Category Archives: Dr. Karen Becker

Coughing: This Seemingly Harmless Symptom Could Foretell a Deadly Disease

Share

Coughing: This Seemingly Harmless Symptom Could Foretell a Deadly Disease
By Dr. Becker

Most dogs develop a cough at some point in their lives, and it’s often difficult for pet parents to determine the cause of the hacking or whether it’s a serious problem In dogs, a cough can be an indicator of a number of different health concerns – some more serious than others. Here’s a brief guide to some different types of canine coughs and what you should know about them.

Kennel Cough

In most cases, when an otherwise healthy dog suddenly starts coughing, it’s usually due to kennel cough or another similar viral or bacterial infection. Kennel cough can involve a deep, dry hacking cough, sneezing, snorting, gagging, or even vomiting. There may also be spasms of coughing brought on by excitement or exercise. If your dog has recently been in a situation where she has had contact with other dogs – for example, in a boarding facility – she may have contracted a kennel cough infection. Symptoms usually appear from 2 to 14 days after exposure. Kennel cough symptoms usually last between 10 and 20 days and can recur during periods of stress. Most cases resolve without medical intervention, so I don’t automatically recommended treatment. And certainly, antibiotics are not immediately warranted. I always prefer to let a dog’s body heal itself naturally, if she is otherwise acting fine. Complete recovery from kennel cough can take up to three weeks in healthy dogs, and twice as long in older patients or in dogs with underlying immunosuppressive conditions. Puppies can also take a bit longer to recover. Since a serious episode of kennel cough can result in pneumonia, if your dog doesn’t start to improve on her own, or if the cough becomes progressively worse, it’s important to make an appointment with your vet to be on the safe side.

Something Stuck in the Throat

A cough that grows suddenly intense or is more of a gagging sound, especially if the dog is also licking his lips or making swallowing motions, could be a sign of a sore throat or something stuck in the throat. If your dog is outside or has just come in from outdoors when the coughing starts, it’s likely he has ingested or inhaled a grass seed or other foreign object and it’s stuck in his throat. If your dog can’t seem to cough up whatever it is, you’ll want to make an appointment with your veterinarian, since the situation could progress to an infection or even pneumonia.

Pneumonia

A cough that sounds wet (a “productive” cough) usually means there’s a buildup of fluid in the dog’s lungs. Fluid or phlegm in the lungs is a symptom of pneumonia, which can have a variety of causes. Bacterial pneumonia is caused by a pathogen, and there are several organisms that can result in infection. Fungal pneumonia is the result of a deep fungal lung infection, and is a more serious and hard-to-treat problem. Symptoms of pneumonia in addition to coughing include loss of appetite, weight loss, fever, lethargy and difficulty breathing. If the pneumonia is bacterial in nature, typically your dog will require antibiotics, rest, immune support, and specific supportive therapies. Fungal pneumonia is more difficult to treat, since many dogs don’t respond to anti-fungal pneumonia drugs. The precise treatment will depend on what type of fungus has caused the infection. Ask your proactive vet about inhalation therapy, one of the most effective, direct ways to treat these types of lung infections. Another type of pneumonia is aspiration pneumonia, also called inhalation pneumonia. This is a condition in which the lungs become inflamed and infected as the result of breathing in a foreign substance like vomit, regurgitated gastric acid, or food. Aspiration pneumonia is life threatening, and the prognosis for most dogs with the condition is poor, so the goal should always be prevention. If you suspect your dog has aspirated something, it’s important to get her to your veterinarian or an emergency animal clinic right away.

Tracheal Collapse

A recurrent, episodic cough that sounds like a goose honk can be a sign of a collapsing trachea – especially if your dog is a small breed. Tracheal collapse is a chronic, progressive disease that can be either congenital or acquired. Dogs with the condition also typically show signs of exercise intolerance, respiratory distress, and gagging while eating or drinking. Treatment options for a collapsing trachea include medical management, which works for about 70 percent of dogs with a mild form of the condition. More serious cases often require highly specialized surgery. Cartilage building supplements are also given to maintain the integrity of tracheal cartilage.

Reverse Sneezing

Another condition common in small breed dogs and also brachycephalic breeds is the tendency to reverse sneeze. While it is indeed a sneeze rather than a cough, the sound a dog makes while it’s happening can be mistaken for coughing or choking. Reverse sneezing is caused by a spasm of the throat and soft palate that is triggered by an irritant, which can include simple excitement, exercise, a collar that’s too tight, pollen, or even a sudden change in temperature. In a regular sneeze, air is pushed out through the nose. In a reverse sneeze, air is instead pulled rapidly and noisily in through the nose. The sound of a reverse sneeze can be startling, and many dog parents wonder if their pet is choking or having an asthma attack. Most dogs that reverse sneeze also assume a telltale stance — elbows spread apart, head extended or back, and eyes bulging. Most cases of reverse sneezing require no treatment. However, it’s a good idea to try to keep track of when the episodes occur so you can determine what the probable triggers are and try to avoid them. If the sneezing becomes chronic or episodes become more frequent or longer in duration, it’s a good idea to make an appointment with your veterinarian to rule out other potential health problems.

