It's Still There!

As many Creature Comforts clients are aware, my husband and I are passionate about gardening. It is not unusual to drive by our home and see one or both of us weeding or mowing for extensive periods. Perhaps because of such fanatical devotion to our home place, we have been contacted for advertising spreads as a background for new yard equipment such as lawn mowers.

During the last photo shoot, a human model with a mower stood in one location of our yard for several hours while the photographer captured the image from several light angles. Our home is on a street that many parents use as a cut through to the back entrance of a local elementary school. After one day of extensive photography, one parent (who happens to be a Creature Comforts Client) noted she knew that we were quite devoted to our gardening hobby, but she had never seen anyone remain in the same place mowing for over 4 hours! Witnessing this after going up and down the street that day while running her daily errands, the next day she commented about the mowing tractor, “It's still there!” 

Sometimes things stay and are noticed. And other times, they just blend into the background and go unnoticed until someone points them out. It's the same in the veterinary world, and today we'll discuss one such thing: acral lick granulomas (Skin lesions that seem to remain forever). 

What are canine acral lick granulomas of the skin?

Acral lick dermatitis (lick granuloma) is a lesion induced by chronic licking, most often on the top of the wrist up to the elbow, as well as on the back hock (ankle). It is more common in large breeds of dogs, but can be seen in any breed of dog. Common causes are intense itching, pain, and obsessive desire to lick (suggesting a behavioral component).  Review of the history and a good examination are necessary to consider an underlying allergic component.

What are the concurrent signs and how is it diagnosed? 

Many patients, licking the area will have a past or current history of skin or ear infections and itching in many areas of the body. This disorder has a classically thickened area of the skin in the wrist (carpus) or ankle (hock) area with hair loss, ulceration, and thickened skin. Since pain associated with trauma, arthritis, prior fractures, tumors, surgery sites, deep infections, and peripheral nerve pain will also cause compulsive licking, in many cases a more in-depth work-up will be required for complicated or reoccurring cases. 

How is it diagnosed since many conditions seem similar?

Besides the traditional testing for infections (skin scraping for mange mites, bacterial and yeast cytology, ring worm culture, bacterial cultures), in many cases a skin biopsy and a radiograph of the area to check for bone damage maybe indicated. Allergy testing for specific environmental allergies and a food trial maybe indicated. Left untreated, secondary problems such as deep bacterial infections and ruptured oil glands can perpetuate the cycle of licking/itching and must be addressed.  Good insect control for fleas, ticks, and mosquitoes is essential. Statistically, 25% of these lesions are resistant to traditional antibiotic therapy, so once again bacterial culture is important!

Can a dog have a primary obsessive/compulsive disorder as the only cause of this skin lesion?
Although it is possible there is a primary behavioral disorder, there are usually concurrent causes for the licking, as mentioned above. However, the licking behavior can become the overwhelming factor.

Why is a diagnosis important?

If the cause of the itching is not addressed the lesion will typically return even after resolution of the signs.

Why do bacterial infections need to be addressed in the long term?

It is estimated greater than 90% have deep bacterial infections in the skin lesions.  These infections tend to be “walled off” and thus difficult for short courses of antibiotics to effectively reach and control. An average of 4 to 8 weeks or longer is needed with the goal being to treat at least 1 week longer than normal findings of the skin lesion including some hair regrowth and resolution of the superficial skin infection.

Why are steroids (glucocorticoids) concurrently used with antibiotics in treatment regimens?

They relieve inflammation, itching, and alleviate suffering of the ingrown hairs and subsequent oil plugs that develop.

One complaint is the licking is 24/7. Any suggestions?

It may be necessary to apply physical restraints such as an Elizabethan or BiteNot collar along with a bandage on the area. Once there are signs of improvement, the restraint maybe removed for limited periods of time when supervised. Realistically, this can be an 8 to 12 week period of treatment.

Is there any topical medicine for these skin wounds?

Besides washing with antibacterial soap, topical preparations containing antibiotics (example mupirocin cream), steroids (genesis spray), and  often DMSO (synotic) are indicated in some combination therapy. Bitter apple and other anti-licking products are helpful for some patients.

What about anti- anxiety medication orally and increase in exercise?

Tricyclic anti-depressants such as clomicalm or Elavil, and Selective serotonin reuptake inhibitors such as Prozac are helpful to cut the compulsive licking. In addition, a doubling of the exercise program to enrich the environment/lower stress and thundershirts will help in many cases.

I have seen these skin lesions on the Lower joints of dogs and they are often hairless 6 months later. Are there any alternative treatments?

