Crawford Dog and Cat Hospital

Them Bones, Them Bones

2010-08-26T20:01:00.002-04:00

So, I was out for a long run on Monday. Actually, I didn't have access to a car, my daughter having absconded with it and I had no other way to go home. Now a more sane person might have called someone for a ride, or at least picked the most direct route home. But nooo, I mapped out a 12 mile route, including a little turn around the high school track for good measure and trotted off. The thing about long runs is that there is a period of time where there is nothing to do other than to let one's mind drift, and drift mine did. As various things started to ache, I focused on a bunch of things that I wanted to write about, most of which I have forgotton, but I'll try to stick with the free association that I went through over the two hours it took me to get home to dinner.

First, I was thinking how I should think of things to write about. Seems to make sense. Then I realized that no one, not even one person, ventured a guess about the film references. I'm not going to assume that there are no readers out there (my ego couldn't take it) so I'll assume there are no Italian film fans. The references were to Amarcord, a 1973 coming of age film with everything a guy could want in a movie with subtitles except there was no karate.

Then I realized that no one knew that in our practice, Bichons, are the master stone formers. They just pop back and forth between struvite and oxylate, frustrating the heck out of their owners and their doctors alike.

By the second mile, I was all warmed up and feeling pretty good. I looked down at my feet and realized that I will need new running shoes after this race in September. (I never race in new shoes) Then I was thinking about the shoe drive that we are running at our hospital, collecting used but wearable shoes to be distributed by souls4soles, a non profit outfit that is actually in Hati right now as we speak, delivering shoes to those who are bare foot.

That kept me distracted for a while, until I started thinking about my pace and heart rate and all of those mundane things that I need to keep track of if I am to finish this run in any kind of shape and still be able to get the rest of my work outs in over the week. I was trying to juggle my schedule so that I didn't have runs on back to back days because that is really hard on my legs. Which led me to think how lucky I am that my knees are good. My mind quickly did some trick to ward of the evil eye and then I thought I should talk about arthritis in pets. There was one brief digression as I ran on a bit of roadside path that made me worry about ticks and lyme disease, but that topic doesn't really fit the trend of nutritional posts I wanted to write and maybe I could put that off for a week or so, even though we are getting into the second peak season for deer ticks that spread the disease, even tho we don't have a lot of deer in my area and then I notiticed that I hadn't taken a breath and the run on thought had become a run on sentence and I was going to pass out if I didn't slow down.

So miles 4 - 8 were mostly on joint disease. Now, both dogs and cats are subject to degenerative joint disease. I am talking about the type of arthritis that is caused by wear and tear on the joints. There may be underlying instability in the joint as in hip dysplasia. Sometimes it is a genetic predisposition such as the abnormal looking joints in Basset Hounds. And sometimes, it is just part of the aging process. We think of dogs as being arthritic, but there was actually a retrospective study that looked at the x ray films of cats admitted to hospitals for other reasons. 22% of the cats over a year old in this study showed radiographic evidence of osteo arthritis.

So what are we to do? There are plenty of medications out there to treat arthritis in dogs, not so many in cats. Some are non-steroidal anti-inflamatory medications (not in cats please). There are nutriceuticals such as glucosamine, chondroitin, green lipped muscles (who knew they had lips). There are surgical treatments (not so good). New research shows promise using stem cells. And we have had some very good success using our laser to treat painful joints in both dogs and cats. But what if you could do one thing to prevent, or at least mitigate, the degenerative changes in the joints.

Well, if you are a regular reader, you know that weight control is very important in preventing arthritis in pets. Purina did a great study in labs showing a correlation between arthritis and increased (excessive) body weight. (Leaner dogs also lived longer) So, work with your veterinarian to get the weight off of your heavy furry friends. Or, better yet, don't let them get fat to begin with.

What if they are thin and have arthritis anyway? It does happen you know. There was a series of three articles published in the past year in the Journal of the American Veterinary Medical Association (JAVMA) showing that there was an excellent response to a diet made by the folks at Hills. Dogs fed J/D (Hills cleverly uses initials to make it easier for veterinarians to remember what the food is for. Joint Diet - get it?) had a good resolution of clinical signs related to arthritis. In fact, there were all sorts of things that were measured and showed improvement over the initial 30 day period that the food was fed. I know, these diets are expensive. Not really when you consider that one of the articles demonstrated that dogs could reduce the amount of NSAID that they took when they ate this food. Add that savings in (not to mention that there are no side effects to feeding J/D and there can be with medications) and then the food is not that expensive after all. Oh, what about cats you ask? Well, they just came out with a diet for cats (Feline J/D, so clever those folks at Hills) and it works great too.

Now stop your whining before you start. "My cat won't eat that food" I can hear it already. They have a money back guarantee, my rep told me so today. If your cat won't eat the stuff, you can return it to your vet and get your money back.

So, here it is, you can actually decrease your pet's chances of getting a debilitating disease by feeding it optimally to prevent obesity. And if your pet is unlucky enough to develop osteo arthritis, you can "treat" the condition with food. Hey we all have to eat anyway, why not feed something that will make your pet's legs get better.

I'm not going to go into what I ws thinking about for the last couple of miles of the run. It wasn't pretty, and the thoughts were not all that pleasant. Just leave it to I finished, I was happy with the time it took, my legs felt OK and I had a cold beer waiting for me. My idea of optimal, post workout re hydration and recovery.

Something's Amiss if a Dog ....

2010-08-10T20:51:00.004-04:00

OK, so no one read the last blog post. It can't be that no one knows where the film quotes are coming from. But just in case there are hundreds of you out there and you are just to shy to let me know what movie I'm rambling on about, today's post title is another hint.

I also purposely skipped dogs in last week's post about lower urinary tract disease. No, not because I think dogs are second class pets. It's just that their disease is actually easier to write about and the photos that I have are better, or at least more dramatic.

Now, dogs with lower urinary tract disease often have infections. These respond well to antibiotics. The diagnosis is made by clinical signs, (frequent urination other than marking by unaltered males), +/- blood in the urine, a urinalysis indicating infection or inflammation, and sometimes a culture. Simple UTIs (urinary tract infections) are more common in females than males, an anatomical issue not a sexist one, and should respond to a short course of antibiotics. Cure should be confirmed with a follow up urinalysis. UTIs that do not respond to treatment usually fall into one of several categories. 1. The antibiotic chosen was not appropriate for this specific infection due to bacterial resistance, solution, culture to get correct antibiotic sensitivity. 2. Antibiotic was appropriate, but not given for a long enough time or at the correct dose. 3. There is some sort of underlying problem causing the infection or the clinical signs that are interpreted to be an infection. These can be any of the following; bladder failing to empty completely due to anatomical defect or neurological problem, obesity causing anatomy problems leading to ascending bacterial infections, bladder tumors, or (if you peaked ahead) bladder stones.

This radiograph is a much better illustration than the cat photo from last week. Need I point out the mass of minerals in this poor dog's bladder. I hope not because I still haven't gotten around to the use of arrows in my photographs. (any hints on this would be greatly appreciated.)

Bladder stones in dogs are similar to urinary stones in most mammals. They are mineral concretions that form in the urinary tract. We do see calcification of the kidneys as well, but clinical kidney stones are less common than bladder stones in dogs. The most common stones historically were struvite stones. These phosphate based stones need a nidus to form, usually a bacteria and are therefor associated with UTIs. An important factor when talking about prevention. Struvite stones are usually smooth, yellow to tan colored little rocks. They tend to form in alkaline (not acid) urine but I have seen them look like anything and form in all sorts of urine. The only way to tell what type of stone the dog has is to get one and send it off to the lab. Now, in male dogs, there is usually only one way to get one, surgery. I have been lucky in females and have been able to get them to pee out a small stone that we can have analysed. The other cool thing about struvite stones is that they can be dissolved by diet. While the SO diet by Royal Canin will do this, I find that S/D (could that be for stone diet?) made by Hills does a great job. Struvite stones can be dissolved in about 1 month in most dogs. There is a catch for the guys tho. I don't like to try to dissolve stones in a male dog. The thing is, that before a stone dissapears, it becomes small. Small stones can pass out of the bladder and get stuck in the urethra, just above the os penis (penis bone) This can cause an obstruction, a true surgical emergency.

So for all you guy dogs out there, and you know who you are, your choice is surgery. Here's what came out of the bladder above.

Pretty impressive collection, huh? Now once the stones are out, if they turn out to be struvite, we do put the dogs on S/D just to make sure that we are good to go and that nothing else is forming. Then we put the pet on a maintenance diet and monitor the urine every month. What are we looking for? Infection. Remember, these stones need a nidus of bacteria to form, so if we can catch the UTI early, we can prevent the struvite stones from forming. The thing we have to be careful about tho is the other end of the spectrum, stone wise. We used to try to promote an acid urine, either by diet manipulation or by adding acidifiers to the diet to prevent these stones from forming. That's when we started to see an increase in the number of oxylate stones in our canine patients. These stones cannot be dissolved by diet, do not need infection to form, and must be removed surgically in males and females. They are rough surfaced and can stick to the lining of the bladder. They can be difficult to remove and I can only assume that they are quite painful. Once out, we usually use the Royal Canin diet to prevent them from coming back. This diet maintains a neutral ph so as not to encourage struvite stone formation and works by decreasing the precursors for stone formation in the bladder. Another new improved option is Hills C/D multicare, it does the same thing. I won't put another set of links to the website, just follow the ones above.

So the take home message is, re occurring bladder symptoms in the dog are not usually just repeated infections. Additional testing needs to be done to find out why the dog is having the problem, what the problem is, and what can be done to cure this episode and prevent future ones. It is an on going problem that can be managed very well with diet and follow up.

Oh, and if anyone thinks they know their stones, here's a little trivia question. What breed do you think has the greatest incidence of bladder stones in our practice. I'll give you a hint, nah, no hint, but I will give you a prize. First person that doesn't work at my hospital to leave the right answer as a comment will get a $10 gift certificate for some really outstanding pet food. Check it out at www.TheVetsChoice.com.

To be Fit as a Fiddle, a Cat Has to ....

2010-08-03T21:33:00.016-04:00

OK, there it is, right in the title, my homage to Fellini. Not that the oblique film reference has anything to do with today's topic, I'm just trying to show that I am a multi dimensional kind of guy. The first person to identify the reference and leave it in a comment will win ..... My undying respect for your film knowledge. I mean come on, I gave you the artist, you should be able to figure this one out.

But on to our first topic in nutritional therapy, feline lower urinary tract disease. (maybe we should have stayed with Italian films). Back in the dark ages, when I graduated from vet school, (go Penn class of '84), we used to see a lot of cats with signs of lower urinary tract disease. You know, increased frequency of urination, perhaps some blood or straining in the litter box with little urine produced. In male cats it would frequently get bad enough that they would block and be unable to urinate at all, necessitating surgical intervention of some sort. Ultra sound was not readily available, so we assumed that these cats had infections and gave them antibiotics and made some diet recommendations (at the time Hills Prescription Diet C/D was all that was really available) and lo and behold, most of these cats got better. Logic, incorrect as it might have been, dictated that there was an infection that the antibiotics cured. Current theory was that the ph of the urine (measure of acidity calculated by the inverse of the negative log in base 10 of the hydrogen ion concentration, but now I am just showing off) was too high so we added acidifiers to the diet as well.

Theories came and went over the next few years, but the antibiotics stayed. In that time we thought it was the ash content of the diet, the magnesium content of the diet, the ph of the urine, and people even thought that urinary disease in cats was related to the phase of the moon. What did change, is that we started to culture some of these cats' urine and we found, you guessed it, no infection. So what was going on? We had made the urine acid, we had given antibiotics, but then after really screwing up the urine of these felines, we started to do some imaging. First was x rays. It's hard to see in this photo, (and I don't know how to put arrows in these yet but hey, I'm an old dog learning new tricks.)

The bladder is to the left of the bones and to the right of the black gas. If you look carefully, you can see a line of small white stones. This is what we started to see on a certain percentage of our bladder x rays. Stones are made of minerals so they show up white. Most are struvite (phosphate) or calcium oxylate stones. It is hard to tell which are which on radio graphs, you need to take them out and send them off for analysis. The thing is, a lot of cats had urinary tract signs, negative cultures, and no stones on radio graphs. Enter the ultrasound machine. Now, some people can read ultrasounds with no problem. I on the other hand have difficulty. So, I have a doctor that does imaging come to our practice to do our studies. And what he finds in many cases, is simply a thickening of the bladder wall. No infection, no stones, no nothing.

These are cases of sterile interstitial cystitis. A potentially serious inflammation of the bladder that causes all of the signs that we see. Sometimes it is self limiting and usually episodic. That explains why so many cases get better after a week of antibiotics. They would have gotten better even without antibiotics. Some do not resolve so quickly and others are real bears to manage. They require constant dietary manipulation and medication just to keep the disease under control.

So what do we do to manage feline lower urinary tract disease? Well if we find an infection, antibiotics are still the answer. If we find stones, we take them out. Here are the stones from the cat in the above radiograph. Easier to see now that they aren't in the cat.
We will send these off to the lab and once we know what type of stones they are, then we will make long term management recommendations. The tough cats are the ones with the sterile cystitis (SC). These get a combination of pain medications, anti inflammatory medications and even some anti anxiety medications. But the only thing that seems to have any science behind it is dietary manipulation. Now, anicdotally, colleagues of mine in feline only practices have told me that they have significantly reduced the incidence of FLUTD (feline lower urinary tract disease) in their patients simply by having all of their clients feed canned food. It seems that the increased moisture may play a roll. Cats are notoriously poor drinkers so it does make sense that a more dilute urine brought on by increased water intake might help with irritants in the bladder. There are actually studies showing that feeding canned SO a diet made by Royal Canin actually has been demonstrated to decrease the signs of FLUTD in cats. It will also dissolve those pesky struvite stones and prevent new calcium oxylate stones from forming. It is our go to diet for most of our cats with FLUTD. There are some issues tho, it is high in salt which can be a problem if cats have marginal kidney function.

Another choice is a Diet made by Hills. Remember the C/D I mentioned earlier? Come on, pay attention. Well it has been reformulated. It is designed to dissolve struvite stones in the dry form, so it probably will in the canned form as well. The canned formulation is lower in salt than the Royal Canin diet and we are going to start using this a bit more for our cats with SC.

So we have come a long way from just popping our feline friends with antibiotics every time they strain to urinate. And, we have done far fewer urethrostomy surgeries on blocked male cats, which is a good thing. We can control and treat many cases of FLUTD in cats with diet and common sense. Talk to your veterinarian for dietary recommendations and don't forget to let me know if you figure out the reference at the beginning of this post.

I didn't forget about dogs, they are just entirely different beasts and I will post about them next time.

You are what you eat, they are what we feed them

2010-07-19T21:19:00.002-04:00

I have to say that I was pleasantly surprised by the feed back that I received for the last blog series. Maybe there is something to this whole series concept. People that are not related to me actually sent me suggestions for topics and I wrote about them. I whole new experience for me, positive feedback from the blogisphere.

Now I've made this mistake before. As rush chairman at Penn Iota chapter of Phi Kappa Psi fraternity in the late 70's I did sign off on a series of theme parties that went from the very successful Hawaiian themed rush kick off, to the disastrous "Come Get Mugged", beer mug give away, (those of you that were there will remember that we ended up with hundreds of leftover beer mugs), I'm still going to give this theme thing a go.

So, I would like to write a series of posts on nutrition and the treatment of disease. We use nutritional therapy as a stand alone for certain conditions and as a adjunct therapy along with medicine and surgery for others. Sometimes just diet changes, sometimes supplements. There is a whole lot of misinformation out there. People are making recommendations that are not based in science. Alot of these people want to sell you something. Some of them are just misinformed, Some are just parroting things that misinformed people from the previous sentence told them. Others are just silly.

