Sunday, June 3, 2012

Day 9: Urinary Tract Infection Diagnosis, Food Allergy Diagnosis, Erythema, Assisting with A Pregnant Spay, Bladder Stone Surgery, and Ear Mites


                This morning, I went into a couple of the patients’ rooms with Dr. Todd while he talked to the pet owners and assessed what was wrong with the pet, based on the complications the pet was having.  The first pet was a golden retriever who the owner thought was having some sort of urinary problem.  The owner said her dog, Bella, had been having problems for a few days, maybe a week at most.   She seemed to be having some slight problems passing urine, and when she would she would go to the bathroom on the hair that’s on her bottom, when normally she had always been pretty clean when she would go to the bathroom; she was also licking more in that area and squatting more frequently, and an odor was produced when she would rub her bottom area against the floor.  She wasn’t dribbling urine at any time, she wasn’t having any accidents, and she didn’t react as though she had pain while urinating; though the owner said that she whined a bit when she was touched in that area while receiving a bath.  Dr. Todd believed she had a urinary tract infection based on the symptoms Bella was having, and possibly vaginitis since she was producing an odor when her bottom was rubbed against the floor.  He looked her over while I held Bella, and said she was a little irritated around her vulva.  Nothing too bad or major, but he could definitely see a bit of irritation.  He also took her temperature and checked/expressed her anal glands (anal glands should be expressed with bowel movements [they’re what give their fecal matter its smell, and also what dogs smell when they sniff each other], but most dog’s glands either don’t do this, or they don’t release that much.  Because of this, most dogs have to go to their Veterinarian or groomer to have their glands expressed [squeezed] every few months or so [also depends on the breed and size of the dog].  Otherwise, they can irritate the dog, produce odor, and cause infection.).  I took Bella in back after her glands were expressed so her bottom could be cleaned, and after Lauren helped me clean her up I took her back to her owner and Dr. Todd prescribed her some antibiotics for the inflammation and irritation.
The happy Golden Retriever, Bella.

                The second room I went into with Dr. Todd had a shih tzu mix that belonged to an elderly couple.  They said that their dog had been pawing at his ears frequently over the past couple of days, and he had also started to shake his head a lot; a sure sign of either allergies and/or a yeast infection (dogs get yeast infections in their ears).   The dog had a yeast infection five months ago in January, and the couple thought he might have a yeast infection again; so they were using leftover medicine from that time as well as cleaning the dog’s ears more frequently over the course of this past week.  They said he doesn’t like it and puts up a bit of a fight when they try to clean his ears, and they also said that his ears are very dark inside, though they aren’t normally like that (that is a sign of a yeast infection).  Dr. Todd looked into his ears and saw the dark, moist, goopy stuff in his ears.  He said that it’s hard to tell what specifically causes the ear infection, but typically in young dogs, yeast infections like this are caused by allergies.  It’s also hard to tell if the dog’s ear infection is definitely caused by a food allergy, for he could be allergic to something outside or something in the home.  However, the most common type of allergy in dogs is food allergies (he also said that it’s most likely not a seasonal allergy because he had an infection in January, which wouldn’t have happened if he had a seasonal allergy.  Therefore, it’s most likely an allergy to food or something in the house; but since food is the most common type, he most likely has a food allergy.).  Even more specifically, the two most common food allergies in dogs are beef products and dairy products.  As Dr. Todd began to get rid of some of that goop in the dog’s ears, he asked the owners about the dog’s diet.  They said that they feed him kibbles and bits, Cesar, Pup-Peroni, rawhide bones, and table scraps (meat, cheese, ice cream, etc.).  Kibbles and bits, Cesar, Pup-Peroni, and rawhide bones are all beef products, and the owners also fed him a lot of dairy.  Because of this, Dr. Todd told the couple that all beef and all dairy needs to be completely gone from his diet for a minimum of three months.  Then after three months are over, they can start challenging his body by giving him only cheese for a few days, and see how he reacts; then give him only beef for a few days, and see how he reacts, etc.  If the dog begins to scratch his ears and have a reaction to, let’s say, cheese, then they know he can’t have dairy products.  Same goes for beef.  He told the couple that the doctors actually like to recommend that dogs with food allergies should only be on a high quality, single protein-source diet, like only chicken or only fish (it doesn’t matter if it’s wet food, dry food, or both; just as long as they are the same single protein source), and also a single carbohydrate-source diet (this isn’t typically too much of a problem because most of the time, the same carbohydrate source and protein source are paired together.  For example, the most common carbohydrate paired with fish is potato).   Dr. Todd also told the couple that some high-quality product brands are Blue Buffalo and Eagle Pack, and the majority of specialty pet stores will have high-quality brands for 90%+ of their food selection.  He then told them that if they would prefer, there are also some specialty pet stores that have high quality, grain-free diets, so they eliminate the carbohydrate all together so that it is solely a protein-source diet.  He said that fish is actually a really good and highly recommended protein-source diet to feed because it gives the dog all the desired nutrients, and it’s also high in omega-3 fatty acids, which helps decrease the itch sensation.  There are a lot of chicken-diets, fish-based diets, lamb-based diets, etc.; he just reminded them to not have any beef over the course of the next three months.  Dr. Todd also said to eliminate any treats over the next three months as well; he said to feed him nothing except which ever protein-based diet they choose to feed him in order to ensure the irritation and infection leaves, and to also ensure that they can find out what he definitely is allergic to.  Normally there wouldn’t be any problems with what they choose to feed him, but since the dog has allergies, he has to be on a very specific diet.  Dr. Todd also asked if the dog licks and scratches his feet a lot, to which they replied yes; that is a sure sign of allergies, and so that helped Dr. Todd confirm his assessment that the dog most likely has allergies.  He told the couple that he would give the dog an injection of dexamethasone, which is a fast-acting synthetic steroid that would decrease the inflammation and irritation.  He also told the couple to put Mometamax, an ear infection antibiotic, in the dog’s ears every day for a full two weeks, and to clean his ears at least twice a week, preferably every other day if possible, for the full two weeks.  He said for cleaning the ears, massage the cleaner in the ears, then tease a cotton ball or tissue, and stick the cotton or tissue piece into the ear and wipe it around; but not to use a Q-tip because they can really irritate the infection and inflammation.   Dr. Todd said then once two weeks are up, if they wish to bring the dog in to check him they can, but whether they bring him in or not they should go on a maintenance and clean the ears out once a week; the ears need to be dry because the yeast infection thrives on moist, waxy environments.  We then brought him into the back and Lauren cleaned and medicated his ears, and when we brought him back Dr. Todd recommended that they bring him back once yearly for a check-up on this since it seems to be happening once a year.
The Shih Tzu mix, Booshka.

