We Are The Champions!!!!

For the first time after so many years, the Creature Comforts little league team was the championship winner in Cary!!!! Congratulations!

Losses and Saying Goodbye

I have been following a cardinal bird family that chose to grace a vine on my back patio with its babies. Every morning while drinking my coffee over the last couple of weeks I have chosen to be seated close to the nest to witness the anticipation, hatching, feeding, and parent consternation of the family. There was such a lovely pattern to my day to check on the family from a distance, yet in such close quarters. The morning serenade followed by flitting from tree to tree distracted me from completing my papers. The feathers were just starting to appear on the babies as they vocalized their hunger pains.These decisions are all about our pets, and keeping their best interest and needs to live well should be our primary concern. Most pet owners would choose to keep their pet alive for a longer period of time. The problem is figuring out what point "living well" stops. The disease (pain, cancer, dementia, illness) is already destroying the pet's quality of life. Humanely, the only choice that's left is HOW we want our pets to pass away: comfortably rather than alone.
The best outcomes will be realized through the partnership of your primary care veterinary team, the patient's family, and referring veterinarians. This collaborating team must set the benchmark to never be complacent. Rather as a collective they should approach the quality of life concern to ensure everything possible in the best interest of the patients and their families. They should make sure their approach to life and death is offered and conducted in compliance with the highest ethical standards.
Thinking I had many more days of this visual and auditory splendor, I went to my sister’s home in Kernersville overnight for a Belmont horse race hat party.
Today I returned to an empty nest: no parents, baby birds, or singing. The loss, although seemingly silly, is profound. We have a black snake that found close by the scene, and my husband heard a loud commotion of parent distress shortly before I arrived home.
Did they suffer or did they go quickly, I may never know. It makes me reflect on the decisions many of my clients face with their own pets and mortality.
What is the most common question client ask when facing life threating issues with their pets?
With debilitated patients, one common concern of pet owners is suffering. Terminal illness, obesity, pain, and a combination of infirmities have made daily living difficult. In discussions, client will struggle to verbalize the overwhelming emotional, physical, and in many circumstances financial burden of caring for their dear companion.
Is there a way to document or score the quality of life of a pet?
It is difficult to put a score on something as intangible as the life a living being: one that gives us unconditional love, conditionally. The simplistic phrases, “You will know when it is time because your pet will tell you,” or “The good days will be outnumbered by the bad days,” do not provide supportive, measurable scoring. Issues such as mobility, more good vs. bad days, happiness, hygiene, hydration, hunger, and hurt are critical to monitor. As an overview, I have listed the following questions.
1. Is the pet suffering (and isn't going to be getting better)? These indicators include: Loss of interest in what they usually like - food, walks, toys, treats.
2. Significant weight loss especially if due to lack of appetite not due to nausea, which is quite common as death approaches. Appetite loss (so long as we anticipate and prevent nausea) is not painful and is a natural step in the dying process.
3. Inability to stand and/or walk (especially if the pet is made anxious or is at risk of injury, bedsores, etc. due to its inability to move adequately). To lower risk of falling, adaptive changes in the environment can be made, such as non-skin floor surfaces (Sam’s club has a “jigsaw puzzle” spongy floor squares that make great temporary floor covering). Also raised food/water dishes and even taking these to your pet when no longer ambulatory help. Frequent turning of recumbent pets laying on orthopedic or memory foams to lower risk of “bedsores” is essential. Prevention of access to stairs unless supervised and assisting the pet is critical to lower risk of falling. Use of slings and vests with handles such as from http://www.ruffwear.com ,http://helpemup.com , and http://www.gingerlead.com websites are helpful to assist pets in rising & mobility and lower the risk of lower back injury in pet owners.
4. Pain control is a significant concern, and clients cannot use human standards such as crying as a benchmark. For discomfort, regular pain assessments by your veterinarian are ESSENTIAL for a pet approaching the end of his/her life to make sure multi-modality pain management (variety of treatments) are utilized.
5. Frequent seizures/altered mentation (behavioral changes) that impair quality of life.
6. Of the top 10 things that a beloved family pet loved to do, if down to <5 that is a quality of life issue.
7. Sleeping 100% of the time and it is a struggle to get up to eat, go outside, or interact with family or other pets.
8. Owners living in fear of what they will find of their pet's condition when returning from being away from the house.
9. Being engaged with family activities and actions seems to be decreasing. Try taking the “games” or interactions to your pet (tug-of-war, fetch). Create “hang out” sites around family gathering spots and outside in favorite areas.
It is hard to let go of a beloved family member. Dr. Betsy, what wisdom to you have about this from your 33 years of veterinary practice in speaking with pet owners ?
For additional help, the quality of life metric scale http://aplb.org/resources/quality_of_life.html , created by Dr. Alice Villaobos is helpful to quantify observations.
Betsy Sigmon DVM

