Anesthesia Fears

      When we recommend a surgical or dental procedure that will require general anesthesia, fear of anesthesia is frequently paramount in the owner’s mind.  Fear of anesthesia is universal.  In people, patients often fear anesthesia more than the procedure itself.  This is true even though patients often are at a greater risk of dying from the procedure than from the anesthesia.   For example, women have about the same risk of dying from an uncomplicated pregnancy as they do from having anesthesia.  The fear of anesthesia is much greater than the real risk.  Though we can’t ever take the risk of anesthesia to zero, the risks are very minimal in animals and people.

     The first anesthesia was used by a doctor at Massachusetts General Hospital in 1846.  Ether was the first agent used; later chloroform was introduced.  In the 168 years since the beginnings of anesthesia, veterinary and human medicine have worked and struggled to improve safety.  We long ago stopped using drugs that were explosive. Current agents also do a much better job of protecting vital functions.  New drugs are constantly on the horizon and we are always fine tuning monitoring parameters and techniques.

       During anesthesia in our hospital, veterinary surgical staff monitors blood pressure, oxygen content of the blood, ECG and blood carbon dioxide levels, among other parameters.  In addition to mechanical monitors, we know, and have always believed, that the best monitor is well-trained staff. At the Lien Animal Clinic, every patient is assigned a licensed veterinary technician who is with that patient from the time they are prepped for surgery until they wake up. The technician administers drugs that relax the patient and provide pain relief, induces the patient and places an endotracheal tube, enabling the patient to breathe oxygen as well as the anesthetic gas. The same technician monitors anesthesia throughout the surgical procedure and is with the patient until it is fully awake following surgery. Our belief is that the technician should act as an advocate for the patient, including requesting additional pain control or other techniques to provide patient comfort and safety.

      Most patients have a blood test before anesthesia ensuring that they are normal metabolically.  All patients have intravenous catheters that supply vital fluids throughout surgery and give us constant access to their blood stream.   All patients are intubated so they can breathe oxygen along with anesthesia gas. This provides additional safety in cases where it becomes necessary to offer respiratory support. 

       We hear quite often that certain breeds are sensitive to anesthesia or specific medications.  This is rarely true. Each patient is unique and our drug and anesthesia protocols are based on what is best for that patient, not on their breed.  A multi-drug approach is the most effective and safest approach.  We add the benefits of certain medications while decreasing the negatives by using anesthesia cocktails with lower doses of individual medications.  Typically, animals receive pain medications with sedative medications prior to anesthesia.  This relaxes them, pre-treats for pain and removes the stress from their experience.  Then, an IV catheter is placed and the patient receives anesthesia-inducing medications.  The endotracheal tube is then placed enabling them to breathe anesthesia gas and oxygen.  Following the procedure, the patient is given oxygen until they eliminate the anesthetic gas from their body.  If appropriate, pain medication is repeated on recovery.

This scenario is exceptionally safe and is our standard protocol.  Know that the care-giving team providing your pet’s anesthesia is skilled and focused on your pet for the duration of its procedure and attentive to its needs through discharge from the hospital.

      Always feel free to discuss any concerns with us about any care your animal may need, including anesthesia or other procedures.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Family Medicine

     The blog I re-posted last week was by Dr. Brita Kiffney.  Brita is veterinarian in Bellingham and is my cousin.  I have always been very proud that we are both veterinarians.  In all the interactions we had as kids I don't ever remember talking about both of us wanting to be veterinarians. We just looked up when we were in college and saw we were following the same path.  I graduated from vet school in 1989 and Brita in 1995. We had this happen again a few years ago when we realized we were both pursuing board certification with the American Board of Veterinary Practitioners (ABVP). We are now both Diplomates of the American Board of Veterinary Practitioners, specialty Canine and Feline Practice, and certified just a year apart.

   
Brita's dad, Paul, is my dad's little brother.  Their dad, Don, was a physician as was his brother, Austin.  Don and Austin practiced together in the Kraabel Clinic near Woodland Park Zoo.   Grandpa and his brother were in practice when penicillin was discovered.  My Uncle Paul tells stories about how magical his Dad's little black bag that he carried on house calls seemed.  He learned later that mostly he could only dispense hope.  Grandpa used to talk about the advent of penicillin ushering in the era where doctors could finally do something.  Our Uncle Al is also a physician and orthopedic surgeon, though he hasn't practiced since the early 90's.
   
Brita and I grew up with our family taking care of us.  I remember going to the Kraabel Clinic. There was a messy doctors' office with shag carpeting and dark paneling and a spot in reception where lollipops were kept.  Helen, the great nurse who seemed larger than life, would always let me have as many as I wanted. My memories are sketchy since I was young when they both stopped practicing and they were both gone by the time I was in middle school.  Our Uncle Al was a great role model.  I spent a lot of time at his office with various orthopedic/sports injuries over the years.
   