Many patients have extensive scar tissue that will never grow hair. In some cases a CO2 laser is utilized but the results have been mixed. Other patients, in spite of in-depth work ups for concurrent illness, need to continue to wear an Elizabethan collar when unsupervised. Sadly, in many cases “it’s still there”.

Betsy Sigmon DVM

Hospital Director, Creature Comforts Animal Hospital

Make A Wish!

It has been a magical month: lunch with Astronaut Richard Clifford, Awards Ceremony at Auburn, and my son, Jason, graduating from University of South Carolina. Whew!  Then is past weekend, I drove to the mountains to visit with a long time friend who is a physical therapist at Cerebral Palsy Children in North Africa. The most blessed gift of all of these events, however, has been the graduation of my nephew, Dr. Scott Thomas, from Medical School in West Virginia one week ago. Perhaps the question arises, "How this supersede all the prior events, including my own son's graduation?"

Scott is the second son of my brother, Tommy, a pediatrician in Matthews, NC.

  Approximately 12 years ago, Scott began having terrible headaches. Specialized testing revealed a brain tumor, a Teratoma, which silently develops in teenage boys. It is quite similar to the cancer that Lance Armstrong had. Scott went through surgery, chemotherapy, and radiation therapy. One shining light is in the midst of his treatment and isolation from peers was contact from the Make a Wish Foundation. He was granted his wish of a pool table and other indoor entertainment items to share with his 6 siblings and friends (when possible). A huge race car fan, Jeff Gordon invited him to tour his setup at Rockingham raceway. What an experience! Through the years, Scott has volunteered at Victory Junction, the Petty family’s summer camping experience, among other service opportunities.

But I digress. On Saturday night at the Raleigh Convention Center, the Wish Ball, a major fund raising opportunity for the Eastern NC region of Make A Wish, honored Scott as the first Make a Wish recipient to graduate from medical school. I am very proud of his accomplishments, and grateful to the Make a Wish Foundation for all they do for children with medical health challenges. By granting their wishes, they provide a shining moment  of happiness.

With that, I return to the veterinary world to discuss today’s subject: Taking cats to the vet.

What is the "teaching moment" concerning cat-friendly transport in taking cats to the veterinarian ?

Many cat owners dread bringing their cats to the vet. Their  cats hide when they see the carrier, scratch and & bite  their owners, vocalize all the way to the clinic,  and are upset with the sights and sounds of dogs nosing their  carrier in the reception area. To enact a pre-emptive strike, there has to be a better way! The Catalyst Council has an excellent video on its web site about acclimating cats to carriers. Cats do NOT like change in their lives so the following are brief pointers: 

-Start habituating cats to the carrier and car early by leaving the carrier out in the house on a regular basis and taking your cat on little mini-trips around the neighborhood. Feed in the crate or place special treats/toys in the cage with the door open. 

- Put soothing synthetic pheromones (Feliway spray)  or clothing the cat associates with a favorite person in the carrier before transport 

- Cover the carrier with a towel 

- Withhold food before a car trip or consider motion sickness medications for those cats that get carsick 

Are sedatives available for cats that are very fearful of veterinary visits?

Yes, alprazolam at ½ of a 0.25mg tablet at 1 hour prior to visits per 10 lbs of body weight. In some cases, gabapentin, also called Neurontin, is used as a sedative tool.

Is there a separate entrance for cats at Creature Comforts by request?

Yes, there is an entrance on the south side of the building (marked with a concrete cat)  with a dedicated parking spot at the door. Use the drive up call button “Fast Pass” to alert the CCAH team that you have arrived. Inside a cat room with a dedicated play area and a soothing aquarium video will help calm your cat.  It is away from the noise of the practice for our special feline friends. 

What can be done to decrease stress for your cat in the exam room?

- Allow time for adjustment; let your cat wander at first if it wants. Approach kitty in a calm manner while trying to avoid eye contact. 

- When possible, let the veterinarian examine your cat where the cat wants to be, handling with minimal restraint, utilizing a towel sprayed with Feliway(from CCAH) to over calming and darkness 

-   In some cases,  additional medication is needed to reduce stress or pain 

-   About 90% of cat exams can be done with your cat in the bottom half of the carrier on the lap or with the cat directly on the lap.

What is Feliway, Pheromone therapy?

 A cat's sense of smell far exceeds our own and is important in communication, social behavior, sexual activity, and food appreciation. The scent of dogs, unfamiliar people, and the marking of another cat (even rubbing) can be frightening and arousing for another cat. 

