When a “Stroke” Is Not Really a Stroke…It’s Vestibular Disease

When a “Stroke” Is Not Really a Stroke…It’s Vestibular Disease

 

“I think he had a stroke!”  This is one of the most common lines in hear in a veterinary clinic for a not so common condition.  Vestibular disease is something that we can mostly see in dogs but I have seen in a couple of cats.  It can be very scary to a pet owner but in actuality is typically not as bad as they may fear.dizzy face

Have you ever been seasick?  Or sat in a swivel chair spinning around then tried to walk normally afterwards?  If not, try it now…  I’ll bet you’re stumbling all over and probably dizzy as all get out.  Great, now you know what these animals are experiencing.  The human medical condition most closely related would be vertigo.

Vestibular disease occurs when a portion of the middle ear is affected causing this imbalance.  This area of the ear canal is innervated by the vestibulocochlear nerve (cranial nerve VIII) and it is responsible for both hearing and balance.  In some cases, the facial nerve (cranial nerve VII) can also be affected as ear_diagram_petthey are directly adjacent to each other.  This is where some people see a recognizable sign of a stroke, as defined in a human, when the face seems paralyzed or drooping of the lips on one side.  This is not as commonly seen as the other signs.

The visible signs of vestibular disease do tend to cause some alarm because it can be so disturbing.  Ataxia, or stumbling around and being unable to walk is typically the first sign noticed and oftentimes can be severe enough that animals will fall down or be unable to walk.  This is an example of a severe case.  Many patients will also have a head tilt, leaning towards the affected side.  This can be absent if both sides are affected.  Also disturbing is nystagmus, which is the technical name for a repetitive twitching of the eyes – here is a great video examplehead tilt

So why is is not a stroke??  A stroke involves a blood clot being lodged into a vessel preventing flow and oxygenation to an area.  Vestibular disease does not involve blood clots.  In a young dog, we often target a middle ear infection as the cause for this condition.  In an older dog, they could have a brain lesion (inflammation or a tumor) or most commonly we see this in older dogs and we don’t know the reason (we call this idiopathic).

A physical exam will be needed with your veterinarian to help narrow down the cause of the problem.  We will look in the ear to assess the canal and ear drum.  Evaluation of the eyes and their movement can help CatEarExamus determine which side is affected.  In older patients, we will often recommend some baseline blood tests to check for other problems that might be complicating the diagnosis or treatment.  In some cases, we may recommend radiographs (x-rays) of the skull to help evaluate for ear issues related to a structure called the bulla.  If we do suspect a brain lesion, we may refer you to a specialist for more advanced imaging.

There is some good news despite all this!!  The overall outcome for these cases is positive for a large majority of them. For ear infections, we can treat with systemic antibiotics.  For the other causes and ear infections, we treat the patient symptomatically to help control the nausea and motion sickness.  Aside from this, sometimes it just takes good nursing care at home and the tincture of time.  Again, many of these patients do well and recover though in a very few instances a slight head tilt may remain.

Wrapping up here, I just want to say that this condition is not as scary as one might initially think.  It’s still wise to have your veterinarian check your pet over and provide recommendations to help them manage.  Not all cases can be easy to figure out but hopefully I’ve helped you to remove some of fear you might experience if you see this in your pets.

Pet Vasectomies…Are You Nuts?!

Pet Vasectomies…Are You Nuts?!

 

A reader has asked me about vasectomies in cats & dogs and why they aren’t being recommended.  I’ll do my best to answer and have a discussion about this but also use this as an opportunity to discuss the more common procedure of orchidectomy, or otherwise known as castration or neutering.  I have chosen not to include any graphic medical photos though they really would emphasize some of the complications & problems.