Brita and I took the medical legacy in our family into veterinary medicine.  I have always felt medicine was in my blood, even if I didn't chose to direct that towards human patients.   Early in my career, I would see the occasional client that had been a patient of my grandpa or Uncle Austin.  It always made me feel connected across decades to a set of brothers that I only really knew for a short time.  I recognize their contribution to my life in veterinary medicine.

Life has interfered many times and Brita and I have had times we haven't kept in great contact.  But between social media and ABVP that has changed.  We initially reconnected over the ABVP certification process and have stayed in better contact since.  We just got back from the annual ABVP continuing education conference.  It was great to spend time with Brita and our extended group of friends in the organization.
 
Significantly, Dr. Fritzler and I are proud that the family legacy may move into the next generation.  I wrote in a blog before that our sons both want to be veterinarians.  We just found out this week that our oldest son Geoffrey got through the initial application process to vet school and has an interview in January for a spot in the WSU College of Veterinary Medicine Class of 2019.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Having a Happy Thanksgiving with Pets

Reposted from Dr. Brita Kiffney, DVM, DABVP

Thanksgiving stress and how to avoid having to go to the veterinarian the day after!

We all know spending time with family during the holidays can be stressful. Arguments break out over the smallest things. Fights erupt over deep-seated issues. It's hard to remember the topics not to discuss; there are the obvious ones like religion and politics, but don't forget your aunt just divorced, (maybe best not to speak of men?) or your step sister hates her new haircut...

It is easy to spoil your pets in response to all this stress- hey, they don't argue about politics or care about the tattoos your son has acquired!
Just remembers that some treats can lead to injury or illness for our pets. The following are some tips for a happy holiday with you pet. 

1. Fatty Foods:  Foods high in fat can give your pet pancreatitis or gastroentertitis. Avoid feeding your dog or cat turkey drippings, turkey skin, bacon, or other high fat foods
2.  Alcohol: Cats and dogs are very susceptible to alcohol toxicity- they don't just get drunk , they can die from alcohol ingestion. All poisoning problems boil down to the amount (dosage) of alcohol ingested compared to weight. Most of our pets are much smaller than a typical adult human. Within 30 minutes of a pet drinking alcohol, symptoms can appear: staggering , depression, and stumbling. Keep alcoholic beverages and medications out of your pets reach during the holidays. 
3. Bones:  Bones can lacerate or obstruct your pets' insides. Save the bones for soup - not your dog. 
4. Onions:  Onions and onion powder can cause destroy your dog or cat's red blood cells, which can lead to anemia. 
5. Grapes and Raisins:  Grapes and raisins  can cause kidney damage to both dogs and cats.
6. Chocolate:  Death by chocolate- it can actually happen to  your dog or cat; so keep the sweets  out of reach.
7. Fresh Water:  When there are a large number of people in the house, there's a good chance to bump into the water bowl leaving your pet dry. 
8. Quiet Time:  Cats and dogs need to have a place to escape from all the holiday festivities. Make sure there is a quiet room, crate or other location they can escape the curious grandchildren, or drunken adults!
9. Garbage:  The garbage is sure tempting to your pet during thanksgiving. Its full of food wrappers (that can cause a gastrointestinal blockage if eaten) , high fat foods like grease, corn on the cob (can cause obstructions) and spoiled items. All of which could lead to vomiting, diarrhea and a trip to your veterinarians office.
10. Bread dough:  Some dogs will  ingest raw bread dough. The yeast added to bread dough converts the carbohydrates to alcohol and in the process, carbon dioxide is released which makes the dough rise. This same reaction occurs in the stomach once the bread dough is swallowed. Not only can this result in alcohol overload (see above) but the stomach distension can cause serious breathing and heart problems

Happy Cats

We all want our cats to be happy but they are sometimes a perplexing species.   As I write this, my cat, Mango, is happily climbing into the paper recycling bin in my office.  Somehow, that is logical to him.  More to the point, when our cats are unhappy, or stressed, they may do things that make our lives more difficult such as inappropriately urinate.  Thank you to the AAFP for sharing the following information
Behavioral problems are the number one reason cats are surrendered or euthanized.  When we understand cat behavior we enhance their health and well being and even save lives.  They have environmental and social needs just like everyone else.  In considering these needs, remember that cats are:

1. Solitary hunters that need to protect themselves from danger.
2. Cats use vocalization, posturing, and scent to communicate their stress if they feel threatened
3. Cats are territorial and will feel threatened if that they perceive that territory is challenged.
4. They have a very strong sense of smell and hearing and may be threatened by smells and sounds that we don't think are significant.
5. Cats are social animals but don't really like living with other cats, unless they are siblings.  Cats often don't live in a three cat household.  If a dwelling has three cats, they actually live in a three cat apartment building with distinct regions for each and that can create stress.