Heart Disease

Coughing can also be a sign of heart disease in dogs. Other signs of a heart problem include a bluish tinge to the tongue, loss of appetite, fatigue, weakness, decreased exercise endurance, a too-fast or too-slow heartbeat, and increased respiratory effort. If your dog has been diagnosed with a heart condition and coughs mainly while she’s resting, lying down, or at night, it could be a sign the disease is progressing. Treatment of heart disease in dogs depends on a variety of factors including the severity of the problem, the age and health of your pet, cost of treatment, and other considerations. A visit to a board-certified veterinary cardiologist can provide more information about the severity of your pet’s heart condition. There are a variety of natural modalities that can support a weakened cardiovascular system, so consult your holistic vet for the best options for your pet’s specific diagnosis.

Any Persistent Cough Should Be Investigated

Other conditions that can cause coughing in your dog include chronic bronchitis, heartworm disease, and some types of cancer. A dog’s cough that doesn’t resolve quickly on its own should be investigated, and the sooner you make an appointment with your veterinarian, the better your pet’s chances for either a full recovery or a well-managed condition.

Don't Let Your Pet Have Surgery for Scary Lumps Until Your Vet Does This

Share

Don’t Let Your Pet Have Surgery for Scary Lumps Until Your Vet Does This

By Dr. Becker

Today, I’m filming at my practice, Natural Pet. I decided to include my newsletter readers in how I go about determining when to remove lumps and bumps on a pet. As it turns out, my dog Violet needs to have two masses removed, so I’m going to walk through the process of determining how, why, when and what to do about lumps and bumps when you find them on your pet.
I say “when” you find a lump or bump, because if your furry companion is blessed to live long enough, it’s not a question of whether your dog or cat will develop a skin tag, sebaceous cyst, wart, tumor, or fatty mass called a lipoma – it’s a matter of when. This is because as pets age, just like humans, their skin doesn’t remain beautiful and flawless. Most humans even at midlife are dealing with skin tags, discoloration, and lumps or bumps that are benign in most cases.

It’s important, as the terrain of your pet’s body changes, to have new lumps and bumps evaluated by your veterinarian. My first recommendation — as you’re doing your routine at-home wellness checks of your pet and you find something that feels different on the skin – is to part the fur and take a closer look with a light source like a flashlight. It’s important to identify things that have been there awhile and things that are new – or things you aren’t sure were there last week but are there now. It could be something as simple as an insect bite or a scab, or it could be something you can’t identify.

Animals can develop sebaceous cysts or pimples very quickly — even overnight or during the day while you’re at work. It’s rare that these lumps or bumps require emergency action. Occasionally, a mass like an abscess or boil may require urgent care. If your pet is really uncomfortable and you know the mass is growing or changing, you’ll want to make an appointment with your vet, preferably within 24 hours. But rarely is it necessary to visit an emergency animal hospital or make an emergency appointment with your vet because of a lump or bump.

A Lump or Bump That Is Rapidly Growing or Changing Should Be Evaluated by Your Veterinarian, and Sooner Rather Than Later.

What I advise my Natural Pet clients to do when they find a lump or bump is to monitor it. If the mass is growing or changing quickly, it’s best to see a veterinarian sooner rather than later. If you notice there is, for example, a discoloration on the skin or what looks like a skin tag, and it doesn’t get bigger or change cialis over the course of days, weeks or months, then just mention the area to your veterinarian at your pet’s next wellness exam. But again, if the area is changing rapidly, you do need to have your pet seen by your vet as soon as possible.

In my dog Violet’s case, I noticed she had two very small pea-sized lumps on her body. They were firm, and I could move them around under the skin. I knew they were new lumps, and I decided to monitor them. Over a period of time, both lumps grew larger and firmer, so I did exactly what I advise my clients to do, which was to evaluate them.

I performed what is called a fine needle aspirate. It involves inserting a needle into the lumps, extracting cells, and typically, sending samples to a pathologist for evaluation and a preliminary diagnosis.

In Violet’s case, I stained the slides myself and looked at them in-house with my microscope. I didn’t like what I saw. The cells had a high mitotic division rate, meaning they were replicating quickly. I sent the slides out for a second opinion. The pathologist thought there could be spindle cells, which can indicate a tumor — cancer. He suggested the lumps be surgically removed, and today is the day.

My Two Rules of Thumb for How to Treat Growths on a Pet
This is a slightly different approach than what I learned in veterinary school, where students are taught that if a pet owner brings up a lump, bump, skin tag or mass, you should suggest removing it because the vet makes money and the client goes away happy.

Following that instruction means lots of pets will be undergoing anesthesia on a regular basis. For many lumps and bumps, removal is totally unnecessary because the masses are benign and there’s nothing to worry about as long as they don’t impinge on the pet’s quality of life or longevity. As long as the mass isn’t cancer and doesn’t impede the animal’s movement or quality of life, there’s no reason other than aesthetics to lop the thing off. In my opinion, the risk of anesthesia and surgery far outweighs the benefit of having a lump-free pet.

My two rules of thumb are:

If the fine needle aspirate shows there’s something dangerous brewing, like cancer, then surgically removing the mass will give the pet the best chance to be cancer-free. So you need to go to surgery.
If the fine needle aspirate shows the lump is benign, which means there are no abnormal cells and nothing to worry about, then leave things alone.
Of course, I always mark down exactly where the mass is, the size, the date, and the results of the fine needle aspirate on the animal’s body chart. Then I measure the mass and check for changes each time I see the pet at future appointments.