I’ll be honest.  A vasectomy on a cat, dog, chinchilla, horse, and other animals is not something that I was taught in veterinary school.   Neither did my wife who graduated 2 years after me or the vet students or recent graduates (within the last 2 years) that I spoke to.  This really means that the first barrier to actually doing the procedure is actually most veterinarians not knowing how to do the procedure.  The procedure is described in some surgery textbooks but the caveat is that there are two ways to do the procedure.  This typically means there are risks to both ways as neither procedure is perfect.

EnlargedProstate radsSome complications can include scrotal swelling, bleeding, and failure of the procedure (meaning if not done properly by someone familiar with the procedure, a pregnancy can still occur).  There are also options for chemical castrations but there is similarly a possibility of complications particularly due to the technical skill needed to carry out the procedure as well as the chemical that is being placed into the body.

I always love doing surgery and learning new procedures.  So why do we veterinarians recommend castration as opposed to vasectomies?  The real issue is hormonal influence and behavioral tendencies of intact dogs.  Certainly, a dog or cat that has had a vasectomy will not be able to impregnate a female but they will still have the impact of testosterone on their body.  This is the reason the zoos often do vasectomies in their population of animals so that they can’t rampantly breed but will still maintain the behavior they would often exhibit in the wild.

Let’s be honest though…your cat is not a bengal tiger and your dog is not rare breed of wolf.  Sex hormones are good foraggressive dog helping manage weight.  Dogs that are intact do have a slightly higher metabolic energy requirement but not as significant a difference as seen in female animals.  Weight problems do not tend to be an issue as long as you manage food intake and proper exercise.  Additionally, we do not recommend neutering before 6 months as doing the procedure too early can cause bone growth to go longer meaning that dogs will get larger.  This is not necessarily a good thing as it can lead to bone & joint problems.  Testosterone replacement appears to be more effective in humans than in dogs and is not a practice typically carried out in companion animal medicine.

cat fightCats & dogs that are intact do have a higher tendency to fight and roam.  From my time working in an emergency clinic, it would be a fair approximation to say that about 80% of dogs that I saw that were hit by cars, they were intact males.  Animals that are still intact also run the risk of testicular cancer.  More commonly though, the prostate becomes enlarged due to the hormones and this can cause enough swelling of the prostate gland that animals can having difficulty defecating or urinating.  There can also be an increased risk of perineal hernias which can cause further problems defecating or even the incredibly painful testicular torsion.  Lastly, have you ever smelled the urine of an intact cat?  Would you really want that in your house?

Feasibly, the benefits to castration far outweigh any potential gain from your cat or dog “keeping their manhood.”  Neutering your dog just makes sense in terms of pet over-population and the control of unwanted behaviors.  It is also a simple and cost effective procedure that can be done by your family veterinarian.  Maybe someday there will be a larger place in the veterinary community for this procedure but for now I’ll leave you with this classic line I found from Texas…neuter bumper sticker

A Day in the Life of a Veterinarian

A Day in the Life of a Veterinarian

 

A lot of people have always asked, “how do you do it?”  Most often, they are referring to the act of euthanasia and relieving animals suffering.  But our profession is more than that.  And no, it’s not just playing with puppies and kittens though sometimes that is the best part of our day.  All this in consideration, I thought I would take you through a recent 24HourIconday I had with all the ups & downs that may come with it.  Just to preface this, it will try to be like an episode of “24” except no explosions, car chases, or Kiefer Sutherland.

 

My job at the Kingston Veterinary Clinic is scheduled from 9am to 6pm every Tuesday.  The particular Tuesday we’re looking back at happened like this…

 

Charlie Taylor waiting7:00am – The buzzing of the alarm goes off.  Yes, it’s good to be alive but the sound is still unpleasant.  The morning begins as I get ready for work and take care of all 5 of our own family pets.  Then I leave the house with 30 minutes to go before work.