To meet the environmental needs of your cat

1. Provide a safe environment.  Cats prefer to rest alone in an enclosed space with several avenues for exit. 
2. Provide separated and plentiful key environmental resources.  All cats need access to litterboxes, food and water without the threat of challenge.  This usually means one of each resource per cat plus one (ie, a 3 cat household would have 4 litter boxes).
3. Provide play and predatory opportunities.  Use of interactive toys like feathers and strings pulled across the floor trigger necessary activity
4. Provide positive and predictable human to cat social interactions.  Each cat has an individualized amount of interaction it needs regularly.
5. Provide an appropriate environment for their sense of smell.  Keep odors to a minimum but avoid harsh detergents and over sterilization of their environment.  They mark their world with their face and body.  If that is removed when a new cat is in the environment they may find that stressful.  Feliway, or other synthetic pheromones may be calming.

A happy cat equals a happy owner.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Pet Vehicle Safety

I was driving the other day and saw an all too common sight.   A lady in a big truck was in the left hand turn lane and her dogs were in the passenger seat of her truck wandering loose.  Those dogs have little chance of survival in a significant accident.

Dogs in loose in vehicles today remind me of vehicle safety for kids in the 1970's.  My mom tells of my first car seat.  It was a platform that hung over the front seat giving a mom a place to set the baby while driving.  It was essentially a springboard that ensured a clear path to the windshield with sudden changes in force.  Our family went on many drives to the Oregon coast with my brothers and I loose in the back of the family station wagon (you know the one - Faux wooden paneling on the sides) with our comic books, pillows, and blankets.  Cars had seat belts but no one used them.  Only the dorky parents made their kids wear them.

Things have changed though.  No one would leave their child unbuckled anymore.  Childhood is a progression though a series of the appropriate car seats.  Yet, the dogs are wandering about the car.  If they are up front, airbag deployment can be lethal.  Loose anywhere and they can become a projectile in an accident and be thrown around the car and may injure others in the car.  There are number of commercial harnesses available.   While they are a good start and a good idea, little to no independent testing has been done on them.  Alarmingly, the Center for Pet Safety reports a high failure in crash test simulations they have performed on common brands.  Their website does have one brand they certified.  Crates are commonly thought of as a safe option.  They can collapse in an accident though and their structural stability has rarely been tested.

So, many questions remain about how to achieve safe car travel for pets but following some basic principles can be lifesaving.

1. No pet should ever be in the front seat.
2. Small dogs and cats may be kept in carriers.  The carriers should be placed in the back seat on the floor behind the front seats.  Do not belt these to back seat seat belt.  The carriers may collapse under force.  
3. Do not use booster seats.
4. The safest place for a dog is in the back seat in a Center for Pet Safety approved harness, properly attached to the seat belt system.  Do not attach tethers.
5. Without the harness system, larger dogs are safest further back in caged cargo area systems as shown.  A carrier in the back is the next best option.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

A Boy and His Dog

     Amidst the many tasks I was trying to accomplish this evening, my daughter Aubrey asked me to read her essay for English.  Aubrey is a high school junior and an emerging writer.  She wrote about our old dog Jack and her older brother, Geoffrey.  I brought Jack home as a little puppy when Geoffrey was 5.  I had seen his litter for 8 week vaccinations and he was one of the puppies that didn't have a home yet.  He came home with me that night.  Geoffrey is off at college now and Jack has been gone for several years.  As Aubrey writes, he was always Geoffrey's dog.  I was there for his passing that she writes about and remember it like it was yesterday.  It is interesting to hear it reflected on through someone else's eyes.  I was so moved by what she wrote, I asked her if I could post her story as a "guest blog".

                                                  A Peaceful Companion by Aubrey Kraabel

Jack was our old wise guard dog. From the moment he came into our family, he fit in. He was a big silly lab as a puppy and a calm, stable companion in his later years. Jack was a family dog. We all loved him but none of us could deny the fact that he was really Geoffrey’s dog. Geoffrey used to let him sleep on the beds and couches and could spend hours on the floor playing with him. It wasn’t hard to tell that Jack felt the same way about Geoffrey. Jack was loyal to us all, but the rest of us were like distant relatives compared to Geoffrey.

           Jack stayed with us for nearly twelve years, through moving to a new house, the addition of our younger brother and several changes in our cast of pets. Jack died in the fall, as the days were getting colder. We were all there when he let go. It was cold out on the grass of the lawn, but there was a heavy chill in the air that had nothing to do with the temperature. We said our last goodbyes, petting his soft black fur and telling him we loved him. My parents had done everything they could for him, but there was no cure for his old age.

The afternoon ticked on after Jack’s heart stopped, oblivious to the pain in our chests. One-by-one, my family and I trickled back inside, all except Geoffrey. Geoffrey stayed curled up next to Jack. Geoffrey remained there for hours, spread out on the grass. Jack was at his side, finally peaceful and free of the pain from his joints.   