I'm going to try to limit my discussions to things that the general scientific community knows to be true. I will offer my opinion when I feel it is appropriate, but will tell you when it is my opinion. I will try to provide references when I can to support my statements, and I will try to make them independent or at least independently corroborated when I can.

So what do I want from you dear readers? Well, I'd love you to keep reading. I would also like it if you could send me some subjects that interest you. Disease conditions your pet's have that are being managed with nutrition or that you would like to manage with nutrition; things that you have heard that you would like to know more about; things that have worked for your pets and things that have not worked. I'll do some research, see what I can find out, and then post. You are free to comment, but I'll cut you off at the knees if your comments are just sales pitches to my readers.

Now this may sound like an excuse, but some of these posts will take some serious thought. So, there may be a bit of a lag between them. No, I'm not getting lazy during the height of my triathlon training season, I just want to bring you quality information along with my entertaining wit.

So let me know what you want to read about and we'll get started. I announce my new posts on twitter , so feel free to follow. If the whole twitter thing is too much for you to deal with (I mean who likes to tweet anyway), become a fan on facebook, I announce my posts there as well. It is also a great source of information and cute pet pictures, if I do say so myself.

Keith Niesenbaum, VMD

www.CrawfordDogandCatHospital.com

Live Long and Prosper, the final chapter

2010-07-07T20:18:00.007-04:00

OK, those of you that have been following along probably have some documentation indicating that this was going to be a 5 part series and if you've been counting, it's only 4. Too bad, my blog, my rules. I actually am quite surprised that I was able to focus long enough to string together 4 posts over a rather regular interval on a related subject. Fortunately, I just got back from vacation, so I should be able to avoid the rant that happened in a previous post. I'm feeling very mellow after spending some quality time with family and friends and their dog. That's right, a true busman's holiday, their dog Zeus was with us for the week. Just to make me feel at home, my host's fed their dog some table food (you all know how I feel about that) and he had a bout of an upset stomach that ruined a previously reviled and hideous, yet functional area rug in the living room. But I digress. Zeus is a really cool dog of the 60 lb mixed breed type. Not without his foibles like a bit of separation anxiety and a quirk that won't allow him to pee or poop unless he is taken for a walk at the most inopportune time. One thing I will say, he is well behaved. In fact most of the dog's we encountered on this trip to Martha's Vineyard were well behaved. Well, that one black dog did almost knock his owner over trying to get to Zeus on one of our previously alluded to walks and their was the dog aggressive Leonberger on the beach that barely looked like a Leonberger but we'll defer to his owner since the owner and the dog both were trying to behave.

Why am I prattling on like this you are probably asking at this point. Well, I would like to address an often overlooked reason for early death in both dogs and cats. Euthanasia for behavior issues. Cats are trickier so we can get them out of the way first. While I have seen cat's euthanized for behavior issues, these are often not training deficiencies, but rather behavior problems. The most common being failure to use the litter box, destruction by scratching and aggression towards people and other animals. These can be stress related, although looking at the lifestyle of most of the cats that I know I can't imagine a more stress free life.

However, the stereotype of the cat collector aside, cats are not pack animals like people. In the wild they are generally solitary hunters, coming together when necessary at common feeding areas and to seek the company of other cats to make kittens. (there, doesn't get anymore G rated than that does it?) We put a bunch of them together in one home and sit back and wait for behavior issues to develop. There are a number of good sources of information on reducing this stress, but my favorite is put out by The Ohio State University, School of Veterinary Medicine. Give it a look see.

To summarize, make sure everyone is neutered (cats not people, different topic and less G rated), have adequate, clean litter boxes with varied substrate, separate feeding and watering areas, and plenty of perches and scratching posts. This should take care of most of you issues. For those that are particularly troubling, consult your veterinarian, and take a look at the Ohio State link.

Dogs are both more complex and actually easier to deal with. They are pack animals and as such can and should be trained. That doesn't mean that all dogs will be neurosis free and never have a bad moment. I mean, my dog Cookie is generally well behaved unless you let your toddler put their face too close or it thunders out. Even Zeus had his moments this week. However, it is a rare dog that can't be made obedient in most, if not all situations. Dogs should listen to their owners, come when called, sit, stay, and go to the bathroom outside. Some can even be trained to pick up after themselves and friends although I think Piglet has way too much supervision in this video.

The point is, well trained dogs are easier to deal with and people will enjoy being around them and therefore, around you as well. So start as a puppy, socialize your pet, and get some basic obedience training. Oh, and you can't just go to some classes when your dog is 4 months old and expect that it will be trained for life, you have to keep working at it and working at it.

If I had read the manual for the digital camera that my wife purchased a couple of weeks ago, I would have a picture of Zeus behaving for you to see and it would make this blog more interesting. So, if you have photos of your dog doing tricks, why don't you post them on my Facebook Fan Page so everyone can see them. Or, if you know how, put them in a comment right here on the blog.

While we're talking about comments. I had to reject a couple in the past week. While I love to hear from you all, please don't submit comments for products or services. If you want to promote yourself, then write your own blog. It's not hard, any well trained dog or cat can do it. Heck, even a veterinarian that can't use a digital camera can do it.

Next week, we'll try to focus on nutrition and specific diseases. If you have any favorites that you would like me to touch on, let me know. These may end up being a little less rambling and a little more educational, but hey, you never know.

Keith Niesenbaum, VMD

www.CrawfordDogandCatHospital.com

Live Long and Prosper, Third in a Series

2010-06-28T21:46:00.015-04:00

So here it is, a couple of days late due to a little techno hang up. (I couldn't find any pictures to use for this post even though I have saved many over the past couple of months in anticipation). I think the glitch has something to do with my abandonment of the Blackberry Storm that I have hated for two years and the acquisition of the yet to be mastered Droid Ally. However, I think that my technology foibles can be another whole series of posts for some future date. I'm not here to talk about phones or apps, or even my laptop computer which seems to spend more time at a certain apartment in Brooklyn than it does on my lap. I'm here to talk about one of the most important things you can do to help your pet live a long and healthy life. We've covered vaccines and Nutrition/weight control. Now it's on to oral health.

Now this doggie seems to have nice, shiny, white teeth. You might say, "Gee, the gums look a little red and maybe I detect some staining on that upper 4th premolar." (big tooth with two points). You might also wonder why this dog has a clear tube coming out of it's mouth, and why Kim's fingers are so close to the aforementioned pointy teeth. Well, as you might have guessed, this dog is sleeping and it's teeth didn't look like this a little while ago.

They looked like this. (Cue the horror movie dramatic music)

Yes, it's true, someone probably let this dog lick them on the face and couldn't imagine why it's breath smelled like 2 week old dead fish. But bad breath is not the only problem that we see with dental disease of this degree. As you can imagine, this dog's mouth must hurt. Go to your dog right now. I'll wait, bring him or her back to you computer. Now sniff his breath. Lift his lip carefully like Kim was doing in the first picture. If you smell rotten eggs or see any staining on the teeth, or worse, if you see tarter and red gums like this you call your veterinarian first thing in the morning, hang your head in shame and make an appointment to have your pet's mouth examined and the disease treated. That's right, disease. Oral disease is a painful condition that leads to tooth loss. Infections in the periodontal pocket can cause abscesses. Cat's (not pictured here due to the aforementioned tech issues) also get cavity like lesions that expose the nerves. Bacteria can get into the blood and cause kidney disease, heart valve disease, and liver abscesses. Toxins from these heinous bacteria make your pet feel like crap. This is serious stuff. Oh, I know, your pet is too old for anesthesia and dental treatment. Horse Hockey! (for all you Col. Potter fans). Old age is not a disease but rotting teeth are. Have your vet perform a complete physical examination, including the oral cavity. This, along with some basic blood work will determine the safest way to treat your pet's mouth.

See, here's another dog with horrendous teeth. This guy isn't going to be so lucky. Once the teeth were cleaned and radiographs were taken, it was determined that not all of the teeth could be saved. That's right, we had to make the phone call that owner's hate to hear, "Mrs (fill in your name if you haven't been taking care of your dog's teeth.) we have finished Fluffy's cleaning and radiographs and we have to extract several teeth" The owner always gasps and asks how the dog will eat. I tell them, "better than he is eating now because these teeth are loose and painful."

Notice how clean the teeth left behind are? Notice how many are missing? And this is only one side of the mouth. I assure you that the other side looks much the same. Do not let your pet's teeth get like this. Your veterinarian should be examining your pet's teeth at every wellness visit. You should ask your veterinarian if your pet's teeth are OK and if yes, what you should do to keep them that way. If no, what do you have to do to treat this disease. Once the mouth looks like the pre pictures above, no amount of brushing, or treats, or prayer will clean them. I have to clean them. Then you have to work out a home care program and do your part. Oh, yeah, when your veterinarian tells you the teeth are bad, don't answer with, we just had his teeth cleaned last year. Look in the mouth and have the doctor show you the problem. Then the two of you need to come up with a plan to treat the problem and then prevent the problem from coming back so soon.

You may have noted a bit of terseness in my tone for this post. You are correct, I am ranting again. Next to overfeeding your pet, not taking care of it's mouth may be one of the worst things you can do. It will decrease lifespan and will make for a horrible quality of life for both of you.

I'll calm down now. I hope no one got bitten looking in their pet's mouth. I should have warned you to be careful earlier. I also wanted to thank my associate Dr. Brian Spar for the photos. He has an I phone and he will be glad to tell you how much better it is than any technology I could ever posses. (wait until his I phone 4 starts dropping calls). Also, special thanks to Kim Green for helping to display the oral cavities. She is our Licensed Veterinary Technician and she does our dental cleanings and takes the oral x rays for our patients. She will also be the one calling you to tell you if we need to do extractions or additional work.

One more post in this series, then it's on to another topic. I think there is an over/under poll going on as to how many days it will take me to finish off the series. I was really good for the first two.

Keith Niesenbaum, VMd

www.CrawfordDogandCatHosptial.com

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Live long and prosper, #2

2010-06-14T19:03:00.007-04:00

So this could be a first, but I'm actually blogging according to some pre-arranged schedule. Two weeks in a row, keeping to the topic of what you can do to help keep your pet healthy. Last week, I talked about regular vaccinations for your pets. I know everyone read and enjoyed it but in case you need to review, just check it out here.

This week is a topic that is near and dear to my heart and one that will cost you nothing and save you a bundle in veterinary bills over your pet's life. I'm talking about nutrition and fitness, or more specifically, controlling your pet's weight. I touched on this topic briefly in the past, but obviously no one was listening to me because I keep seeing overweight pets. Well it's time to take the gloves off and get down and dirty. If you have an overweight pet then this is for you.

This is a fat cat. It's not cute, (OK, maybe a little), it's fat. There are a whole slew of diseases that fat cats get more often than normal weight cats. First thing that comes to mind is diabetes. Yes diabetes as in your cat has a high blood sugar, will get severe complications and need insulin injections for the rest of it's life diabetes. Fat cats also are more prone to arthritis. Studies have shown that a large percentage of older cats have arthritic changes on radiographs. These cats may suffer in silence. Once can only imagine how carrying around this extra weight will make things worse. Overweight cats also have a higher incidence of respiratory disease, heart disease, and certain tumors. If that's not gross enough, they also have a higher incidence of constipation. You haven't lived until you've had to sedate a cat to pull obstipated poop out of it's butt. DO NOT LET YOUR CAT GET FAT!!! Talk to your vet about appropriate diets, especially after spay or neuter surgery as this will alter your cat's metabolism, lowering their caloric needs. I'll not get into details here, but try to avoid high carbohydrate diets, and stick with a large proportion of canned food that is higher in protein and fat. Think Catkins (Atkins) diet, as I cross over some copyright law line and walk all over Dr. Atkins' name. If there is interest, we can look deeper into this topic in the future. Some blogger guru said that I should keep my posts at around 800 words and those who know me know how hard that is, so lets move on.

OK, dog owners, you didn't think I was going to let you off the hook did you? Dogs get fat too. Actually, it was a run of fat, crippled, could not get up off the floor, dogs that made me decide to write this whole series of articles. I actually had to put a 135 lb Golden retriever to sleep because it was so fat that it had Pickwickian syndrome. Follow the link, I didn't make it up and it is a great SAT vocabulary word for my younger readers. Fat dogs have degenerative joint disease, increased risk of torn ACL ligaments, hip dysplasia, heart disease, and a total lack of vitality. Is it worth giving into that begging at the dinner table? Just say no!

Now I just got back from a half Ironman triathlon this weekend. I don't just throw this out because I want you to know that I can complete the 70.3 miles, even in the brutal heat, (1.2 mile swim, 56 mile bike ride, 13.1 mile run) but because I want you to know that I know what a battle this is (weight control that is). I spent a day getting passed by guys and gals that looked like this greyhound in the picture. We don't have to limit our pets diets until they look skeletal. A Labrador will never look like this guy, and the poor pugs will develop body image issues just looking at the photo. The point is, we all have an ideal body weight and we need to get there to stay healthy.

So, what's a pet owner to do? Feed a healthy diet. Feed to body condition, that is to say, if the amount you are feeding is leading to weight gain, cut it back. If your dog doesn't eat the food that you put down every time, in 3 seconds, but is maintaining weight, you do not have to top dress it with pan drippings (fat), or chicken breast, or hamburger, or anything. And exercise. This is tougher for cats than for dogs, but 20 minutes with a laser pointer every day will do wonders, if it doesn't make you crazy. And dogs need to walk, or run (breed dependent) every day, twice a day if possible. I go crazy when people tell me they exercise their dog every Saturday for 10 minutes if the weather is good. I look at them and realize that they are on the same type of exercise program. They should check with their doctors and veterianarians to make sure that they are starting out on a healthy, suitable program, then get off the couch people, and grab a leash, it's good for both of you. Take a spouse out with you and the dog, talk to each other meet your neighbors. (unless you live up at like 173rd street, then maybe you should leave your neighbors be and make sure you have a big dog and walk before dark.)

Some dogs (not most cats) like to swim. Great exercise. But I have to say, if they learn to ride a bike and pass me at my next triathlon, I'll have to find another athletic activity. My ego can only take so much. I can take being passed by the old men and women, but the first time a dog takes me down at an Ironman event, I'm done.

So, now I'm out of ideas for the next three posts on what you can do to keep your pet healthy. Give me some ideas. If I have any hope of keeping to this schedule, it will be up to you. This idea came for crazyboutdogs on twitter. Follow her at www.twitter.com/crazyboutdogs. Follow me at www.twitter.com/knvet and become a fan of our facebook page at Crawford Dog and Cat Hospital

Keith Niesenbaum, VMD

www.CrawfordDogandCatHopsital.com

Live long and prosper, the first installment

2010-06-08T20:44:00.005-04:00

It seems that I have been seeing so many sick pets in the office lately. OK, not so much serious illness, although there has been our share of that, but sort of chronic, debilitating things, mostly things that could have been prevented if a little care had been taken. So, rather than rant and rave as we all know I can, I decided to take a more constructive course and write a series of articles on things that you can do for your pets to help them live to their normal life span with a good quality of life. Some of these things will involve your veterinarian, some of them will be lifestyle changes for you at home. I figure on five articles and only have topics for the first two lined up. So this is your chance to leave me some suggestions for future posts.

New pets are a new chance at a healthy pet so let's start with your new puppy or kitten. I think the the most important thing you can do is get them vaccinated. Now, before you get into an uproar about the evils of over vaccinating our pets and how vaccines are responsible for everything from allergies and autoimmune disease to global warming and vampires, I think you need to sit back down and continue reading.