A synthetic product, Feliway, mimics the natural pheromone that is deposited when a cat rubs their face on objects and provides calming effects in unfamiliar or stressful environments such as car rides. Spray the crate a minimum of 30 minutes before placing cat in carrier for transport.  It is available in both diffuser and spray. 

What else can be done to ease kitty's visit?

Get cats into the exam room as quickly as possible. Cat's hearing is approximately four times more sensitive than ours, but cats don't localize sounds well. They hear higher frequencies than people, including ultrasounds. The noise from veterinary medical equipment can startle feline patients.

What can be done for hospitalized cats?

Cats that must be admitted to the hospital have an escalated need for a sense of familiar things to help make them more comfortable. Items from home, such as bedding, brushes, food, bowls, or toys are helpful to bring comfortable home smells. Placing your cat's carrier in the cage if there is sufficient space provides a familiar hiding place. 

What are some basic visual cues in understanding cats and their body language?

 Understanding visual communication with a range of subtle body postures, facial expressions, and tail positions is important to diffuse tension. 

Brenda Griffin, DVM, MS, DACVIM, author of Maddie's® Shelter Medicine Program (University of Florida College of Veterinary Medicine) has noted several important points in these areas.  In order to protect themselves, cats don't display pain and illness as dogs and humans do. Thus their illness if often more advanced when presented to the veterinarian than dogs.

Any cat will try to defend itself if it feels threatened. It is important to remember that fear is the #1 cause of "misbehaving" at the veterinary clinic. This is normal feline behavior derived from predator avoidance behavior in the wild. Recognizing body postures associated with fear helps prevent escalation of the fear and possible injury to all involved. 

Fearful animals usually engage in one of the Four F's: 

* Freeze - a cat crouches and becoming immobile 

* Flight - the cat actively tries to hide 

*Fight – aggression (for suspected self-protection to avoid a frightening stimulus 

*Fidget – tremor in fear 

 In addition, facial signals of the eyes/ears give immediate feedback as to the fear and aggression level. Similar body language is implied by tail position of a cat.

1.      Erect ears indicate the cat is alert and focusing on a stimulus.

2.      Ears swiveled downward and sideways indicate a defensive cat.

3.      Ears swiveled to display the inner ear flap sideways indicate an aggressive cat.

4.      Pupils slit indicate a calm cat

5.      Pupils widely dilated  signal fear and the fight-or-flight response

6.      Pupils oblong signal aggression.

7.      Pupil size generally correlates to the intensity of the situation and cats use it to read each other’s intent to fight or not.

8.       The cat's tail is held up vertically or wrapped indicates relaxed, friendly intentions.

9.       A tail held straight down or perpendicular to the ground indicates offensive postures.

10.   A tail lashing vigorously from side to side indicates an agitated  state.

Betsy Sigmon DVM, Hospital Director

Creature Comforts Animal Hospital

Sage, a Bengal cat owned by Martha Hall

Happy Mother's Day!

Happy Mother’s Day!

On this very special day, I reflect on my own mother, Ruth Finken Thomas, and all the wonderful nurturing and guidance she gave to her 6 children through the years. The daughter of an architect and granddaughter of a Presbyterian minister, she married the son of a bootlegger from Western Kentucky that she met at Cornell. Her guidance inspired her offspring. Her children included a pediatrician, nurse, 2 CPAs, a teacher, and me, the veterinarian.  Even as a nutritionist, she loved a homemade dessert and believed all cake mixes served at church suppers should come with a toxic warning.   She encouraged us in all our endeavors, even my flying of planes.

In trying to find a photo of her I also came across cards of inspiration that she sent me in school. For the last 18 months of my veterinary training she was fighting terminal cancer; yet, her notes were always filled with encouragement for me. As a woman of strong faith, her last card to me was a passage from 1st Corinthians 2:9. To that passage she added, “Isn’t it great God plans special surprises for us?”, followed by “For my very special DVM daughter, of whom I am very proud.”  Two months after I graduated in June of 1981 she passed away. Her legacy would be not to mourn her passing, but rather to demonstrate what she taught each of her children: to invest in the lives of others and make a difference. 

This week, I was awarded the Wilford S Bailey Distinguished Alumni award at Auburn University 2014. It has been 33 years since she passed away, yet I think of her almost every day and her love of life and family. Thanks mom for the many blessings you bestowed on all of us! You are deeply missed!

With that, as spring is all around us let’s turn to the topic of the day:  Micro chipping cats so they will not go missing!

Why is it important to microchip even indoor cats?

Invariably, a door is left open and a totally indoor pet escapes. Often it is for short periods; however, with natural disasters or predators to chase, it can be a long and frightening hunt.