I had never seen anything like it before. My closed-off, “tough guy” brother was laying in complete silence next to his companion’s body. Geoffrey has never been an emotional person, nor has he ever been a “family man”. He spent most of his high school days either at work, school, sports or a friend’s house. He was rarely home. So much so in fact that it became the family joke that he really just stored his stuff at the house and stopped by to change and eat the contents of the fridge.

That day, however, he stayed home. He was at Jack’s side until the light faded to a soft grey against the surrounding trees. Geoffrey returned all the favors that Jack had done for him, protecting Jack and staying faithfully at his side until the last moment.

I remember standing on the smooth wood of the kitchen looking out into the yard. Seeing Geoffrey show such loyalty and love for Jack gave me a new understanding of my distant older brother and brought us together. I knew exactly how he felt. Although Jack was not really my dog, I’d been through it all before. My family has always had pets. We learned from a very young age what it’s like to lose them. My brother will always remain a mystery to me, but I know we can always find a common ground when it comes to our pets.

When Geoffrey finally came inside, we didn’t say much, just letting him have his space. That night at dinner we ate together like always. Somehow we found ourselves smiling and laughing as we shared all the old stories about Jack. Today, Geoffrey still has Jack’s ID tag on his keychain, carrying a memory of his best friend with him wherever he goes.

That Fall day, Geoffrey was there for Jack in his final hour and my family and I were there for Geoffrey afterwards. Jack’s health had been rapidly declining. We all knew there was nothing else that could be done. Jack had reached a point where he didn’t need anymore fancy treatments or anymore fighting for what was already lost; he just needed a loyal friend to be by his side at the end. Geoffrey fulfilled that need. Although my brother has never been as good at being there for his human family, I know that he can rise to the occasion when he needs to.

Geoffrey’s actions demonstrate a lesson for us all. We should all remember to be there for each other. Whether that means keeping a friend’s spirits up when all they want to do is eat ice cream and cry over The Notebook for the hundredth time, or just having a presence within your family. We all have hardships and challenges. Facing them is much less intimidating when you know you are not alone. The world is a much better place when we work to understand and be there for each other.

After all, I think we all need someone who will be there for us until the very end.

Your Itchy Dog - The Usual Suspects

Image Source:  Novartis AH

     "My dog won't stop scratching" is a typical lament around here in the fall.  We see itchy dogs all year but it is more common now.   Last week, I often had several appointments in a row for itching.  It can be frustrating.  The dog is usually uncomfortable.  His people can't sleep with the collar jangling all night.  Mange or infections may cause itching but allergic dermatitis, in its multiple forms, is the most common cause.  Allergic dermatitis may be caused by food allergy, inhalant (atopic) dermatitis, contact dermatitis, bacterial (or Staph) hypersensitivity, or flea bite hypersensitivity.  Or, put more succinctly, a dog’s skin may react to things they eat, anything they breathe in, anything they touch, their own bacteria, or bites from things that crawl on them, fleas being the most common.

     It is commonly thought that food sensitivity is the biggest player in creating itchy skin.  The true incidence of food allergy is 0.9% of cases.  So, if we only approach the problem from a dietary perspective we are merely scratching the surface :).  Food allergy is most often a non-seasonal problem.  It is usually generalized over the majority of the body but doesn't really follow any specific pattern and can mimic other causes of itching.  

     Inhalant allergy, or atopic dermatitis, is an itchy skin reaction to things in the animal environment.  These allergens were long thought to enter the body only through inhalation but we now know they can enter through the skin as well.  When they enter through the skin, a breakdown of the normal epidermal barrier has occurred in that creature’s skin. The breakdown allows the allergen unwelcome entry to the animal’s immune system. These allergens may include things like grasses, pollen, shrubs, molds, cat and human dander, and dust mites.  The potential list is lengthy.  This allergy is often seasonal.  It typically involves the feet, face and ears but not usually the back and up over the tail base.

     Contact dermatitis is less common but includes specific skin reaction to things the animal touches.  This may include grass and plants they run through, bedding, or the backing of carpeting.  This allergy may or may not be seasonal.  It usually affects the area under the forearms (axillary region), the groin (inguinal area), or the belly.

     Bacterial hypersensitivity is a reaction to the normal bacteria on the skin.  Any of the other allergies can lead to bacterial overgrowth and secondary infection.  Bacterial infection and reaction are most common on the belly and inguinal region of the body. Certain breeds like the German Shepherd and Golden Retriever are more prone to bacterial infections in general.

Source:  elanco.us

     Flea allergy dermatitis is the most common allergy we see this time of the year.  Flea allergy may be seen any time of the year and we won't always find fleas, even when we know that they are the cause.  An important distinction needs to be made between a flea infestation and a flea bite hypersensitivity reaction.  A dog may be covered in fleas but not be reactive to them.   Another dog may get a single flea bite and have his system react to the flea saliva from the bite.  That dog may itch intensely for an extended period of time. This is a very important concept because when flea allergy is on our list of possibilities for your animal, we are going to recommend flea control whether we saw an actual flea or not.  Flea hypersensitivity usually results in itching on the lower back and over the tail base and spreads down the back legs and on to the belly.  

