Monday, February 16, 2015

Surgical Log. A Typical Wednesday


            The second floor of our clinic houses our kennels, kitty boarding alcove, staff lounge, doctors’ offices, radiology suite, dental tables, treatment area and our surgical ward.  I had the pleasure of helping design the space with Dr. Fritzler years ago and it is a joy to work in.  A client who toured the space referred to it as, “the inner sanctum” and I have called it that ever since.  While most of my week is spent examining patients during appointments, I dedicate one day to surgical and dental procedures.  Wednesday is my surgery day and I will see a combination of dentistry, teeth extractions, routine surgery, diagnostic procedures, growth removals and more extensive surgery.
            The surgical team on Wednesday includes two licensed technicians, Sarah S. and Kirsten H., an assistant, Hilari B., and often one other doctor, Nick Paulson.  This team may vary but this is a team I have had together for some time now.   We work together to accomplish the medical tasks in front of us.  The technicians are your pets’ nurses.  They administer and monitor the anesthesia,  clean the teeth during dentals and take all dental radiographs.  They also administer chemotherapy and prepare animals for surgery.  Assistants also prepare animals for surgery, perform radiographs and other diagnostic tests, hold and recover patients and perform other tasks as they are qualified.  My staff is exceptionally skilled and well trained and we could not provide the level of medical care we provide without them.
            When patients are dropped off the morning of a procedure, it is an emotional and stressful moment for owners when we walk out of the exam room with their pet and head upstairs.  Upstairs is unknown and procedures are unfamiliar and the thought of anesthesia is stressful.  We strive to keep owners aware of progress during and after procedures, though how long a given procedure may take is quite variable and we often find ourselves with unpredictable delays.  Complications or a more involved twist on one animal’s procedure will delay completion of procedures on the remaining patients. 
            Truthfully, there is no typical Wednesday.  I often say that I have quite literally never been bored.  A past Wednesday is a good example as it involved an array of cases.  Moose came in for a dental and tooth extraction.  He broke one of his big shearing teeth in the back of his mouth on his upper jaw.  He was showing no signs of pain; the broken tooth was found on his yearly physical.  On reflection, his mom did think he had been acting differently.  We cleaned his teeth, took radiographs of the affected tooth and surgically extracted it.  Zsuska also had a dental and a similar tooth removed.  She was showing her dad that her mouth hurt.  She is huge and can be aggressive.  Handling her was an additional challenge.  Another older kitty had multiple teeth that needed to be surgically extracted.  These teeth, especially in older animals, can be quite difficult to remove.  It is literally, “like pulling teeth.”  Both animals had a full set of radiographs taken of their mouths.
A pug was in for a minor growth removal.  All the Brachiocephalic breeds (smooshed face dogs such as Bulldogs, Pugs and French Bulldogs) add another layer of complexity to their anesthesia because of their breathing issues.  We have a very specific protocol, developed by Dr. Jeanine Barile, to handle brachiocephalics safely.   Dr. Barile has a strong interest in and extensive knowledge of brachiocephalic medical care. 
Also on that Wednesday, Dr. Nick Paulson performed an abdominal exploratory surgery to collect biopsies and diagnose why a dog was losing weight.  He found Lymphangectasia, a disease that is entrenched in the lymphatic system of the intestinal tract.  It is only diagnosable on biopsy, typically taken during a full exploratory.  There is medication to treat it and the dog should do well.
            We also took several sets of radiographs under sedation, performed an ultrasound on a kitty and removed fluid from around her lungs to help her breathe better.  Kirsten spent time with a golden retriever collecting samples for submission to the Golden Retriever Lifetime Study.  The enrolled animals come in periodically for urine, blood and toenail trimmings to be collected for evaluation. The data will be used to help develop protocols for treating cancer and other diseases in all dogs.
            I enjoy my surgery days, the challenges they bring and their randomness.  Know that everyone who interacts with your pets is skilled and knowledgeable and that we care about our patients and their recovery, comfort and safety.


