What’s wrong with Buddy? Even Dr. House would have been stumped!

There’s an expression in medicine, “When you hear hoof beats don’t look for zebras. Look for horses.” What that expression means is that the most common or logical cause for a problem is usually the right answer (the “horses”) while the rare and unusual diagnosis is most likely not the answer (the “zebra”).

Buddy, a 3 year old male Jack Russell Terrier, came in with a history of difficulty swallowing and regurgitating for about a week. A thorough history was unremarkable as were laboratory tests. Radiographs (X-rays) were suspicious for a possible foreign body in the stomach. Endoscopy (a flexible telescope passed into her esophagus and stomach) showed an inflamed esophagus (esophagitis) but no foreign body as did exploratory surgery. Biopsies of multiple organs were normal. After recovery, Buddy was treated for esophagitis, but only slowly and partially responded. He was sent home on continued medication and a prescription diet for the esophagitis while we waited to see if he would continue to progress. In the interim, I consulted a close friend and colleague, Dr. Stan Marks, a world renowned gastroenterologist. After reviewing Buddy’s case with him, we decided to re-evaluate him the following day to check for a particular clinical sign: enlarged salivary glands. Sure enough, the following day we found that his previously normal salivary glands were grossly enlarged but showed no signs of cancer or inflammation. This unusual finding coupled with the clinical signs and surgical findings, revealed a most rare and unusual condition known as Phenobarbital Responsive Sialadenosis. This syndrome is in essence a form of a seizure disorder or limbic seizure. Sure enough, after a few days of continued treatment, Buddy’s salivary glands got smaller, his swallowing returned to normal, and he became a very happy and loving little dog with a great appetite. In fact, instead of trying to “eat” me, he now licks my hand. We all feel gratified by solving a challenging medical puzzle and seeing it as a positive outcome with a very happy pet and pet parent. That’s why I love what I do. And yes, every so often we do see the odd zebra!

What’s wrong with Buddy? Even Dr. House would have been stumped!

There’s an expression in medicine, “When you hear hoof beats don’t look for zebras. Look for horses.” What that expression means is that the most common or logical cause for a problem is usually the right answer (the “horses”) while the rare and unusual diagnosis is most likely not the answer (the “zebra”).

Buddy, a 3 year old male Jack Russell Terrier, came in with a history of difficulty swallowing and regurgitating for about a week. A thorough history was unremarkable as were laboratory tests. Radiographs (X-rays) were suspicious for a possible foreign body in the stomach. Endoscopy (a flexible telescope passed into her esophagus and stomach) showed an inflamed esophagus (esophagitis) but no foreign body as did exploratory surgery. Biopsies of multiple organs were normal. After recovery, Buddy was treated for esophagitis, but only slowly and partially responded. He was sent home on continued medication and a prescription diet for the esophagitis while we waited to see if he would continue to progress. In the interim, I consulted a close friend and colleague, Dr. Stan Marks, a world renowned gastroenterologist. After reviewing Buddy’s case with him, we decided to re-evaluate him the following day to check for a particular clinical sign: enlarged salivary glands. Sure enough, the following day we found that his previously normal salivary glands were grossly enlarged but showed no signs of cancer or inflammation. This unusual finding coupled with the clinical signs and surgical findings, revealed a most rare and unusual condition known as Phenobarbital Responsive Sialadenosis. This syndrome is in essence a form of a seizure disorder or limbic seizure. Sure enough, after a few days of continued treatment, Buddy’s salivary glands got smaller, his swallowing returned to normal, and he became a very happy and loving little dog with a great appetite. In fact, instead of trying to “eat” me, he now licks my hand. We all feel gratified by solving a challenging medical puzzle and seeing it as a positive outcome with a very happy pet and pet parent. That’s why I love what I do. And yes, every so often we do see the odd zebra!

A New Year and New Hope

2011 is now behind us, along with the good, the bad, and the ugly. However, in the words of an old Spanish saying, “the greatest thing the Almighty created was one day to follow another”. So, a new day (year) begins with renewed hope for all of us, and our pets. 2011 saw an economy in a downward spiral, unemployment still high, and morale at an all time low. 2012 offers new home. New hope for an upswing in the economy, more jobs, and newer and exciting breakthroughs in health care. In an effort to help clients who are still sadly experiencing the hardships of lost jobs or decreased income, we are taking the initiative by offering lower cost vaccine clinics each month so we can keep our patients vaccination protection at the highest level while offering these services at substantial savings. (Call our office for more details).

We are also seeing new therapies that can help our patients lead longer , happier, and healthier lives without suffering unnecessary pain. Such modalities as Laser Therapy, Acupuncture, and new drugs will help us achieve these new heights yet all in an affordable way. Many of these cutting edge therapies have been taken from human medicine, while human medicine has learned much from veterinary medicine. This is what is now referred to as One Medicine. (To be discussed in a future posting). All are pointing to a new, innovative, and exciting 2012.