I'm not talking about vaccinating with every vaccine on the market whether it is effective or not. I'm not talking about vaccinating every pet for diseases that they have no risk of ever being exposed to. You need to have a rational discussion with your veterinarian about your pet's anticipated lifestyle and the risk factors associated with this life style. It should be obvious (although I know it always isn't) that a dog that lives on the 53rd floor of a Manhattan high rise and never goes out, even to pee, does not need the same vaccines as the Field Trial Labrador that summers on Shelter Island and competes upstate on a regular basis. (for those of you not in New York you can substitute your own low risk and high risk locations). I'm not neglecting cats either, indoor cats do not need the same vaccines as those that go out. (shame on you if you let your cats go out)

I have worked in areas where vaccination was not emphasized. I have seen cats die of Feline Leukemia or Calici Virus infections. I have seen dogs die of Parvo and Distemper. These diseases are all preventable with adequate vaccinations.

I hate when I see a new puppy or kitten and it has been vaccinated every week from the time it was 4 weeks old. This sort of over vaccination may well cause damage to the immune system and all sorts of problems for the pet in the future. We start our dogs and cats at around 6 weeks of age with core vaccines and vaccinate every 3 - 4 weeks until they are 16 weeks old. Other vaccines are added through the vaccine period according to each pet's risk factors. Do not vaccinate your pet according to some generic vaccine program. At our practice we tailor an individual program for each pet and your vet should do the same. Don't add a vaccine just because it is only a couple of bucks more and you think you are getting a good deal. Save that for the supermarket.

Adult dogs are vaccinated periodically. Some vaccines need to be boosted yearly, some every three years. Some owners prefer to have antibody levels measured to see if pets need boosters at all and this blood test can be done for some of the vaccines on an annual basis.

Vaccines are not always benign. The purpose of vaccination is to stimulate the immune system to fight disease. There can be adverse reactions ranging from tenderness at the injection site, to fever, to severe anaphylactic reactions. There is some evidence that some vaccines can cause tumors in cats in rare instances. Your veterinarian should be prepared to help you balance the risk versus the benefit for each vaccine that he or she is recommending.

Once we have done all that we can to prevent possible fatal or seriously debilitating infectious diseases with a customized vaccination schedule we will move on to discuss things that you can do as your pet matures.

I'm still open to suggestions so leave a comment and let me know what you think. Those of you who don't agree with what I said in this post shouldn't be shy either, let me know what you think.

The links in this post go to my web page, an excellent source for information written by board certified veterinarians. The search function is on the library page and is open to anyone to use as a source. Oh, it's free. Oh, I won't try to sell you anything. No ads, it is an informational web site. There is a particularly good photo of me on the staff page. (If I do say so myself).

A special shout out to a friend on twitter that recommended this topic. You should follow by clicking on this link to the twitter page.

You should also become a fan of ours on Face Book. Crawford Dog and Cat Hospital. Here, I'll make it easy, just click on this link. We have started a weekly give away and we post it on our website. This week's goes until Thursday (tomorrow) so check it out asap and stop by to pick up your prize if you are in the area.

Keith Niesenbaum

www.CrawfordDogandCatHospital.com

www.TheVetsChoice.com

The Garden is Beautiful, but it can also be treacherous;.

2010-05-20T21:01:00.012-04:00

I know garden season is in full swing. when I start to see rashes like this on my wife. (No this is not her, just a photo that I got elsewhere.) What would cause her otherwise normal skin to erupt in lines and patches of itchy blisters causing her extreme discomfort and misery?

Well, if you spend much time outdoors in our area, then you will recognize the culprit right here. That's right, we all know leaflets three, let it be ... Poison Ivy.

Now, she is an avid gardener, and in her defense, she not only knows the rhyme, but knows what the plant looks like, most of the time. In fact, we are so defensive about poison ivy at our home that we probably have no pants with three leaves in any of our gardens. But, as cautious as she may be, it seems that every year, it sneaks up on her and she ends up with a nasty case requiring topical treatment with steroids, administered by ours truly, just so she can get through the work week.

"Hey", you say. "Sorry bout your wife, but this is supposed to be a pet blog". Right you are, just using a topical reminder to segue into today's topic. By the way, most dogs don't get rashes from poison ivy. (some do, it's not unheard of). They can gallivant in the woods and get the oils on their coat. Then when they snuggle up to you , the oils rub off and pesto, you have the rash. Remember, the rash is not contagious, it is spread by the oil. The best product I have found for getting the oil off before you get the rash is Tecnu. Check it out.

OK, so poison ivy is not a big problem, you might ask, "what are some common flowering garden plants that can cause a problem for my pets?"

Hyacinths are beautiful and smell great. The flowers and greens of tulips and hyacinths are not generally toxic, but their bulbs contain alkaloids and/or allergenic lactones. If you are sensitive, and my wife is, wear gloves when planting the bulbs. Once you get them in the ground all should be well.

Daffodils contain the toxic alkaloid, lycorine. Ingestion can cause severe vomiting, diarrhea, abdominal pain and potential respiratory distress in dogs or cats. I hope that you will recognize them as the pretty yellow flowers that come up in the spring. I had a photo, but somehow it got deleted and since this blog post is not about a week later than I wanted it to be, I'm not going to try to figure out how to get it back up.

Here's a photo of a common plant that I actually had a client call me about last week. OK, by now it was probably 2 weeks ago. Calla lilies and Peace Lilies are actually not that toxic. Ingestion of the plant or flowers will cause GI Upset. You know, the medical euphemism for vomiting and diarrhea. The cat in my practice that instigated my mentioning these plants was vomiting a couple of times a week, after eating some of the lily leaves in the house.

Oh, look. I found the photo of the daffodils. Here they are on the left below.

Don't confuse the relatively harmless Peace Lilies or the Daffodils with the seriously dangerous true lilies. The Easter Lily above and to the right, Asian Lilies, and Day Lilies are potentially deadly. All parts, leaves, bulbs, flowers, even pollen can cause severe, life threatening acute renal failure in dogs and cats if ingested. I would advise not planting these in gardens or having them in the house if you have pets that are likely to be exposed to them. My former associate almost lost a cat to lily toxins. Fortunately, she is an excellent and tenacious clinician and the kitty pulled through.

Like the coral snake, these flowers are pretty to look at but very deadly. Just as an aside, remember, red on black friend of jack, red on yellow kills a fellow. If you know what this refers to, please leave a comment and let me know that you are out there. There are no photos of snakes or other venomous critters this post, but if you guys want, we can do that some time in the future. Not a big problem here on Long Island, but I bet the crew in the south and south west would have another story to tell.

Finally, most fertilizers will be toxic to pets as well. Keep dogs and cats off of the lawn after chemicals have been applied. Check with your gardener or read the label yourself. A good general rule is to stay off for 48 hours after the stuff has been watered into the grass. Better yet, have an organic lawn or garden.

If your pet has been exposed to something and you're not sure if it is toxic, call your veterinarian. (Gosh, I bet veterinarians hate when I write things like that and they get all sorts of calls, but it is what I am here for for my clients). If you're not my client, call the Pet Poison Helpline at 800-213-6680 or online at www.petpoisonhelpline.com.

I would like to shout out to www.PetDocsOnCall.com for more helpful pet care tips. They gave me the Pet Poison Hotline number and the idea for this blog post. OK, them and my wife's poison ivy.

Keith Niesenbaum, VMD

www.CrawfordDogandCatHospital.com

Get a taste of our practice by becoming a Facebook fan at Crawford Dog and Cat Hospital.

Bacterial Alphabet Soup

2010-04-27T15:03:00.009-04:00

There has been a fair amount in the press recently about antibiotic resistant super bacteria that are going to end the world. TV, print, Internet, all talking about MRSA, MRSI, MRSP, and even the dreaded flesh eating bacteria, I think that I will skip the horrid flesh eating bacteria for now, as it is mostly a human disease problem and the pictures would be far to gruesome for this blog. If you have a genuine interest or just want to see gross pictures, you can follow the link here.

Let's start with MRSA. I'll translate, first from alphabet to medicalese, to English. French translation will require a different author. The initials stand for Methecillin Resistant Staph. Aureus. Staph. Aureus is a round (cocci) bacteria commonly found on the skin. While we used to think that all of these potentially disease causing cocci were Staph aureus, it turns out that this is a pathogen of people and other species have there own species of Staph. Here is group of Staph as seen under the microscope, a Staph meeting as it were.

The M is for methecillan, an antibiotic and the R is for resistant. MRSA is resistant to, that is not killed by methecillin or any penicillin type antibiotic. The problem is that many of these bacteria also develope multi drug resistance, that is that many antibiotics will not affect them. As you can see this can cause a big problem.

MRSA has become a huge source of complications in human hospitals as this is a place were there are alot of sick people, and bacteria, and antibioitics to stimulate resistance. (We can talk about how bacteria become resistant in another post if anyone comments and is interested)

Dogs can get colonized by MRSA. They get it from their owners and it might not ever cause a problem. However, if they should have some weakening in their immune system, allowing these bugs to get a foothold, then we can have a problem. At our practice, we have seen several cases of MRSA recently. In each case we were able to trace the source of infection back to an owner that had been treated in some sort of health care facitlity.

What about the other intitials you ask? Well, as I alluded to earlier, other species of animals have there own staph bacteria. In dogs they were reclassified as Staph. intermedious (SI) and most recently, Staph. pseudintermedious. Here is a picture of staph, closer up. Can you tell what species it is? No one can just by looking. Special tests are needed.

In fact, you can't tell if this is a resistant staph or just a plain old staph just by looking at a photo micrograph. Sensitivity to antibiotics is determined by doing cultures and sensitivities in the clinical path lab. We have seen an increase in the number of MRSP infections in our practice over the last few months. I'm not sure if that is because more of our staph infections are resistant to methecillin, or if we are just more aware and doing more cultures. These animal staphs can colonize people and cause diseae if the opportunity arises.

Now, were do we see most of these resistant staph infections in our animal patients? The number one location is in the ear. That is why your veterinarian should not just look at an ear like this and send you home with anti biotics.

Or even worse, just take a phone call from you and dispense antibiotics without a thorough examination. We do a cytology exam on all ear infections. (look under the micrscope to see if there are bacteria present). If there are bacteria, we do a culture and sensitivity so that we can prescribe the best medication to cure the infection. Then we set up a maintenence program to prevent future infections. The indescriminant use of antibiotics is one cause of the increased incidence of resistant infections. You need to wash your hands after treating infections so that you don't pick up these bacteria and have them growing in you waiting to cause disease.

Here is the other very common location for bacterial infection, the skin. People often mistake this type of lesion as ringworm (another topic for another day) but this is a classic presentation for a staph infection in a dog. These also need to be treated with appropriate antibiotics, both topical and systemic.

Now what can we do to prevent the spread of bacterial diseases from patient to care giver, owner to pet, and pet to owner?

WASH YOUR HANDS!! Do it frequently and do it well. Use antibacterial soap. Use the hand sanitizer stations that popped up during the swine flu scare. These will kill bacteria as well as flu viruses.

Keith Niesenbaum, VMD

www.CrawfordDogandCatHospital.com

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Spring is here and the smell of what? is in the air?

2010-04-12T13:02:00.007-04:00

So the weather has turned warm and I was finally out for one of those long bike rides that I have been promising myself for the past month or so. My first long course triathlon is rapidly approaching and it is time to get some hours in the saddle as it were. We were out on the North Shore tooling around the hills of the Gold Coast and dodging landscaper's trucks who were also out taking advantage of the nice weather to tend to their chores, when I was taken back to a childhood memory by a familiar smell. Now the overwhelming odor was chocolate, but that could easily have come from the melted Reese Peanut Butter cups that I use to refuel myself on these long rides, but there was a subtle difference. This was a more earthy smell. Now I remember.

When I was but a lad, back in the day, my Pop-pop worked in some capacity for the EB Evans Company. The company is still in existence (a quick google search will confirm this but that is really tangential to where I am going with this story.) I remember that his company made Ice Cream toppings. You know, Butterscotch, Hot Fudge, maraschino cherries. Sidebar here, don't eat an entire bottle of maraschino cherries, I seem to recall that it will make you puke. Anyway, attempt at self induced cherry poisoning aside, my Pop-pop would bring us all sorts of great stuff to pile onto our ice cream, or dump into our milk. Although I'm sure this didn't help my weight issues growing up, it was a wonderful thing for a pre-teen boy to have access to. Tastes aside, smell is a stronger memory trigger and I remember that he also gave my dad huge burlap bags of old cocoa hulls to use as garden mulch. Back in the early '60s, this was novel. The company perceived this as a waste product and my dad thought it was the best gardening product ever. As a kid, I thought it was wonderful that the entire yard smelled like a gigantic chocolate bar, only more earthy like a truffle soaked chocolate bar.

Now, 50 years later, cocoa mulch is very popular. I guess that as more people have figured out that this is a good mulch and the companies that probably paid to have the stuff hauled away, or at least turned their backs when employees gave their grandsons early childhood spring time memories are selling it by the ton. Add in the new popularity of truffles, the earthy chocolaty smell of this mulch was everywhere this weekend.

But, if you've been reading some of my earlier posts, you know that there is often a flip side to these sorts of things. While I was content to lay out on the lawn and smell the chocolate, dogs are not quite so content. As with some other items, such as carpet, they eat this stuff. Maybe they think it really is truffle soaked chocolate (mmmmmm) or maybe they are less discerning and just acting like, well dogs. The thing is, chocolate mulch has two problems. One is it's chocolate and we talked about that a while ago. There is enough chocolate in the stuff to cause all the problems we mentioned with eating the real stuff. The second problem is it's mulch, not meant to eat and can cause all sorts of intestinal blockage requiring human intervention to remove the garden supply.

Here we are, a young Rottweiler, on the table with a belly full of something. The hands belong to the talented and patient Dr. Spar who is removing all sorts of goodies from the insides of this silly beast, via an opening that didn't exist until a few moments before the picture was taken. The suspect foreign body was carpeting. I don't know if the dog had read the last post and thought it was an instructional manual or if he came up with the idea on his own, but the owner was pretty sure that carpet was the offending material as some of it was passing out the rectum for several days. Well, we all get to be wrong sometimes and this was the owner's time.

The thing is that this pup isn't particular at all. He didn't even care about the flavoring, he just wanted to eat plant material.

This is just a small sampling of the leaves that were removed from his stomach. If my botany serves me well, they were mostly oak leaves. Can't tell you what type, mostly slimy oak leaves from spending the better part of the week inside the dark confines of a dog.

The thing is, we really need to watch what our pets get into. If this had been the cocoa laced mulch, this dog would have had all the signs of chocolate toxicity in addition to the physical obstruction of the non edible plant material. Happy ending tho, leaves out, dog home, and I will ride on the North Shore again this weekend searching out the smells of my childhood.

Keith Niesenbaum, VMD

www.CrawfordDogandCatHospital.com

and for healthier snack options.

www.TheVetsChoice.com

Beverage of Choice?

2010-03-23T11:33:00.004-04:00

I'm posting this photograph of my former associate in surgery a couple of years ago. (She moved out of state, I didn't have a contract put out on her). This dog had eaten a large amount of carpeting and thought that it would be best if we took it out of a new opening since it wouldn't pass out of any existing natural holes in the body. Both dog and veterinarian did very well. so well, that we got to repeat the entire procedure when the dog did it again.

This illustrates a point that I feel that I have to make, we can't leave our pets alone with things that might be dangerous. We saw the kitten that ate the needle in an earlier post. By the way, she came in for suture removal and is doing well. Just to prove that kittens are not all members of Mensa, her owner caught her trying to eat a tooth pick before she was even fully recovered from the first surgery.

Our pets will do things that are dangerous time and time again. They will eat non food items time and time again. They will get into the garbage and end up with horrible gastro enteritis time and time again. And we think, "stupid pet". In reality, it's stupid owners. We have to protect them from themselves. Do not lock them in rooms with Berber carpet that is their favorite flavor. Keep sharp pointy objects away from them. Do not let them in the garbage.

