Bladder Stones (calcium oxalate) gathering together

                    
It is that time of the year when my five siblings and I gather together at a mountain location (Seven Devils) to recall stories of our past, and of course, to eat. I left work at noon on Saturday and hustled up Highway NC 421 to eye candy vistas of fall in the North Carolina mountains.

My siblings are all great cooks (I brought vanilla Oreos), so a big part of the visit is a home cooked meal on top of the mountain setting. The day even started with a bagel cook off between Tommy and Joanie.

After dinner, my sister Susie (the critical care educator/nurse) presented a surprise "media memories" for all of us. It was a true labor of love as we recalled stories of our past, looked for faces of nieces and nephews in their parents as youngsters,  and reveled in the blessing of our wonderful mom that glued us together. We laughed at the size 14 London Fog coat our mom purchased (she was a size 6) for a trip to Europe because it was "roomy" we suspect as a frugal shopper it was because of the 75 percent off price tag. 

Genetically it is a proven fact that I was born with curly, red hair and a devotion to animals. From the stick horse experience with sister Susie to pony rides to visits to the Statue of Liberty, I document for pure entertainment the evidence presented Saturday night. 

Such gatherings are great; other gatherings, such as the accumulation of bladder stones in pets, are not. Thus, today's blog entry discusses how calcium oxalate bladder stones begin. 

Why has the prevalence of calcium oxalate stones increased in cats and dogs in the last 10 years?

Over the counter acidifying diets, changes in diet composition (calcium, phosphorus, magnesium, oxalate), leash laws creating more indoor, sedatory  life styles, decreased water consumption with less exercise, small breed ownership with increased risk in small dogs, obesity, and pets living longer are the major risks suspected. Note also in poor economic years, ownership of small pets increases.

What are the statistics on stone analysis sent to national labs such as in Canada?

Seventy percent were in male dogs. The breeds were predominantly as follows: Schnauzers, Min poodles, Lhasa apso, Bichon Frise, and Shih Tzu. Only in female Schnauzers was there an exception to the male rule. It is speculated that testosterone increases production of oxalate and estrogen increases citrate leading to soluble calcium citrate. In cats the breeds at risk for male and female cats include Persian, Himalayan, Burnese, and Ragdoll.

There must be some medical risks. What are the more common ones?

High calcium blood levels from a variety of causes (medications such as long term use of prednisone or diuretics), kidney disease, abnormal kidney excretion of calcium, tumors ( lymphoma, hyperadrenocorticism), and dietary supplements high in table salt or calcium chloride.

What is the most common treatment?

Surgical removal is still the most common. In specialty practices, bladder flushing of female dogs and lithotripsy are being offered in some cases.

If surgery is performed to remove oxalate bladder stones( there are no medical cures) what is the return rate?

Forty-eight percent return within 2 years in dogs, seven percent in cats.

What medical options are recommended to lower risk of oxalate bladder stone return?

Monitoring blood work, especially serum calcium levels, and utilizing diets such as Royal Canin SO diet (canned) to keep urine concentration thin (specific gravity less than 1.020 in dogs and less than 1.030 in cats).

In some cases the oral supplement potassium citrate will be recommend to raise the urine ph if consistently at 6.5 or less (more acid increases stone formation).  The complex calcium citrate will be formed that flushes out in urine as it is more soluble than calcium oxalate. In addition, a mild rise in the urine ph flushes out calcium oxalate complexes quicker so not as likely to gather and form stones.

Sincere thanks to Dr Greg Grauer and Clinician's Brief for content for this blog.

