Incurable Carp Pox

Fantail goldfish with carp pox

My poor goldie, a carrier for CyHV-1, broke out with 2 side lesions after a stressful week of overfeeding caused nitrates to spike, shredding his fins. Although water quality was immediately restores, and the fins mostly healed, the pox continued to erupt and grow. He's about 6 years old.

The water issue was too much for his two tank mates; he is the lone survivor, other than a 17 year old immortal catfish. 

Red fantail (sold to me as a Ryukin),     blue Oranda,     calico Fantail

I've been a goldfish keeper for more than 50 years (yes, I'm old), but this is the first time I've ever seen this happen.

Note: if you hire a pet sitter, HIDE the fish food and leave teeny amounts in a 7 day pill box. What we call "a little" and other people call "a little" varies a lot. 

Gifts for Pet Lovers, Book Review, $15

This is a quick note to tell you how useful I've found the Merck/Merial manual for Pet Health.  There is a home edition that you can pick up in the $15 ballpark that will cover everything you want to know about caring for your own pets. It covers mostly dogs, cats, and horses, but also exotics from fish to prairie dogs. The text is a simple read, probably at 11-12th grade level.

At what age does a cat normally develop tumors or polyps?  What is lung worm?  How is FIP treated? Diseases that are zoonotic are important to know and can be found in this book also. Can you deal with behavior problems in horses?  Colic - there's a word that makes horse owners shudder, but there's an entire chapter on Digestive Disorders of horses in this hefty book.

Over 1300 pages of information of the like that I learned in veterinary college, and some things I didn't know about at all!  How to make a first aid kit for your birds, info on sugar gliders, viruses of amphibians, ferret hazards, and so on.  I have to say this is my go-to first book when I am puzzled by something with my Animal Cornucopia. 

It also covers emergency care for horses, dogs, and cats, drugs used to treat specific disorders (informational, not a formulary), trauma care, bites, and poisoning symptoms and what to do in different cases. If you are searching for a gift for an animal lover, animal person, pet parent, this is the book to get.  Just click! You'll be glad you did! (Clicks help support the blog, you can always search for other products once you get there.....thanks!)

So get this book for the pet lover on your gift list.

 

If you need pet sitting service, be sure to visit our website at www.AllPetsCS.com  Coming to Las Vegas?  We can take care of your pets in your hotel while you are enjoying the city.
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Keeping Horses Warm

The recent cold snap across America has a lot of folks scrambling to cover pipes and protect pets from the unusually low temps.  I am one of those folks, with nearly 30 animal outside that are hostage to my efforts to keep them safe.

I've been asked sometimes about blanketing horses and feeding extra grains and corn during cold spells.  Um, no, that's not the best course of action in most circumstances.  Of course, an explanation follows!

Here in Las Vegas we have pretty mild winters, and are not generally set up for snow, or even much rain for that matter (less than 4 inches per year average). We are set up to combat heat and sunlight, with shade and misting systems, and we are usually set up for wind, being a desert it is usually windy here if nothing else.  Shade covers sloping west or south west, pvc and brass mister systems, and five foot high solid or semi-solid panels on the north side are the usual protections.

For horses over 20, and temps that go below freezing, I will use a blanket that is not for Alaskan winters but has a light to medium poly-fill and a water resistant nylon outer, or even a heavy canvas rug if the horse has a good winter coat. My miniature looks like a bear and will never need a blanket in any Las Vegas winter unless he was clipped, something I have no need to do for him.

My Tennessee Walker mare, however, is 23 years old, and although she grows a decent coat, I hate to think of her leggy ectomorphic frame shivering in the cold, so the lightweight blanket goes on in the evenings, and it comes off in the daytime.  We have yet to experience a daytime high of less than 32F so given that's my criteria, if the sun is out, the blanket comes off. I remove the blanket so she is not "acclimatized" to wearing it.  It's the body getting used to a temp and then adjusting its personal internal thermostat so the environment.  If she wears the coat all day, it will not generally keep her "as warm" than if we remove it for part of the time. When it goes back on, it resets the thermostat to keep the cold away better.

