Archive for the ‘Things you should know’ 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.

Dog and Cat Lifespan and spay/castration

Saturday, July 13th, 2013

I have a professional and academic interest in spay/castration for dogs and cats, and have read extensively on the subject.  Obviously, we do a fair bit of it in the practice, and I taught spay/castration at Penn full-time for seven years.  So it’s not just part of the job for me–I want to know how to optimize the procedure (small wounds, lots of pain control, short surgical times, good process), optimize the benefits (when is the best time to do in in a dog’s career), and understand any negative effects.  While the advantages for spay (female surgical sterilization) for dogs and cats is unequivocal (so clearly advantageous as to be beyond reasonable debate) and the advantages for male cat surgical sterilization–castration–was similarly overwhelming, the case with male dogs was less clear.  There were some likely behavioral advantages, there were some diminished health risks, but there was more limited data.  When asked by owners, I would describe my bias as being pro-surgery, but that I lacked data to show why I believed in that approach.  Until now.

In the same issue of the Journal of the American Veterinary Medical Association, there was mention of two independent studies looking at (among other things) longevity of pets.  One by the Banfield group of veterinary hospitals found that spayed and castrated dogs and cats live significantly longer than their un-spayed/castrated counterparts.  Another study looked at dog patients in veterinary teaching hospitals and found that castrated males lived (on average) 13.8% longer than intact (not castrated) dogs, and that the benefit for female dogs is even greater–26.3% longer lived if spayed vs. intact!  That is more than a year for males and can be several extra years for females.  Wow!  Both of these studies were quite large numbers across many breed types, and their findings are in alignment with respect to a consistent magnitude and direction of the benefit (in the Banfield study, castrated male dogs did even better, at 18% longer lived vs. intact).

This is great news for pet owners who have followed our advice to spay and castrate all these years–you can credit those procedures for tacking on an additional 1 or 2 years to your pet’s life.  Give yourself a nice big pat on the head from your dog or cat for that.

(I’d provide a link right here, but WordPress has decided to become slightly difficult–the “insert link” radio button is inactive, and numerous repair suggestions have failed to restore it to functionality.  There is a link just to the right titled “Banfield State of Pet Health 2013″.  Lifespan and Cause of Death link is the other study referenced).


Chewing gum, change, and other deadly things in your purse

Saturday, February 20th, 2010

Yup; two pieces of a certain kind of chewing gum could be fatal to your dog. You’d think that something this dangerous to your family would be sold from behind the counter at a pharmacy, or with a great big warning sticker. But it’s not. And I’ll bet that 2/3rds of the women reading this have such a product in their purse right now. If your dogs should snoop into that, there could be trouble.

Xylitol is a sugar substitute that appears quite safe for people, but can be dangerous or fatal to dogs. It can cause a dangerous drop in blood sugar, which can result in seizures, coma, and liver failure. This is serious, bad stuff, and yet it looks so innocent. Please, keep your purse away from your dog if you chew gums sweetened with xylitol.

What else lurks in your purse? Over-the-counter medications or prescription medications. A surprising number of calls come in each year where people were poised to take their own medication, set it up on a counter or table, and while they were getting some water or taking a phone call the dog (occasionally the cat) gets the medication. Sometimes, this is not a big deal, but some medications are potentially disastrous for your pet. Also, putting a prescription bottle on the nightstand and leaving it there with a young dog in the house seems to be the equivalent of leaving a squeaky toy there; young dogs love to chew open the vial and get into the pills (never mind that if you HAVE to pill your dog or cat, it can be a three-ringed circus of frustration).

Oh—pennies. That’s right, pennies. Since 1983, pennies are largely made of zinc instead of copper, and zinc dissolved in stomach acid to become a toxic compound in dogs. I saw a number of these while I was a surgery tech at Penn while in veterinary school and saw one as a brand new graduate in 1990 when a Yorkie ate 42 cents in change, including two pennies. Zinc toxicity produces dangerous, sudden loss of blood (the blood cells break up inside the circulatory system); luckily, said Yorkie was saved through good luck, surgical removal of the coins, and good care.

Dogs are always looking for a chance to explore things, to see if chewing and swallowing stuff is as fun as they think—keep your pet safer from the dangers of your purse, and save yourself some anxiety, too.