I’ll be leaving shortly for The North American Veterinary Conference in Orlando, Florida. It’s the world’s largest and most exciting veterinary conference imaginable. I’ve been attending each year for over 20 years (you can see the framed artwork in our practices) for one simple reason. When I return, I’ve learned the latest and greatest veterinary medicine has to offer and I’m rejuvenated and happy to bring this new level of care to our patients. Look for an update next month.

Rocky's Hopeful for 2012

For now, I’m hopeful for 2012. For the economy, for our clients, and most of all, for our patients. I’m confident we’ll be in better shape this time next year. Just ask Rocky!

An Actual Case involving human exposure to Bartonella ( Cat Scratch Disease )

Mr. Smith (names changed to protect the innocent) made an appointment for his cat Kitty (also a pseudonym). She had been suffering from stomatitis (gum/oral inflammation) for several years and had been treated with potent repository corticosteroids for as many years. (Footnote: long term repository corticosteroids carry the risk of causing diabetes mellitus, renal problems, and other serious problems). The diagnosis was a “presumed” diagnosis , never having been confirmed with diagnostic testing, biopsies, or other standards of evidence based medicine. Our initial examination did confirm stomatitis, but not the typical type of stomatitis treated with corticosteroids. The lesions were more consistent with an infectious agent. Mr. Smith was very limited in funds and only wanted “the injection” (i.e. steroid) to ameliorate the symptoms of pain and inflammation Kitty was exhibiting. Although I explained that we really needed to confirm a diagnosis which no previous veterinarian had done, he pleaded with me to give Kitty “the injection” to help her feel better. I acceded with only one requirement: that he allow us to at least test Kitty for Feline Leukemia/Feline Immunodeficiency Virus/ and Feline Bartonella. The samples were drawn, “the injection” was given, and Kitty and her owner left, all of us hoping for the best. Kitty’s Feline Leukemia and FIV tests thankfully were both negative. Her Bartonella ( Cat Scratch Disease ) results however was STRONGLY POSITIVE +4! At this point, Mr. Smith was informed of the results, the implications of living with a FeBart positive cat in his household, and especially the zoonotic potential of Cat Scratch Disease ( CSD ). Kitty was immediately started on a three week course of an appropriate antibiotic. Hopefully she, as most FeBart Positive cats do, will respond well and not suffer from stomatitis any longer. By the way, Mr. Smith and his girlfriend are currently being checked by their physician since they both were showing signs and symptoms consistent with CSD. Watch for future updates.

Feline Bartonella aka Cat Scratch Disease

When Ted Nugent sang “It’s nothin dangerous I feel no pain ” in his song Cat Scratch Fever, he never knew how wrong he was. The fact is that we are now able to diagnose Feline Bartonellosis (Cat Scratch Disease or CSD) much more readily now and treat it more aggressively as well. As a veterinarian, I am seeing more and more apparently healthy cats test Positive for Bartonella than ever before. Part of it is due to the fact that we are routinely testing more cats, but also because the source of the disease, the common flea, often goes untreated in cats. In fact the best prevention for Bartonellosis is the use of effective and consistent flea control products recommended by your veterinarian. But, the problem doesn’t end there. Because Feline Bartonellosis is a Zoonotic disease ( transmissible from animals to man and vice verse), its diagnosis is even more important.
In cats, the symptoms of Feline Bartonella are numerous and varied, ranging from stomatitis ( oral or gum inflammation ) to chronic respiratory signs ( chronic nasal discharge and conjunctivitis ). In people, the symptoms can be even more varied, from skin lesions that take a long time to heal to swollen lymph nodes. Even signs of brain disease, eye diseases, or flu like symptoms are commonly associated with Feline Bartonellosis ( CSD ). The difficulty in diagnosing the disease in people, however, is not the lack of sensitive and specific tests, but the lack of physicians who consider it as a differential diagnosis. I will discuss an actual case in next week’s blog that will “bloggle the mind”. Meanwhile, if you would like to learn more about Bartonella and CSD, go to www.natvetlab.com where you will find numerous articles and reference sources that will provide you with resources to expand your knowledge.

Pet Dental Health Month Helping Pets Feel Better and Live Longer

There are now a lot more dogs, cats, and even ferrets without bad breath and with cleaner teeth walking around in Whitestone Queens and Rockville Centre and Hempstead Long Island. This past month was devoted to pet owner awareness of the importance of good dental care for pets. Pets have teeth too, you know! Good dental care can affect other organ systems and prevent infections in the mouth from spreading to the heart, liver, kidneys, and other organs. With proper professional dental care and pet owner dental instruction, we have helped make hundreds of pets more comfortable and lessened their pain while hopefully prolonging their lives. And if by chance your pet is in need of dental care, we have extended our special dental health month fees into the month of March. Just mention you saw it on my Blog. For more information, visit our website and some of the links you’ll find there.