I have a hard time explaining it, but that does seem to be how it works.  If you wear a coat in the house where it's warm, it doesn't help as much when you go outside - you need a heavier coat. If you walk about your comfortable house, you put on a coat to go outside and it keeps you warm. Of course, if the horse has a heavy coat, you can't do this, but nature gave the horse what it needs for the climate it's genes hail from - Shetland is cold, Shetland genes grow bigger coats, American minis have Shetland genes, thus - you get the idea. Arabian horse blood will not give a horse nearly as thick a coat, being a desert creature from the equatorial latitudes.

The same goes for a horse clipped for winter time shows.  Put that blanket on because you've removed the weatherproof hairs and left only the fuzzy stubs that will dry quicker after a ride but won't do anything more than a T-shirt would for you.  A barn should not be closed up and hot, it should be in the 50F ballpark, and a blankets on clipped horses.

The other thing people often will do in an attempt to keep their horses warm is to increase grain. Please don't increase your horses' grain rations.  Continue to feed the same amount of grain as always, if any, and increase the hay and roughage.  Grain simply encourages founder, and the bacterial flora will have a party and send their waste products straight to your horses' feet. By the time winter arrives, it's too late to "fatten up" your horse for winter. That is supposed to happen in the wild during summer when food is available.

 

Alfalfa on the left, Orchard-Timothy on the right

Increase hay rations by about 25% for every 10 degrees of F temp below normal.  If your normal winter is 30F at night and 50F in the day, and it's down to 25F with 40F daytime highs, give an extra 2-3 pounds of hay at night.  This should be a high quality grass hay like orchard or timothy, not a legume like alfalfa.  Alfalfa has a high percentage of calcium which can cause an imbalance in potassium and other electrolytes.  When water intake is reduced, as it will be in the winter, it is easier to become dehydrated and in imbalance.  If temps are staying below freezing, don't be afraid to increase grass hays by 50%.  It creates much more heat to digest the hay and roughage than it does the corn and grains, and won't contribute to hoof maladies.

My dog ate (fill in the blank) !

Well, here is a new one I've heard about.  I've seen a lot of things removed from a dog's stomach, but this one is sad because it came too late. It came out during a necropsy (animal version of autopsy) and the killer was an AA battery. 

I've seen dogs eat rocks, jewelry, cat poo covered in clay litter, a tea bag with staple and tag, peach pits, a Scrunge, a sponge, chocolate of course, but never had I thought that a dog would pick up something so innocuous as a battery, and a dead battery at that.

The toxins in a battery do not go away, they just become inaccessible to the electronic thing that needs the toxins to run.  



 

This is just one example.

And that isn't the only kind of battery you need to beware of.  Watch batteries, hearing aid batteries, remote control batteries, smoke detector batteries, toy batteries - anything that uses portable power is a potential killer. The smaller the battery, the easier it is to swallow, altho a small battery in a big dog may be found in time before it's too late.

 

Radiographs!  If your dog is vomiting or having diarrhea, and the vet doesn't have an answer, try an X-ray.  Yes, they're pricey.  Yes, they find things that you'd never guess at.  I spent a lot of money on my dog getting acupuncture and supplements when a single x-ray would have shown the stone in her bladder, which, once removed, cleared up her incontinence in 12 hours flat.

 

It is the time of year we hear "Batteries not included" with just about every item on the Christmas list.  You buy batteries, batteries can roll off a tabletop, you won't miss them when they're gone (like your wedding ring would be missed).  They don't necessarily cause a blockage, but serious gastrointestinal pain and suffering follow their ingestion.  They rarely come out without doing some damage along the way (unlike, say, a dime or the cat poo).  Don't leave batteries laying around - 9 volt, AAA, AA, C, even D can be swallowed and kill.

 

Speaking of cats, don't forget that tinsel from the tree can snare up their intestines like an accordion, and death happens quickly.  It's so fun to play with, shiny, and irresistible, just use garland and keep the tinsel off the temptation list.   It is a surgery that is rarely successful if even the cause is discovered in time.     