Side note on garbage. We think that our dogs get diarrhea and vomiting because they ate greasy garbage. That might be part of the problem in some instances. I think that a large number of these dogs actually get food poisoning from bacterial toxins in the garbage. Remember, garbage is spoiled food. It is ... well garbage. The same bacteria such as salmonella, e coli, campylobacter, staph, you name it , the same bacteria that make us sick, can make them sick and it does. Time and time again. Keep them out of the garbage.

And just like our children, keep them away from house hold products that might be dangerous.

We admitted a kitten to the hospital today that sat in a puddle of this product. Lysol, kills germs. After all it is a quaternary ammonium disinfectant. Hard on bacteria, hard on cats. This kitty knocked the bottle over and then sat in the puddle while mom ran off to get some paper towels to clean up the mess. The bad news is that cats are very sensitive to these products. Even worse news, when we called the 800 number on the bottle, the lovely person on the other end of the phone did not know that this product is dangerous to cats. They were helpful and tried to get us a poison control number, but by the time they figured out what was going on, we had all the information that we needed from several of our Internet sources and had started therapy.

The biggest problem that these detergents cause in cats is physical trauma to the oral cavity. Ulcers, tissue damaging, even complete soughing of the tongue. This cat had some much mucous it inhaled some into it's lungs. (sorry to radiographs to post this time). A bath, some steroids, some respiratory nebulization to clear the secretions and so far so good. Unfortunately, we might not know the extent of the damage for a couple of days. Hopefully, I'll not have any pictures of oral pathology to share with you. Most of the ones that I saw on line were post mortem. This is nasty stuff.

So please, be careful out there.

Keith Niesenbaum, VMD

www.TheVetsChoice.com

www.CrawfordDogandCatHospital.com

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Spring is in the air and Fleas are in your yard, and on your dog, and on your cat, and in your home ...

2010-03-19T12:15:00.010-04:00

I knew I should put this photo at the top of the post just to get your attention. Yup, this little monster is a flea. Look how big and ugly he is. Doesn't even fit into the frame of the picture. Just waiting to jump onto your dog, or cat, or even you and bite you over and over again, taking blood meals until he or she finds either she or he, mate and lay eggs in your brand new sofa, or plush carpeting, or even the cracks of your hardwood floor, infesting your house and making you spend millions of dollars eradicating a plague like one not seen since the days of the Exodus from
Egypt. (OK, sorry, but passover is on my mind).

Fleas don't care if your dog or cat is a mixed breed or a pure breed. They don't care if it is old or young. They don't care about anything but biting someone over and over again causing all sorts of discomfort and spreading diseases. Fleas spread the black plague in europe, they spread bubonic plague in the south west, they spread cat scratch diseae everywhere. (and you thought that was a cat problem).

And just for those that thought, oh my little pookie won't get fleas, this next photo is of fleas on skin. Now, I shamelessly lifted this photo from elsewhere but I can tell you that with my limited experience in lifting photos with or without shame, this one looks like it is of a person with fleas.

EWWWWWW !

And this is all before I get started on ticks. Here is my homage to ticks. These disgusting little guys are embedded in a dog. While it is an old wives tale that they burrow so deep that they disappear into the pet, they do attach, take a large blood meal, and then drop off. But often not before spreading diseases like Rocky Spotted Mountain Fever or Lyme Disease. They will attach to people and do the same nasty things.

So, if all of this is so gross and dangerous, what can we do about it? The answer is easy. Short of wrapping your pets and yourself in a plastic bag, or moving to antarctica, the key is using a safe and effective product to control fleas and ticks.

But wait you say, You heard that all of these products are dangerous poisens that will kill your pet and turn your home into a superfund toxic waste site. Really, get a grip. There are products that are not safe. There are products that don't work, but there are products that are safe and effective. The EPA report last fall did find that as a group, some of these products did have adverse reactions when used in pets. Unfortunately, they did not discriminate between products, just condemed the entire group of treatments. They did not differentiate between products used with veterinary supervision or with out. Did not try to determine if the dose was correct, or if the product was even appropriate for the species of pet it was used on.

Now come on, this is Dr. Keith talking to you. Would I let you hurt your pet? My clients know that I'm not going to recommend something that doesn't have the research behind it. I'm not going to tell you to use a product or give a vaccine or medication if your pet doesn't need it. We're talking about disease prevention here.

Talk to your veterinarian. Get a recommendation for something to use to prevent disease. Be a responsible pet owner and buy the product he or she says is best for you. If they don't have it, you can probably get it from an on-line source. Frontline plus for dogs and cats as well as K9 Advantix for dogs (DOGS ONLY) are both excellent products and you can get them from this web site, delivered directly to your home, no shipping charges or anything. Just do it now, the bugs are getting ready to pounce.

Keith Niesenbaum

www.CrawfordDogandCatHospital.com

www.TheVetsChoice.com

ps. Look for me at the NYC 1/2 Marathon this weekend. I'll be somewhere in the back of the pack and will need all the encouragement I can get.

A needle in a Haystack.

2010-03-15T12:39:00.005-04:00

I've decided that I can't continue to keep some things to myself. No I'm not talking about another rant as in some previous posts. (see 8/25/09). I just can't believe some of the things that my patients eat. I'm not talking about edible items. I'm not talking about semi edible, or even quasi edible items such as the Turkey Carcass of Thanksgiving '92. although the turkey story is one of my wife's all time favorites, I'll leave that for another time. Noooo, I'm talking about totally inedible, possibly toxic, straight up dangerous, will kill your pet meals.

Now, sometimes we get lucky, like the kitty whose radiograph is below.

Lucky you might ask, How so? Lucky because the owner actually saw this cat eat that needle. In fact she tried to grab it out of the kitty's mouth, risking her own digits in the process. Unfortunately, a second too slow and the needle was just coated in enough cat drool to make it tough to hold onto and zoop, it was gone.

The radiograph confirmed that it was in the stomach, along with enough cat food to feel a feral colony in Queens. (no colony specifically comes to mind but this is a good time to give a shout out to the groups in Whitestone that are doing a great job caring for their colonies). More on trap, neuter and release programs at a later date.

Of course, the full stomach posed a dilemma. If I waited for the food to pass, who knows where this needle would go. If I jumped in and did surgery, we risk complications from regurgitation, or even worse from peritonitis when the food leaks into the abdomen. Now you know this probably goes well if I'm posting it but hey, sometimes I might throw in a real tear jerker just to see if you're paying attention.

We anaesthetised the cat and I made a large (really large) incision so I could exteriorize the stomach. I didn't include any bloody intraoperative photos, sorry. The stomach was full but after a bit of searching, I was able to feel the needle and push the eye end up against the gastric wall. A small stab incision with a #11 blade and voila, no more needle. Quick 2 layer repair and kitty was home in a day, looking for more mischief to get into.

The thing is, the owner was aware that the cat might eat the needle and thread so she put it up on a counter, away from where the cat usually goes. That's the cool thing about cats. There is no place that they don't usually go. She saw the kitty jump up on the counter and scarf the needle like it was an anchovy waiting to meet it's maker. The rest, as they say is history.

Why don't you guys let me know some of the things that your pets have eaten and we can see who has the strangest tail to tell. If need be, I'll post the turkey carcass story, you know how I hate to be out done.

Keith Niesenbaum, VMD

http://www.thevetschoice.com/

http://www.crawforddogandcathospital.com/

Welcome to our blog

2010-03-09T17:56:00.008-05:00

So, with the passage of time, we have developed several on line presences and they are scattered all over the internet. I have been advised by some who know far more than I do that I should integrate these, you know, pull them all together in one place. I tried to do that with our web page at http://www.crawforddogandcathospital.com/ but not everyone knew about that.

I tried to do it with our facebook fan page , Crawford Dog and Cat Hospital /Black Forest Kennels. Check it out and become a fan for updates. It will let you know when I post here on this blog, or somewhere else. I even use the same logo for all of our sites. (Shout out to Justin for his design).

You can follow me on twitter, www.twitter.com/knvet. Those posts tend to be the most frequent and are not always animal related. (They can also be a bit more snarky as up until now no one really knew that it was me)

I have a rather extensive network of business contacts on Linkedin. Check that out at http://www.linkedin.com/pub/keith-niesenbaum/4/617/a0a.

There are also a couple of other places that you can find us on the web. I am an independent distributor of an excellent, holistic dog and cat food line called Life's Abundance and information can be found at http://www.thevetschoice.com/ It's the food that I feed Cookie, my intrepid Shih Tzu and many of my clients think it is the greatest thing since sliced bread. You can sign up for a newsletter on the web site, no obligation. Give it a try, you can always cancel by unsubscribing. (like anyone ever unsubscribes to anything)

We also have an online store that is currently selling veterinary theraputic diets shipped directly to your home. It is your source for Hills Science Diet, Purina, Royal Canin, and Eukanuba veterinary diets. Check it out at http://www.petsneedfood.com/. (you'll recognize the logo, I just got tired of posting the same picture on the blog time and time again.

So there it is in a nutshell. Most of the places you can find me on line. Check them out and stay in touch. Oh, and feel free to comment so that I don't feel like I'm blogging into empty outer space. Vets need feed back too.

Come Fly with Fifi

2010-03-04T13:51:00.003-05:00

Spring may be in the air, but even before we all pull up stakes and head out for spring break, many pet owners have been traveling with their dogs and cats to escape the harsh winter we have been having here in the Northeast. This is not a new phenomenon, but it seems that more people have smaller dogs and they want to travel with them. There are a couple of things that they should be aware of.

First, dogs can fly in cargo, that is under the plane, or in the cabin if they are small enough to fit under the seats. Check with your airline far in advance as they may limit the number of pets that can fly in the cabin. In fact, a recent article in the NY Times highlighted the concerns of the Canadian Medical Association that pets in the cabin may be a risk to human passengers and are recommending that no pets be allowed in the cabin. Hmmm, that would certainly crimp the vacation plans for a lot of pampered pets that I know.

Each airline has different requirements for pets on domestic flights and they change regularly so you will need to check with them. Don't expect your veterinarian to be current on each airline's policy. My head would explode if that were part of my daily routine. International flights are a bigger problem and you should check with the consulate in the destination country for the current regulations.

Some pets travel really well, like some people I guess. Others, not so well. We generally do not like to sedate animals for travel, especially those traveling in cargo. Nothing like a poor reaction to a tranqulizer at 30,000 feet to ruin a trip. For dogs that are very anxious, speak with your veterinarian. There are some medications that might work with minimal risk to your pet. In some cases it might be best to leave Fido at home with a firend or, heaven forbid, at a kennel. (Note tongue in cheek sarcasm here as I do own a kennel and the dogs really do very well here while you are off galivanting about. Just remember to buy them a t-shirt so they feel loved).

Whatever your decision, make sure that you canine companion is up to date on vaccines and if you are headed south (and I hope you are) make sure that he or she is taking heartworm prevention and that you are using something for fleas.

Stay safe and have a great travel season.

Keith Niesenbaum, VMD
Check out our Face Book Fan Page, Crawford Dog and Cat Hospital/Black Forest Kennels.

Chocolate is for Easter Bunnies

2009-12-22T15:14:00.006-05:00

We usually think of chocolate overdose in dogs as a problem around Easter or even Valentines Day. I have to tell you that today was our first chocolate ingestion of the Christmas season. In this case, a 40 pound dog ate an 8 oz bag of Hershey's Kisses. Now I like chocolate as much as the next guy, possibly even more than the next guy, but at least I pause to unwrap them before I scarf down the entire bag.

Sometimes we eat chocolate plain. Sometimes we eat it baked into cakes, mixed into ice cream, etc. The first problem with these sweets is the fat. A sudden high fat meal (such as the above bag of Kisses) can create a lethal metabolic disease in pets called pancreatitis. Vomiting, diarrhea, and abdominal pain are just the beginning of this disaster. Remember, in the case of pancreatitis, it is the fat that causes the problem more than the chocolate itself.

The fat and sugar in the chocolate can create an unpleasant but temporary upset stomach. This is what happens in most chocolate ingestion cases. This was certainly the case in our patient today. The amount of chocolate that he ate was not enough to cause serious neurologic signs

Chocolate can be, however, directly toxic because of the theobromine. The more chocolate liquor there is in a product, the more theobromine is present. This makes baking chocolate the worst for pets, followed by semisweet and dark chocolate, followed by milk chocolate, followed by chocolate flavored cakes or cookies. Theobromine causes:

Vomiting
Diarrhea
Hyperactivity
Tremors
Seizures
Racing heart rhythm progressing to abnormal rhythms
Death in severe cases

Toxic doses of theobromine are 9 mg per pound of dog for mild signs, up to 18 mg per pound of dog for severe signs. Milk chocolate contains 44 mg / ounce of theobromine while semisweet chocolate contains 150 mg per ounce, and baking chocolate contains 390 mg per ounce.

Number of OUNCES of CHOCOLATE a Pet Would Need to Ingest for TOXICITY
Weight of Pet in Pounds	5	10	15	20	25	30	40

Milk Chocolate (ounces)	2	4	6	8.2	10.2	12.3	16.4
Dark Chocolate (ounces)	0.7	1.4	2.1	2.8	3.5	4.2	5.5
Baking Chocolate (ounces)	0.23	0.5	0.7	0.9	1.2	1.4	1.9

50	60	70	80	90	100

20.5	24.5	28.6	32.7	36.8	41
6.9	8.3	9.7	11	12.5	13.8
2.3	2.8	3.2	3.7	4.1	4.6

(I appologize for the screwed up graphics, but my technical ability is less than medical talents)

As you can see, smaller dogs are at a greater risk of toxicity because of their size. It is much more likely that a small dog will get their paws on a few ounces of chocolate than a big dog will find a pound of the stuff lying around.

GI upset can occur at much lower doses.

It takes nearly 4 days for the effects of chocolate to work its way out of a dog’s system. If the chocolate was only just eaten, it is possible to induce vomiting; otherwise, hospitalization and support are needed until the chocolate has worked its way out of the system.

So, while you are curled up on the couch drinking your hot cocoa this winter, make sure to keep the candy out of your pet's reach.

Have a safe and happy holiday season

Keith Niesenbaum

www.PetsNeedFood.com

www.TheVetsChoice.com

Holiday Time and We all Need to Watch our Waists

2009-12-07T12:00:00.009-05:00

So the holidays are upon us and not a moment too soon for those of us that love to gorge on the mounds of baked goods that arrive at the office, interspersed with gooey chocolates and the occasional fruit basket. Unfortunately for the staff as well as our patients, too much of a good thing is ... well, too much. While we are watching the scales (well I am watching the scales) trying not to undo all of the good that I did training last year, our patients are not always so vigilant.

First up was the post Thanksgiving turkey toxicity rush. You know, all the dogs ( and some cats) that were able to con their owners with plaintiff looks and whines, into forking over way too much in the way of table food. These guys and gals were in all week after the holiday with vomiting, diarrhea, and the occasional more serious case of pancreatits. I must say, quite the mess.

It's not that I'm against treats in moderation, but pets that are eating a particular diet should not get rich treats from the table. Owners don't seem to realize that their pets don't know what is best for them and will eat whatever we put into their bowls or toss them from the tables. Don't do it! You know who you are.

This is also the time of year that we try to emphasize weight loss to our clients for thier pets. It is difficlut to get them out to exercise because it is getting colder and the streets can be slick. However, this is the time it is the most necessary. Since I know that you all aren't going to listen to my about not feeding treats (Oh, I know it is always the spouse/kids/parent/in law), you must work on the other side of the equation, that is calories burned. Get out for a walk with your dog twice a day. Start with 15 or 20 minutes and build from there. If it is cold and your dog seem chilled, get a sweater or a coat for your pet.

Cut out the treats, or at least cut back. Try a low calorie, but high quality diet and feed according to the label. Here is a good place to start as the site has a weight loss diet and some low fat treats. Or ask your veterinarian for specific dietary recommendations.