Why I love Veterinary Medicine.

I see so many happy, healthy, sick, injured, playful, and yes, dying animals too, every day of my career. Yet, I never cease to marvel at the level of love and commitment pet owners show them. Pets have become so much a part of our families and lives that I am convinced that many people do not consciously differentiate between a 2 legged and 4 legged family member. They do for their pets whatever it takes to try to cure them, alleviate their pain and suffering, and comfort them. There’s no difference in the emotions they feel, be it for a dog, cat, bird, or lizard. That little animal has somehow brought out the best emotions in their human family. In doing so, they’ve proven that they are truly a member of the family.They have earned my admiration, love, and respect. I am honored to be their “other family doctor” and will continue to provide them with the best veterinary care possible. From my hometown of Rockville Centre to our friends and neighbors in Whitestone, Queens. Our doctors and staff will always give our patients the best in veterinary care.

Green Tip That also saves you money!!!

Amazing how necessity becomes the mother of innovation. My wife developed an allergy to conventional cat litter….both clay, clumping, as well as most other commercially available litters. She decided to try something that we had used for years in post-op kitties after neuters and other surgical procedures. We always recommended using shredded paper or commercial sterilized news print litter. So, she thought, why not put all the junk mail and other unwanted printings we all get everyday to good use. She started to put our office paper shredder to work overtime. Shredding un-coated non-glossy paper through the shredder resulted in small, highly absorbent pieces of paper that could easily and at little cost, fill a litter box. Each of our cats readily accepted their new litter (after a slow “weaning” mixing process over a period of a week). We are now exclusively using our unwanted junk mail and paper and feeling good about putting it to good use. Helping our environment and saving money at the same time can be a good thing. Plus, my wife’s nose appreciates it, too. Please remember to remove staples from papers and not to use colored paper as it is difficult to see if there might be any alteration in your pets’ elimination colors (eg blood in urine or feces).

Whom Do You Trust in Pet Foods?

Every day clients bring their pets to veterinarians and when the interview gets to discussing nutrition, I must admit I’m sometimes at a loss. New pet foods are being released almost on a daily basis and, quite frankly, it’s impossible for any one person to be able to evaluate all these new foods. The pet food industry is very savvy. They know the “Hot Button” words to push: natural, organic, no preservatives, gluten free, and many more to numerous to mention. Unfortunately, having these catch words on pet food packaging does not guarantee that you are getting what you expect and want for your pets. This past week, The Baltimore Sun reported last week a Pet Food Recall by one of these trendy pet food companies, Blue Buffalo. Now, several years ago there was an industry wide pet food recall involving virtually every pet food company. However, the industry has been careful since then to maintain strict quality control measures. Many smaller, newer companies may actually be “farming out” their manufacturing in order to keep costs down and consequently, control over quality may fall through the cracks. Careful reading of the package label may raise a red flag. Phrases such as “Distributed by….” or “Manufactured For….” may be an indication of such practices.
So, to answer my title question, “Whom do you trust in pet foods?”, we trust the tried and true companies that have proven track records over decades and whose products, research and development have resulted in healthy pets and longevity. This is where your veterinarian comes in. We have brands that we have used and recommended for many years because they produce results. Hills Science Diet, Eukanuba and Iams, and Royal Canin products are among the products we have found to be reliable in their results over the years. There are many other companies that produce high quality pet foods as well. Again trust your veterinarian’s experience to guide you. Hopefully, you will look beyond the “Buzz Words” and look more at the quality control and digestibility studies pet food companies should be providing to you. In the end, it’s quality and results that count.

What’s New In Pet Care?

Veterinary Medicine is such an exciting profession. We’re constantly learning new and exciting techniques to improve our diagnostic and therapeutic treatments for our patients. Two such technologies are digitized x-rays (radiographs) and PCR (DN A) testing.
Digitized x-rays give us the ability to not only improve the quality of our images, but obtain expert consultations from our Board Certified Veterinary Radiology consulting team. With the addition of these consults, we can obtain important diagnostic information for our database and make more precise and timely diagnoses.
PCR (DNA) Testing has revolutionized the diagnosis of multiple diseases. Diseases transmitted by ticks, infectious respiratory diseases, and infectious diarrhea can now be quickly and precisely diagnosed with this new technology. The advantages of these new tests are a quick and precise diagnosis resulting in targeted treatments. Additionally, identifying infectious agents can both help identify the source of infection (e.g. dog run, grooming parlor, boarding kennel, etc.) and hopefully prevent the spread of disease and minimize the severity of the disease.
These are just 2 of the newest and exciting technologies available to veterinarians. If you’d like more information, please email us for more information.