetWatch letting her know that her kitty was found.  It turns out that Idaho was missing for almost 2 months!  Idaho has a loving home with a little girl who was heartbroken when he went missing one snowy afternoon.  This little guy thought it would be a good idea to explore the outdoors when a family member opened the door.  Quick as lightening, Idaho streaked through the door and by the time the family raced out after him, he was gone.  The owner called both 24 PetWatch and the humane society where she adopted Idaho frequently, hoping that someone either turned Idaho in or called to say they found him through his microchip. Her daughter would look for Idaho in their apartment complex constantly, always telling her mom that she thought he must be there somewhere.

The joy in this woman’s voice on learning that her kitty was found was undeniable; the fact that the little girl will have her beloved kitten back in time for the Christmas holiday is a miracle for her  – and for Idaho!

Working in the veterinary field can be many things; there are a multitude of emotions that we feel on a daily basis just doing our jobs – and sometimes it can be heartbreaking and sad.  Today, though, is a triumphant day for us though; because of 24 PetWatch, we were able to quickly find Idaho’s owner and we were lucky enough to be instrumental in making a family whole again.  Christmas has come early for one family!

Technology updates

Saturday, March 13th, 2010

While I like to write, I am not a blogger by design. This space-the blogosphere—is slightly un-natural for me, but I believe in the incredible power of information, of connection, and hope to provide the occasional odd bit of knowledge in these posts.

So, what great big thought have I got to share today? I had a good day in surgery with the Penn Vet students yesterday (3 dog castrations, one dog spay, two cat spays). The students are in class of 2010—just four months away from graduation, and exactly twenty years after I finished at Penn Vet.

I’m writing this from home, where it used to be impossible to conduct any sort of office work or medical text research (my veterinary library was at my practice); now, I can access journals, texts, veterinary school resources, and veterinary specific networking sites that allow exchange of current clinical information. When I graduated, if I could not find the answer to a problem, I would call a former professor in Medicine or Surgery and ask. Now, from my phone, I can find answers I would have waited days to receive. I am able to connect with specialists and colleagues not just from a practice or two away, but from a coast or a continent away. No longer is absence of information an acceptable state of affairs. We can get to information (the trick remains how to make decisions with imperfect information in a way that is rational, timely, and helpful).

We’re making some leaps in technology at Bridgewater Veterinary Hospital, a new website with exciting new functionality. We’ll be introducing email reminders, web-based medication refills, and other communications enhancements. We look forward to improved accessibility, and improved service to our clients.

Welcome Back

Saturday, February 6th, 2010

To me.  In 2006, I left full-time practice at Bridgewater Veterinary Hospital for a teaching position at Penn Vet in a new program focused on the plight of homeless animals in shelters.  I stopped all clinical work at the practice in 2009, to focus on some new programs in development at Penn.  It’s not as though I haven’t been busy, it’s just that I had to take some time away for the new program under my direction at the vet school.

My job at Penn is to teach spay and castration techniques to the students, and we do this in shelters and also at the Ryan teaching hospital.  So far, I’ve had the pleasure of working  with dozens of interns and surgeons, and over 450 vet students.  We have surgically sterilized thousands of pets, which has been a huge help to the shelters coordinating with Penn.  I also teach classes on the subject of animal sheltering, free-roaming cat issues, and diseases of particular concern to shelters and rescue groups.

The students also bring their own pets to me for veterinary care, so my clinical work has continued.  I like this clinical role, as I get to know the students and their pets just a bit better than I would in the classroom or operating room.

At the urging of several friends and associates, I have returned to clinical practice at Bridgewater, working two shifts each week.  My time in the office should allow me to do more of the things I enjoy—seeing pets and their families.  I’m re-energized to be back, and looking forward to seeing some of you in the office soon.