Remember, weight put on now is tougher to take off than weight never gained. I guess I will never have a career in platitude writing.

Stay halthy and have a happy holiday season.

With Every Season ....

2009-09-08T15:52:00.004-04:00

OK, although Labor Day weekend is not technically the end of summer and autumn is still a bit away, we all think of it as the time to pack away our white pants and leashes, and pull out our more earthy toned garb.

This September is the first time in a while that I don't have any races on the fall schedule so I took the opportunity to take a leisurely run across the George Washington Bridge to NJ and back. Too late for it to be really hot. One week to early to see the ships sail up the Hudson. Still not foliage change. Seems like I blew it, except that it was really cool. I would have taken pictures but alas and alack, no camera, no blackberry, just me, nature, some bike riders and about a thousand cars, hanging out above the river. The view was great, you'll just have to take my word for it. Cookie, bless her heart, stayed back in Washington Heights with her sister. Didn't think her little legs were up to the trip, although she would have been game for at least part of the journey.

Next weekend, it's off to the Catskills. Yes it is still too early to see the leaves change color, and no, there is still no race on my calender. However, it is the inaugural weekend of Canine Club Getaway. A weekend vacation for people and their dogs. I'm going to be the camp doctor and my wife is coming along for moral support. It should be interesting at the very least. I'm giving a lecture on canine first aid and running a fitness evaluation clinic. We will also be doing a microchip clinic and screening for Heartworm, Ehrlichia, Anaplasma, and Lyme disease. These are all insect borne diseases that we see hear on long Island.

Heartworm is spread my mosquitoes. I don't need to tell you what the wet spring meant for mosquito populations in our neck of the woods. Heck, they are bigger than some of the dogs I saw in the office today.

The others are tick borne, also a pest that seems to have enjoyed a growth explosion, exploiting what ever weather change it is that they like.

Anyway, I will be micro blogging on twitter all weekend with plenty of photos. Follow me at www.twitter.com/knvet for up to the minute details. Next week, I'll post a detailed synopsis of what went on, complete with 8 x 10 color photographs with descriptions of each on.

Keith Nisenbaum, VMD
www.CrawfordDogandCatHospital.com
wwwTheVetsChoice.com

Yet anoter Pet Peeve

2009-08-25T12:38:00.003-04:00

It seems that summer is more stressful here at Crawford Dog and Cat Hospital than other times of the year. Or, perhaps, I've just learned that venting on line in writing is better than committing violent felonies against random people in the name of maintaining my own sanity and there has been no real increase in incidents.

The latest button pushing is the dumping of cats and kittens by my back door. Now this infuriates me for several reasons.

People dump these kittens in boxes with inadequate ventilation in all kinds of weather in the back of the parking lot assuming that we will find them before the elements cause them irreversible harm. (so far the idiots are right about this one.)
People dump these kittens (oh and lets not exclude the adult cats as well) assuming that I won't just put them to sleep or send them off to the shelter where they will put them to sleep. (Don't tell anyone, but they are right about this one as well. The exception is sick animals which are humanely put down)
I spent hundreds of dollars for video surveillance cameras and a sign pointing out that there is a system in place, only to have these morons circumvent the system or keep their cars out of the field of recording so I can't get their licence plate number and call the cops and prosecute them to the fullest extent of the federal law that they are violating. I would also publish their names and photos in the local papers so that they could be humiliated.
The final infuriation, the straw that breaks the camels back, the proverbial whatever it is that pushes me over my limit, is that I am accumulating cats again.

So, here I am. Defeated by the irresponsible, reckless, potential animal abusers. Outsmarted by those that I choose to assume are idiotic, morons (much dumber than a regular moron) that dump their responsibilities on my doorstep and leave all of their pet related problems for me to solve. And now dear readers, and I know you are out there because you all told me you are, I need your help. Look at these faces. They are attached to cats and kittens that need a home. They are growing up and their cuteness window is closing.

If you know anyone that wants a kitten, FELV and FIV negative, parasite free, and current on vaccines, have them give me a holler. I'm on Long Island and these guys are ready to go. I would keep them myself, but I've done that before and I have 5 of my own living in the hospital already. Call the office at 516 746 1566 or check us out on the web by following the link above.

Keith Niesenbaum, VMD
www.TheVetsChoice.com

The Scientific Method

2009-08-18T15:05:00.003-04:00

Summer is finally here and we all have heard about the evils of leaving a pet in the car, even with the window's open a slit to keep it cool inside. Gosh, it's supposed to get hot enough to fry an egg in there. Now, if you've been following me on twitter, you know that I have been trying to figure out how to get multiple pictures in a single post. Well this little experiment is dedicated to the scientific method and multiple posts in the search of truth.

It is 90 degrees here in Nassau county and the humidity is somewhere near 90%. My car is white, as you can see above and the rear windows are covered. Take my word for it (I could only post a limited number of pictures), it was around 80 in the car with the AC on. I parked the car and put this thermometer on the dash. This reading was at 1:51 today, 10 minutes after I got out of the car.

Now, you're going to say, "yea, but that's the dashboard. What about the seat" Once again, due to photo limitations, you will have to take my word for it. The shady seat was only 100 degrees. The sunny seat was about 110. Both pretty hot, I would think. But remember, my car is white and the windows are covered. So lets move to the next car in the parking lot.

This little black beauty has been sitting in the lot all day. Windows are up and as you can see the temperature on the seat is maxed out at 120. Could be higher, don't know, didn't want to break my brand new thermometer. I know that I will have other uses for it and I don't want to cook it the first time that I play with it.

So 120, probably won't cook an egg. The car's owner wouldn't let me try. Some silliness about ruining the cloth seats with yolk. Still, way too hot for a dog. A simple experiment showing how hot it can quickly get in a car. Of course we don't know how long a dog would actually last in this environment, but something in my professional oath probably prohibits me from putting my dog into the car to find out, no matter how much she keeps my up snoring at night.

So, as you can see, no live animals were harmed during this experiment. Don't leave your pets, or kids in the car unattended. We haven't seen any cases of heat stroke and lets keep it that way.

Keith Niesenbaum, VMD

www.TheVetsChoice.com

Julie, Julia, and Niesenbaum

2009-08-14T12:10:00.004-04:00

I saw the movies Julie and Julia last weekend at it was a momentous occasion for several reasons. First off, I saw a movie in the theaters rather than from the preferred location which is via Netflix in the comfort of my own bed. The Netflix/bed option has several distinct advantages over the theater. I can start and stop the movie as needed, I can snack on my choice of foods without taking out a mortgage to pay for them, the floor is not sticky, and of course, I am in my bed, with my wife and there are no strangers to interact with. Now, movie purists would argue that I am not getting the full movie experience as the film maker intended, but that would be way to big of a digression for my animal blog.

So why am I writing about this movie at all? Well the truth is, I identify with it on so many levels that I wanted to share.

First, I am old enough to remember The French Chef television show, not just the Dan Akroyd version, but the real show. Prior to Top Chef, Iron Chef, and the rest of the crop of current TV cooking shows, I was reared on Julia and Graham, both of whom entertained me as they worked their way, imperfectly through complex recipes that I could make at home if I purchased their books and was older than 10. I loved/love cooking shows as I love cooking and eating. Hence I liked the film.

Second, much like the second main character in this movie, I am blogging. This is an exercise that sometimes feels quite unappreciated. Sort of an unrequited labor of love. You see, until recently, I felt that I was ruminating (cow reference appropriate as I continue to eat and become more bovine as time goes on) only for myself. A sort of therapy, an exercise for me and unseen by anyone. Or so I thought.

You guys are reading this. Yeah!!! Not only are people commenting on the blog (please keep them coming) but people who follow me on twitter are letting me know that they are reading as well. Unlike Julie, I'm not getting 80 comments a day, but in all fairness, she is probably a better writer than me anyway.

Everyone have a great weekend.

Keith Niesenbaum, VMD
www.TheVetsChoice.com
www.PetsNeedFood.com

That's What I'm Talking About

2009-08-12T20:17:00.003-04:00

Not that I want to gloat, but I would like to follow up on my last post about following recommendations of people that may not know what they are talking about.

I saw a dog last week as a second opinion. It was one of those cases where the first opinion wasn't wrong, the people just had a sick dog and wanted someone else to have a look at it. As a matter of fact, while I was having a look at it the first opinion veterinarian called the owner on their cell phone and actually suggested that they do a test that turned out to be the absolute correct test to do, but I jump ahead.

These nice people own a nice dog that went to their regular veterinarian because it wasn't feeling well. Turns out it wasn't feeling well because it was in liver failure. The vet diagnosed this and told them the dog had hepatitis (inflammation of the liver) Their friends said that if this dog is so sick you need to take him to see Niesenbaum (bless their souls). I examined the dog, and the blood tests the other vet had done, and looked at the x rays the other vet had taken. I also noticed a large bruise on the dog's chest. I suggested that we repeat the blood tests since things seemed to be getting worse. I added a clotting profile and a leptospirosis titer. (Link to previous post that I mentioned) First vet called and suggested we do a lepto titer (see above line). The blood count showed almost no platelets. An ultrasound showed mild to moderate liver disease and the rest of the clotting profile and the lepto titer were pending.

I started treating for the low platelet count (thrombocytopenia) and put the dog on antibiotics that would cover the possibility of leptospirosis. The dog stabilized and there was no more bruising. Guess what?? The lepto titer came back today and it was positive.

So all you pet owners that live in areas where your veterinarian tells you that there is a risk of catching leptospirosis VACCINATE YOUR DOGS! This dog almost died. It is not out of the woods yet. It exposed the staff at the previous vet hospital as well as my staff, and the family that owns this pet to a potentially dangerous disease.

Boo hoo, if it had been vaccinated it might, I mean might, have had a reaction. Most likely not and if it did, most likely very mild. It would have saved the owners thousands of dollars between the two hospitalizations. It would have kept dozens of people from getting exposed to a zoonotic disease. It would have prevented me from ranting about this topic twice in a week.

Keith Niesenbaum, VMD
http://www.thevetschoice.com/
www.CrawfordDogandCatHospital.com

A Veterinary Rant

2009-08-10T12:57:00.006-04:00

Up until now, I have tried to keep my posts educational, non-opinionated, and free of controversy. But... all good things must come to an end. I need to ventilate about one of my pet peeves, breeders that think they are veterinarians.

Now, when I started practicing, I was more easily intimidated by breeders. I mean, they would say things like my breed can't do X, or my breed needs Y. They would tell the people that they sold to puppies to that they had been breeding all their lives and veterinarians don't really know anything about (fill in the blank for the breed). I was a baby vet, never mind that I had been in school for longer than most of these breeders had been in business, but it can be difficult to convince a new pet owner that the wizened old breeder that sold them Fluffy the maltipoodoodle has had no medical training and is talking out of a hole other than their mouths. So for years I would just nod and let it drop.

Now there is a new axe to grind. I have been practicing medicine for 25 years, the last 21 as a small animal veterinarian on Long Island and I know what I am talking about most of the time. If not, I refer to a specialist that will cover the rest of the time. My Ivy League education and years of experience should count for something.

That is why I am starting to loose it every time a new puppy owner comes in and tells me that their breeder said the dog can't have a leptospirosis vaccine or it will explode or something. I know that historically, this vaccine has caused more reactions than other vaccines. But hey, every vaccine that I ever got caused at least some reaction. Ever had a painless tetanus shot? Also, in our area, leptospirosis is a real problem, made worse by the wet summer that we have had. We have had several cases of lepto this year. I know dogs that have died of leptospirosis. Oh yeah, Mr. and Mrs. Breeder, it is contagious to people as well. So let's not vaccinate these dogs and let them bring a disease into the homes of these nice people that you sold this puppy to and make everyone sick. You know I only recommend these vaccines to make money anyway, or so I've been told.

So people, pick a veterinarian you trust and follow his or her recommendations. Get your information from a reliable source that has done some research, or read some research, or at least knows what they are talking about. Don't just take my word for it, here is what the CDC says about leptospirosis. They have some idea of what they are talking about, unless you think they are part of the greater government conspiracy to over vaccinate your dog. Your veterinarian is also a good source of information. They spent at least 8 years in school learning to take care of your pet and untold hours of continuing education since graduation honing their knowledge. The years that they have spent practicing have not been for naught, they actually have learned something over the years. If you don't trust your veterinarian and think that he or she is an idiot because the breeder told you so, find a different veterinarian, or a different breeder, or you will get what you deserve in the end. Unfortunately, your pet may be the one to suffer along the way.

Keith Niesenbuam, VMD
http://www.thevetschoice.com/

Cookie Week Three

2009-08-06T14:00:00.002-04:00

So the little Shih Tzu that could is still kicking. It seems that the medication that we started her on, along with my obsessing, regular ultrasounds to evaluate her heart (by more than one veterinarian) and a cardiology consult have saved the day.

OK, maybe she is just stable and all the fussing isn't really doing anything other than make me feel better. She did have a follow up ultrasound with the Doc that helped me with the initial diagnosis. Dr. Leleonnec was kind enough to let me rush my beast down to his house on a Friday evening so that we could get the echo cardiogram. He even ruined the finish on his dinning room table with the alcohol that he used for the echo. (oops). We repeated that study last week and the disease hadn't progressed. I am trying to be good and remember to give her her medication every night. So far, success.

I also had Dr. George Kramer, a local cardiologist, have a look at her. He agreed with the echo diagnosis but thought that the condition was more chronic than I had first thought. To be fair, Dr. Leleonnec said the same thing. It appears that this is just a case of the murmur sounding much worse than the disease. He seemed to feel that exercise restriction and medication is not needed at this time. I think I'll keep her on the benazepril and not run her ragged fetching the stuffed duck. However, if she continues to keep me up at night with her bizarre sounds and snoring I'm going to feed her a bunch of salt and push her into failure I swear.

I'll keep you all posted.

Keith Niesenbaum, VMD

www.TheVetsChoice.Com

Doctor becomes an owner

2009-07-24T13:18:00.002-04:00

I think I'll digress a bit from my earlier series on cruciate ligaments and their treatments to share a bit with you all. Last week my dog, Cookie, was diagnosed with a serious cardiac disease. We can talk about the specifics in future posts but for now I just thought I would use this forum to let some people know what is going on with her. She is well known by my clients as well as my friends as she comes to work every day and camps out behind the front desk in the hospital. She is always with me as she has a bit of separation anxiety and hates to be alone. If you take a look at our web page, there is a shot of her in the community section sitting on my gym bag at the Pet Expo last year.

On Friday, she was sitting behind the front desk, acting normally, when Kate picked her up to show to a client. She immediately noticed that her chest was vibrating. What she felt was a grade 6/6 systolic murmur, associated with her mitral valve. I called in a favor that night and ran her over to my friends house. A quick echo cardiogram on his dining room table revealed the severity of her condition. We immediately started her on cardiac medications and I have a call in to see if there is something that we can do surgically to correct the defect. I'm not sure that there is.

The good news is that other than slowing down a little bit, she is not aware that she is so ill. We had a ton of company over the weekend and she handled it quite well. Her appetite is good and she is still eager to come to work each day. Needless to say, the family and my staff are devastated. I will try to keep everyone up to date, and if people are interested, we can also discuss the specifics of her condition here on the blog.

Treatment for ACL injury

2009-06-23T14:13:00.012-04:00

So I still haven't mastered posting multiple photos to the blog, but fortunately I do know how I do this surgery. There are many ways to repair an injured ACL in a dog but this is the way I have been doing it for years with very good success. First the meniscus cartilage, which is not visible in this picture, needs to be inspected and removed if damaged. Then the remnant of the ACL is removed along with any cartilage buildup that will interfere with joint function. The joint is flushed, and closed. I then inject some local anesthetic into the joint before we go on to stabilize the knee.

The photo below shows the knee joint closed and the lateral stabilization suture in place. I use a large nylon suture and a crimp instead of a knot to hold it.