Booshka was shaking his head a lot during the appointment.

                A pitbull mix named Remmy came in a little while later who also had ear problems.  He had actually been in a few days ago with an erythema infection in his left ear, and he was back in today getting checked on and getting a re-bandage.   When Dr. Todd unwrapped the bandage, he showed me the redness and bumps that can happen with erythema.  His ear also began bleeding again (like it had been a few days ago) because the infection was so bad.  Dr. Todd gently cleaned it and wiped the blood, and once the bleeding began to subside, he placed Surolan, an anti-inflammatory antibiotic, on the erythema, put some gauze into and around the ear to soak up any more blood, and then wrapped bandages around his head and ear.
Remmy getting his ear cleaned.  The redness and bumps from the erythema can be seen inside the ear. 

Dr. Todd trying to stop the bleeding.

Remmy after being all bandaged up.

                Something that really excited me today was when Dr. Karen was performing a spay on a stray Yorkie mix.  The dog happened to be pregnant, but no one knew that before the surgery because she wasn’t far enough along where anyone would have been able to tell by looking at her or at an x-ray (Dr. Karen estimated that she was about a month along at the time of the spay).  Since she was being spayed so that she could be put up for adoption, the surgery continued and Dr. Karen removed the fetuses, uterus, ovaries, etc.  As much as we would like to, we unfortunately can’t keep every animal that might be born because there just isn’t enough room or homes for every animal or every stray.   Tracey brought in some euthanizing fluid to inject into the sacs so that the puppy fetuses wouldn’t suffocate, but since they weren’t that far along they seemed to die as soon as they were cut off from their mother.   After Dr. Karen finished performing the surgery and had stitched the Yorkie mix up, she cut open one of the sacs and we looked at the month-old puppy fetus, which was very tiny.  After she opened the first one, Dr. Karen allowed me to put on surgical gloves and cut open the other two fetuses myself, which was really cool for me to do since I’ve never done anything like that before.   The first one that I opened, I didn’t cut deep enough to cut through the amniotic sac; so once I opened the rest of the placenta and took the amniotic sac (with the puppy fetus in it) out, it looked like the puppy fetus was in a bubble, which was kind of a cool additional sight to see besides just the puppy fetuses.  With all three of the puppies the snouts, eyes, and front paws/legs could be seen.  We carried the Yorkie mix to the runs and placed her in her stall on a blanket so she would be more comfortable when she finished waking up.
The puppy fetuses while they were still in the uterus, before Dr. Karen removed them.

The small, round bulge Dr. Karen is holding between her fingers is a ovary. 

One of the puppy fetuses.  If looked at closely, the front leg/paw can be seen, along with an eye.

The first fetus I cut open, while it is still in it's amniotic sac.  Again, a eye can clearly be seen, along with the front right leg/paw.

                Later on in the day, Dr. Amanda performed a bladder stone surgery on a German Shepard.  He had a lot of tiny stones in his bladder, and then a had a very smooth, medium sized stone followed by a very large stone that was made by a bunch of small stones clumped together; it looked like a peach pit.  After flushing the urinary tract out with saline solution (to make sure no stones were left or caught in the tract), Dr. Amanda stitched him up and we placed him into the recovery room while he began to wake up from the anesthesia.   After that, Chris took me over to the microscope to look at ear mites.   Chris is a volunteer who takes care of and checks on the cats that are there.  She had just cleaned out the ears of one of the stray kittens she has been taking care of, and a lot of dark brown goop had come out.  She told me that if there is a lot of dark brown goop in a cat’s ear, especially around the pinnae (ear flap) or in the ear where it can still be seen, it should be checked to see if it’s dirt or ear mites; for this kitten, it happened to be ear mites.  I was pretty interested to see the mites as well because I’ve never seen them before either; they are strange looking, and they were scuttling along fast on the microscope slide when we looked through the microscope.  After showing me the mites, Chris finished cleaning out the ear and applied some mite medication inside the ears to kill off the mites.  She said she will be cleaning the ears every day, and since the medication should be killing the mites nearly right away (within a day), she will be checking the ears again tomorrow and apply a different medication to kill off any eggs that the mites had laid.
Dr. Amanda making an incision in the bladder so she can scoop the stones out.

Some of the small stones and the large, peach pit-looking stone.

Some more smaller stones and the smooth, medium-sized stone.

Example of the dark brown goop that will be found if the cat has ear mites.

What an ear mite looks like under a microscope.

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