My dog, "Taco Belle"

Betsy Sigmon DVM
Hospital Director, Creature Comfort Animal Hospital

Cary,NC

Kennel Cough: It Can Take Your Breath Away

It is that time of year when the North Carolina Mountains beckon you to come and take a leisurely drive to absorb the fall vistas. On Friday, I traveled up Highway 321 to Blowing Rock and then completed the circle going back via Morganton on Highway 220. It was a journey I last completed with my grandmother, Helen Finken, in 1983. She was 95 at the time and remarked as we saw majestic Grandfather Mountain that she loved the mountains as their age made her feel so YOUNG. Her daughter, my mother, had recently passed away. In a reflective mood she said that it was not natural for a daughter to pass away ahead of her mother.  Then she lapsed into recollections of her father, a Presbyterian minister in Brooklyn with a German congregation. Once World War I broke out, he came home and announced that German would no longer be spoken in the house hold; they were Americans.   Lots of memories embraced me of that lady as I stopped at the overlooks, hiked Linville falls, and drove on Linn Cove Viaduct on the Blue Ridge Parkway.

 Funny that as the cold, crisp air at times took my breath away that canine respiratory issues come to my mind. Thus, today’s blog subject is infectious lung disease.

I THOUGHT THAT ONLY DOGS AT KENNELS GOT KENNEL COUGH?

Bordatella, a highly contagious upper respiratory bacterial infection, affects one in 50 dogs and one in 36 under one year of age. More accurately called Canine Infectious Respiratory Disease (CIRD), it is also seen with casual contact with other dogs in the neighborhood, at training classes, dog parks, on walks, and grooming parlors.

IS BORDATELLA BACTERIA THE ONLY COMPONENT OF CANINE INFECTIOUS RESPIRATORY DISEASE?

No, there are as many of 14 other bacterial and viral infections that are grouped in this same syndrome. A Bordatella vaccination is a good starting point, but it does not completely protect against all agents grouped in CIRD: Canine Influenza, Mycoplasma, Parainfluenza- 2, Adenovirus-2, and Herpes Virus among others.

WHAT OTHER FACTORS PLAY A ROLE IN DEVELOPMENT OF RESPIRATORY ILLNESS?

Patients already debilitated by other illnesses, undergoing chemotherapy, young/old age, anatomical issues (think bull dog with tracheal defects), and environmental factors (poor air circulation, poor hygiene, overcrowding) have all played a role in the development and the severity of the disease.

ARE THERE TESTING AND HANDLING GUIDELINES FOR PATIENTS WITH SUSPECTED CIRD?

Besides avoiding direct exposure to other dogs (ask receptionist for side entrance to the clinic if you suspect infectious respiratory disease), some patients with mild signs will receive simply supportive care. Others may need a specialized culture of suspected organisms, bloodwork, chest radiographs, and even hospitalization in an isolation ward.

WHAT IMMUNIZATION GUIDELINES ARE RECOMMENDED BY CREATURE COMFORTS for CIRD?

Vaccinate all puppies starting at seven weeks of age for bordatella, repeat in six months, and then once a year for all dogs that get out of the house and around other dogs (even casually). Influenza vaccine is an optional vaccine based on risk assessment of the region (travel to states close to horse/dog racing tracks, documentation of outbreaks in kennels in the area), or requirement of the boarding/training facility.

Photo courtesy of Michelle Widmann of “Molly” the retired squirrel dog

Betsy Sigmon DVM, Diplomate American Board of Veterinary Practitioners, canine & feline

Hospital Director, Creature Comforts Animal Hospital

Flea Myths

With the opportunity to have a weekend away from the practice, my sister and I took our dogs to one of the walking trails recommended in the News & Observer newspaper near Reidsville, Chinqua Penn.  For those blog followers that did not grow up in the Piedmont section of North Carolina, Chinqua Penn is the former estate of Jeff & Betsy Penn. Combining their fortunes from tobacco and electrical power, they traveled the world to bring treasures (from at least 30 countries) to their 31,00  square foot mansion built in the early 1920’s. In 1959 it was donated to the State of North Carolina until it was closed in the 2002. Then in 2006 it was sold to a private tobacco entrepreneur and reopened for tours. Unfortunately, the owner declared bankruptcy in 2012 and the house was closed and contents auctioned.