 

Going away for the holidays?  Call a trusted Pet Sitter to care for your furry friends while you are vacationing.  In Las Vegas, call me at 702-560-8234, or visit my website at All Pets Concierge Service, LLC.  I am a licensed veterinary technician who has never had a dog eat a battery or a cat eat tinsel!      

 

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Working with protocols: anethesia

As for anesthesia in dogs and cats, and exotics and livestock for that matter, this is an area where I was constantly at odds with others, from the other technicians to the veterinarians as well. I spent many, many hours monitoring anesthesia during my training, at a nationally known facility in Las Vegas.  It's a testing and training facility not just for technicians, but also for veterinarians and human doctors as well. 

A technician is trained in anesthesia in different contexts. I was trained not only by the book but also hands on, by the doctors, including experts in anesthesia.  I was assigned to perform the blood work, assess an anesthesia risk category, calculated the drug dosages, induce the anesthesia, monitor the animal while in surgery, and recover the animal post surgery. Sometimes this entire process would last 4-5 hours.  Then, we'd do it again for the second half of the day.

We were required to know every part of the machine, how to assemble and disassemble, to read the pressure gauges, change the filters, etc.  Every part of the machine was required  knowledge and anything less than 100% was a fail.  This is one area that is critical to care of our patients. We had to know the physiological effects of everything associated with anesthesia, from the drugs, the rate we injected a drug, when to increase O2 and when to decrease it. There was no fooling around; this was probably the most serious part of our training.

Sometimes, in our training, we would monitor a dog while it was kept under anesthesia to test veterinary candidates in radiology proficiency.  In these long sessions we often saw drops in blood pressure, O2 levels, high CO2 levels, hypothermia, and other complications, simply because of the nature of the procedures.  These were not textbook cases and required thinking at all times, usually while wearing 20 pounds of lead, for 2-4 hours at a time.

During some of our sessions, we would use a CLOSED system. Medical people often think I'm nuts when I say I monitored animals on a closed system, which means that the waste gases exhaled from the animals are recycled instead of being exhausted to a filter and then into the air. It involves closing a critical valve, and on some machines, you can no longer even close this valve completely because of the potential risk to patient. But close it we did, and knowing what was involved was obviously critical to a successful outcome.

So.....when I was going to be demoted for not following protocols, I was a bit stunned hearing the doctors didn't trust me with anesthesia. WHAT?  Oh, I see, every pet no matter it's size or health status was to be started on 3% O2 and 3% Sevoflourane for 3 minutes. That is one of the dumbest protocols I've ever heard.  How can you get your patient unconscious if you are pumping that much O2 and gas at the same time?  The O2 must be LOWER than the inhalant or they all but cancel each other out. Why 3 minutes?  A Great Dane will need 5-7 minutes to reach a surgical plane, a chihuahua about 2 minutes.  And does the chihuahua that is 5 years old and healthy get the same dose as the Great Dane that is 5 years old and undergoing an emergency surgery?  No!

Incredible.  Sevoflourane is probably the safest anesthetic gas made for veterinary purposes.  it's used for human purposes as well.  Animals can remain under Sevoflourane for hours without serious risk.  Most veterinary practices use this gas above the others for this very reason. In the overwhelming majority of cases, it is used on an open system with venting to the outside. To say "average" we could say that to induce a pet you turn the Sevo to 2 or 3 %, and the O2 to 1-2%, and this varies of course.  The pet is physically monitored by a human being while it goes from a light plane, to a deeper plane (which sometimes appears lighter or deeper) and then the 3rd plane for surgery.  It involves listening to the heart, feeling for a pulse, looking at the pupils, and of course, watching the chest rise and fall. 

During this time the human usually attaches various monitors, including a capnograph to measure CO2 exhaled (the company I worked for didn't have one on either of its machines, the most important tool in IMHO to monitor patient status), a sphagnomymometer to measure blood pressure, and electric lines at the chest and hip area to monitor electrical heart activity (not a substitute for watching the chest and listening to the heart, ever).  The gums are checks for color to indicate blood flow, and the tongue is used with a light device that measures the saturated O2 in the blood. Usually one of those things or another one will act as a thermometer also.  And don't forget the fluids we talked about last week.