The only reason other than cancer that I recommend surgery for lumps or bumps is if the patient’s quality of life is compromised. For example, skin tags that grow on the margins of a dog’s or cat’s eyes are entirely benign, but because they are on the eyelid, as the pet blinks it can cause corneal irritation and pain. In a situation like that, even though the mass is not cancerous, I do recommend surgical removal because it’s causing the animal discomfort.

Another example is warts on dogs. They can be very itchy, and a dog can spend the entire day licking and chewing the area. The pet parent returns home from work to find a big, open, bloody wound on the dog. The wart itself is benign and harmless, but the patient’s quality of life is suffering because of the itching and self-wounding. In such a situation, most veterinarians would recommend removing the wart, as would I.
Why Every Lump or Bump Should Be Evaluated Using a Fine Needle Aspirate Procedure in Violet’s situation, because her fine needle aspirate came back with questionable cells, we’re going to proceed with surgery to remove those lumps. I’ll excise them (cut them out) and send them to the pathologist for determination of what the cells are. If the cells are worrisome, I’ll follow up the surgery with an appropriate integrative protocol. If it turns out the lumps have a high cellular replication rate but are benign, I won’t need to follow up other than with a mild detoxification protocol to help her body rid itself of the anesthesia drugs she’ll be given.

The importance of the fine needle aspirate procedure can’t be overstated. Veterinarians aren’t psychic. Once in awhile a client will say, “My vet felt this mass and said it needs to come off.” The problem with this approach is we don’t know what’s going on inside that mass unless we extract some cells from it and evaluate them. So I always recommend doing a fine needle aspirate.

Another reason for a fine need aspirate is there are some types of tumors that need to be excised very widely. For example, mast cell tumors need to be surgically removed in most cases, and they need to be excised with a very wide margin (removing the tumor plus surrounding tissue). When a vet does no more than feel a mass and advise it should be removed, if it happens to be a mast cell tumor and he or she does a very small cosmetic cut to remove only the mass, fingers of tumor cells can be left behind to slip down into deeper tissue. That’s why I always get a confirming diagnosis with a fine needle aspirate – so I know what surgical margins to take based on the type of tumor I’m dealing with. This is an extremely important aspect of tumor removal.

Still another reason for a fine needle aspirate is that some tumors require the expertise of a soft tissue surgeon. I’m not a soft tissue surgeon. My practice is 90 percent internal medicine and I also treat a lot of exotic pets. If Violet’s fine needle aspirate showed a deep-seated cancer, I would have asked the soft tissue surgeon I work with to complete the surgery because that’s his area of expertise. But in this case, I feel very comfortable excising Violet’s lumps myself.

This is a good question to ask your veterinarian – does your pet’s lump or bump removal require the expertise of a special type of surgeon? For example, if Violet or another of my pets had a bony tumor, I would ask the orthopedic surgeon I work with to step in, because bone surgery is not within my area of expertise. Your vet should not be offended by such questions. Questions like, “Do you feel comfortable doing the surgery?” … “How many have you done?” … “Would you feel better if I went to a soft tissue surgeon or an orthopedic surgeon for the procedure?” … “If my pet has to spend the night, who will be here to take care of her?” — these are all questions you should feel free to ask your veterinarian, even if you’ve been a client of the practice for years. Protocols change and evolve. You should feel very confident that your vet is comfortable performing a procedure on your pet.

It’s Important for Pet Owners to Be Informed About Anesthesia, Pain Management and Recovery Procedures Used by Their Veterinarian
At my practice, we have a form, “What’s Different About Anesthesia at Natural Pet?” It goes over some of the basic questions about surgeries requiring general anesthesia, like “What are we going to do for pain management?” In my opinion, if your pet is about to be cut with a scalpel, he requires pain management. Period. Some vets believe pain will help “keep a pet quiet” and resting while he heals. This is simply not true. What we know about pain is that it inhibits wound healing.

In my opinion, there is no reason and no excuse not to administer excellent pain management. If you’re nervous about having your pet on pain medications, I can assure you your dog or cat will heal better, with fewer complications, if you accept a pain management protocol for your furry family member. The type of pain management — the dose, the category of drug, the addition of natural supplements – will be based on the procedure(s) your pet undergoes, her age, any concurrent medical conditions, and what type of medicine your vet practices (for example, traditional Western, holistic or alternative, or integrative). But pain management must be addressed in my opinion.

Another thing you should ask your vet is what type of anesthesia will be used. Hopefully, your vet is using up-to-date inhalant anesthesia. At Natural Pet, we use an inhalant anesthesia called sevoflurane. Isoflurane is another commonly used inhalant anesthesia. It’s important that your vet is using one of those two inhalant drugs.

You can also ask about pre-op medications. We recommend a drug called butorphanol, which is what I’ll be using with Violet today. The great thing about butorphanol is that it helps reduce the amount of inhalant anesthetic a patient requires during surgery. It will help to keep Violet’s drug dose low. But we also know that butorphanol blocks some pain fibers. What we know about giving pain meds prior to surgical procedures is they help reduce the amount of intense pain a patient may experience by blocking pain fibers before the procedure even begins. That’s smart medicine, in my opinion.
At Natural Pet, we have certified anesthetic equipment, which means an independent company visits annually to check all of our equipment to make sure everything is working exactly as it should.