You can see the crimp on the suture. In this dog, a large dog, a second suture is place to insure stability. The skin is closed and we use ice and IV pain medication in the immediate post op period to reduce pain and swelling. We also treat the joint with a laser immediately post op and the next day to speed recovery.

There are many different techniques to repair cruciate injury. Many people will advocate one over another. I have found this approach to be straight forward and easy on the patient. It is also less expensive than some of the other repairs. I have tried to balance outcome and cost so that we can help as many dogs as possible. For clients that request it, we are fortunate enough to have many referral hospitals where surgeons can do the more technically difficult procedures such as tibial plateau leveling and tibial crest advancement if it is indicated.

In the next posts, I'll address post op care, rehab for stifle joints and long term treatment of the degenerative disease of the stifle joint.

Keith Niesenbaum, VMD

http://www.crawforddogandcathospital.com/

http://www.thevetschoice.com/

http://www.petsneedfood.com/

Why is my dog lame?

2009-05-11T11:06:00.013-04:00

So I was out running the Long Island Half Marathon with a couple of members of Team Crawford, our unofficial hospital running team, and had plenty of time to reflect on knees. I saw old knees, young knees, normal knees, knees with braces, ... you get the idea. Runners have plenty of knee issues. I'm at the age where many of my friends have had surgery on their knees for either meniscus damage or cruciate ligament injuries. So this problem is common in active older people as well as in dogs. The thing is, the nature of the injury is different in dogs and people, although the clinical signs (pain, swelling, lameness) are the same.

In people, injury to the ACL (anterior cruciate ligament) is usually a traumatic injury. You know, the tennis ball goes one direction and your knee goes the other. In dogs, ACL injury is usually a degenerative injury. The difference is subtle but important. In people, the ligament is often normal and is injured by the trauma. In dogs, the ligament is abnormal, and although the lameness is often proceeded by a perceived trauma, most often this ligament was going to pop sooner or later. The implication of this distinction is that the other ligament is often bad as well. So dogs with an injury to one ACL are at a much higher risk of tearing the ligament in the other knee.

Once the knee is destabilized by a torn ACL, other horrible things can happen in the joint. If you remember from the last post (It's OK, take a second to look back at the beautiful pirated photo of the knee model) there are other structures in the joint. That soft cushion of cartilage, the meniscus, is often torn at the time that the ACL goes. (see the illustration below) This causes more pain than the torn ligament sometimes. Knees with chronic partial tears can cause intermittent lameness. These knees tend to develop pretty bad arthritis over time.

Next post we'll talk about some options for treatment and possibly things we can do to minimize the undesirable effects of this condition. Until then, you might want to check this out to help your pet's joint health. Many runners I know use similar supplements designed for people, why not use one designed for dogs. I also know dogs that use Omega 3 fatty acids for arthritis. It is the major active ingredient in many joint diets, but in far too small a quantity. Here is a great way to get enough of a really good thing for you and your pets.

Keith Niesenbaum, VMD

http://www.thevetschoice.com/
http://www.crawforddogandcathospital.com/

What the H_LL is the ACL

2009-05-04T22:20:00.004-04:00

OK, things got out of hand at work and I slipped back into an old pattern and I haven't posted for a while. I guess that when I decided to write about cruciate ligament injury in the dog, I found the topic so overwhelming that I just avoided the entire project. So, I'm going to divide it up into several smaller posts and the task will be easier for me to tackle. This post will deal with the ligament itself, and an explanation of some of the anatomy of the knee.

The knee is a pretty remarkable joint. The photo shows a model looking at the knee from the front. The joint, is a hinge, designed to flex and extend in one plain of motion similar to the way a door hinge opens and closes. It also has some very amazing shock absorbing principles, that allow us to run and jump. The joint runs into real problems when we ask it to do things it isn't designed to do like rotate, or hyper extend beyond it's normal range of motion.

There are extra articular structures (outside of the joint) that keep the knee stable. The muscles of the thigh that cross the joint and several collateral ligaments that do the same. You can see these collateral ligaments on the outside of the model.

Inside the knee, there are two cushions of cartilage, called the menisci. The medial meniscus on the inside and the lateral meniscus on the outside. They are labeled in the photo above. Finally, making a cross in the center of the knee are the two cruciate (cross) ligaments. The anterior (ACL) and caudal (CCL) cruciate ligaments. These guys keep the knee from sliding forward and backward. In fact the instability caused by injury to the ACL is called anterior drawer sign because when the muscles are relaxed you can actually pull the tibia (shin bone) forward like a drawer in a desk.

So now we all know where everything is. Next post I'll talk about what can happen to these structures. Then finally, we'll get around to explaining how they can be fixed.

Until next time, check us out at:

www.TheVetsChoice.com

www.CrawfordDogandCatHospital.com where you can search our library for free information

Feline Stomatitis

2009-04-10T13:48:00.004-04:00

I just watched my associate finish a dental procedure on a very painful mouth that looked a whole lot like this one. Since I missed Pet Dental Health Month, (not yet blogging regularly) I wanted to share this with everyone so that hopefully your pet will not have to go through such a prolonged, painful course of disease before you seek treatment.

Feline Stomatitis, is a painful, inflammatory condition of the mouth. We are not sure why some cats get this condition. Some veterinarians think that there is a chronic viral infection with Calici virus. Others think it is from chronic poor dental hygiene. Still others think that it is an over reaction to the tarter, plaque and bacteria, found in the cat's mouth. One thing most veterinarians agree on is that there is some sort of immune system over reaction in the oral cavity. If recognized early, stomatitis can sometimes be controlled with frequent dental cleanings, anti biotics and a stringent home oral care program. Once the cat's mouth looks like the one in this photograph, the only treatment is surgical..

In the case of our kitty today, he was admitted for blood tests, general anesthesia, a good dental cleaning above and below the gum line and dental radiographs to evaluate the extent of dental disease. Then all affected teeth (most of the uppers as well as a canine_ were extracted. He will be sent home on anti biotics and some oral rinses and we will recheck him in two weeks. If we are lucky, the mouth will heal well and we can control this disease just by having the owners take care of the mouth at home.

To have success, we must make sure that radiographs are taken and no roots are left behind under the gum line. In many cases, this treatment is not aggressive enough and we have to go back surgically and remove all of the teeth and diseased bone. Long term anti biotics follow the oral surgery. There have been many reports of cats doing very well once all of the teeth have been extracted and the diseased tissue removed.

The most common objection I get from clients is their fear that their pet won't be able to eat with no teeth. In fact the cats do better after treatment as their pain has been alleviated. Some will still eat dry food, but we try to get most onto a diet of canned cat food.

You should check your cat's mouth regularly and call your veterinarian if you see any signs of redness, swelling or bleeding from the gums. If the cat chatters it's teeth when you are looking in, then the mouth is painful and needs immediate attention. Your veterinarian should examine your pet's mouth as part of the regular physical examination and let you know if anything needs to be done to keep the oral cavity healthy,

Dental health is a team project. Good nutrition, regular dental care, and home care with observation will keep your pet's smile intact and breath fresh and clean.

Keith Niesenbaum, VMD

http://www.thevetschoice.com/

http://www.crawforddogandcathospital.com/

Heartworm Infections in Dogs and Cats

2009-04-01T13:42:00.006-04:00

The diagram to the left (still working on images on my posts but I seem to be getting better at it) shows the life cycle of the heartworm parasite in the dog. There is an important distinction between dogs and cats but we'll get to that later.

Remember posts ago, I said that I like to have my pets on year round parasite prevention. It's not for the heartworm, because as you can see, the vector/intermediate host is the mosquito and there are none around in the cooler months here in NY. Those of you in the south need to talk to your vets about heartworm season. We keep our pets on parasite control all year round because of intestinal parasites.

The infected mosquito bites our pet, our us (although people are rarely infected as our immune systems take care of the problem) and the parasite goes through development and matures to an adult. Males and females live in the heart and the large vessels of the lungs. They mate and baby worms (microfilaria) are released into the blood stream to be picked up by the next mosquito and the cycle continues. The time from infection to microfilaria in the blood is about 7 months, so when your pet is tested this spring (and the American Heartworm Society recommends testing all dogs yearly even if they are on preventatives) we are really looking for last year's infections. In cats, the worms do not really mature as well and we often see single sex infections or no adults at all, but in a moment we'll discuss why this disease is still important in our cats.

In dogs, the most common clinical signs that we see are those associated with congestive heart failure. Large masses of worms are in the heart and obstruct blood flow. I thought I could post a photo of a heart with worms, but It seems that if I try to upload more than one image per post it just stacks them at the top of the post and it doesn't look right.

In cats, we see respiratory disease or sometimes just sudden death. The syndrome was recently identified and named Heartworm Associated Respiratory Disease or HARD. Many cats with chronic coughs have had previous infections with heartworms.

In both species it is easier to prevent disease than to treat them. We have already reviewed different medications and your veterinarian can recommend one that he or she feels is best for your pet.

There is no treatment for cats. We have to wait for the parasites to die and hope that they don't kill the cat first. Seems like a good reason to put them on prevention. We did a massive screening test on our feline patients about 5 years ago, sponsored by Pfizer (the manufacturers of Revolution) and found several cats that had heartworm exposure and one that had active adult infection. Interestingly enough, indoor and outdoor pets were equally affected. I guess those screens do have some holes in them.

In dogs the treatment involves hospitalization and treatment with several injections of an arsenic compound. Some dogs cannot withstand the treatment and some are left with permanent damage to their hearts and lungs. If caught early, most will respond OK and go on to live happy lives. But it seems given all we have talked about concerning our options, that prevention is the way to go.

I'm going to try to post some interesting cases that I've seen in the next couple of weeks. However, you all know that I can get distracted. Until then, follow me on twitter at www.twitter.com/knvet and check out our web sites.

Keith Niesenbaum, VMD

www.TheVetsChoice.com

www.crawforddogandcathospital.com

Great Opportunity

2009-03-27T23:20:00.002-04:00

Would You Like To Get Your Pet Food For Free & Earn Extra Income?You are invited to attend a special conference call to learn how you can get your pet food for free and earn extra income!

Don't let a bad economy get you down! The pet business is BOOMING! People will spend anything on their pets and only want the very best for them.Find out how YOU can be a part of the booming pet industry!

The Purr-Fect Business For Pet Lovers And Pet Professionals!•Trainers •Groomers •Breeders •Kennels •Pet Sitters •Dog Walkers •Veterinarians •Daycare Operators •Shelter Workers and olunteers •Animal Rescue Operators •Emergency Service Professionals (K-9 and rescue units)

Date: Monday, March 30, 2009
Time: 8:00 PM EST
Phone Number: 616-347-8200
Passcode 800479#
Contact: Keith Niesenbaum, VMD
Phone: 516 746 1566
http://www.thevetschoice.com/

FLEAS!! And what to do before you burn your house to the ground.

2009-03-25T10:34:00.005-04:00

I know it is probably bad formatting to start with a picture, but I want some credit for being able to post an illustration at all. Now I'll explain it.

The adult fleas live on our pets, they take a blood meal (bite the pet) and then mate and the female lays eggs. These eggs may stick to the pet, or fall off into the environment. They hatch and molt and develop into larvae. These in turn make a cocoon and pupate. The pupae then mature into adults, hungry for a blood meal and the whole cycle starts again. How long does this cycle take? It depends on the environmental conditions, but if things are just right they can go from adult to adult in a couple of weeks. Even more ominous, the pupal stage can survive for months in the environment, hatching out when conditions are right.

This life cycle is important to understand because it will help you to prevent flea problems and aggressively treat infestations if you missed the opportunity to prevent the problem.

Prevention is easy. Monthly application of a topical flea product that not only kills adults but prevents the immature stages from developing will keep your pets and your home flea free. We recommend Frontline plus or Canine Advantix for our dog patients. These pets are on monthly parasite control (see previous post) so we don't need to worry about worms or heartworms (see next post). For cats we recommend Advantage Multi or Revolution. You can use a product that is only for fleas and ticks, but if you are going through the trouble to use a product for fleas, why not take care of internal parasites and heartworm disease at the same time. Yes, cats can get heartworm disease but that is for a future discussion.

Now if you were naive enough to think that your pets would never get fleas and your house is now infested with the pesky buggers, you have to deal with the fleas on the pets, and the fleas in the environment. I no longer recommend owners treating the surroundings themselves. Gone are the days of setting foggers off in the home and contaminating the environment with toxic pesticides. If you have a severe infestation, use a professional exterminator.

In moderate to severe infestations, you can still get by without dumping poisons into the living room. Use a quick kill product such as Capstar that you can get from your veterinarian. This will kill all of the adult fleas on the pet in less than 24 hours. Unfortunately it doesn't last so new adults will jump on. I have clients use it every 2 days while we are getting a problem under control. Then add a topical product to every pet. This will continue to kill fleas as they jump on the dog or cat. The growth inhibitors will also control fleas in the environment where the pet spends most of its time (the pet bed or corner of the run where they sleep.)

Vacuum the house well and throw out the bag when you are done. Wash all bedding in warm water. You can use an area spray for the highest traffic areas. If you are going to bath your pet, do so before you put the topical products on, no sense in washing them right off.

Now I know you are going to think, I can get a cheaper product from the pet shop. Fight the temptation as not all of these products are as safe or effective as those that your veterinarian will have on hand. In addition, the person advising you at the store may not be well trained and could possibly give you incorrect advice.

And why is it important to treat these fleas? Well besides the fact that they are gross and icky, they can cause disease in people and pets. I have seen dogs and cats actually die from anemia as these parasites suck the very blood from these poor animals. What a horrible way to die. They are also vectors for diseases that can infect both people and pets. If you follow this post, you already saw the link to Ted Nugent last week.

Next post I'll finish this series with a discussion of heart worm disease in dogs and cats. Hopefully by then I'll be able to put my graphics in the middle of my post.

Keith Niesenbaum, VMD
www.TheVetsChoice.com
www.CrawfordDogandCatHospital.com

Worms

2009-03-20T13:48:00.004-04:00

As promised, here is the second post in a series of four on pet parasites. I picked the generic title to try to titillate the search engine spiders in an attempt to get more readers.

Intestinal parasties, or worms, are parasites that live in our pets' (you guessed it) intestines. They are important because not only do they cause disease in our pets, but some of them are zoonotic, meaning they can cause disease in people as well. This is why we emphasize regular fecal tests, parasite control for all dogs and cats, and prompt treatment when worms are found. At Crawford Dog and Cat Hospital, we follow the recommendations of the Center for Disease Control as Outlined by the Companion Animal Parasite Control Comission. Their website will provide excellent information on different parasites, their life cycles and more in depth descriptions of each worm.

Well how can my pet get worms? "My cat never goes outdoors", or "my dog doesn't even like other dogs". Many pets are infected long before they came to live with youl. Both round worms and hook worms have very short life cycles and can infect puppies and kittens in the uterus, before they are born. Most treatments, do not kill all of the larval stages of these worms, so even if your fluffy one has been dewormed, only the adult worms were killed. The larval forms will continute to mature and eventually shed eggs into the environment. Potentially re-infecting the pet or exposing the people in the home to parasite infections as well. This is why you need to deworm them multiple times if they are infected.

Older pups and kittens can be infected through their mother's milk. And after weaning, pups and people are at risk of infection from microscopic eggs in the environment. It is very important to clean up pet wasted before these eggs mature. In the south, it is very important not to walk bare foot where hookworm larva may be in the soil.

The curious thing about round worms and hook worms, is that they can lay dorment in their animal hosts for years. That's why it is important to test all pets regularly and use some sort of preventative. These dorment infections can become active later in life, so the mature cat that is walking on the kitchen counter can have rondworms eggs on it's feet, even if it hasn't been outdoors for years.