Plant Poisons in the Yard: Beware of the Castor Bean!

I spent the week-end introducing my dog, Taco Belle, to my sister Rosie’s new dog, Hallie. As an only dog, Taco Belle was very disappointed to be asked to share the great, fenced back yard with her new “cousin,” Hallie. After the initial “meet and greet” and neighborhood walk, the relationship is still in a stalemate.

Part of the visit was to puppy proof the yard and review landscaping plants for toxicity. To my sister’s disappointment, it is not just the plants but also the rugs, mulch, and pots among other things can be potential objects chewed leading to intestinal upset.

There is no way to 100% prevent accidental ingestions in puppies. The focus should be directed to ways to enrich the environment with activity, brain games, and interactions with 100+ people and pets (well-vaccinated, of course) by 5 months of age. Bored, isolated, young dogs are more likely to get into trouble. My sister has elected for the moment to split time between doggie daycare, neighborhood dog sitters, and lunch time at home with Hallie. In looking to re-stock her flower beds, we went to the local garden center to look at ornamental plants for sale. One that caught my attention was the Castor Bean Plant.

What is the issue with having Castor bean plant in the backyard garden?

Although valued for their colorful nature and ornamental beans, the plant contain ricin, one of the deadliest toxins known to man. The dried beans are often incorporated in decorative bead necklaces from places such as Mexico. There is some toxin in the leaves of the Castor bean plant. Other names for castor bean plants are Mole Bean Tree, Wonder Tree, African Coffee Tree, Mexican Weed, and Palma Christi; the seeds are sometimes called dog tick seeds.

What are the signs of toxicity?

Although signs may be delayed for 6 hours, the ricin released when the bean is chewed causes oral irritation, burning of the mouth, and increase in thirst, vomiting, diarrhea, kidney failure and convulsions. The poison is inactivated by heat and age, so often the beans in jewelry will be less potent. In addition, if the bean is not chewed (hull needs to be cracked), the toxic effects are lessened. The prognosis is guarded if signs have already developed. There is no antidote for ricin poisoning; treatment is supportive. In dogs, as few as 1 bean ingested and chewed can be fatal. I seem to remember ricin in the news in the subways of Japan. 

Is it more deadly inhaled? Are there any other more recent murder plots in the news?

Yes. It is much more toxic parentally (inhaled) rather than orally. Recently a man in Oklahoma in April of this year was arrested for plotting to kill his pregnant girlfriend with a pizza laced with ricin. Luckily, the plan was not completed. In addition, ricin is significantly inactivated by heat or cooking. The U.S. Center for Disease Control (CDC) has classified the viruses, bacteria, and toxins that would most likely be used in a biological attack as Category A (severe risk) and Category B (low mortality rate and relatively easy to disseminate). Ricin is a category B classification that supposedly Saddam Hussein had stockpiled (among others) as a biological weapon. 

What should you do if you think your pet has ingested a poisonous plant? 