Asking your veterinarian about recovery is also very important. Don’t let anyone tell you that anesthesia is routine and nothing to worry about. Anesthesia is anything but routine, because what it does is keep a patient hovering between unconsciousness and death. That’s a fine line, and one that must be closely and carefully monitored. Mistakes can be fatal.
A pet’s recovery from surgery is also critically important. Maintaining body temperature before, during and after a procedure is important. When I perform any procedure, I have a technician that remains with the patient the entire time and does not leave the animal’s side during the recovery process.

Anesthesia monitoring during the procedure is another important area you’ll want to ask about. Are they monitoring temperature, pulse, respiration and oxygen levels? Your vet should be able to answer “Yes” to each of those questions. I have clients who learned to ask these questions of their regular vets, and elected not to use certain practices based on responses like, “Well, we don’t really have monitoring equipment. We just look at the color of the tongue.” That’s a huge red flag. I would never recommend putting a pet under anesthesia at a practice that doesn’t have up-to-date anesthetic monitoring equipment. Checking the color of an animal’s tongue as the only method of anesthetic monitoring is unacceptable.

Another thing to understand is there’s no cookie-cutter anesthetic protocol for all pets. If an animal has kidney disease, liver disease, cardiac disease, is older, or has a chronic medical condition, the anesthetic protocol should be adjusted to accommodate the individual needs of the patient.

Preparing for Your Pet’s Surgery

Violet is a very healthy dog. She’s almost nine and has no medical issues. Her pre-op bloodwork is perfect. That’s another point I want to make. Don’t let any veterinarian anesthetize your pet without checking vital organ function (via bloodwork). I never anesthetize an animal without checking organ function, because I need to be absolutely certain the organs of detoxification are capable of doing their job.

Probably the biggest risk associated with anesthesia is when the body is incapable of processing the anesthesia drugs. That’s when unexpected deaths occur. By checking vital organ function, we can evaluate the potential for kidney or liver dysfunction and forego the procedure if the risk is too great. Insuring organ function is normal is an important aspect of using anesthesia safely.

On the day of surgery, your vet will ask you to fast your pet. That means no food or water for a specified number of hours prior to the procedure. How long your pet must be fasted generally depends on the drugs your vet plans to use.

Violet had dinner last night, and she had water up until midnight, but she has not consumed any food this morning. If your pet sneaks food or you forget and give her food or water, tell your veterinarian, because the GI tract needs to be empty and rested. If an animal consumes food or water too close to undergoing anesthesia, the chances of vomiting and aspirating are much greater, and the situation can become life-threatening. So if your pet sneaks something or you forget and feed or water him after the deadline, be honest with your veterinarian the morning of your pet’s procedure.

Introducing Violet

So here’s our patient, Violet, who happens to be my own dog. She has two lumps that developed suddenly. I noticed them when they were pea-sized, but now they’re about the size of a quarter. They are growing rapidly, they contain spindle cells that could indicate cancer, and so they’re coming off based on my #1 criteria: something dangerous could be brewing in those lumps. Of course, Violet doesn’t even know she has lumps. She has no idea why she’s here today. The lumps don’t bother her, but they bother me because the fine needle aspirate told me there are some weird cells involved.
Some people worry that if the fine needle aspirate comes back benign initially, who is to say the lumps will still be benign in two or three years? That’s a great question, and what I suggest to clients is if the fine needle aspirate comes back benign, just relax. There’s no need to worry unless the mass grows or changes. If that lump stays the same, we can be confident nothing is happening to the cells inside the lump, and there’s truly nothing to be concerned about.

Lumps should be regularly monitored, however. If the mass changes in size or appearance, it needs to be re-aspirated even if previous diagnoses were benign. The thing with cancer is that the cells always replicate. They’re always growing. They can be slow growing or very aggressive, but regardless, they replicate faster than normal cells. If a lump on your pet has never changed size, the chances of cancer are slim to none, because the size hasn’t changed. If on the other hand you have a pea-sized lump that suddenly quadruples in size, it’s time to do another fine needle aspirate.
Now, even though I don’t advocate anesthesia to remove benign lumps and bumps, I do ask clients whose pets need a surgical procedure if there’s anything else they want me to take care of while the animal is under. Violet has some skin tags and a few warts – as I mentioned, she’s almost nine. I’m going to leave all those alone. But if for example she had bad teeth (she doesn’t) – if she needed a dental procedure – now would be a good time to do it. Put her under anesthesia once and get everything taken care of.
Violet does have a rather large skin tag, and it’s growing. It creeps some of my family out, but not me. I told them we should refer to her dingleberry as her “beauty mark.” They’re not buying it. Anyway, here’s her skin tag – hopefully you can see it. It’s large and growing, but totally benign. There’s no medical reason to remove it. But because it will take me all of 30 seconds to remove it while she’s already under anesthesia, and because some of my family members think it’s gross, I’ll take it off.