      It is also important to consider that any given animal doesn't have to have just one of these causes.  They often work in concert especially in dogs that we see multiple times during many different seasons of the year. It is quite common to see a flea allergy reaction in a dog with atopic dermatitis and a secondary infection.  It is not surprising for that dog to also have food sensitivities.  We also keep in mind that there may be other complicating factors in some patients.  Concurrent yeast infections or hormonal imbalances, such as low thyroid may play a role.

     This is the list of possibilities that runs through our heads when evaluating an itchy dog (the list is pretty similar in the cat, as well).  Remember that flea allergy is very common. In the fall in the Northwest, if a dog has itching on their back and at the base of the tail, they have a flea allergic reaction until proven otherwise.  This is true whether we find fleas or not.

     So, keep your pet on flea control!  This will avoid the most preventable itching. 

     

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Reflections on an Anniversary

The 17^th of this month is the anniversary of when I started at Lien Animal Clinic.  I have been at Lien for 24 years. I have practiced veterinary medicine now for half of my life. You’d think I’d get it right by now and stop calling it practice. J

I graduated from WSU in 1989, a few months after my 24^th birthday. I was very young and desperately wanted to be good at this. I accepted an internship in Rochester, NY at a group of seven hospitals to pursue that goal. I worked the hours. I saw the emergencies all night. I lived and breathed the profession in lieu of all else. At some point, I looked up and it was going well. There were teachers among the doctors, there were staff who helped me learn and there were clients that had faith in me. I walked out of the experience fundamentally changed from when I had walked in. I drove away in my little yellow truck with Dr. Fritzler (then she was just Beth), our two dogs, Camille and Cloie, and “New York is Not My Home” by Jim Croce queued up in my cassette player. We took a month to meander back across the country.  There’s a small motel in Illinois whose baseboards were never the same; Camille was just a puppy at the time and may have needed something to chew on.

            Beth still had a year of veterinary school left in Pullman. I moved back to Seattle to work for a year and then we planned to reconsider where we wanted to live. I interviewed at seven clinics. I remember being annoyed at trying to find parking at Lien when I went to interview. Completion of an internship played well and I had offers at all of the practices. Some of them were much bigger. Most of them were nicer facilities.  Anyone who knew the old Lien clinic knows that it was not a place of fantasies. My first desk was in the treatment room next to the only treatment table. Surgery had no windows. The building in general was very dark. The waiting room paneling is somewhere in a museum to the 1970’s next to an avocado colored refrigerator. But, there was something about Dr. King. Larry was genuine. You trusted him instantly and you knew he cared. I liked and trusted his wife Connie as well.  I chose them over glitzier surroundings and I can look back on that decision as one of the best gut decisions I ever made. 

So, on September 17^th, 1990 I started working at Lien. It was just Larry and I. He had been by himself for many years.   I still don’t know how he did that. We were busy. I saw tons of cases and we helped each other. We did good work. He and I shared emergency calls 24/7 and it was daunting. When that first year was up, I stayed. I liked my job, the clients and the people I worked with.  Beth came over to the west side after graduation. We moved off and on for several years trying to stay close to both our jobs.  We got married in 1992 and moved to Vashon Island in 1994. On the island, we could have our horses and we planned on raising a family. Our first son, Geoffrey, was born in 1995 and Beth joined Lien part time in 1996. She joined the clinic with the intent that we would eventually buy it from Larry and Connie.

So Beth and I started practicing together 2 days a week in 1996 and it was fantastic.  It has been a positive shared experience. Even in the small confines of that building, it was never too much togetherness.  We each had our own patients and surgeries but we always had each others backs. We could always relate to each others struggles and triumphs. In December of 1997 our daughter, Aubrey, was born. We bought the clinic in February of 1999.

Ownership has brought an enormous set of challenges and required the development of a very different array of skills. Our youngest son, Nick, was born in 2002. While the struggles have been great, so too have the rewards. We were able to replace the old building in 2009.  There are now seven doctors working at the clinic. 

            I grew up here and I have watched the clinic emerge into the bustling entity it has become.  I watched the profession grow and change.  I also have seen my kids grow up here.  Nick wants to be a veterinarian.  Aubrey works now as a receptionist.  Geoffrey just applied to veterinary school at WSU. 

Sometimes one ponders what they have done with all the time.  For me, at least during insightful moments, I can see the years weaved into all that surrounds me.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

How old is my pet?

While we all know that pets age faster than their owners, it is not always clear how much.  Conventional wisdom has typically estimated pet aging at about 7 years per year of human life.  This rule-of-thumb becomes obviously inadequate for cats and large dogs.