There are many toxic plants in residential landscapes. Some are fatal and others are intestinal irritants or neurological toxins. Because dogs’ indiscriminately eat and chew on things, they are much more likely to be poisoned than cats. Report to the veterinary team the approximate time frame of ingestion, as many medications will not be effective after one hour. If suspected in this time frame, call Creature Comforts Animal Hospital to find out if it is okay to induce vomiting. If it is okay, and if your pet is conscious and alert, follow these directions:

1. Give about one tablespoon of 3% hydrogen peroxide per 15 pounds of body weight. 

2. Repeat once in 10 minutes if the pet doesn’t throw up. 

3. Identify the plant, or take it to your vet if possible (iPhone photo as well). 

4. Monitor your pet for any change in behavior.

5. Take the pet to Creature Comforts or your closest vet. If after hours, call your local emergency veterinarian. Once at the clinic, medications that reliably induce vomiting in five minutes will be implemented. For lots of good information on poison plants, see the ASCPA website, http://www.aspca.org/pet-care/poison-control/plants/

Please feel free or submit topics for future blogs. In addition, I would love to post your submitted pictures for pet of the week. This week we salute Henry Wolf, a Great Dane. Congratulations to the Creature Comforts little league team! Champions for Town of Cary 2014 in their age group. Great teamwork, guys!!!

Betsy Sigmon

Denny and Eliza: Retrospective On the Dynamic Duo

 It is a lesson learned to remain professional yet compassionate in approaching relationships with clients and their pets. Veterinarians are paid to provide educated opinions in their evaluations of dogs and cats under their care. Clients are free to choose their professional care givers just as veterinarians can select whom they care to serve. Somehow in this verbiage the true meaning is lost to state what a sincere privilege it is to be entrusted with the health care of these animals and the “behind the scenes” lives of their owners. In some cases the stories shared are “stunning revelations of private lives to share under the guise of confidentiality & non-disclosure in the client-patient relationship”. In others I feel humbly honored to be entrusted with personal stories of vulnerability. In this case, a relationship that touched me in so many ways I will share with you on this Father’s day, 2014. It is the story of Denny Mercer and his precious standard poodle, Eliza. 

Eliza, a black standard poodle, came under my care at 4 months of age in 2000. Denny I had already known each other from my previous veterinary position in the community. Their bond and mutual devotion from the beginning was sincerely the benchmark meaning of the human-animal bond. There was nothing that Denny would not do to ensure the well-being of Eliza. In reverse, it was stunning to see how incredibly focused Eliza was in her daily actions to listen to Denny and respond accordingly. As noted by one friend, he had never seen a dog go full force for a ball; yet, once Denny says stop, Eliza would not move until verbally released. It was rare to see Denny around town without Eliza riding as a companion in his truck.

Denny never met a stranger. He had such a love for his family, his Lord, and those of us lucky enough to be called his friends. He truly took pleasure in helping others.As the son of government official and lay minister, he was taught to be self-reliant. I admired how he could build furniture and work with most tools exhibiting great talent. In addition, he had lived the life of a contractor, art instructor, private investigator, and golden glove boxer.  After receiving his pilot’s license at the age of 17, he joined the air force where he joined a squadron that refueled planes midair. He owned many small planes (including unlimited category aerobatic airplanes) and thus introduced many pilots to aerobatics. One favorite quote by him in living on a grass airstrip in Apex was “when I die and go to heaven it would be a lateral move”.

In addition he had a wickedly dry sense of humor. Many of his friends would join him for what he would call “fine dining” at the Wendy’s in Apex where he was a regular. It was a bit of a game with employees as  he would have them check to make sure he got his senior discount. Once while dining at Wendy’s with a friend, dressed up for a later event, the manager asked if they were going somewhere. To which Denny quickly replied “Yea, we are going to eat someplace nice”.  So the manager laughed and continued to watch the situation. Once the meal was complete, the manager brought Denny and his friend each an unrequested Frosty (a regular treat for Denny after each meal). Except this time the friend had a heaping Frosty  cup  with the spoon dangling, and Denny’s, well shall we say there was a tablespoon of Frosty at the bottle of the cup with the spoon stuck in the middle. Needless to say, for once Denny was speechless.