If Violet’s only issue were her giant skin tag, I would never recommend anesthesia just to remove it. It’s totally unnecessary. But because she’ll be out anyway for removal of the two masses, I’ll add one small cosmetic procedure and snip off the skin tag. I’ll also be trimming her nails. She doesn’t like nail trims, so I’m going to do it while she’s out. So if you have a pet that doesn’t like nail trims, like Violet, ask your vet to do a pedicure while your dog or cat is under anesthesia for another procedure.

Violet Receives Her Pre-op Medication

So now I’m going to give Violet her pre-op medication. My vet tech, Ashley, will hold Violet while I do the injection. This medication is to reduce the amount of anesthesia necessary. It will take about 20 minutes for the drug to relax her, so we’re just going to hang out with her while she gets sleepy.

I’m also going to apply some essential oils. This one is called Peace & Calming, and I’m applying it to the tips of Violet’s ears and on her spine. She’s actually quite nervous right now, so using essential oils will help support a calm experience for her as the butorphanol starts to relax her.
Now that Violet is beginning to relax and we have her on the surgery table, I’m going to put a catheter in her front leg. The reason it’s important to have a catheter is that if there are complications (which we don’t expect, but it’s important to prepare for them) and I need to administer medication – let’s say her heart rate drops and I need to give her some drugs to get her heart rate back up – I need to have a really easy, already established point of entry for those medications. So I’m going to pop a catheter in. As you can see, the butorphanol is working. She’s starting to really relax now.

Violet is on a heated surgery table, which is very important. Your vet may not have a heated surgery table, but he or she should use some type of heated blanket to maintain your pet’s body temperature. Violet is maintaining her own body temp right now because she’s not yet unconscious, but once she is, she’ll appreciate that extra heat.

Okay, the catheter is in. Pre-op meds are on board. We are now going to induce Violet under anesthesia, which means I’m going to inject the drug propofol into her IV. This will take her rapidly from a conscious state to an unconscious state. Once she’s unconscious, I’m going to put a tube down her trachea and tie it to the roof of her mouth. We’re going to fill the cuff of the tube with air (which will form a seal in her trachea). This is to make sure, of course, that we’re keeping her trachea, larynx and glottis open in the back of the throat so we can administer gas inhalant anesthesia and 100 percent oxygen to her lungs and keep any debris, mucus and fluid in her mouth out of her trachea.

Putting Violet Under Anesthesia

I’m giving Violet the propofol slowly now as she takes some nice, deep breaths. Her eyes are getting heavy. She’s fully unconscious by the time I finish injecting the propofol.

Ashley’s going to check her jaw tone now (this is how we assess if she’s ready to put the trach tube in) so we’re propping her up so I can see down her throat. And Ashley will hold her mouth open while I move her tongue out of the way and feed the tube down the back of her throat and into her trachea. I’m going to tie it to the roof of her mouth, and we’re going to get her started on 100% oxygen and inhalant gas anesthesia by attaching her tracheal tube to the oxygen and anesthesia tube.

At the same time, I’m going to put a smaller tube down her esophagus, which is going to monitor her temperature, pulse, and respiration. And then we’re going to hook a clip on her tongue, which will monitor the oxygen-carrying capacity of her bloodstream. The beeping noise — we’ve come to love that beeping. It tells us the patient has a nice strong heart rate. Ashley will lubricate Violet’s eyes so that her corneas don’t dry out. And I’m going to start some fluids, some lactated ringers, which is an electrolyte fluid solution, to help keep her blood pressure up and her body hydrated during the procedure.

Now, this is Violet’s dingleberry (her giant skin tag), which I’ll be removing as a cosmetic procedure because it’s unsightly and bothersome to my family. We would never perform anesthesia just to remove a benign skin tag. But because she’s out we’ll take advantage of it. This is one scary mass we’re going to remove right here, and this is the second scary mass we’re going to remove. Ashley’s going to clip the hair and clean these areas to get the skin prepped for surgery.

Removing Violet’s Masses and Skin Tag

Okay, Violet has been clipped and cleaned. All three sites have been prepped. Ashley will re-prep as we go along. I’m just going to remove the first lump. I will carefully cut it off, and put it in the specimen container.

Okay, the first one’s done. I’ll hand off the mass to Ashley, who will pop it into a formalin jar, and we’ll submit it for pathology.
Now, I’m just putting in a last stitch here in the first incision, and we’ll move along to the second tumor.

Okay, we’re done. We’ve removed the second mass. The second mass was slightly larger, so I cut it in half to allow the formalin to infiltrate the mass. I’m going to pass this one off as well to my lovely assistant. All we have left is Violet’s benign skin tag, which will come off incredibly easily with just a little lick of the scalpel.
Right now, I have a hemostat on there to help occlude any blood supply to the tumor or the skin tag. I’m going to easily and gently remove that little dingle just like that. And that will make my entire family much happier because it’s gone. Tada!

Now, we’re going to start waking Violet up. Ashley’s going to turn the gas off and we’ll let the oxygen flow continue until she regains consciousness. We’ll leave her tracheal tube in until she’s able to swallow. Now we’ll do a little cleanup of her incisions, I’ll get out of my surgical apparel, and Ashley will perform a pedicure.