I go into such detail as I was one of  the many North Carolinians that toured the home and loved it. Now it is abandoned, stripped of its priceless treasures, and very sad. The walking tour, http://www.chinquapenntrail.org/, takes one around the farm perimeter: Brunswick stew camp with huge rock tables, pump house, summer house, rock dam, and pet cemetery. Taco Belle and her dog cousin, Hallie, had a great time.

 I enjoyed the walk immensely, yet was so sad that a wonderful home has fallen into such disrepair. Farmland adjoining the property is still operated as an experimental agricultural station by NCSU, and there are plenty of Angus cows grazing on the pastures. I was completely unaware of the changes at Chinqua Penn and the myth it would survive for future generations.

What other myths are out there this time of year regarding flea control?

IS SUMMER THE WORST TIME FOR FLEAS IN NORTH CAROLINA?

No, fall is actually the time when maximum fleas occur as one flea can lay 50 eggs a day, and thus, the total flea infestation in the environment by October is extremely high.

FLEAS ARE GROSS, ONCE THEY ARE TREATED END OF STORY, RIGHT?

Unfortunately, it is at least a 3 month cycle to treat. Even more serious are the diseases carried in the flea saliva/bite: tapeworms, Bartonella (Cat Scratch Disease), and the Plague are the three most commonly mentioned.

WILL FEEDING RAW GARLIC OR BREWER’S YEAST CONTROL KILLS FLEAS? WHAT ABOUT ULTRASONIC PET COLLARS?

Nope. There is no scientific or clinical evidence of this, and in cats GARLIC can cause anemia. Unfortunately, the ultrasonic collars can actually be detected by pets and change their behavior.

WILL SPREADING DIATOMACEOUS EARTH(DE), BORAX, AND SALT ON CARPETING, PET BEDDING, AND FLOORS AND VACUUMMING EVERY 3 DAYS AID IN THE CONTROL OF FLEAS?

This is partially true; yet not really practical. When used, application to pet sleeping area seems the most effective to desiccate (dry out) flea larvae.

WILL SPREADING CEDAR SHAVINGS, NEMATODES, IVORY SOAP, and PLANTING PENNY ROYAL IN THE YARD AID IN THE CONTROL OF FLEAS?

Soap and water work only on the adult flea, so since they are mainly on the pet, this will not work in the yard environment where there are few adult fleas (plus soap kills the grass). Nematodes, although a fad several years ago, were not proven to be effective yard treatments as there are few flea larvae in the open spaces. Cedar shavings & Penny Royal, both natural flea repellent, would be impractical to treat entire yards due the volume required for effective control.

KEEPING PETS STRICTLY INDOORS PREVENTS FLEA EXPOSURE?

Many pet owners (especially those with cats) live on the theory that being indoors lowers exposure to external parasites. Fleas, however crave indoor environments. All it takes is one pants leg, shoe, a flea hitchhiking in the house on the fur of another pet, and one male/one female flea to start an infestation of thousands in a few weeks in the Southeastern United States.

In summary, it is still open flea season in our area. Effective flea control programs include a combination of flea combs, bathing, oral/topical flea medications, and indoor/outdoor environmental control (utilizing products such as Knockout premise spray and/or licensed pest control operators). Frequent washing and vacuuming of bedding is important.  Control ROAMING of wild animals such as raccoons and opossums (the primary carriers of fleas into yard), and clearing of brush helps to control areas of flea nests.

Fleas do not spread by jumping from pet to pet,  ut rather a pet passes through an area where another host (cat/dog/raccoon/opossum) has contaminated the area with flea eggs, larvae, and pupae stages.

Visit capcvet.org for more information and flea updates by region.

CHECK OUT THE NEW NEXGARD FOR ORAL FLEA/TICK CONTROL IN DOGS TO REPLACE TOPICAL THERAPY IN A NEW , NOVEL FORMULATION.