Prevention and detection is easy. Regular fecal examinations are a must. Twice a year for dogs and cats that go out. Yearly for cats that have tested negative in the past and haven't been outside for years.

All dogs should be on a monthly parasite control medication such as Heartguard, Advantage Multi, or Sentinel all year long. (that's 12 months of the year) This will prevent heartworms, control intestinal parasites (treat them with some of the products) and some of these products will help to control fleas as well. (fleas will be the topic of an upcoming blog post).

All cats should be on montly parasite control programs as well. We recommed Revolution or Advnatage Multi for cats. Ideally all year long, but for indoor cats, 6 months of the year is probably adequate. These products also control fleas, a source of the bacteria that causes cat scratch fever, the bacterial infection, not the Ted Nugent song.

So we can live safely with our pets. Just keep in mind that prevention beats the crap out of treatment and disease, especially when it comes to intestinal worms. Next post, we can talk about flea control as the weather hopefully starts to get warmer here in the Northeast.

Keith Niesenbaum, VMD
http://www.crawforddogandcathospital.com/
http://www.thevetschoice.com/

Parasite Control 1 of 4

2009-03-16T20:09:00.003-04:00

I have been trying to keep my hospital staff trained on the topics of parasite control and prevention in our pets. Here is a summary of what I tell them, regularly this time of year.

I divide our parasite control program into 4 parts. We emphasize prevention over treatment, and I tell them and our clients that there is no one product that can control all 4 parts. The trick is to determine a particular pet's risk factors and create a custom program to keep everyone healthy.

Today we'll talk about ticks. Here on Long Island, ticks are an important vector of disease. Not only are they gross (non-medical term) but they transmit the bacteria that causes Lyme Disease, Ehrlichia, Rocky Mountain Spotted Fever, and anaplasmosis. In other areas of the country they can carry other things as well. Many of these diseases are contagious to people as well as dogs and cats.

There are several different species of ticks, and they vary in size and appearance. For a good set of pictures of ticks in their different life stages follow this link. Suffice it to say, different life stages carry a different risk of disease transmission.

With ticks, prevention is the key. Once a kennel or home is infested with ticks, good luck getting rid of them. Also, preventing tick attachment is the best way to prevent disease transmission.

Several tick myths debunked:
1. Ticks do not burrow under the skin and disappear into the host animal. They do feed, engorge with blood and drop of into the environment to moult to the next life stage.
2. The best way to remove a tick is to hold a match to it. Actually, the best way to set your pet on fire is to hold a match to the tick. You can coat the tick in Vaseline as this will block it's breathing pores without the risk of combustion. Or, using a tweezers,gently grasp the tick behind the head, and applying gentle traction, pull it from your pet's skin. Here is one of several tick removers you can use. (Disclaimer: I have not used this particular product and am not associated with the company in any way)
3. You can get ticks off your dog by soaking it in motor oil. See above for combustion comment. If you really think this is a good idea, we need to talk, I mean really talk.

Prevention is much easier than it used to be. In the old days, OK when I graduated from school, we used smelly, relatively toxic dips. Now there are several products on the market that work very well. We recommend and sell Canine Advantix for use on dogs and Frontline Plus for use on dogs and cats. Both are applied monthly, have good residual activity against fleas and ticks (another post on Fleas will follow) and are safe for your pets. They can be purchased from many sources, but the best place is from a veterinarian or a veterinary supervised source as the product can be assured to be dated well and safely stored. Use as directed and contact your veterinarian if you have any questions.

Next post will be on internal parasites you know, icky WORMS.

Keith Niesenbaum, VMD
http://www.crawforddogandcathospital.com/
Life's Abundance Field Representative

Seizures in Pets

2009-03-14T09:17:00.002-04:00

This is an article that I borrowed from a friend of mine, Judy Bishop. I have reviewed the information and with only minor editing changes have posted it here for my readers so that you can have exposure to some very important information.

Seizures in pets are scary, but very treatable. You feel helpless, hopeless and panicked when watching it happen. What should you do if you suspect that your pet has had a seizure? What are the treatment options and prognosis? When are seizures an emergency? In some cases, your dog or cat may not need medication, but there are things you should know about epilepsy and seizures in pets and what you can do to keep you and your pet safe. What is a seizure? Although seizures are often thought of as dramatic events, there are a number of different types of seizures, some of which may appear to be quite subtle. A generalized seizure (Also known as grand mal seizure, fit or convulsion) generally causes an acute decrease in state of consciousness, repeated movements of the body, excessive salivation, vomiting and often a loss of bladder and bowel control. This event may last from 30 seconds to a few minutes. It is generally followed by a period of drowsiness, difficulty walking or seeing as well as changes in behavior which can last around 24 hours. This is known as the "Post-Ictal" period.The other main type of seizure is a focal motor seizure which is a much less dramatic occurrence. A focal motor seizure will cause just a repeated twitching movement in either the face or limbs and usually only lasts a few seconds. These type of seizures may often go unnoticed especially if they involve fairly innocuous movements like swallowing. Seizures are one of the most frequently seen neurological problems in pets. A seizure is also known as a convulsion or fit. It may have all or any combination of the following:1. Loss or derangement of consciousness2. Contractions of all the muscles in the body, stiffness, or sudden, violent shaking, muscle twitching or slight shaking of a limb.3. Changes in mental awareness from non-responsiveness to hallucinations, including staring and altered vision.4. Involuntary urination, defecation, or salivation5. Behavioral changes, including non-recognition of guardian, viciousness, pacing, and running in circles. A seizure may last from one to five minutes. Afterwards, the pet may seem exhausted, confused and disoriented.What causes seizures in pets?Seizures can be caused by numerous things - poisons, skull injury, viral and bacterial infections, congenital malformations, heat stroke, parasites, fungal infections, low blood sugar (diabetics), and so on. By doing a physical exam and blood work, most causes can be eliminated. Seizures occur because of a change in the electrical activity of the brain. This can be caused by a variety of things including diseases of the nervous system and the brain itself such as epilepsy. Seizures may also be the result of a blow to the head, chemicals, poisons, fever and even nutrient deficiencies such as calcium deficiency in nursing mothers.What are the three phases of a seizure?Seizures consist of three components:1) The pre-ictal phase, or aura, is a period of altered behavior in which the dog or cat may hide, appear nervous, or seek out the guardian. He may be restless, nervous, whining, shaking, or salivating. This may last a few seconds to a few hours.2) The ictal phase is the seizure itself and lasts from a few seconds to about five minutes. During this period, all of the muscles of the body contract strongly. The pet usually falls on his side and seems paralyzed while shaking. The head will be drawn backward. Urination, defecation, and salivation often occur. If it is not over within five minutes, the animal is said to be in status epilepticus or prolonged seizure.3) During the post-ictal phase, there is confusion, disorientation, salivation, pacing, restlessness, and/or temporary blindness. There is no direct correlation between the severity of the seizure and the duration of the post-ictal phase.Is your pet in trouble during a seizure?Despite the dramatic signs of a seizure, the animal feels no pain, only bewilderment. They do not swallow their tongues. If you put your fingers into his mouth, you will do no benefit to your pet and will run a high risk of being bitten very badly. The important thing is to keep the animal from falling and hurting himself. As long as he is on the floor or ground, there is little chance of harm occurring. If seizures continue for longer than a few minutes, the body temperature begins to rise. If hyperthermia develops secondary to a seizure, another set of problems may have to be addressed.What is the conventional treatment for seizures? Treatment for seizures is directed at the underlying cause or disease in cases where this is known. Anti-epileptic drugs such as Phenobarbital are commonly used to prevent seizures which are severe or occur frequently.When should I consult my pet’s veterinarian?Seizures are frightening to witness. Stay calm. Try to time how long the seizure lasts. First thing to do is to stay clear. Seizing animals may bite (without knowing it) and trying to hold them down may cause injury. They will not 'swallow their tongue' as you may have heard. Keep fingers away from the pet's mouth. Remove any objects in the area that can injure the animal.Call your vet. With the first seizure, the patient receives a full physical exam, laboratory work up including blood tests, urine analysis, and sometiems an EKG -- seizure control medications usually wait at this point. UNLESS the first seizure is a severe cluster seizure (several happening at once) or a continual seizure called Status Epilepticus, this is a medical emergency. If anything is found on physical or blood work that may cause seizures, the underlying conditions will be addressed and treated. It is important to seek medical care for your pet if he/she has more than one seizure per month, has changed behavior in between the seizures (Excluding the “Post-ictal” period directly after the seizure) or becomes generally lethargic, has difficulty in walking or refuses food.What should I do if my pet experiences seizures?While the owner should keep a diary of when/where the seizures occur, how long they last, was the animal acting strangely/doing any activity in particular before the seizure, and how long after the seizure did it take for the animal to be 'normal'. This may provide clues if a pattern is noticed.There are definite seizure triggers for some animals, and if they can be identified, the number of seizures can be reduced if the trigger (activity, excitement, etc.) can be avoided.What can be done to prevent future seizures?Veterinarians generally prescribe 1-2 weeks of anticonvulsant therapy and then re evaluate the pet. The next treatment is determined by how long it takes for another seizure to occur. That may be days, months, or years. At some point, many animals have seizures frequently enough to justify continuous anticonvulsant therapy other times, medication can be gradually discontinued under veterinary supervision. Veterinarians usually do not recommend medication until seizures occur about every 30 days or unless they last more than five minutes.It is important to avoid sudden discontinuation of any anticonvulsant medication. Even normal dogs and cats may be induced to seizure if placed on anticonvulsant medication and then abruptly withdrawn from it. Your veterinarian can outline a schedule for discontinuing the medication. A prevention plan is a simple method of enhancing the level of nutrition and making lifestyle changes. It is an attempt to address any special needs your pet may have. Rule out other health problems such as Thyroid, Diabetes, Cancer, Liver or Kidney disease. A health problem may be triggering seizures. Over the past decade, natural approaches have been found to be helpful in some patients, either prior to stronger medications or in addition to them, so that you may not need as high a dose. Feed High Quality Food. Poor nutrition is a direct cause of many major and minor diseases. Therefore, a commitment to optimum health and longevity for your pet must include a high quality diet. Research has shown that a low quality diet -- meaning a diet loaded with chemicals, fillers, stabilizers, coloring agents, sodium nitrate (found to produce epileptic-like changes in the brain activity of rats who ate it regularly) and by-products -- can lead to allergies, nervousness, hypertension, diabetes, weight problems, dry skin, and many other common ailments. Because of what goes into pet foods today and what does not, it is important to know how to read labels, and know the history of the company manufacturing the pet food. We recommend HealthyPetNet Life's Abundance Premium Food for Dogs and Cats. HealthyPetNet products use high quality ingredients -- healthy ingredients that are useful to your pet's body. It is essential to choose a high quality food. It is also important to supplement your pet's food. This is important, since every animal is unique and has different nutritional needs. Even healthy dog and cat food may not provide all of the vitamins and minerals your pet demands. Differences in pet age, surroundings, exercise level, and genetic makeup produce animals with widely varying needs. Some dogs and cats may need a quality supplement in addition to a quality food. We recommend HealthyPetNet All Natural Dog and Cat Supplements.

I would like to add that dogs with seizure ddisorders can lead very long and happy lives. It is important to find and treat any underlying disese, improve the baseline health status of the patient by optimizing nutrition and minimizing environmental stresses, and control serious or frequent seizures with medications.

For more health care information check out our practice web page and follow our blog. We look foward to your comments and suggestions on this and future posts.

What you need to ask your veterinarian

2009-03-10T16:00:00.003-04:00

This post is taken from the notes I made in preparation for a presentation on Thursday morning. I am a member of BNI international and each week, a member gets to give a presentation about their business.

I want everyone to think about their veterinarian, specifically, ask yourself if you like your veterinarian. If the answer is no, then this is a short discussion and you have to ask yourself why you still go there. If the answer is yes, or yes, but, then you should ask why you like your veterinarian.

Some people will answer that the doctor is nice, or he/she loves animals. The hospital is pretty, or modern. The facility is clean, and there is no smell. The staff is courteous and helpful. These things are all important, and they are things that you can see and make a judgment on. You certainly don't want to go to an animal hospital that is dirty, or smells bad. You don't want to go where the staff or doctors seem to be unhappy, or don't seem to like animals. But what you can't see, or know, is what goes on once you leave the exam room.

Even in the exam room, you should have a good interaction with the doctor and staff. Do they ask about your pet? Are recommendations made specifically for your pet and it's lifestyle (more about this in a future post), or do the recommendations seem canned and applied to all animals? Do they do a complete physical examination, looking into your pet's eyes, ears, and mouth? Is the chest listened to with a stethoscope and is the abdomen carefully felt for abnormally sized organs or tumors? Are the medical records complete, legible and can you get a copy if you want it? Are all of your questions answered?

While you are asking questions, there are some other things you want to be aware of. If the pet is going to be anesthetized, who will monitor the anesthesia. In NY State, only veterinarians, and Licensed Veterinary Technicians (LVT) can administer medications, anesthesia, and monitor anesthesia. Do they have monitoring equipment? In our hospital, a LVT monitors anesthesia using several machines, keeping an eye on the heart rate, respiration, the oxygen saturation, and body temperature. It looks like a scene from ER, your pet is hooked up to many monitors so that we can do our best to assure a successful outcome.

During anesthesia, do all pets have an IV catheter placed, and do they get fluids to help support them during anesthesia? What types of medications are used and is the pet intubated to maintain a safe airway.

Does the hospital have an in house laboratory for running blood tests. At Crawford Dog and Cat Hospital, we have a complete in house laboratory. This enables us to run blood work the morning of surgery to make sure that everything is OK. It also allows us to get results back for sick pets in under an hour, so that a diagnosis can be obtained and a treatment plan formulated. If your veterinarian does not have an in house laboratory, how long does it take them to get back blood test results? This could be important if your pet is critically ill and time may make a difference in the outcome.

Now I know that everyone assumes that the surgery suite is sterile and clean, but it is important to make sure that the operating room is an operating room and used for nothing else. Here is a picture of ours :
http://www.crawforddogandcathospital.com/site/view/102351_SurgerySuite.pml In addition, ask if a clean sterile pack is used for every procedure. One would think, "of course", but I assure you that this is a place that many low cost clinics keep their overhead down. They re-use packs for multiple surgeries.

The technique for performing surgery is very personal. We use a laser seen here http://www.crawforddogandcathospital.com/site/view/102352_Laser.pml because we feel there is less bleeding, less pain, and a faster return to function. Many practices use scalpels, and this is fine, both are just a way to cut tissue. The important thing is that the surgeon be comfortable with what he/she is doing. It is also important that adequate pain control measures be taken. Yes that's right, surgery hurts dogs and cats just like it hurts people, and all of our pets should have pain medication after surgery.

Speaking of some painful procedures, remember your last visit to the dentist? Now I'm not talking about a simple tooth cleaning, although this needs to be done for our pets regularly. I'm talking about extractions, tumor removals form the gums, or even root canals. Dentistry, including cleanings, cannot be done with the dog or cat awake. It is impossible to safely, and effectively evaluate and treat dental disease above and below the gum line in an awake pet. In addition, dental radiographs should be taken, just like when you go to the dentist. See? http://www.crawforddogandcathospital.com/site/view/102350_Dentistry.pml

Everything that we talked about for surgery and anesthesia holds true for dental procedures as well. Adequate monitoring, good technique, competent, trained staff, appropriate well maintained equipment, and post procedure follow up including pain medication when indicated.

I hope that this little glimpse into the workings of our hospital will give you an idea as to what you need to be aware of when selecting a veterinarian for your pet. Check out our full web site at www.crawforddogandcathospital.com, especially the library page where you can search for articles written by specialists about a variety of topics concerning your pets health. We will be posting on this topic again in the future, so follow this blog for more information. You can also follow me on www.twitter.com/knvet for less detailed postings about our day to day activities here at the office and on the road.