Violet’s Recovery from Anesthesia

Violet’s procedures are done. All of her masses came off fine. She was totally stable during anesthesia. We’ve turned the anesthesia off and she’s breathing 100 percent oxygen. She will start blinking and swallowing soon. Once she regains those reflexes, we’ll take the 100% oxygen away, and breathing room air will actually help facilitate her waking up process.
Ashley’s going to hang out with Violet, check her vitals, and monitor her temperature. She has a hot water heating pad on her to help maintain her body temperature. Ashley will check her body temperature every three or four minutes until she’s awake.

Now, Violet has been off the surgery table for about 15 minutes. The tracheal tube came out. She’s breathing room air on her own. She’s recovering fine. She’s peaceful. She’s got great pain meds on board. Temperature’s fine and stable. She’ll probably get up and try walking in a few minutes. She’ll go home in a few hours. It’s important when your dog or cat is recovering from anesthesia that she is alert, awake, and able to walk before going home.

You should feel free to ask your veterinarian any questions you have about the procedure. Your vet won’t have answers about the masses right away, because they must be sent to a pathologist who will examine them microscopically. In about three to five days, I expect the pathologist to provide a report on Violet’s masses, at which time I can make an appropriate treatment plan.

Keep in mind that anesthesia shuts down the GI tract. So Violet won’t poop for at least a day, maybe two. Tomorrow, she’s going to take it easy. It’s important that she doesn’t lick her incision. We’ll either put an E-collar on her, or a t-shirt to make sure she’s leaving her incisions alone. I want her to take it easy for the next few days, not have a lot of exercise and just allow her body to recover from the anesthetic.

I will be giving her milk thistle, which will help her liver detoxify from the medications and the anesthesia. Probably by tomorrow afternoon, she’ll be wondering why we’re making her rest!

Hopefully, this video will help you make more informed decisions about the lumps and bumps on your pet that you choose to remove, how you choose to remove them, and a treatment protocol that makes you feel good about the anesthesia involved in this type of procedure.

Dr. Becker and Dr. Dodds Talk About Titers.

Share

Dr. Becker and Dr. Dodds Talk About Titers.

How Long Will Your Pet’s Rabies Shot Last? You Might Be Surprised…

By Dr. Becker

Today I have a very special guest chatting with me via Skype, Dr. Jean Dodds. Dr. Dodds is an incredibly busy woman, and among her many undertakings is her involvement, along with Dr. Ron Schultz, in the Rabies Challenge Fund. The purpose of the fund is to determine the duration of immunity conveyed by rabies vaccines, with the goal of extending the required interval for rabies boosters to five and then to seven years.
Dr. Dodds has agreed to spend some time today discussing antibody titers with us. It’s a confusing topic. Not only are there different types of titers and different methods of titering, but the “when,” “how” and “why” of titering confuses not only pet owners, but veterinarians as well. So I asked Dr. Dodds to start by explaining what a titer actually is.

What, Exactly, Is an Antibody Titer?

Dr. Dodds replied that a titer is a blood sample from which the serum is analyzed to determine the level of antibodies present to an infectious agent like the distemper virus, parvo, hepatitis, and other diseases. When the blood serum antibody level is measured quantitatively, we are measuring a combination of the animal’s natural exposure to the infectious agent as well as vaccinations against it.
Next I asked Dr. Dodds to explain why some diseases are only acquired once (and thereafter, the animal has lifetime immunity), whereas other diseases pose an ongoing threat throughout an animal’s life.

“Sterile” (Lifetime) Immunity versus Short-lived Immunity

Dr. Dodds explained that certain diseases produce what we call “sterile immunity.” Those diseases include distemper, parvo, and hepatitis in dogs, and panleukopenia in cats. When an animal is exposed to these diseases and recovers, or is vaccinated properly against them, the animal becomes immunized. And we must keep in mind that immunization is the outcome of proper vaccination. The act of administering a vaccine doesn’t necessarily mean the animal has been immunized against the disease.
When an animal is properly vaccinated and becomes immunized, he receives sterile immunity, which is long lasting — a minimum of seven to nine years, to a maximum of lifetime immunity — as measured by titer tests. This means the pet cannot become infected, nor will he shed the virus should he be exposed. (Since the diseases of distemper, parvo, hepatitis and panleukopenia are everywhere, the risk of exposure is constant.)

But as Dr. Dodds goes on to explain, there are other vaccines that do not produce sterile immunity. Those are vaccines against Lyme disease, leptospirosis, bordetella, and other upper respiratory/kennel cough-type viruses, and even canine influenza. The vaccines against these diseases don’t last very long – typically seven months to a year. The antibody levels against these diseases, as measured by titer tests, fall off with each successive year.
But … does that mean the animal is not protected against the disease? According to Dr. Dodds, the answer to that question is unclear. There are antibody titer levels, and there are things called immune memory cells, which remain for a lifetime. Even with low titer values following vaccination, pets may still be protected for up to a year or even longer by immune memory cells if exposed to one of these diseases.

Dr. Dodds frames the question this way: “The problem, I guess, is how do you know when you do a titer against one of the shorter-lived agents in terms of duration of immunity … how do you know that the animal is really protected or not? You’re not going to challenge them [by deliberately exposing them to the virus or bacterium] to make that determination.”
Dr. Dodds says that it would seem, for those shorter-lived vaccines, if they’re needed at all – and that’s a very big IF – animals may need to be vaccinated more often, like every 18 months to two years. This is in contrast to the sterile immunity core vaccines for distemper, parvo, hepatitis and panleukopenia, which we should not have to administer after pets reach midlife, as long as they have measurable titer values.