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

Monday, February 9, 2015

Marijuana Toxicity


The legalization of marijuana is sweeping the country.  Please keep in mind that regardless of legal status, marijuana is still poisonous to our pets.  Legalization definitely has increased the number of poisoning cases seen by veterinarians.  The pet poison helpline has experienced a 200 percent increase in the number of cases over the past 5 years.

While marijuana toxicity is unlikely to be lethal it still may require medical treatment to recover.  Pets may be exposed to marijuana through smoke, ingestion of the plant, ingestion of foods laced with marijuana such as brownies, candy, butter or cookies, or ingestion of products that contain hashish.  Additional problems may arise if a pet eats products that also contain chocolate.

The signs of marijuana poisoning begin about 30 to 60 minutes after ingestion or much sooner if inhaled.  Signs may include glassy eyes, stumbling and incoordination, vomiting, and pupil dilation.  They may also show signs of excitement and agitation.  Urine dribbling and incontinence may be seen.  More serious symptoms may be changes in heart rate, coma, tremors and seizures.

Recovery may take anywhere from 18-36 hours.  Treatment may involve hospitalization on intravenous fluids, anti-vomiting medications, oxygen, blood pressure monitoring, support of normal body temperature, and even respiratory support in severe cases.  Initial management may involve attempting to induce vomiting and administering activated charcoal.

If you suspect your pet has been exposed to marijuana, please call your veterinarian and/or the Pet Poison Helpline at 1-800-213-6680 immediately.


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

Dental Care for Cats

What is Dental Disease?

Kittens have 26 teeth, while adult cats have 30. If each tooth can be considered a patient, that equates to a lot of dental care! Periodontal disease is considered the most prevalent disease in cats three years of age and older. The periodontum is comprised largely by the "unseen" portions of the teeth which lie below the gum line, in addition to the gums. Therefore, detection and assessment of periodontal disease can be subtle.

Dental disease begins when bacteria colonize the mouth and a plaque biofilm is formed. Over time, this biofilm mineralizes, and calcifies into tartar. The bacterial population accumulates, which leads to inflammation and results in p
eriodontal disease. Additional factors such as misaligned teeth, systemic disease, nutrition, and genetics may also contribute to disease.

There are four stages of periodontal disease, with Stage One being the most minimal and progressing through to Stage Four. Stage One is the only stage that is considered reversible, through the use of professional and home dental healthcare. This is the reason that the recommended time to begin professional dental evaluations and cleanings is within the first or second year of a cat's life. Professional dental evaluation should be performed thereafter every 6-12 months, and will involve a general examination while the cat is awake, but also may require anesthesia to allow for complete examination. An anesthetized examination will include dental charting, periodontal probing, and  potential intraoral x-rays. Dental procedures (such as teeth scaling and polishing, or surgical extractions of diseased teeth) are often performed at the same time as the anesthetized examination. More frequent dental examinations may be required for patients with severe dental disease; your veterinarian can help to guide you in this process.

In addition to periodontal disease, cats can also develop other dental diseases, including feline odontoclastic resorptive lesions (FORL), stomatitis (widespread inflammation of the mouth), and fractured teeth.

What to Look for?

Signs of dental pathology can include bad breath, dropping food or chewing only on one side of the mouth, facial swelling or draining wounds, bleeding or discharge from the mouth or nose, sneezing, pawing at the mouth, tooth grinding, or discolored teeth. Often there are no obvious signs of dental disease. Most cats with dental disease still eat without a noticeable change in appetite! Discuss your cat's teeth at their routine preventive care veterinary visit.

If you are suspicious of dental disease, an examination by a licensed veterinary professional is indicated.

Home Care

The gold standard for preventative dental home care is tooth brushing. Additionally, a variety of dental prescription and non-prescription diets, treats and toys, along with oral rinses, gels, sprays and water additives have been developed. The Veterinary Oral Health Council (VOHC) provides a list of the specific products which meet certain standards for the retardation of plaque and calculus, and can be found on their website. Home care is not sufficient once dental disease has progressed past Stage One -- only professional dental therapy can effectively treat the more severe stages of dental disease.

Thanks to the AAFP for this information.

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