Keith Niesenbaum, VMD
Crawford Dog and Cat Hospital
Garden City Park, NY

The Youth of America

2009-03-02T12:24:00.003-05:00

So two posts in a week. Must be the bad weather here in New York. Regardless, I had an excellent experience yesterday and I wanted to share with anyone that happens to be out there. No I'm not talking about the run in Riverside Park along the Hudson River, although that was spectacular as well. I'm talking about the New York City Science and Engineerig Fair at City College.

What? you might ask. I know I did when I signed up to judge at the preliminary rounds. Ididn't even know where the campus was (135th street and Amsterdam Ave) That's right, it is Harlem. But boy is it a beautiful campus. http://portal.cuny.edu/portal/site/cuny/index.jsp?front_door=true

There were 400 high school students with science projects on all topics. Some were quite well done, some, not so much. All of the students were very energetic and proud of the work that they had done. I judged animal science projects (6 in all). Makes sense I guess, although next year I might ask if I could do health and medicine. Each student presented their research project, the hypothesis, the experiments they designed, their reults and conclusions. I think I was more nervous than they were. The six projects that I had to judge were all quite good and the kids seemed proud of their accomplishements. The top 25% from each group will advance to the finals later this month. I am going to try to make it to that competition as well and I hope to see the six students that I met there as well.

I don't know if they are accepting judges for this year's finals or not, but if you have a science background you should look into this for next year. http://collegenow.cuny.edu/sciencefair/judges/

Don't forget to check out our practice web page at www.crawforddogandcathospital.com and our on line site at www.petsneedfood.com.

I may be getting the idea

2009-02-27T20:33:00.002-05:00

I think I am finally getting my head around this entire networking thing. I have been exposed to Linkedin.com as well as twitter and see the value of expanding our presence on the web. Of course, this takes time and the majority of my time needs to be dedicated to the hospital, which has been quite busy the past couple of weeks. I am going to try (I know, I've said this before, but as no one was listening, it didn't matter until now) to post regularly.

We have seen several cases of pancreatitis in both dogs and cats in the past week. As I explained to my kids when they were small, "itis" means inflammation. Pancreatitis is inflammation of the pancreas.

This little organ serves two major functions. First it makes insulin so that we can utilize carbohydrates as an energy source. Insulin helps the body drive glucose (sugar) into the cells. Without adequate insulin, you got it, the animal becomes diabetic. That is why diabetic animals need insulin injections. (maybe we can talk about diabetes another time).

The other function, the exocrine function, involves the secretion of digestive enzymes into the small intestine. These enzymes, amylase and lipase, help the body to digest our food. In pets with pancreatitis, these enzymes leak out of the pancreas. OUCH! This painful condition causes loss of appetite, lethargy, and vomiting. Dogs and cats can become quite ill during acute episodes and without aggresive intervention, can become dehydrated. In severe cases, prolonged hospitalization is needed as patients cannot eat or drink anything. Sometimes it can be fatal. In chronic cases, there is enough damage to the pancreas that it cannot make enough insulin and the pet becomes diabetic.

The diagnosis is made with a complete physical exam and blood work. It two of the three cases we saw this go round, we also got ultrasounds to look at the pancreas and give us an idea of how serious the disease was. The jury is still out on all three cases.

One dog, a little (ok, not so little, this guy weighed in at over 20 lbs) Lhasa Apso, was admitted and responded very well to IV fluids, pain medication and anti emetic medication. Another case, a Golden Retriever, was treated as an outpatient at the owner's request. Today he was not vomiting but was still not eating normally and was acting lethargic. The third case is a cat that is not doing well. This big guy weighed in at 20 lbs as well. Right bigger than a dog. It presented initially two weeks ago as a diabetic and resonded to insulin but soon regressed and stopped eating. Now we have a full blown acute attack of pancreatitis. Severe enough that the cat has hematology abnormalities and we needed to add steroids to it's treatment program, a problem in diabetics. Today she started eating, and the sugar is in the normal range. Steroid dose is stable and the blood count is stable as well. Hopefully, we will be able to get this guy under control and home to mommy in short order. Stay posted and we will let you know how it turns out.

Follow my short updates at www.twitter.com/knvet. Check out our web page at www.crawforddogandcathospital.com, and check back here regularly. And let me know if there is anyone out there.

A sad day at Crawford Dog and Cat

2008-12-03T20:33:00.002-05:00

We had a busy but somewhat sad day at work today. We started with someone that was watching their brother's dog call in to say that the dog had died suddenly last night and wanted to know if we could do a necropsy examination to find the cause of death. These are often unrewarding and I am often reluctant to do them as they cost the client a fair amount of money and are inconclusive as often as not. Not so the case this time. This poor dog was a golden retriever and they are very prone to cancer. I was relatively certain that we would find some sort of bleeding tumor, associated with either the spleen or the liver. I searched through the abdomen and was unable to find anything too far out of the ordinary. Photo's were taken for the record, but I will spare you all the gore.

The chest was a bit more informative. The heart was grossly enlarged so I decided to remove it and the lungs from the chest, no easy task as most of these structures are associated with large blood vessels and if the dissection is not done carefully, it really turns into a bloody mess, with little hope of gaining any useful information.

The organs were successfully removed and the heart was huge, or at least the pericardial sac was huge. I'll explain. The heart is encased in a sac called the pericardium. There is usually a small amount of fluid in the pericardium that lubricates the heart and allows it to move freely in the sac. Here is a picture: http://www.lausd.k12.ca.us/Figueroa_EL/images/Mystery%20to%20Medicine/pericardium.jpg.

This poor dog's pericardium had about 250 cc of unclotted blood in it form a bleeding tumor on the base of the heart. This restricts the heart's ability to contract and caused this poor pups demise. The woman watching the dog was relieved that the dog did not suffer, as death is somewhat rapid once the bleeding starts. I was also able to assure her that she did nothing wrong and that there was no way for her or her brother to have known that this catastrophe was brewing.

Then my final call of the day was to deliver the cremated remains of a cat to a house call client. She is an older woman, not in good health herself. I met her and the cat about a month ago when she had me out to the apartment to trim the pet's nails. I examined the cat at the same time, and to the owner's surprise, diagnosed a large tumor on the cat's liver. She was shocked, and even worse, when I told her that the poor pus only had a short while to live, she broke down and cried. Unfortunately, my prediction was accurate, and I had to go back out to the home to euthanize the cat just before the holiday. It is always a little awkward when I don't really know the owner or the pet. She was sobbing and the poor cat was almost comatose. Today I returned the ashes to her and we shared a hug. She had about 4 cases of cat food which she gave to me. I'll use it to feed orphaned cats or get it to a shelter.

She was clutching one of her pet's toys in her hand and she pressed a bill into my hand for "gasoline" I tried to refuse but she insisted. I'll use it to buy toys for the strays at work.

Although both people suffered a great loss, I felt lucky to have met them both and fortunate that I was able to help them in some way during their times of need. We all have those unpleasant interactions, especially this time of year when people are very stressed. It is enriching to meet nice people that appreciate the good will of others. Hopefully this will rub off on everyone they meet and on those that I meet going forward.

A promise is a promise

2008-11-20T18:04:00.004-05:00

So those of you that follow me on Twitter, (I know there are at least 5 of you) know that I promised to keep the blog more current, so here is a quick post to acknowledge that.

The ever popular media star, Brian Spar BVMSC has just been contacted by the Today Show and they are going to whisk him off in a limo on Monday morning for an interview. He has gotten quite a bit of attention since his marathon debut. Check out his blog at: www.dmbhealer.blogspot.com

I have been in contact with several cat rescue groups in the Whitestone Area of Queens. Now, we've been down the Trap, neuter, release (TNR) road before, but it seems that these particular organizations are doing a good job controlling the feral cat population and are in need of some professional help with their colonies. So, perhaps we can give them a hand. We'll see how that plays out. I'm sure that it will yield some interesting photo opportunities and hopefully I'll become technologically proficient enough to get them posted here for your education and or amusement.

Time to Get serious

2008-11-18T14:11:00.002-05:00

OK. The races are over and now we have to get back to business. NO more excuses such as I have to run, ride, swim, lift. OR, I'm too tired, sore, busy... I need to focus on what is going on here at Crawford Dog and cat Hospital and try to keep everyone up to date as much as possible.

First things first, I'll post a detailed race entry later this week so that those that care (if anyone other than me) can read about the Ironman experience as I saw it.

For now, I have been busy trying to set up some networks so that I can stimulate some growth here at the practice. There are many things that I would like to do to help our patients but as with most expansion plans, they take money and money takes patient visits so ...

I have joined a business networking group, BNI. We meet
Thursday mornings and our goal is to help each other by referring potential contacts to each other. It is a novel idea for veterinarians as we rarely look outside of the animal industry for new business. So, I thought I would give it a chance. The web site for the national group is: www.bni.com and you should give it a look. I'll let you all know how it goes in the near future. For now, off to make a house call.

Busy Spring

2008-07-09T14:49:00.003-04:00

Well I know I've been remiss about posting, and no one wants to read a blog that is never updated. I will try to be better about regular posts, but you all know how life gets in the way.

After a very smooth transition, we have said good bye to Dr. Wu and hellow to Dr. Spar. Dr. Wu is settling in up in Ct. working through the chores associated with moving into a new house and a new job.

Dr. Spar seems to have stepped right in and it's almost as if he was here all along. He has gotten into the NYC Marathon and is raising money for a charity that combats childhood obiesity. A noble cause that is close to his heart. As you may or may not know, Dr. Spar was featured in last spring's issue of Men's Health Magazine for loosing about 180 pounds. (He knows the exact number and will let you know if you ask.) We will be posting a link for those of you that want to help him reach his fund raising goals.

The challenge for our staff is that the marathon is the same weekend in November as my Ironman Triathlon. Since we both will be out beating ourselfs up on November 1 and 2, I thought it only fair if we both work on that Monday. So come on in, stop by with or without a pet and watch us try to get around the hospital. I'm sure we'll be happy to tell you all about our races.

Glad to be back

2008-05-20T20:54:00.003-04:00

Well, after a two week hiatus, it's good to be back at the hospital. Alot went on while I was gone.

The pictures on our website show the happy members of Team Crawford at the Chihuahua races at Petco. Check it out at: http://www.crawforddogandcathospital.com/site/view/108916_IntheCommunity.pml

Also, we finally got most of the staff to hold still for staff photos, (might have been some torture involved, I don't know, I was out of town). See the smiling faces on our staff pages at www.crawforddogandcathospital.com.

Finally, congratulations to Dr. Spar for breaking the 2 hour mark at the LI half marathon. Now lets hope he gets into the NYC marathon this fall.

I was on my first long vacation in ions but am back for now. I would like to spend the next couple of posts talking about what I learned about dogs in France, but we'll save that for next time.

Off to Cornell for the weekend, college graduation for my number one son.

Off for a while

2008-05-02T13:24:00.002-04:00

I wanted to try to keep a regular posting schedule, but this is going to be a bit of a challenge this upcoming month. I will be off for two weeks, a long time coming vacation and then have to head up to Ithaca for my son's college graduation at the end of May. Things should run regularly in my absence as Dr. Wu is familiar with how things go here and our new associate, Dr. Spar has caught on quite quickly. Hopefully I'll have some nice photos from my trip to share when I get back.

Spring Cleaning

2008-04-23T20:53:00.002-04:00

Well, Hector shamed me into it. You all know Hector if you've been by the clinic. He's the guy that is always running around with some job that needs his immediate attention. And when he isn't doing whatever he is doing, he's helping whomever needs help with whatever unruly dog happens to be creating havoc at that particular moment.

Well, one task he has taken upon himself recently is to take our food delivery packages for petsneedfood to UPS for delivery. (www.petsneedfood.com). Just like my kids, he always wants my car keys and my credit card. Apparently the clinic vehicle was in need of a wash as people were starting to rib him out in the real world. So today, a beautiful spring day, Hector took my car and my credit card out to the car wash. Doesn't it look grand?

I should have uploaded a photo of Hector is appreciation, but I didn't have one on my home computer. This was actually my first attempt at posting a photo on the blog and I wasn't even sure that it would work. Once again, we have proved that you can teach an old dog doctor new tricks.

I don't know if any of you will be at the Nassau Suffolk Challenge, a metric century bike ride out of Sea Cliff this weekend. I'll be there with my training buddies.

Also, Dr. Spar is getting ready to taper for his first attempt at the Long Island half marathon in two weeks. Look for him there. He is attempting a PR for the distance so he may be very serious before the race. Try to catch him as his jovial self after the race.

And lets not forget our canine athlete. Kim Norcott (nee O'leary) is leading up our canine Team Crawford. Team members will be racing at the World's fastest Chihuahua races at Petco in May. Check out our web page for more information. www.crawforddogandcathospital.com. Better yet, come on in with your chihuahua and sign up to race with us.

Damn That Tree Pollen

2008-04-16T11:40:00.003-04:00

Well, winter seems to finally be loosening it's grip and spring is here. The bulbs are up, the birds are singing, and the trees have started to dump pollen into the air. I know I can feel it, that itchy sensation in the back of my throat. Unfortunately, the dogs can feel it as well.

Atopy, or an allergic reaction to environtmental pollens, is a big problem here in the Northeast. While we humans get respiratory signs, you know, runny nose, itchy eyes, and sinus infections, our canine companions get itchy skin. The most commonly affected areas are the feet, face, and armpits. We also see a load of ear infections and anal gland problems with dogs suffering from allergies.

Diagnosis of environmental allergies can usually be made on physical examination (yes you need to have your pet seen by a veterinarian), and history. Sometimes, the diagnosis is complicated by be several factors, concurrent skin infections, yeast infections, and otgher systemic diseaess, that mimic allergies all need to be treated or ruled out. Then there are those, non seasonal allergies that also throw a monkey wrench into the diagnostic mix. Hose dust mites, mold spores, and food allergies are all non-seasonal allergies that will present with similar clinical signs as pollen allergies but will last all year long.

We like to do some base line testing to aid our diagnosis. Fungal cultures to rule out ringworm (no it's not a worm rather a fungus similar to athletes foot), skin scrapes to rule out mites, and impression smears to check for yeast a bacteria. Rarely do we start with allergy testing right off the bat as it can be expensive and not always yield information that will help us with our diagnosis.

Once we have our diagnosis, there are several treatment options depending on the severity of the lesions, the length of the season, and the owner's willingness or ability to treat their pet. I think I'll leave that discussion for another post. Maybe next week, and maybe I'll be able to figure out how to add photos by that time, so I can show you all what I am talking about.

A new venture for us at Crawford

2008-04-09T12:35:00.003-04:00

Things are changing at Crawford Dog and Cat Hospital. After 6 years, Dr. Wu will be leaving us this spring to take a position in Ct. The move was inspired by her husband who has accepted a residency at Yale University in aneshtesiology. Imagine my surprise when she didn't want to commute back her to Long Island to stay with us.

We are fortunate to have Dr. Brian Spar join our staff. We have all known Brian for 8 years or so. He did several externships with us as a veterinary student. Since his graduation from the Royal Veterinary College in London, he has been working on the South Shore of Long Island. When the time for Doctor Wu's departure approached, I tracked him down and took him out for several long runs alnog the Wantaugh Parkway. Nothing like hypoxia to get a guy to see things your way.

Although none of us feel that we can replace Dr. Wu, Dr. Spar is already fitting right into our practice. Some of the clients have alread met him, and he has been very well received. It was his idea for us to start this hospital blog so that we can share some of our experiences with you all. I will try to post at least once a week. I want to share our comings and goings as well as new medical information, web sites to check out, and interesting cases that we see at the hospital.

So keep checking back and feel free to comment on my posts. You should also check out our web site at www.crawforddogandcathospital.com. This site tons of information about our hospital as well as current pet health information and a search engine that lets you research your veterinary questions from quality sites on the web.