In human terms, we could compare veterinary core vaccines to polio vaccines, and perhaps measles, mumps and rubella vaccines. These vaccines provide lifetime immunity, whereas a tetanus vaccine, which is a bacterin, may not last for a lifetime.

Why Intranasal Bordetella Vaccines Are Better Than the Injectable Form

Next I asked Dr. Dodds to talk about kennel cough (bordetella) vaccines. There is the injectable form and the intranasal form. An animal can receive one of these vaccines and immediately be infected with kennel cough.
Dr. Dodds answered that upper respiratory virus vaccines are not 100 percent effective, and in fact, she just received some information stating they are only about 70 percent effective. But there are home and commercial boarding facilities run by people who are really concerned about their own liability, even when the risk is minimal. Some insist on bordetella vaccines every six months. In those cases, the vaccine used should be intranasal.

I asked Dr. Dodds her opinion of the injectable bordetella vaccine. Does she ever recommend it? She replied that she would not, because the intranasal form contains interferon, which provides partial cross-protection against other upper respiratory viruses.
On a side note, the intranasal bordetella vaccine should never be given as an injectable, and the injectable form should never be administered as an intranasal vaccine. Dr. Dodds said recently a Rottweiler received a bordetella vaccine administered incorrectly and acquired acute hemolytic anemia.

Different Types of Titer Tests and the Potential for Conflicting Results

Back on the confusing topic of titers, I asked Dr. Dodds to discuss hemagglutination inhibition, or HAI, because it is a common method some labs use to run titer tests.
Dr. Dodds explained that HAI is the gold standard for measuring immunity to, for example, parvo. It’s the original technique that has been mostly replaced in today’s clinical labs with the more efficient enzyme-linked immunosorbent assays (ELISA) on serum. ELISA tests are quicker and there are very good ones available.

She goes on to say that the parallel to HAI is serum neutralization, SN. It’s considered the gold standard for the canine distemper virus. But again, ELISA tests have replaced SN in most labs because the process is cumbersome, and it is also more costly. The ELISA assays have recently been shown in a refereed paper to give equivalent results to HAI and SN.

I asked Dr. Dodds to discuss another technique called IFA, or immunofluorescence antibody technology. How does it fit into the titering picture? She answered that IFA is something she’s actually quite proud of because back in the late 1990s, she helped develop a similar test and published her findings. In 2000, Dr. Dodds and Dr. Lisa Twark published a very large study of about 1,500 animals, comparing HAI and SN with the new IFA test.

The IFA test measures immunity in much the same way tests detect presence of disease. But as Dr. Dodds explains, vaccine titer levels are typically much lower than disease levels. She likes the IFA test because it simulates what happens with a natural infection – determining how well an animal is protected using the same methodology.

At the major diagnostics lab that runs IFA tests, a “yes” answer to the question of whether an animal is protected actually means the animal is well protected. If a pet isn’t protected according to an IFA test, no question about it, you need to revaccinate except in the case of dogs that have experienced prior adverse vaccine reactions or non-responders – animals that are genetically non- or low-responders to vaccinations, as they simply will not acquire effective immunity to a certain disease no matter how many times they are vaccinated.

Regarding ELISA tests, in my own practice I’ve used them, and noted that some animals show no notable protection against distemper. But when I recheck them with the IFA test, they are protected. This is confusing, and I asked Dr. Dodds about it.

She responded that at her lab, Hemopet, they do their own in-house laboratory titer testing. And they use ELISA technology. If they get a negative on a test – and it’s almost always for distemper – they send it out for an IFA confirmation test. They then provide both sets of results to the animal’s veterinarian so he or she can use professional judgment and case history to decide whether or not to re-vaccinate.

Dr. Dodds explains that she’s not overly worried about a low distemper titer unless the pet is around wildlife. She does worry about parvo. If a parvo titer comes back negative on an ELISA and positive on an IFA, again, the results go to the animal’s vet so he or she can make the judgment call. But Dr. Dodds does discourage vets from delivering combination vaccines and recommends instead a single parvovirus vaccine booster. Single-agent vaccines are significantly less stressful to the body immunologically.

Maternal Immunity: What Is It? Why Is It Important? How Long Does it Last?

I asked Dr. Dodds to talk about situations in which there is potentially some lingering maternal antibody in a young pet, meaning the puppy or kitten is still protected, or partially so, by its mother’s antibodies.

Dr. Dodds first explains that maternal antibodies are what the mother imparts to her litter via the placenta during fetal development – this accounts for up to 10 to 15 percent – and the rest comes from the colostrum in her milk. When the pups or kittens nurse, they receive maternal antibodies. How long those will last depends on how high the mother’s antibody titer was while she was pregnant. Maternal antibodies are usually gone by the time a puppy or kitten is 16 weeks of age, but they start to drop off around 8 to 10 weeks. So there is a “window of vulnerability” between, say, 10 and 16 weeks when young animals are not completely protected.