Many factors come into play in determining lifespan.  Species, breed, size, heredity, diet, spay/neuter status, veterinary care, and lifestyle (such as, indoor or outdoor for cats) all factor into length of life.  In dogs in particular, size matters.  Big dogs don't live as long.  Small dogs may not be "senior" until 10-12 years old, while giant breeds may be "senior" at 5 years old.  Routine physical examinations, proper nutrition,  preventative care, and appropriate senior care are the best ways to tip the lifespan balance in our favor.

The chart below is a rough guide to consider your pets real age.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)
Outreach Chairman,  American Board of VeterinaryPractitioners

Feline Inappropriate Urination – Part II: Please Make It Stop

        Once we've considered who is peeing in the heater vents and we have asked ourselves why they are doing it, we can  tackle the what, where, and how of  solving the problem.  Treatment has to be individualized to each situation and cat, or cats.  Of course, we may not discover the  exact reason for the inappropriate urination  so a multimodal approach is best in most cases.   

1.      The soiled environment.  The urine-soiled area needs to be thoroughly cleaned with an enzymatic cleaner, such as Nature’s Miracle, to  eliminate future visits.  The area also may need to be closed off from the offending cat.  Plastic totes, double sided tape, foil, furniture placement, potted plants, and invisible fencing may all be  used to prevent access.  If the specific area is not easily identified, a black light can help locate soiled spots.

2.      The litter box.  Make sure the box is roomy and comfy for everyone who needs it.  Obese cats and large cats need more space.  As a rule, sides, liners and covers are bad.  Kittens, older cats and the infirm may have a hard time negotiating sides on the box.  Liners are just annoying when kitty   tries to scratch around and cover feces and urine.  Box covers trap smells and block kitty’s view of intruding other cats.  As a cat, one typically likes a 360-degree view while eliminating.

3.      The box placement and number of boxes.  As stated before, one box per cat, plus one, is recommended; and make sure that there is a box on each level of the house.  Put the boxes in well lit, quiet areas away from food and water but close to where the cats spend the majority of their time.

4.      Pick the right litter.  Most cats prefer fine-textured, unscented litter, several inches deep.  If in doubt, try litter box samplers.  Put out several different boxes with several different types of litter - clay, sand, paper litter, or even soil.  Let your cat cast its vote with urine and go with the demonstrated preference. 

5.      Cleanliness.  As a basic rule of thumb, scoop the box daily.  This may not be enough in multi-cat households if one box is particularly popular.  If you ask the cats, they would each want a personal litter box valet that kept the other cats out of the area, looked away while they used the box, handed them a kitty treat as they exited the box, and then removed any offending material immediately.  Always empty and thoroughly clean boxes every 1-2 weeks, depending on use.

6.      Avoid punishment.  Never physically punish your cat for inappropriate elimination.  Not only  is that ineffective, but it quite likely will make things worse.  Punishment will create more anxiety and cats will not connect the crime to the punishment.

7.      Medical treatment.  If your veterinarian uncovers medical issues such as drinking more water or urinary tract infection, treatment plans will need to be determined and implemented.

8.      Anxiety and urine spraying.  Anti-anxiety medications may be utilized.  Drugs such as Prozac, amitryptylline, and busprinone can be  prescribed.  Medication use would need to be discussed with your cat’s doctor.  Such therapy is often life-long, although withdrawal of medication may be considered after long periods of good behavior.  We may also use pheromone sprays, such as Feliway, to promote positive feelings in the cats when they enter the area involved.

        Feline inappropriate elimination is a frustratingly common problem.  It is imperative to act quickly when it happens.  The longer such a problem goes on, the more difficult it may be to correct.  Once the offending cat is identified, take him or her to your veterinarian for a thorough physical examination and have a discussion about your options.  Once medical disease is ruled out, together we may tackle the many issues discussed here and formulate our best plan.  With thought, perseverance, environmental manipulation and appropriate medications, we can  often help.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)
Outreach Chairman, American Board of VeterinaryPractitioners

Help! Why is My Cat Urinating Inappropriately Everywhere?

        First let’s set the record straight.  Your cat does not view its urinary habits as inappropriate, regardless of where the cat happens to pee.  Feline house soiling in the form of urine placed outside the litter box and urine marking are normal feline behaviors.  It is us, the cat owners and feline lovers, who find random urine placement objectionable.  Second, it is no joking matter.  Inappropriate urination is a very common reason cats are relinquished to shelters.  These cats often are not suitable for placement in a new home and many are euthanized.             
         If veterinarians and veterinary staff can help someone understand and solve this problem, they can improve cat owner's lives and may even keep cats out of shelters.
         In multi-cat households, we will need to identify the guilty party or parties.  It is not uncommon that multiple cats may be involved in this outside-the-box activity.  
         For cats that are intact, we need to consider having them spayed or neutered.
         As an important aside, cats never inappropriately urinate out of vindictiveness to their owners.  

