Margaret C. Saiki, D.V.M.,
Over 20 Years of Experience!
Former Medical Director
of major emergency clinic

In home pet euthanasia in San Jose, Ca

Feline Arthritis: How to tell your cat has arthritis

How to tell if your older cat has arthritis.

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Surprisingly and despite what one would expect, lameness (limping) and stiffness are not the most commons signs of arthritis in the cat. The most common findings an owner will notice are changes in behavior and lifestyle. Unlike in the dog where limping and stiffness is a reliable predictor of arthritis in the cat it is not. The changes in behavior and lifestyle seen are subtle and therefore detection of these problems relies more and more on the shoulders of cat owners. The most common problems include in the ability to jump and a decrease in the height of the jump.

 

Changes in Mobility

Changes in Activity

Changes in Grooming

Changes in Temperament

 

Behavioral changes include:       

      

·        Changes in Mobility: Ability to jump, Height of jump, gracefulness, Changes in elimination such as reluctance to use the lifer pan; missing the litter pan; reluctance to go outside.

·        Changes in Activity: sleeping, playing, hunting, change in posture for claw sharpening

·        Changes in Grooming: not grooming certain areas

·        Changes in Temperament: seclusion seeking, intolerance towards people, children and other animals, vocalization or aggression when handled.

The feline species is smaller and therefor lighter. They bare less weight on their limbs and therefore do not stress their joints (arthritis means inflammation of the joints) as much. This is the main reason that limping is not a major reliable problem. Knowing this as a pet owner is important, for it helps owner detect problems in their cats that maybe easily overlooked.

Hemangiosarcoma: A common highly malignant cancer of large breed dogs

Hemangiosarcoma: A common highly malignant cancer of large breed dogs

 

 Margaret Saiki

 

As a mobile veterinarian my blogs have touched on subjects which I see commonly in my veterinary house call practice. In keeping with this theme this blog will focus on a common cancer seen in large breed dogs, hemangiosarcoma and the dilemmas owners face when their pet’s develop this tumor.

 

Introduction

Unfortunately hemangioscarcoma (HSA) is a common malignant, highly malignant tumor in the dog and especially any large breed dogs. One in 5 German shepherd dogs, golden retrievers and Labrador retrievers will develop HSA.

HSA can occur in any tissue that has blood vessels because it arises from a cell in the blood vessel called the endothelia cell. As you can imagine this tumor is very vascular and bleeding is a common occurrence. Being vascular, it spreads (metastasize) easily. The most common sites for this tumor to occur in the dog are the spleen (50-65%), heart (3-25%), under the skin (12-17%) and liver (5-6%).

At the time of presentation to the veterinarian, 80% have spread or metastasized. The most common tissues for this tumor to spread to are, the liver, tissues surrounding the internal organs and liver although any tissue of the body.

It is beyond the scope of this blog to detail this cancer in detail. For a more information about hemangiosarcoma in dogs please go to the highlighted link. (Wikipedia) I would like to comment on what is most commonly seen and the issues surrounding this situation.

 

Most common problem seen

In a pet hospice care perspective, this cancer presents many management issues all depending on which tissues of the body are effected. For the purposes of this blog article, I will be discussing the most common problem we see concerning this tumor.

As stated above HSA occurs 50-65% of the time in the spleen. The spleen is a highly vascular organ responsible for filtering old red blood cells, holding them in reserve and plays a role in the body’s immune system.

HSA tumors can grow to be quite large and cause bleeding into the abdomen because of its friable nature. If large blood loss occurs, your dog can become weak, lethargic and pale.  Uncontrolled bleeding will result in death. If the bleeding into the abdomen stops on its own patients can gradually reabsorb some of the lost reds cells and gradually over a few days gain strength. In fact, it is not uncommon for these patients to present with to their veterinarian with a history of intermittent episodes of weakness with gradual recovery.