 My thanks to the dog stars: Shayle Dettelbach, Sherlock York(dach), and my Taco belle(chi)

Betsy Sigmon DVM, Diplomate ABVP canine and feline

Hospital Director, Creature Comforts Animal Hospital

Sunset over a Canadian Lake

Litter box avoidance and steps to direct when urinating outside litter box

I recently received the above photo from a colleague, Bo Bergman DVM, that reminds me that there is already a spot of fall in Vermont. The gorgeous colors and reflection in the lake below are a stunning respite from the hectic pace of life. In everyone’s life, there seems to be a moment or place that is memorable. When possible, in my own life it is the Blowing Rock, NC area of the mountains, and I try to get up there whenever my schedule allows space to watch sunset over the Johns River Gorge.

Cats have a way of letting us know they like a spot (kneading, sleeping, or scratching in a special spot) and that it is an acceptable behavior. However, for indoor cats, they can also let owners know their displeasure with their bathroom facilities (litter box) to defecate beside the litter box.

WHAT ARE SOME STEPS A CLIENT CAN USE TO CORRECT INAPPROPRIATE DEFECATION BESIDE A LITTER BOX?

Use fine sand scoop able litter, not pine or scented types. Sand mimics the desert sand of their genetic heritage. Cats do not like perfume in their litter when offered the choice

Avoid plastic liners as it distracts cats and they often try to avoid them as the plastic feels funny to scratch and often cats prefer a different surface. Conversely, plastic is often placed in an area a cat urinates or defecates away from the litterbox to discourage using that spot.

IS IT IMPORTANT TO SCOOP THE LITTER IMMEDIATELY AFTER A CAT VISITS THE LITTER BOX?

Scoop the litter box once a day; however avoid constantly surveying and scoop instantaneously.

EVEN THOUGH I THOROUGHLY CLEANED THE AREA OF THE ACCIDENT, I AM CONCERNED THAT THE SCENT OF MY CAT IS STILL PRESENT. ARE THEIR ANY GOOD WAYS TO GET RID OF THE SCENT SO A CAT IS NOT AS LIKELY TO GO TO THE SAME SPOT?

Use of Zero Odor brand (on line or at stores such as Bed, Bath, and Beyond) TO clean up accidents is one of the best products to eliminate pet odors.

I LIKE TO KEEP A TOWEL AROUND THE LITTER BOX TO ABSORB ACCIDENTS, A PLASTIC LINER UNDER THE LITTER BOX, AND A HOOD ON THE BOX TO CUT ODORS. ARE ANY OF THESE A CONCERN?

Eliminate towels under and around litter boxes as many cats prefer them as a substrate than certain types of litter. Cats are most vulnerable when they are urinating and defecating and prefer to see 360 degrees when “doing their duty”. If a hood is utilized, it should be clear, not solid plastic.

Get rid of plastic liners or sheets under litter boxes as the sound or location could be a turn off.

I HAVE A PUPPY IN THE HOUSE, SO I HAVE EXTRA PUPPY PADS NEAR THE LITTER BOX. RECENTLY, I NOTED MY CAT USED THE PUPPY PAD TO URINATE. WHY?

Do not use puppy pads in the area as the pheromones in the pad may encourage inappropriate urination

HOW MANY LITTER BOXES SHOULD A CLIENT HAVE IN A 3 CAT HOUSEHOLD? HOW BIG SHOULD THE BOXES BE?

Make sure to use the rule of cat boxes as 1 per cat plus 1. Avoid use of A ROW the boxes beside each other as cats have zones in the house.  Also if there are 2 floors be sure when possible to have one litter box on each floor of cats explore the whole house. Theoretically, a box should be 1.5 x the length of your cat. I recommend sweater boxes or a concrete mixer tub from Lowes home improvement as it allows an owner to experiment with 3 to 4 types of litter (oatmeal, clump, clay, pelleted, etc.) to find the substrate a cat prefers.

Information is the recommendation of Dr. Nicholas Dodman, Animal Behavior Clinic Director, Cummings School of Veterinary Medicine at Tufts University

PHOTOS of Mike the cat, courtesy of Dan Pantzer

Betsy Sigmon DVM, Diplomate American Board of Veterinary Practitioners, canine and feline

Hospital Director, Creature Comforts Animal Hospital, PLLC