I say these things as a background for my experience with Denny over the July 4th, 2011 Holiday. During one of his clinic visits with Eliza, I lamented I wanted to enrich the experience of cats coming to the clinic and build a real “cat playhouse”; yet they cost $3500. After the natural ribbing, he wanted to see an idea of the “cat house”. We met for lunch after which he suggested we head over to Home Depot to obtain supplies. As we walked the aisles he coached me in the types of wood, durability, and purpose. It was quite an education that I thoroughly enjoyed. With a couple hundred dollars of materials, we headed to the check out. As a salute to the military, Home Depot has a 10% off purchase for July 4th. The cashier asked if he had a military card. Denny at 80 years of age said, no, but rolled up his sleeve and asked if this tattoo on his arm  he obtained  in England during his military service would work. Not much to scan, but the tattooed was honored and off we went to the airplane hangar to build the official CCAH cat house.

  I was familiar with the location as I had already been to his house to talk “gardening” and purchase plants from his talented wife, Rita through the years. She is a renowned expert in putting plants in just the right spot. The plane hangar was ideal for space and fun to watch future pilots practice touch and goes steps away from the “construction site”. At times, many of Denny’s pilot friends would stop, get out of their plane help with the play space and then take off again. Others drove up in their trucks to work for hours and offer opinions as to what a cat would like for entertainment.  

Eliza watched faithfully by his side in the hopes of one more ball retrieval or simply to offer unconditional support for whatever project engaged Denny. My role was as an apprentice carpenter, not one that would ever have the skills of Denny but rather a sincere appreciation of someone that could take a piece of wood and create a masterpiece. Each day I came with a new request: Ferris wheel, bridge, steps, teeter totter, and pergola among other things. Then I would come back and out of scraps of spare wood he would go into his shop and create my idea.  In the process, I learned so many stories about Denny and the true meaning of peeling back the layers of his personal experiences and entrusting them to me forever. My relationship with Denny was forever changed; I was now crossing over to be a Denny groupie: one of a large following.

The Sunday the project was finished, the caravan of workers transported the new play area to the clinic. It was a proud moment and a memory I cherish until this day. Once in place, a plaque was installed: handcrafted by Denny Mercer. Denny became my protector and close friend forever on that special July day in 2011.

Sadly, in March of 2012, Denny was taken from us in an unexpected fashion after complications from by-pass surgery. Eliza, remained in the loving care of Rita, and the story goes until Thurs of last week. I received the call to help Rita in a quality of life decision for Eliza was facing challenges from a degenerative neurological condition. I think Eliza was until the very end looking for Denny and putting on a brave face for all of us. As I said good-bye to her in her passing, in many ways it was saying good-bye to Denny as well. Later, Rita sent me the beginning blog photo and the comforting statement: Eliza and Denny…….. very happy to be together again.

I am forever changed by this memory and the blessing of being a veterinarian.

Betsy Sigmon DVM, Diplomate American board of Veterinary Practitioners

Hospital Director, Creature Comforts animal hospital

(and official care take of the Denny Mercer, CCAH “cat house”)

It shouldn’t be that hard to look that simple!

As I mentioned in the last blog entry, our yard has been used as a background in advertisements for yard tractors. This past week a team of over 12 people were on site  for the simple task to photograph a riding mower. The scenario included: human models, directors, stagers, photographers, videographers, lighting specialists, and a site coordinator. The simplicity of the shot seems lost in the complexity behind it.

In setting up for the yard photo shoot, I wanted to clean up my low maintenance “moss beds” that surround the backyard pond for the "Zen moment." Six hours later, after cleaning out multiple weeds between the stepping stones, I questioned the wisdom of putting in moss rather than mulch between the stepping stones. Yes, it looks simplistic, but it shouldn’t be that hard to look simple and uncluttered.

With that I lead into today’s subject: vitamin B12 deficiency: a simple, yet complex issue.

 How common are Intestinal issues to pet owners?

Pets often present to veterinarians with vague signs of lack of appetite, intestinal signs (vomiting/diarrhea), and lethargy. Although most are on a well-balanced, commercial diet, one potential cause is a Vitamin B12 (cobalamin) deficiency. Dogs and cats can deplete their stores of B12 in one to two months.

What is Vitamin B12?