 

9:00am – I arrive at the Kingston Veterinary Clinic and have a quick look at the schedule.  It’s a full morning as I’m completely booked up with appointments from then until noon.  Alright, time to start!  The first appointment looks to be a simple one – a dog with an ear infection.  But the owner just cleaned the ears at home!  This makes a diagnosis more difficult but we agree on a symptomatic treatment plan and they depart.  In the next room, a family awaits with their kitten they just adopted from the humane society.  No problems but they want to establish a relationship and just have a general health check up.  I examine the kitten and deem her healthy so we have a discussion on feeding & litterbox use before they depart.

 

A healthy puppy I vaccinated

A healthy puppy I vaccinated

This continues over the next few hours.  Vaccines on a middle-aged dog, itching & scratching for 3 weeks on another dog (he had fleas!), a cat urinating outside of the litterbox and her owners are frustrated by it…that was just the next hour.  I had a few more appointments involving a mixture of vaccines, skin & ear problems (which are very common in the summer), and a case of diarrhea in a dog that eats whatever he wants.

 

11:30am – I came to my last appointment of the morning which was a cat who had a 3 day history of being lethargic and breathing a little heavier than normal.  His owners were concerned but had not felt this was an emergency so he was not brought in earlier.  As I examined this kitty, I could see an abnormal movement in his breathing pattern and I could hardly hear any lung sounds.  I was suspicious of a pleural effusion, which is a build up of fluid in the chest surrounding the lungs which makes it difficult to breathe.  I was given consent to take an x-ray (radiograph) and the diagnosis was confirmed.  I went over the possible causes and prognosis with the owner then explained how we would have to drain the chest which they agreed to do.

 

More normal lung capacity in a cat

More normal lung capacity in a cat

Pleural effusion in a cat

Pleural effusion in a cat

12:15pm – I spent the next 45 minutes getting the patient ready and doing the procedure of tapping the chest.  The intricate details of this will be told at another time.  Once we were finished, the cat was breathing much better and I called his owners with an update.

 

1pm to 3pm – This is the time of day on Tuesdays when I can get caught up on records, phone calls, filling prescriptions, maybe have a bite to eat, or take my dogs out if I brought them to work that day.  On rare occasions, I’ll end up seeing an emergency if the other doctors are fully booked or I could get an emergency surgery (which everyone I work with knows I would drop everything in a heartbeat to help a patient).

 

3pm to 5pm – Appointments start up again with another mixture and variety of vaccines, a limping dog that we determined was a likely sprain, and a check eye.  For the check eye, the owners aren’t sure what happened but this particular cat is squinting and has a discharge.  I try to get a look at the eye but this particular cat is not very happy,

Example of fluorescein stain

Example of fluorescein stain

possibly because he is in pain.  I get one of the veterinary technicians to hold onto the cat by wrapping him in a blanket.  We are able to get his eyelids open and put some numbing drops in there.  When I look again, I can see some cloudiness and we decide to stain the eye.  I explain the findings to his family and we get him set up with some antibiotics and pain medication to go home.

 

5:30pm – Appointments have run over by a bit and my pleural effusion patient is waiting to be discharged.  The prognosis is not great but they are going to take him home for as long they can keep him comfortable.   I would dearly love to get out on time and get home to my dogs as I know my wife will be at work late (her shift runs an hour later than mine this day) but a few more medication refills have been added to the list as well as the records I still have to do.  I’m also reminded that a client is waiting by the phone to hear about some blood tests we did yesterday.

 

By the time I’m done, admittedly with a brief social break to chat with a co-worker, I’m finally done just after 7pm and begin the commute home.  It’s time to take care of my own pets with a walk outside, some food for both them and my wife & I, and then I settle in with some television as I put the final touches on my next blog post.  It was a busy day and I’m thankful that I didn’t have to euthanize an animal.  And sometime around 11pm I’ll finally get some sleep and rest up for the next day.  Not everyday is like this where it can be a bit hectic but everyday is different which is part of the fun and enjoyment of being a veterinarian.

Jennifer & I with Charlie & Taylor...the cats don't pose well

Jennifer & I with Charlie & Taylor…the cats don’t pose well

To see what else I might be up to on a more daily basis, be sure to like my Facebook page or follow me on Twitter!  Also comment below if there is something you would like to know more about or hear my perspective on.  Thanks for reading & sharing!