Our solution for that is to vaccinate earlier, which temporarily suppresses the maternal immunity that is present. But, the animals become more vulnerable for those few days – from about 3 to 7 days – after a vaccination at 7 or 10 weeks, for example. At the same time, the maternal antibodies are waning. It’s not ideal to suppress the maternal antibodies via vaccination, but it’s also not prudent to wait until they’ve dropped off entirely. So it’s a bit of a catch-22.

That’s why it’s important that young pets not be out at dog parks or other locations where potentially infected animals could be. Puppies and kittens should be well immunized before they are allowed to venture out into the world.

Titering from three to four weeks after the last puppy or kitten shot is a good opportunity to determine if the vaccinations actually worked to immunize the animal. Dr. Dodds agrees but says titers shouldn’t be done before 16 weeks, because if you titer earlier, you can pick up some of that waning maternal immunity which will eventually be gone.

Rabies Vaccines and the Exciting Work of the Rabies Challenge Fund

Moving on to the rabies vaccine, depending on what state you live in, it may be approved for dogs as young as three or four months old. This particular vaccine is risky in terms of its reactivity, because it contains a potent amount of inactivated (killed) rabies virus plus strong adjuvants to help stimulate the immune response. Veterinarians often postpone the rabies vaccine until a pet is six months old to give the body more time to develop. I asked Dr. Dodds to talk about the duration of immunity of rabies vaccines, which are made from killed rabies virus.

Dr. Dodds explained that some people believe modified-live rabies vaccines are still in use, but they are not. Years ago, there was a modified-live rabies formula for cats, and it did occasionally mutate and produce rabies. But today there are no modified-live rabies vaccines in use.

However, the killed-virus rabies vaccine is extremely potent and should not be administered earlier than necessary. Even though rabies vaccine package labels say it can be given at 12 weeks, Dr. Dodds believes it should not be given before 16 weeks. Recently, California passed legislation to allow rabies vaccines at 12 weeks vs. 16 weeks, which caused a lot of controversy and will continue to do so.

As to the question of how long rabies vaccines last, according to titer tests, antibodies can remain in an animal’s blood for seven to nine years, and perhaps longer. But again, the question is: are those pets truly protected against the disease?

The Rabies Challenge Fund recently completed year five of its five and seven-year trials to determine how long the rabies vaccine lasts. They are into year six now. The animals used in the study are living in a kennel breeding facility environment.

According to antibody titers on the study animals, at year three after vaccination they all showed good immunity. At year four they showed measurable immunity, but by year 5, some of the animals no longer had measurable rabies titers. Dr. Dodds and Dr. Ron Schultz conducted something called a vaccinal challenge (rabies revaccination) that showed the animals all had immune memory cells that responded by producing good rabies antibody titers, even though some of the animals had titers below the 0.1 international units per milliliter level deemed by the CDC to be adequate to protect a person against rabies. So Dr. Dodds and Dr. Schultz believe that even five years post-vaccination, the animals in the study have maintained good immune memory to protect them against rabies should they be exposed.

What’s lovely about all this is that the animal body is still capable of mounting a response, from immune memory, to the virus. The body innately knows what to do.
Dr. Dodds wants to clarify that even though we know immune memory response was boosted in the animals in the study, it doesn’t mean the USDA or individual states will accept extending the length between rabies booster vaccinations. The Rabies Challenge Fund hasn’t reached that stage in the process yet. They are still developing data that, quite frankly, many people might not want to see published, and that data is being gathered from canine titers rather than trying to extrapolate data from human titer studies to canines.

How You Can Help

The Rabies Challenge Fund study is the first of its kind, and it takes a lot of money to do the work. It’s seven years of research, data collection, and publishing the results. That’s why Mercola Healthy Pets is partnering with the Rabies Challenge Fund to help raise the remainder of the funds needed to not only complete the study, but to insure the research is published in a manner that will benefit the most pets.

Dr. Dodds explained that much of what she has just discussed with us here does not appear at RabiesChallengeFund.org because it could be considered prior publication, precluding their refereed publication (a publication that has been reviewed and examined by experts and scholars in the field of immunology and veterinary vaccines).
And of course research is still ongoing. They are in year six, and have year seven still to go. The project depends on grassroots gifts for funding the costs of conducting the requisite vaccine trials. Contributions to date have come mostly from kennel clubs and private individuals. None of the money collected by the Rabies Challenge Fund goes to Dr. Dodds, Dr. Schultz, Kris Christine, or others working on their behalf. No salaries or other overhead is involved with the exception of expenses for care of the study animals. Dr. Dodds’ staff at Hemopet administers the fund from their offices in Southern California, and all their time and resources are donated.

I want to extend my thanks to Dr. Dodds for talking with us today and for her work with the Rabies Challenge Fund. Thanks also to Dr. Ron Schultz and Kris Christine of the fund. Extending the length of time between rabies vaccinations, thereby reducing the total number of vaccines animals receive during their lifetime, will be a huge benefit to the health and well being of family pets across the globe. Gathering serial serum rabies titer data during the full course of the study also provides a new database to help veterinarians and dog licensing authorities assess exposure risk and levels of protection, especially for those dogs that cannot safely or should not receive a rabies booster.

Mercola Healthy Pets is proud to partner with the Rabies Challenge Fund to raise money to help improve the lives of animals. This week, for every $1 donated to the Rabies Challenge Fund by a Mercola Healthy Pets reader, we will donate $2, up to $30,000.