 

Survival time

Survival is quite short after diagnosis. Without treatment it is usually 20-60 days with a 1- year survival of less than 10 %. Surgery plus chemotherapy increases survival rates slightly to 141-179 days with a 1- year survival of 10% or less. With these statistics it mind, many owners do not pursue treatment and elect pet hospice care or more commonly humane pet euthanasia. Survival times can better be predicted if the tumor is fully staged with lab work, ultrasounds and x-rays. There is no cure for HAS at this time.

 

The Owner’s dilemma

Unfortunately, it is difficult to predict when a fatal bleed will occur. Owners are left with the difficult decision of when to consider a humane pet euthanasia. They are torn between having more time to spend with their beloved pet and not wanting to risk having them die because of a massive bleed. In the between the episodes of bleeding and recovery, their dogs seem to have a good quality of life.

Palliative care protocols for these patients are limited. There are palliative care protocols for HAS using oral Yunan- Paio; metronimic chemotherapy with HDAC inhibitor, masitinib, T-cyte injections or IV carboplatin every 21 day. Consult a veterinary cancer specialist for this palliative care treatment option.

The decision when to consider a humane euthanasia for your pet with HAS therefor depends on being able to detect when bleeding is occurring.

 

What owners should know if their dog has HSA and have elected not to treat:

Learn to the best of your ability to evaluate the vital signs of their dogs. These vital signs should include heart rate, respiratory rate, pulse quality, color of the gums and capillary refill time (crt). Capillary refill 

 

 

·        time is how fast it takes the color of the gums to return back to normal after being pressed on. Ask your veterinarian to help you learn how to evaluate your pet’s vital signs. Learning these signs will be a clue to help you know when your dog is in the middle of an abdominal bleed.

 

·        In general if there is large blood loss you will notice:

 

Increase in heart rate

 

Increase in respiratory rate

 

Decrease in redness of the gums or even pallor

 

Prolonging of the capillary refill time

 

Decrease in the quality of the pulse strength

 

Some astute owners can detect an enlarging and pendulous abdominal area.

 

Generalized weakness, not eating, not drinking, decrease in general alertness

 

·        If you suspect bleeding maybe occurring try wrapping the abdominal area with a towel and tape in order to apply pressure and hopefully stop the bleeding event.

 

 

 

Hemangiosarcoma is a highly malignant, aggressive and difficult to treat. Electing to perform surgery to remove the bleeding organ such as the spleen and adding chemotherapy can prolong survival, but for only a few months (5-6).  Electing a loving at home pet euthanasia, is an alternative many owners. It is this practices hope to help your pet pass peacefully at home. 

 

 

 

Neuropathic Pain in Dogs and Cats

nerve cell         spinal cord and nerves

Neuropathic pain in dogs and cats

A blog by a mobile house call veterinarian

Margaret Saiki on Google+

 

Introduction

As a part of my series on pain management, I wanted to discuss the concept of neuropathic pain. Neuropathic pain is the type of pain caused by a problem with parts of the nervous system. The word “neuro” refers to nerves or the nervous system. The medical term “pathic” refers to being affected by a disease of a specified part.  Helping to relieve chronic pain in dog and cats is one of my most important tasks in my mobile house call practice which provides pet hospice care, palliative care and geriatric patient evaluations.

Pain in general is basically divided into 3 basic categories:

1.      Physiologic pain: Pain in response to tissue injury

2.      Inflammatory pain: Pain as a consequences of tissue damage and the subsequent inflammatory process of the body

3.      Neuropathic pain: Pain as a result of abnormal processing of signals by the nervous system.

Dogs and Cats like all mammals share a similar nervous system to that of humans. Unfortunately dogs and cats are not able to communicate that they are painful, nor able to describe the type and location of their pain. This makes diagnosis, research and treatment very difficult. However we as veterinarians can 

 

gain insight or understanding by using human medicine to understand what can cause pain, how pain manifests and how best to treat pain. If humans feel neuropathic pain it is reasonable to assume that dogs and cats feel this type of pain.

 

Neuropathic pain

 

The nervous system is a complicated system functionally and anatomically. It is beyond the scope of this article to describe the anatomy, function and variety of ways neuropathic pain develops. Suffice it to say that the nervous system contains many pathways than can malfunction and cause neurologic based pain.

 

Neuropathic pain is initiated or caused by an initial lesion or dysfunction in the various nerves of the body. Then nerves are damaged and then fire abnormally resulting in pain.

 

Diagnosis

 

Again neuropathic pain is difficult to diagnose in veterinary patients, for it is best diagnosed via a description by the patient. The veterinarian and pet owners must rely on changes of behavior. Does the patient express dullness, aggression, difficulty in movement (See chart in my previous post on how to detect Acute and Chronic Pain) yelping for no reason, scratching motion without touching the skin, do they continually bite or attack an area?

 

Historical information about their pet’s past medical problems is an important part of the diagnostic tree. Where there events in the medical history which are known in human medicine to result in neuropathic pain?

 

Neuropathic pain-Associated Conditions

 

Trauma

Tumors

Infections

They also encounter similar diseases, traumas, inflammatory processes, infections, metabolic problems and surgeries as humans. Veterinary medicine has uses human medicine as a template 

Hernia repair

 Pelvic fractures

Limb nerve entrapment –thru surgery

 Amputation

Back problems which might cause nerve entrapment. Intervertebral disc herniation

Spinal cord injury

Diabetic neuropathy

Tumors

Feline interstitial cystitis

Inflammatory bowel disease

Pancreatitis

 

A Physical exam, including palpation and manipulation or the body helps to detect sites of pain usually in the musculoskeletal system. Observation of the behavior and gait of the pet can also provide clues to the existence of pain.

 

Lastly, a very important diagnostic test is a positive response to drug treatment. Since dogs and cats are unable to fully communicate their pain, a drug trial can end up being a valuable diagnostic tool.

 

Summary

For many older pets chronic pain is a real problem. It is one of the most important factors in living a life of quality. Unfortunately, it can be one of the most difficult disease processes to diagnosis and therefore treat. Most clients understand the concept of arthritic pain, but many do not understand neuropathic pain. Hopefully this blog with help owners understand neuropathic pain and the types of disease which are associated as primary causes. With this information owner can then help their pets by being a voice for historical information, a vital component is diagnosing neuropathic pain.  

 

Does your cat hate going to the Veterinary Clinic?

Does your cat hate going to the Veterinary Clinic?

Use our mobile veterinary practice in San Jose, Ca. (and surrounding cities)

Margaret Saiki

        

 

Many cats for good reason hate getting into a carrier. It means they are going to that scary veterinary clinic with the noise and the dogs. It is even common for them to hide when you even just take out the carrier.

By nature the feline species is consider a “fight or flight” species. This means when they notice unusual situations, are frightened or stressed they either go into a “fight” mode: hiss, swat with their claws, and bite. Or they go into a “flight” mode: run off as fast as possible and hide. They are not “bad” cats, they are just cats.

Obviously the “fight” mode can be the most dangerous. A cat bite to a human can result in hospitalization from an infection. Cat scratches can be deep and have been known to injure blood vessels and cause bleeding.

Unfortunately these pets receive minimal veterinary medical care because owners are unable to get them into carriers for transport to the veterinary clinic.

 

 

State of the Art Mobile Veterinary Hospital

Our house call veterinary service is designed to help cats who do not like going to the clinic. We are trained in many techniques to try and safely handling stressed cats those who are either in the fight or flight mode. It should be noted that many cats actually do not get as stressed being at home and do not require sedation/anesthesia.

In cases where medical treatments or diagnostics are vital we have the ability to sedate or even anesthetize them safely. With our state of the art mobile hospital, we also have the ability to utilize an extremely safe gas anesthetic. We use a product called Isoflurane which is a quick gas based anesthesia. What makes it so safe? It is safe because it is quick acting.

 
One is able to awake the patient up quickly once the anesthetic is turned off. Other, house call veterinary practices, those who have not invested in a modern mobile veterinary clinic, are unable to provide this service.

The first step once you have made an appointment with a mobile vet is to place your pet either in a carrier. If this is not possible, place them in a bathroom where they can’t crawl under the bed or hide behind furniture. We will take it from there!

 

 

 

Pet Euthanasia: Why this decision is so hard!

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