When Your Cat Has To Go…But Can’t

When Your Cat Has To Go…But Can’t

Imagine yourself on a cross country road trip.  Now come to the realization you have a small child in the back who needs to use the bathroom really, really bad.  Incessant cries come from the back seat, “I gotta go to the bathroom!” ringing out every 2 minutes.  Do you remember what it was like when you were that kid?  Good, now you know what some male cats may experience.  Yes, this is all about blocked cats, or more appropriately named, urethral obstruction.fresh step cat

This is a condition that is almost exclusively involving male cats but we do see a rare female urinary obstruction.  It also can occur in dogs but with less frequency.  There may be some warning signs before a full blown obstruction and you should heed them to potentially avoid more significant health problems and to help lower the costs of veterinary care.

Causes

The cause of a urethral obstruction can take some time to figure out and the cause may not always be apparent.  A urinalysis will need to be done to help rule out causes.  Urinary tract infection (UTI), idiopathic cystitis (bladder inflammation for an uknown reason), and mucus plugs can be some causes.  More commonly, we will find urinary crystals or even bladder stones as the main cause for obstruction.

food-bowlOne of the main things I find when I take a history on these patients is the type of diet these cats are on tends to be a poorer quality diet.  By this I mean, less expensive diets that are readily available in most grocery chain stores.  Now this is not to say that the type of food is the primary or only cause for crystals & stones.  In dogs, UTIs contribute to formation of struvite stones but we do not see the same phenomenon in cats (there are multiple types of stones/crystals but for now we will focus on struvites).  Over-saturated urine, alkaline urine levels (the opposite of acidic), and increased magnesium & phosphorous levels are also implicated in the development of struvite crystalluria.

blocked cat diagram
Signs

So back to our road trip analogy…  The first sign people may notice is their cat crying when it is in the litterbox.  This can be an incredibly painful condition.  Sometimes they will still be able to urinate and maybe just producing a few drops but it is not enough.  The urine may also be bloody which owners may notice if their cat is not using the litterbox, which is often the first sign of many urinary tract problems.  Cats can also be found making frequent trips to the litterbox.blocked_cat

The longer the obstruction lasts, more severe illness will follow.  Essentially, we will see the signs of kidney failure.  For cats that are not presented to a veterinarian as soon as signs are noted, their bladder obstruction will cause a back up affecting the kidneys.  Lethargy, vomiting, decreased appetite, and trouble breathing can all be seen.  Some heart arrhythmias can also be noted with significant electrolyte imbalances.  These cats can still be helped but the road to recovery may be a bit rougher.   In the worst case I’ve known, the bladder ruptured and the patient died within minutes but the family had waited 3 days to bring this cat in.

Treatment

By now, cats like these should be at the hospital.  But what exactly will happen now?  After the initial examination & going over an estimate of costs, we will get the patient sedated and place an intravenous catheter.  IV fluids are necessary to help a patient produce enough urine to clear out their bladder as well as to help correct electrolyte imbalances which can be common with a blocked cat.  Next, they are placed under general anesthesia and the process of unblocking begins.  A urinary catheter is passed to relieve the obstruction and then the bladder is emptied.  A urine sample is kept for analysis and the bladder is flushed out before a new catheter is placed that will remain in place for 24 hours.  I always recommend a radiograph as well to see if there are stones that may be contributing to the problem.

hospitalized catAfter 24 hours with the catheter running well and a return of normal blood values, we remove the catheter and monitor the patient for another 24 hours.  If all is going well, they can go home with appropriate medications that were started in hospital or diet changes dependent on the urinalysis findings.  Medications will often include pain medications and urethral muscle relaxants.  But if they re-block, which is certainly a fair possibility, another catheter must be placed and the whole process repeated.  If they reblock again, a surgery may be discussed called a perineal urethrostomy in which the urethra is actually widened.  Simply put, it’s sort of like a sex change for a cat…but that’s a discussion for another time.