Once we know who, then we may consider the myriad reasons a cat may decide that a litter box is not their preferred place to urinate:
1.       Size.  The litter box may be too small
2.       Substrate aversion.  They don’t like the material that is in the box for litter.  Some cats like dirt, or clay, or sand.
3.       Location, location, location.  Perhaps something scary happened where the litter box is and they don’t want to go back.  Maybe it smells funny to them.  Maybe the location next to a loud furnace is a deterrent.
4.       Cleanliness.  They don’t think the cat box is clean enough.  Typically, the litter box needs to be emptied daily to keep cats happy.
5.       Remoteness/distance.  Maybe it is too far to get to the box on time.  Basically, each level of a house needs a litter pan, even if you just have one cat.  This idea is especially important in older cats or any cat with mobility issues.
6.       Bullying.  This is very common.  One cat may prevent another from getting to the potty.  A household needs enough boxes to help defuse bullying.  The rule of thumb is  one litter box per cat, plus one.  For example, a three-cat household needs four boxes.  It doesn't matter whether you want four boxes; the cats want four boxes.  And the boxes don’t count if they are located next to each other.  The idea is that the cat that is being a bully can’t possibly patrol all those boxes.  There needs to be physical separation between the boxes.
7.       Anxiety.  In my experience, this is the most common problem.  Other problems like bullying can contribute to this, but separation from the owner is also a common form of anxiety.  If identified correctly, anxiety issues may respond to medication.
8.       Urine marking/spraying.  This is normal communication in the cat world.   This form of urination usually occurs on vertical surfaces and usually the cat will urinate in its cat box as well. Cats may spray when they are threatened or perceive a threat to their territory.  New cats in the house and cats outside may be a trigger for this behavior.  New things like carpet and furniture or moving to a new home also may be triggers.  Cats also may spray out of frustration.  Circumstances  such as enforced diet change and lack of time with their owner may trigger spraying behavior.  
9.       Medical issues.  This needs to be ruled out by our veterinarian.  A thorough exam and a urinalysis will help identify problems and possibly provide a solution.

If you have a feline friend with urinary issues, let us know.  We would be happy to help.

Next week:  solutions and options.


Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Walking the Relay For Life

        This last weekend we participated in Relay for Life at the Vashon Island high school track.  The American Cancer Society sponsors overnight relay walks in communities all over the world to support cancer survivors and their caregivers and to raise money for cancer research.  We had a combined team of clinic staff and our daughter Aubrey's friends.  The relay has someone from each team actively walking at all times from 6:00 PM one night to 9:00 AM the next morning.  Many months ago when Aubrey proposed this walk, it seemed like a good idea.  Aubrey was on the organizing committee for the walk and that made it difficult to decline.  Later, while I was planning the camping needs and logistics with Dr. Fritzler, it seemed very far from a good idea.  Sitting here the next day, it was fun and moving and was well worth the time and effort.

We set up a schedule to have at least two of us walking at all times.  I spent the most of earlier Friday getting the gear ready, preparing the tents and setting up camp for us.  The night started with recognition of survivors and their caregivers and then the teams started to walk.  My son Nick and I took the first hour in the stifling heat with the sun blazing on us, especially whenever we rounded the track and headed west.  Dr. Fritzler had packed a cooler with sandwiches and drinks and snacks were everywhere.  I had set up a two tent compound so people not walking could sleep.  Nick and I were the only guys, so a separate tent for us and Dr. Fritzler seemed prudent to avoid any awkward cuddling incidents through the night with staff and Aubrey's friends.

          As night fell, small bags with lights were put all around the track.  There was a “luminaria” booth that was making the bags throughout the earlier evening.  I hadn’t really understood what it was.  But then the bags were all lit around the track when it was dark and we walked around them.  Each bag had a message to someone that had succumbed to cancer.  It was very sobering and sad and unifying.  So many people are lost to cancer.  Everyone has a story.  There were notes to aunts and uncles, moms and sons, friends, dads, daughters and grandparents.  I wished I had figured out what the booth was before.  My favorite uncle died of lymphoma when I was 16.  He was only 40. 

          Later, Aubrey broke out an endless amount of glowing bling and we were all covered in glow stick necklaces and bracelets.  Joon, Hilari’s 4 year old daughter, could be seen by satellite.  Dr. Fritzler and I took the 11:00- midnight shift and then slept for several hours.  Kas walked on and did over 14 miles total.  She and I did the 4:00-5:00am shift together with my brother.  Johana came a bit after it started and walked with Aubrey and Kas well into the night.

          Morning broke to the teams all still continuing around the track and the music still blaring.  Oddly tasty
pastries with chicken were served for breakfast and a torrential downpour hit as the walk concluded.

          It was a good night. 

Last month we had a management retreat to consider our clinic mission, core values, and goals.  Dr. Fritzler, myself, Johana, our practice manager, Sarah, our head technician, Kas, our head receptionist, and Andrea, our operations manager all met for a weekend.  We spent time considering where the clinic goes from here and what are our values as a group.  One of our core values we talked about is to be involved in the global community.  The relay was a small start and part of pursuing that goal.