When the animal reaches Plane III, it is time to re-evaluate the anesthesia machine.  Usually the O2 is turned down and the gas is adjusted to maintain Plane III until the end of surgery.  It must be watched, monitored, and recorded every 5 minutes in Plane III.  Better charts in the 21st century don't simply record the number but will show trends by charting on a graph.  These trends are more important than a single number.  I prefer to mark a paper rather than leave my patient to record in a computer, but the company preferred the computer.  Save time, see more patients, record right into the computer instead of transcribing later (when we weren't busy thereby making more productive and efficient use of our time).

  

Monitoring a 45 pound dog, in a closed system, between veterinarian radiology exams.

Here is my example that made me throw in the towel.  You'll love this.

During mid-day, a large dog was prepared for a dental cleaning, a procedure done under anesthesia.  I was to do the cleaning, the vet agreed to be the anesthetist for this time. After 2-3 minutes of starting, my patient seemed to be in Plane II, starting to wake up and twitch, eyelids fluttering.  When I stopped, I turned to see the anesthesia machine at 0 on the Sevoflourane, and I forget today what the O2 was because I realized my patient was about to wake up.  I quickly pushed the Sevo to 5 or 6%, and looked around for the doctor, no where in sight.  I took over anesthesia for a moment to make sure my pet would go back to sleep and not wake up with a tube in his mouth. The doctor appeared, texting her boyfriend, so I returned to my procedure. Suddenly the doctor is aghast that the Sevo is up, accusing me of incompetence, telling me I was about to kill the dog, etc. 

Nothing was further from the truth! My anesthetist had neglected her duty to monitor the patient, I had made an emergency effort to return the patient to status.  I knew the dog was under a high level of gas, so I reached over and turned it down to 3%, putting O2 at 1%, and the deal was done.  So I thought. Those 30 seconds of 5% were important to quickly put the dog back to Plane III.  Had the dog not been intubated and covered with attachments  it's waking would have been inconvenient, but not dangerous.  Waking up under a procedure is never a good thing. 

So, I was reported as negligent and incompetent when I had made a quick emergency decision required because of the veterinarian's obsession with her new boyfriend. Texting on duty was prohibited.  Leaving your patient is active negligence.  Blaming someone else:  Priceless.

The Corporate Powers decided that 5% was a lethal dose and it was my fault (um, no, 5% Sevo is not lethal after 30 seconds on a 80 pound dog). I was not offered an opportunity to air my grievance, especially since I was lower in medical rank than the veterinarian. Another practice within the chain wanted me to join their group, as they had seen me work many times and were sure that what they saw was not an idiot.  But given the distance, and my frustration with the old technology I was working with, I decided to leave the company.

I've been contacted by them in the last couple of years probably 8 times to join their team, get a sign on bonus, etc. but I can't do it.  Go back to machines without capnographs, analog radiology, have to run back and forth between patients and doctors to discuss money and treatments - no thank you. It's a small town, this big city, and most everyone knows most everyone else in a relatively small professional community of maybe 1000 people. I prefer to go out and meet those who are looking for safe, reliable care for their pets during the holidays, and leave the drama to somebody else. 
 

Critical Thinking

I was reading the November issue of Atlanta magazine today, their technical issue.  Something hit me that I thought I needed to share.

An article identifies how we as humans have forgotten how to think.  Intrigued, I read further. It explained how some airline accidents occurred because of too much reliance on the autopilot, and in an emergency, the pilots reacted, incorrectly, instead of responding to the situation, resulting in dozens of deaths.

I was educated as a veterinary technician by a seasoned group of veterinarians, not other technicians as some quick private schools tend to use.  We learned the real-world way to nurse animals as well as the new technologies.  As an example, I will use the anesthesia and fluids drip scenarios to explain.    

In some veterinary practices, there are rigid protocols for starting animals under anesthesia or a certain amount of fluids to be given while under anesthesia.  These figures are always based on weight and species of animal.  However, a thinking person should not need the "basic" protocol to begin with.  Every patient should be treated uniquely and separately based on a number of variables including age, blood chemistry, type of operation, circumstances surrounding the operation, weight, and of course, species.