Vitamin B12 is contained in dietary (mainly meat) protein that is released by digestive enzymes in the stomach. The absorption of vitamin B12 is a complex process that is thought to be initiated with the binding of an intrinsic factor protein produced in the stomach/pancreas and released into the upper small intestine (duodenum). It is later absorbed in the lower small intestine (ileum).

The diets of dogs and cats are high in sources of cobalamin, thus dietary deficiencies are rare except when pets are fed a homemade, unbalanced vegetarian diet. Thus, in pets cobalamin deficiency is more commonly due to chronic small intestinal disease or lack of pancreatic enzymes to help bind and retain Vitamin B12.

What are the signs of low vitamin B12?

 Clinical signs or complications of cobalamin deficiency have been much less well described in scientific literature. Most dogs and cats with cobalamin deficiency only demonstrate vomiting or diarrhea that could be either the cause or a direct effect of cobalamin deficiency. Other documented complaints include failure to gain weight, slow heart rate, seizures, neurological weakness, and anemia.  

What are some of the causes?

Potential causes include lack of pancreatic enzymes to properly digest nutrients that aide in vitamin B12 absorption, chronic inflammation in the intestinal tract, and overgrowth or imbalance of the wrong type of bacteria in the gut that consume cobalamin and thus exacerbate the deficiency.  Hereditary cobalamin deficiency has been recorded in a few dog breeds, including the Giant Schnauzer, Beagle, Border Collie, Australian Shepherd, and Chinese Shar Pei.  In people it is a risk in consumption long term of some strict vegan diets, elderly patients, or extended use of medications that decrease stomach acid production such as Pepcid AC or Prilosec.

How is it diagnosed?

The diagnosis of cobalamin deficiency is a  blood sample after fasting for 6  to 12 hours,  measuring vitamin B12 levels in the below normal to low normal range. Due to the important metabolic role of cobalamin, and since cobalamin deficiency is related to cobalamin malabsorption, it must be corrected via subcutaneous injections based on weight. Treatment involves sub-cutaneous injections of cobalamin typically weekly for 6 weeks, then every other week for 6 weeks, then once every month. Generic formulations of cobalamin are readily available and relatively inexpensive.

Why not give it orally?

 Oral, multi-vitamin preparations do not contain sufficient amounts of cobalamin to correct the deficiency and be properly absorbed. Injectable versions bypass this absorption issue.   Follow-up blood testing to confirm rising cobalamin levels in four months is recommended.  In many cases, treatment is for life. Signs often resolve over a matter of one to two months. Fortunately, there is no indication that over-supplementation of cobalamin injections leads to clinical disease.

In summary, it is currently recommended that all dogs and cats with chronic histories of   gastrointestinal disease should have their blood levels of cobalamin measured. It is an important mitigating factor to consider in cases where there has been sub-optimal response to current therapy for weakness or intestinal upset. It shouldn’t be that hard to diagnose an intestinal condition. Fortunately, there is a simple treatment.

I am humbly grateful for the opportunity to serve my dear clients. There is no better feeling for me to get up each day and be needed!  Thank-you for entrusting your precious pets to my care.

Jackie & Ajax owned by Pam Vashaw

Y-Princess Tribe Help Canine Rescue

One of our clients has a daughter who is involved in a Y-Princess tribe (YMCA), and they did a community service project related to taking care of pets.  I have attached some posters that they did and also put a little bio that about them below.

The Y-pricess tribe, tribe name is "Swimming Indians", and all the girls are finishing up the 3rd grade right now.  They have been together as a tribe for 3 years and have had a great time, making good friendships.  The primary goal for someone to participate in the Y-guides (boys) and Y-pricesses (girls) is to promote time between fathers and their sons/daughters.  The YMCA provides organized activities/events, plus each tribe can do as many activities together as time permits. 

The theme for the third year tribes is community service.  The Swimming Indians did activities such as "Stop Hunger Now", "The Comfort Project", helped soldiers, participated in the the JDRF walk, and of coarse, the help with the canine rescue.  

The posters below are to promote what is involved in taking good care of a pet.  The tribe also collected donations such as food and pet supplies to donate to a local rescue group.

Great job, girls! Pets everywhere thank you!