Final Thoughts

Long term care of these patients doesn’t have to be complicated.  Follow your veterinarian’s recommendations regarding diet choices and follow up visits for rechecking a urinalysis (can be as often as every 3-6 months).  Good compliance on your part can keep your cat happy & healthy.  If you see your cat straining in the litterbox, passing small amounts of bloody urine, or vocalizing while trying to pee, get them to the veterinarian as soon as possible.  The longer you wait, the worse it will be for your cat and your wallet.  Remember what it was like a kid to have to wait on that road trip and don’t put your cat through the same experience.

Annual Examinations – Not “Just Shots”

Annual Examinations – Not “Just Shots”

 

I’ve seen two animals in the past week that unfortunately were euthanized.  But they didn’t have to be.  The first was a diabetic cat who presented to me in a dehydrated, lethargic state.  He also was showing signs of diabetic neuropathy and had lost half of his weight.  His family mentioned that he was peeing buckets and the litterbox was flooding.  He had been sick for some time.  The second was a cat who came in paralyzed in the back legs.  She had not been seen by a vet for at least 3-4 years and was now in immense pain and unable to move.  She had a heart murmur and I suspect her heart disease had been chronic.  Her back legs were cold and now at 10 years of age, she was going to leave this world at an age when most cats are considered middle aged.  Two distraught families…two lives cut short when their health issues could have been prevented or managed.

 

dog exam

Yep, we veterinarians can sometimes make miracles happen and prevent death.  We can help your pets live happy and healthy lives.  The secret to making this happen is the annual exam.  There are almost 160 million owned cats & dogs in the USA (1).  Approximately, 37% of homes in Canada have cat & dogs totalling around some 15 million pets.  The problem lies in that many of these pets don’t get seen by their veterinarian except once a year (sometimes) or when they are sick.  Cats are half as likely to be examined than the family dog.

 

feline physical examFor many of these pets, they are often only brought in for vaccines every few years.  One of the most common things I can hear from clients when they come in is that “he just needs his shots.”  Well, I have to break the news to these people that it’s “not just shots.”  The annual physical exam is just as important, if not more so, than the vaccines.  We need to run our hands over the dog and feel for lumps that could be tumors.  We need to listen to that Fluffy’s heart for any signs of a murmur.  And how about those teeth in Rover’s mouth?  Dental disease, or rather the smell of bad breath, is one of the main complaints about animal health along with pet obesity and skin issues.  As pets become older, an annual exam or even twice yearly exam is even more important.

old dog 2

In many areas, before medications can be dispensed, a valid veterinarian-client-patient relationship (VCPR) must be established.  The definition of this means that we as the veterinarian have examined your pet and had a discussion regarding our exam findings.  So for pets who are on long term medications, even if they are not due for vaccines, they need to be examined annually for this relationship to persist.  We would be in violation of our licensing body if we did not uphold this portion of the laws.  It’s not just good sense to have your pet examined annually, but from our standpoint, we have a legal obligation.

 

Image courtesy of TheSocialDVM.com

Image courtesy of TheSocialDVM.com

Back to our patients from before…  The diabetic cat could have been diagnosed earlier and perhaps his family may have been better able to treat him even though treating a diabetic is not as difficult as one might think.  The second cat had a fairly significant heart murmur that had likely led to thickening of the heart walls and also changes in blood pressure.  She had thrown a clot to her back legs, commonly known as a saddle thrombus.  Had she been seen earlier and her heart disease treated, the current problem could have been avoided and her quality of life could have been better over the past while.  Remember, our job is to advocate for your pet’s health.  When we encourage and remind you to bring them in for an annual check up, it is only for their benefit.  And yes, everything might be normal and healthy, but for every completely healthy animal, I see at least 10 more that have at least one addressable health problem.

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