Is microchipping simple and quick?

Yes, it is similar to a vaccination/injection.

How is a microchip tracked?

It is important to register the information with the microchip data base and keep it updated. When authorities or veterinary facilities find a pet they can scan it with a universal scanner and call the data base if an id number is detected. Then the microchip registry contacts the owner. Without registry of the chip, it is practically worthless. IN SUCH CASES, tracking the chip back to the location it was sold and checking for internal records is the best bet.

How big is a microchip? How long do they last?

 It is about the size of a grain of rice.  They are designed to last at least 25 years

What are some of the more common microchip companies?

Home Again, Avid, and some pet stores.

How are chips registered?

Home Again charges $17.95 per year (www.public.homeagain.com)  and is the system that may pet stores use to register their chips.  Avid charges a onetime fee of $19.95 (www.avidid.com)  to maintain your contact information in the PETrac system. There is a Free Pet Chip Registry (www.freepetchipregistry.com ) that allows any chip to be registered for free.

What if you find a stray animal and have it scanned, next step?

Besides the above sites, there is a free site maintained by the American Animal Hospital Association has a pet lookup site (http://www.petmicrochiolookup.com)

Do microchips have GPS properties?

No

Celebrating the joy and love of Mothers and pets today and every day!

Betsy Sigmon DVM, Diplomate American Board of Veterinary Practitioners, Canine & Feline

Hospital Director, Creature Comforts Animal Hospital

Cary, NC

Oh the places you go!

Some life events take precedent in saying this was a magical moment! Such was my day yesterday afternoon! 

I had bid on the opportunity (through Neuse River Golden Retriever Rescue) to have lunch with an astronaut and I won! The lunch was on for 12:30 and it would be catered at my home. Of course I worked until 12:25 because the life of a veterinarian never slows down.

My luncheon was with astronaut Rich Clifford and his lovely wife Nancy. Through his eyes, along with 2 high school students interested in engineering and Dr. Mackie and his wife, we all learned about the space program. Some of the highlights included: of the 5,000 truly qualified applicants each year there are 23 selected, exercise in space sends sweat splattering everywhere, and the challenging aspects of life in the space station. He is a true American hero in my book!

In addition to his career as an astronaut, Clifford is a spokesperson for early diagnosis  of Parkinson's Disease as he he has been on his own journey in dealing with the disease. As a member of the Michael J Fox Foundation board and the focus of a recent documentary of his life called the "Astronaut's Secret," he is a remarkable man. I will treasure my memories of this event always.

Then later in the day I attended a special  wedding event where I witnessed a very dear friend finding love again. His new bride, in remission from cancer for less than a year, practically glowed in happiness and divinely inspired love walking down the aisle. Magical, yes! Happenstance, no way! Love conquers all. 

With such loftiness, I return to the ground and review this week's overview.

What are the most common 3 problems in dogs this week?

1. Live Ticks in patients that are not currently on a tick controlling product

2. acute sores or "hot spots" in Golden Retrievers

3.  ear infections in my allergy patients. 

Why the sudden upswing in skin/ ear cases?
There has been a massive release in allergens rather widespread over a longer spring period.

What kind of signs are reported by their owners?
Licking of the feet, rubbing face and ears, and reddened skin of the belly/armpits/rectum.

What is the theory behind these areas being irritated?
Besides the direct contact to grasses & pollens in the environment, there is also the inhaled component and histamine release by the body in those areas that precipitates itching and redness?

Where does the bacteria and yeast come from in ear infections?
There is always a small local population that thrives in the wax and debri ( the goo stuff) that response to local inflammation.

In the last year what is your newest revelation in treating ear problems?
100 percent of ear medications are labeled as one size fits all "tx 5 to 7 drops per ear x times a day". Yet the space of the ear canal of a Great Dane is much larger than that of a toy poodle. For oral antibiotics, the dose is based on size. Ear medications should be the same or else risk of under dosing the surface area of larger dogs ear canals. As in oral medication, cost is increased in larger dogs to treat large dog ear problems appropriately. Thus, this year at Creature Comforts the size of ear medications such as mometamax and conofite will be based on body weight when prescribed.

When a dog is very painful with ear infections. Is there a repository medication that lasts 10 to 14 days? While convenient, is there any down size to this treatment? 

Yes, BNT is one such medication.  Owners will note a decrease in hearing that is normally temporary with BNT treatment.

One complaint I often hear is a client bringing in a dog with a painful ear; yet after being told the cytological exam was negative, what is the problem?