For instance, a pet undergoing anesthesia for a heart valve repair doesn't need the same level as one getting a dental cleaning.  Female cats need inhalant anesthesia for sterilization, males do not. Older pets must be monitored for additional factors that younger pets do not need.  Same with giving fluids intravenously while under inhalant anesthesia.  A dehydrated pet in an emergency situation needs an entirely different protocol than a 6 month old spaniel going for a spay.

I want to point out why I decided to leave a well known chain veterinary practice for exactly these reasons, and to remind folks to ask questions about procedures to their veterinarians, which keep doctors and technicians on their toes and accountable to clients.

My first example was regarding pre-anesthetic fluids to a dog about to undergo a spay, a straightforward operation but not exactly a simple one. The doctor asked me to set up the dog at a certain rate before she was going to go to surgery s the dog would get a certain amount of fluids in her body to offset any blood loss or low volume induced shock.  A great, precautionary measure I endorsed. The facility had two fluid machines, a stand with a hook and a box that would pinch the tube until the appropriate amount of flow was obtained in relation to how much you wanted to give over a period of time. One machine was for the pre-op and treatment room, the other was in the operating room.  The machine in the treatment room was, for whatever reason, not functioning, so instead of going into the clean operating room to get the other machine, I set up a manual drip.  This involves calculating the need of the pet, the time period to deliver, the drip rate per ml and then by per drops in a ml, then looking at your watch's second hand and setting the dial that comes on the tube. This is what the dial is for (manual setting).

The doctor came by and was upset that I hadn't used the machine from the operating room.  Did she think I couldn't do simple math?  Did she think that I would perhaps not contaminate the clean machine when it was returned to the operating room?  Did she think I would over or under dose the pet or that I couldn't count drops per second?  I wasn't sure about her reasoning, and not feeling comfortable to ask, I left my system in place knowing I was perfectly capable of doing this task. I bit my tongue over the sanitation issue of the operating room.  

Another instance came along later when setting up for a surgery of a small dog, a straightforward castration of a dog which would take less than 20 minutes.  The dog was small, and the smaller they are, the more attention they need; their body systems fail quicker for the simple reason of volume - a tablespoon of blood means more to a chihuahua than it does to a saint Bernard.  In my head I was able to quickly calculate the fluid dose, which came to about 99 drips per hour, or something of that nature (20 pound dog).  I set the machine to 100, and the doctor has a bit of a hissy fit that I had not set it at 99.  I reset her glorious machine at 99 and we continued on. I resisted telling her she was nuts to be doing my job instead of her own.

Extra fluids on a small dog that amount to perhaps 0.5 of a ml of fluids over a 20 minute procedure. This is even a difficult amount to measure, about 1/10th of a teaspoon. They don't even make measuring spoons that small. In my educated opinion, and the fact that there is more than that amount simply in the tube that delivers the fluids, over 20 minutes, even if there had been complications to cause an hour of surgery, the dog would have benefited from this extra half a milliliter rather than it cause detriment, simply because he was a small dog, all of which can benefit from 6-7 extra drops.     

The reliance on this machine was absurd.  However, the corporate office, in its attempt to create a Big Mac button its cash register, dumbed down the ability of a good technician to calculate and think and set up.  What if I'd needed to suddenly increase fluids?  Instead of simply lifting the bag or squeezing it, I would have had to touch the pad and re-enter data to reset it, then unset it a few moments later down the road, simply to be able to accurately count how many mls of fluid the dog was being pushed, not necessarily what is received, because of the difference in the tube anyway! There are markings on the bag that tell you how much fluid has been dispensed, there is no urgent need for the machine to do it.

I will continue on this vein (pun intended) in another post using anesthesia induction as an example of idiocy when it is always the same, for every pet, no matter what, and the trouble this causes for the pet (and the technician who follows blind protocols without thinking).  In an effort to make things run smoothly, I didn't want to insult the veterinarian's intelligence by stating the obvious, but these things seemed obvious to me, and I kept wondering why they didn't jump out and shout at the doctor.

Lastly, about fluids, I was trained in a theater of veterinarians, well known and accomplished, published veterinarians, and machines were the last thing we relied upon. We didn't use drip machines, and we never stepped away from our patient while it was under anesthesia.  We didn't record everything in a computer, or let a machine read all our blood smears.  Perhaps thinking isn't what this company I worked for wanted.  In that case, a robot could have been doing the work.  What have humans evolved for if not to think? 

Proteins and Lipids and Fats, Oh My!

Been pretty busy these days, so apologies for those following that I've not put anything new out lately.

Diabetic cats are becoming an epidemic in America. Are you noticing any signs?  Lots of drinking and lots of trips to the cat box to urinate? Owies that don't heal?  Weight gain? Lethargy?  You can make changes in your cat's diet to reduce these symptoms and help manage diabetes, but if you are honestly following the guidelines and your cat's health doesn't improve, it might be time to see the veterinary for more drastic measures.

Personally, I find that a diet high in protein and fat will force the liver to produce the glucose needed for brain function, and the body will start to burn the fat for energy needed by the muscles and metabolism. You hear talk of complex carbohydrates, but these food items tend to take longer to digest (of course) which happens closer to the large intestine where the bacteria count is highest. This in turn produces, well, a lot of intestinal gas.  It can be uncomfortable for the cat (and anyone within olfactory distance of the cat), so I recommend staying away from any extra carbohydrates if possible.

Start with canned cat food. Buy a premium food that is not made from ingredients that are primarily "by-products" of some sort of animal.  The canned food is to add moisture and provide the vitamins and minerals that cats need not found in the pure sources of protein and fat we can obtain (unless you want to go hunt mice and songbirds and grasshoppers).  Then we're going to add cooked chicken thighs. Not boneless skinless breasts, but thighs with the skin on.

Two weeks worth of chicken thighs can be had for about $5.  Cook them long and slow in simmering water about an hour, then cool and refrigerate until they are cool enough to handle. Remove the meat from the bone and dispose of the bones unless you want to grind them up into very small pieces - not as small as salt but smaller than peppercorns.  Don't let the cats shew on cooked bones or they could end up with a shard stuck in their esophagus.

Dice the meat into 1/4 inch cubes, fat and lean, add a little of the gelled broth, and freeze half for next week.  Put this week's half in a bowl, cover with tight lid, and then add this to your cat's canned food at about 2 parts chicken to 1 part canned food. Feed the cat a teaspoon or less of the bones or offer about a teaspoon or tablespoon of dry food for some crunch factor.  Be sure that dry food is of the utmost quality and as high in protein as you can find. Beyond One or Blue Buffalo are both good dry foods. Do not use the partially soft foods in pouches; they are usually preserved with glucose.

Fat soluble vitamins include A, D, E, and K. These can build up in fat tissue, and can be toxic, so err on the side of a little less for these four. The rest are water soluble and will wash out pretty regularly, and you need to replenish these. Talk to your veterinarian about adding vitamin supplements to your cat's homemade diet.  You can purchase over the counter vitamins at the pet shops or online made for cats' needs, but again, err on the side of less is more because there are supplements in the canned food, cats make their own vitamin C (unlike humans), and adult cats don't need the same as kittens or geriatric cats.  You do not want to deprive kittens (18 months and under) of vitamins, and your veterinarian should recommend supplements for your geriatric cats (over 10 years).

And yes, this high protein and fat, no carb diet seems extreme.  Most people are so befuddled by the combination, it going against what we've heard for so long about fats and carbohydrates, that it is hard to think about how it works.  Domestic cats are not as far removed from the wild as even dogs.  Nutritional ideas are changing.  When you consider that diabetes in humans (and cats, for that matter) has skyrocketed in the face of low fat diets and complex carbohydrates, throwing carbs, made of starch, made of sugar, at an organism not equipped to digest these compounds, is illogical and contrary.

If you are at all concerned about your cat's pancreas, kidney, and liver functions, have those checked with a urine test and chemistry blood panel test at your veterinarian.  If you don't see results within 30 days, discontinue the diet and have your pet examined for other causes of the symptoms.  If you cat is receiving insulin injections, check with your veterinarian before implementing this diet.  Insulin levels will drop substantially on this diet and then medications may be contra-indicated.