We will be back next year and hopefully for many to come.  Next time I’ll put out a light and note for my uncle.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Man and Man's Best Friend - Remembering Jeff and Partner

            Partner died a number of years ago.  If you asked me when, I would have said it was a few years ago.  I looked it up; he died in 2004.  It seems like I was just in an exam room with him.  I think of Partner often.  He was one of the good dogs.  I see many wonderful patients and wonderful owners and Partner was one of the former.  His dad, Jeff, was one of the latter.  I took care of Partner for the majority of his life.  He was a big German Shepherd that was both serious and silly.  He never enjoyed coming to the vet as much as we enjoyed seeing him.

            We saw Partner a lot during the later three quarters of his life that we knew him.  He was prone to skin infections and allergies.  His skin maladies are common to Shepherds and he took frequent antibiotics to control Staph infections in his skin.  He was also very arthritic in his later years.  We saw him often for Adequan injections for his joints and he took medication for arthritis and pain.  All of this meant that Jeff and Partner knew their veterinarian well.

            Jeff’s daughter called the other day to let me know that Jeff had died.  Jeff was an older man when I met him 17 years ago so I know he had a long life.  To his vet, it certainly seemed to be a happy life as well.  When I met Jeff in the 1990’s, I noticed his address was familiar.  His house was 5 houses from the one I grew up in.  I had been the paper boy for our block when I was a kid.  I remember riding by his house on my bike.  He, however, didn't subscribe to the paper.  I did, eventually, try to forgive him for the slight.  Jeff and I used to talk about “the hood” all the time.   He would tell me the latest.  I would ask about the cast of characters from my time there.  We would reminisce about the old lady that still had her picture window boarded across with plywood and the people that had moved away.  He was bright and funny and had a joyful way about him.  He and Partner were indeed partners in life.  They had one of those special bonds that are a pleasure to watch and fulfilling to experience.  They are what makes veterinary medicine the grand profession it is and the two of them were the type of creatures that motivated James Herriot to put pen to paper. 

I had seen Jeff many times in the years since he lost Partner.  He also had a cat.  It was never as often but when he was in we spoke frequently of Partner.  I think he was the one Jeff never really got over.  I saw Jeff’s own deterioration over the years and watched his memory lapse.  In recent years, his daughter would bring him to the clinic.          

          So long guys.  I said goodbye to Partner years ago but now it is goodbye to Jeff as well.  I trust you are walking together again.  I’m sure Partner's skin is healed and his hips move freely.  I trust also that Jeff is no longer forgetful nor lonely for his friend.  Thanks for stepping into my exam room.  The planet is a better place because you walked on it.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

The Controversial Non-Anesthetic Dental Cleaning

Dental care is a complex issue in veterinary medicine.  Perfect dental care for pets is rare.  Complete homecare can be difficult and more extensive dental care has traditionally always required anesthesia. We provide non-anesthetic dental procedures and we believe these cleanings are an invaluable part of a complete dental program.  At our hospital, non-anesthetic dental cleanings are performed by technicians from Animal Dental Care. They are a company of highly trained veterinary dental technicians that come to our practice.

The non-anesthetic dental (NAD) is an oral assessment and charting, teeth cleaning and polishing done with gentle restraint.  The NAD should be used only with patients that have minimal, early (stage 1) dental disease who are easy to handle.  Because the patient is not asleep, it is not possible to mirror all that can be done in an anesthetic dental procedure.  Deeper disease may be missed in non anesthetic procedures.  Behavior issues and patient compliance can interfere.  Dental radiographs, extractions, and some level of assessment simply is not possible awake.  The NAD and the anesthetic dental should be considered as two distinct procedures.  You and your veterinarian need to determine, often along with the trained dental technician, if a NAD is appropriate.  As noted, we have to consider how much dental disease is present and your pet’s temperament.  During preventive cleanings, Animal Dental Care technicians also may find disease that requires further care under anesthesia.

“Dental” procedures are also often done at pet shops and groomers without anesthesia and without the supervision of a veterinarian.  This easily may lead to pets with too high a degree of dental disease receiving incomplete and inappropriate dental care.  There is no benefit to simple removal of the tartar if deeper issues are present.     

Non-anesthetic dentistry is a controversial topic in veterinary medicine.  There are those that believe dental procedures should never be performed without anesthesia.  They believe that it is not possible to accomplish significant dental cleaning and assessment awake.  We disagree with this.  The technicians with Animal Dental Care have demonstrated over many years and hundreds of patients that they can effectively treat early dental disease.  As long as we select the right patients, good can be done with the NAD.  The best times for us to recommend a non-anesthetic procedure are early in life when there is minimal tartar and in between anesthetic dental cleanings when the tartar build up is low.

We believe providing non-anesthetic dentistry for the right patients in the right circumstances is the best dental care for our patients.  Feel free ask us for more information.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners