Jasper, 4yr MN Goldendoodle
Jasper presents to SSVC for establishing care, as they recently moved to AZ from Kansas. During his physical exam, Dr. Westmoreland notes some harsh lung sounds, and his owners mention he is coughing a little more than normal. What three regional things could be causing Jasper's cough?
- Heartworm
- Blastomycosis
- Histoplasmosis
- Lungworms
CC presents to SSVC in July for an urgent care appointment due to having a seizure at the dog park. Her owners report that she was happily chasing another dog when she suddenly stopped, fell over, and had a grand mal seizure. What is the main concern for CC today?
Heat stroke from hot day, exercise, and BOAS
Thor presents to SSVC for obesity. His owner knows that he is overweight, but is struggling to come up with a plan for weight loss. Thor weighs in at a hefty 26 pounds, and Dr. Westmoreland says he's a BCS 9/9. Describe the BCS scale.
From 1-9
5 is ideal
1-4 in underweight (emaciated to lean)
6-9 is overweight (chubby to obese)
Blue presents to SSVC for having bowel movement accidents in the house. Her owners say that she has always been very well potty trained, and this is a very new habit. Blue always has that guilty look whenever it happens, but she can't seem to control it or get outside fast enough. The feces itself appears normal. What is likely the main cause of Blue's incontinence?
Lumbar/hip arthritis
Oreo presents to SSVC because his elderly owner realized he accidently gave Oreo his own prescription medications, instead of Oreo's joint supplement and heartworm preventative (true story). He doesn't have the original bottles anymore, but he brought the pill's so you can see what they look like. What resource can you use to determine what medications Oreo ingested?
Drugs.com - Pill identifier
(Doesn't work for all veterinary-specific drugs, but great for human drugs or generics)
Based on the regional diseases that Jasper may have, what diagnostics should be performed?
- Thoracic rads
- Lab 4Dx
- Fecal test
- Fungal panel
During physical exam, CC is lethargic, panting heavily, has blue MM, and a rectal temp of 107. What two treatments should be initiated immediately?
Cooling with wet towels over whole body, focus on paws/armpits/inguinal regions (not ice water)
Flow by oxygen
Thor's owner says he free feeds him Friskies cat crunchies, and he has no idea how much he eats. However when he tries to limit his intake, Thor will cry and becomes destructive (scratching carpet, biting, etc.) What are 3 strategies that could be implemented to help with these issues?
- High fiber diet to keep Thor full for longer
- Low calorie diet so he can eat more
- Automatic feeder for several small meals throughout the day
- Give other behavior outlets (toys, cat trees, Feliway, etc).
Blue's owners report that she has been much slower to get up from her bed in the mornings, and occasionally will limp for the first few steps she takes. She still enjoys her walks, but is definitely "slowing down". In preparation to start her on medications for arthritis, what diagnostics should be done first?
- Bloodwork (chemistry)
- Neuro exam
You determine that Oreo ate an Alprazolam 1mg tab (Xanax) and zaleplon 10mg tab (Sonata) approximately 30 minutes ago. What is the timeframe after ingestion that inducing vomiting is likely to be helpful?
Within 2-3 hours
Jasper's 4Dx comes back positive for heartworms.
:(
His owners are very dedicated to him, and ask you what the treatment process looks like. How long does it take, and how much does it cost?
6 months
$1000-2000
When rectal temperature reaches this level, cooling measures should be stopped. Why?
103 F
To avoid hypothermia
Thor's owner thinks this sounds like a lot of work, and asks "Is it really so bad that he's fat? What if we just leave him like this?"
Yes, it's bad! Risks of:
- Arthritis
- Diabetes
- Heart conditions
- Poor coat/matting from inability to groom
- Shortened life span
What treatments are commonly used for arthritis in dogs (medications and other treatments)?
- NSAIDs
- Gabapentin
- Librella
- Joint supplements
- Adequan
- Heating pads
- Assisi loop
- Cold laser therapy
You successfully induce vomiting in Oreo and the alprazolam comes up. However there is no signs of the zaleplon. You know that roughly 50% of the stomach contents comes up with vomiting. Zaleplon is not used in animals, and is not listed in the medication formularies. What is your next step?
Call ASPCA poison control!
The first month of treatment consists of doxycycline and starting heartworm preventatives. The 2nd month starts injections of immitidcide. Where are these injections given, and what are the biggest side effects?
Deep in epaxial muscles
Pain :(
You recommend CC be taken to an ER for continued monitoring and fluid therapy for the next 1-2 days. Why is this recommended?
Heart stroke can cause clotting disorders, organ damage, renal failure, and septic shock.
Dr. Westmoreland calculates out how many calories Thor needs in a day, and his owner agrees to start a prescription weight loss diet. Thor's ideal weight is 13 pounds (currently 26 pounds). How long of a period should be try to get the weight off over, and why is it a problem if he loses it too fast?
Rate of weight loss should be 1% of weight/week.
(1% of 26 pounds is 0.26 pounds/week = 1 pounds/month, losing 13 pounds should take approximately 1 year)
If weight loss exceeds 2%/week, then muscle mass is being reduced more than fat.
Blue's labs look good and her neuro exam is normal, so she is started on Librella monthly. The first few months she responds wonderfully, but after about 6 months her fecal incontinence returns. Meloxicam is started, and Dr. Westmoreland wants to recheck her labs in 6 months again. Why?
Long-term NSAIDs can be hard on renal and liver function. Monitoring is necessary to make sure we don't accidentally cause more harm than good.
ASPCA says that the dose of zaleplon is high enough to cause hyperactivity and restlessness in Oreo. Dr. Westmoreland decides to hospitalize him for the day to provide supportive care. What treatments may be beneficial for Oreo?
- IV fluids
- Food
- Sedation as needed
- Cerenia, to counteract the apomorphine.
While Jasper is undergoing treatment for his heartworm disease, he is confined to his kennel the majority of the time. Why is this so important?
Exercise can put extra strain on the heart and dislodge the dying heartworms, giving a high risk for clots.
CC's owners are determined to make sure this never happens again. What recommendations do you give her?
- Consider BOAS surgery
- Make sure CC's stays lean
- Limits activity on hot days to 15 minutes and avoid hard exercise
- If difficulty breathing it noted, stop exercise and go to a cool place immediately
One year later, Thor is back and his owner proudly says "we did it!" when he weighs in at 14 pounds. You congratulate her on her accomplishments, and she asks if Thor can go back to his normal amount and kind of food now. What do you tell her?
No! Previously obese cats have a lower maintenance caloric need than they did before they were obese, so it is very easy for them to become fat again if a strict diet is not maintained.
We finally manage Blue's arthritis on a combination of meloxicam, Librella, Dasaquin, and a heated bed at home. Her owners want to know if they should stop taking her on walks to give her joints a break. What do you tell them?
Light exercise is good for arthritis! She shouldn't be running hard or pushed to go further or faster than she wants, but leisurely strolls daily will help maintain her joints for longer.
What are some strategies to help Oreo's owner prevent this mix-up from happening again?
- Have someone else in the house responsible for giving Oreo his medications
- Owner takes his pills in the morning, gives Oreo's in the evening
- Anything else!