Inflammation of the ear in allergic responses is often a precursor to infections. Caught early, the ear may be painful and red.  Treatment would include topical products such as hydro-plus, genesis spray, and synotic. Such cases emphasize the importance of a cytology and exam as antibiotic and anti- yeast products would be unnecessary and increase risk of drug resistance when such products truly needed.

Is oral medication needed with ear problems? 
Yes, often an anti-histamine such as Benadryl or combination with steroids such as temaril p is indicated.

If a patient has more than 2 infections in 90 days, additional options to investigate include food trials and serum allergy testing,

Betsy Sigmon DVM with Jay Mackie DVM
With Earl and Taco Belle

As I walked this morning in the spring garden in my yard, the spring tulips, ferns, and hostas are greeting the warming sunshine in their radiant splendor. All seems perfect as the squirrels scamper about with their daily chores. Or is it a perfect setting for a more sinister undertone? It seems that those same conditions that allow the plants to grow also allow shedding of bacterial infections into the environment. One such infection is Leptospirosis.

What is Leptospirosis?  

Leptospirosis is a bacterial infection of people and dogs that is shed in the urine of other mammals (cattle, pigs, horses, rodents, and wild animals). It thrives in the warm, moist conditions of community parks, muddy areas, creeks, and small bodies of water (ponds). It is more common in the Southeastern United States and Hawaii, although it occurs throughout the world.  Most small mammals that carry the infection (skunks, raccoons, rats, etc.) do not appear ill.

How do dogs become infected?

Dogs are infected through minor abrasions of the skin when exposed to infected urine or urine contaminated standing water/soil. Thus playing in communal areas shared with other animals, bite wounds, eating urine contaminated food, and swimming in contaminated ponds or small creeks can lead to infection.

What are the signs of Leptospirosis? Can a pet get infected again?

Depression, fever, lack of appetite, stiff joints, vomiting, red eyes,  an increase in thirst, jaundice, and even bleeding disorders are reported signs in infected dogs. It is more common in summer months when there is rain runoff (floodwaters) and stagnant water pools. It may lead to kidney & liver failure, inflammation of the brain/spinal cord, respiratory signs, and even death. The signs develop 2 days to 4 weeks after exposure (average of 5 to 14 days). Dogs can get infected again.

Can people be infected?

Yes! The latest information from CDC (Center for Disease Control) suggests that 1/3rd of the human infections originate from contact with dogs and 1/3rd come from exposure to rats (and their urine). The signs are similar to that of dogs.  During World War II, servicemen were infected by swimming in contaminated ponds. More commonly it is seen in farmers, mine workers, sewer workers, slaughterhouse employees, veterinary staff, fish workers, dairy farmer, and kayakers (water outdoor sports enthusiasts).

How is it diagnosed?

The most common way is with blood titers run initially and then 2 to 4 weeks later watching for a 4x’s increase in the level. Urine can be screened for the organism but it is not always found.

Is there a treatment?

Yes. Penicillin antibiotics stop the infection in the bloodstream and then a follow-up antibiotic, Doxycycline is used to help clear remaining organisms from the kidneys. However, a patient that is in kidney failure with this infection may require dialysis and there is potential for irreversible damage.

Can a person or another dog be exposed simply by being around the urine of their dog in say a “household accident”?

Yes. Thus, wearing gloves in handling any sick animal is recommended especially when cleaning up urine. Always wash your hands after handling your pet, especially if your pet is not feeling well. To clean surfaces take one part of bleach to 10 parts of water.

Is there a dog vaccine for Leptospirosis or other means of prevention?

Yes!!!!! There is a vaccination for at least 4 types of Leptospirosis, but not for all varieties. It will reduce the severity of the disease, but may not prevent the shedding of the organism in urine with natural Leptospirosis exposure for many months to other dogs and their owners.  The vaccination is administered after 12 weeks of age as 2 injections at 3 to 4 weeks apart, then once a year.

In addition, keeping rodent populations (rats, mice, voles, and moles) under control is key around homes.

What are the dog risk factors to help an owner decide if they want the Leptospirosis vaccine?

Spending a lot of time outdoors, exposure to wild mammals, visiting public parks, and having access to creeks & small ponds are the more common factors.

Can cats carry Leptospirosis and become infected?

Yes, cat can become ill with leptospirosis. However, it is felt they are more likely carriers of the illness as reported infections are low. In addition, feral cat colonies may harbor the disease in southern climates and thus it is a potential risk to human handlers in southern climates.

Betsy Sigmon DVM, Diplomate American Board of Veterinary Practitioners

Hospital Director, Creature Comforts Animal Hospital