After a long study a veterinary  vaccine associated sarcoma task force was unable to identify a specific reason why cats get  soft tissue sarcomas following vaccinations. Dogs do not get them. It is probably a genetic problem with an individual cat responding to a vaccination more than it is a problem with the vaccine itself.  One in 10,000 vaccinated cats get such a reaction. Some vets, myself included, believe that anything injected under the skin could cause such a reaction. One in 10,000 cases is too many for me so we have tailored our vaccine recommendations to our patient's lifestyles.

At Los Altos Veterinary Clinic we altered our feline vaccine regimen  to conform to the conclusions put forward by the vaccine associated sarcoma task force . They created a list of core vaccines as well as a list of non-core vaccines that are optional to keep your cat healthy.

 My personal recommendations to cat owners on which vaccines to give their cat are based on a number of questions having to do with the cat's lifestyle-

All of these are valid reasons to vaccinate indoor cats for rabies.

In general for indoor adult cats I recommend  intranasal vaccination (nose drops, no injection- pretty cool, eh?) be given every third year to adult cats for FVRCP ( short for rhinotracheitis, calici and panleukopenia ). That's it.

Indoor cats cannot get rabies, it requires contact with the rabid animal. Here is the problem.  Some indoor cats will need to be vaccinated for rabies. Most municipalities require vaccinations for rabies for all dogs and cats and they do not discriminate between indoor and outdoor cats. Cats that go to boarding kennels, groomers or travel on airlines should be vaccinated for rabies as most all kennels, groomers and airlines require these shots.

For outdoor cats the risk of coming in contact with viruses is higher so I recommend vaccinations be given for leukemia, rabies and the three-in-one FVRCP intranasal vaccine . I prefer all  these vaccinations to be non-adjuvenated. An adjuvant is something added to the vaccine that makes a better immune response. It has not been proven that adjuvants increase the risk of sarcoma formation but I'm very suspicious that it contributes to the overall risk. I prefer the transdermal spray by Meriel for feline leukemia vaccination be given every three years an adult cats. I recommend the nonadjuvenated Merial rabies vaccinations for cats annually .For cats travelling overseas it is important to check with the country they are travelling to, many countries are not OK with nonadjuvenated rabies vaccines- don't ask me how I know this.

Confused? The simplest approach is just ask a vet what shot your cat needs.   That should trigger a series of questions, not a series of shots. Be wary of veterinarians at vaccination clinics who vaccinate every cat every year for everything.  

  We have an epidemic of diabetic overweight cats. Many of these cats come in my office because they are drinking a lot and urinating more than they used to do. A simple blood test or urine sample confirms the diagnosis of diabetes mellitus in less than a minute.

Diabetes mellitus or sugar diabetes is a disease where dogs and cats require insulin to control high blood sugar .For this article I'm only going to be speaking about cats as dogs have a slightly different response to diet and insulin regimes. 

The good news for cat owners is that there are two tools in the toolbox that used together may actually cure about one third of the diabetics. those tools are diet and insulin.

Cats in nature do not eat carbohydrates, they birds, mice and fish. When I see a newly diagnosed diabetic cat the first thing I do is send the owner to the grocery store to pick up some low-carb cat foods. You can find a listing of these foods under Links we Love  on this website, look under low-carb cat food diets and go to that link. The goal is to get 6% carbohydrates are less. This means no  dry food, only canned foods soon to be able to get as low as 6% total calories from carbohydrates. The best dry food seems to be Evo at 7 %.

Most diabetic cats will have blood sugars higher than 300 and normal cats will have blood sugars below 200. Owners can easily measure blood glucose at home by pricking a little vein in the ear and using an inexpensive blood glucose meter that can be purchased at any local pharmacy. Home glucose readings are much more reliable than any vet clinic can measure because adrenaline surges make the sugar go up. Almost all cats get a rush of adrenaline when they come through our doors.

If diet alone does not resolve the high blood sugar it may be necessary to use injectable insulin. Oral hypoglycemic agents don't seem to work well for cats and is much easier to give cats shots than pills. The endocrinologist at UC Davis, Dr. Edward Feldman, once told a large group of veterinarians that the real use of oral hypoglycemic pills is to convince owners it would be easier on them (and their kitties) to just give the cats insulin injections! It turns out all the type I diabetic cats become type II diabetic cats within the year anyway and all type II diabetic cats require insulin.

High blood sugar seems to poison the cat's ability to make insulin. If we catch cats in time before the pancreases totally lost its ability to produce insulin we may be able to "wake the pancreas up" and achieve  a honeymoon, a highly desirable state where the cat no longer needs injectable insulin. That is my goal in every case. The longer the cat has been diabetic the less likely we are to go on a honeymoon.

The best insulin for cats is insulin glargine. We start at an initial dose of two units twice a day and recheck the cat two weeks later to see if it has come down to normal. A third of cases will no longer need insulin, two thirds of them unfortunately areus insulin-dependent for the rest of their lives. 

Complications are common in long-term diabetics and frequent monitoring of urine for infections as well as blood for concomitant problems is a very good idea several times a year.

Most diabetic cats lead normal lives and diabetes is not as bad to treat as most owners think it's going to be.

 If your cat is drinking a lot, eating a lot and urinating a lot it is time to check for diabetes. 

If your cat is fat it is time to lose the weight, preferably on a low-carb diet.

 Let's make it a  resolution for our cats to lose the weight I won't be losing in 2011 and hopefully prevent diabetes mellitus in all my feline patients.

We are all bombarded by advertisements for stuff we don't need this time of year. In the shopping frenzy that is the Christmas season I think our pets deserve something from us a whole lot more than most of the people on our shopping list. They give back so much- we should not ignore them. 

There are good gifts and bad gifts for pets.

 First- what to avoid. The best stuff to avoid is anything that might result in a trip to the veterinarian's office during the holidays. Christmas trees are ground zero for bad stuff for pets. When people bring presents for you to put under your tree is probably a very good at idea to ask if there's anything that the dog might want to eat in that colorful wrapped box from Aunt Millie. If it turns out to be a Hickory Farms sausage loaf my Labrador Retriever dog Coco would be sure to find it. Coco does not share. I wouldn't mind if she ate the fruit cakes (Kidding Mom!).  

Cats will ingest tinsel, people with cats should avoid tinsel. I remember once seeing a piece of tinsel stuck under a cat's tongue and the same piece of tinsel was protruding from its anus. The cat needed a surgery called an enterotomy where about half a dozen small incisions were made along the length of its intestines to remove small snippets of tensile. Ouch!

Pets themselves make notoriously bad gifts. I am all in favor of puppies and kittens but it needs to be a family decision based on a commitment to take good care of the puppy and kitten for the next 15 years. If you know somebody thinking about getting a puppy or kitten please have them give me a call and I will be happy to give them some pointers on how to find the dog or cat of their dreams.

For dogs toys I like to buy solid rubber toys bigger than their head. I avoid giving dogs small squeaky toys as I've taken too many of them out of their stomach the day after Christmas. Suddenly that five dollar dog toy costs over a thousand dollars or more to remove from Rover's gut on Christmas Day so skip the Rubber Duckie type toys. Rawhide chew toys are okay but I avoid anything made out of rope. Avoid bones too, they crack teeth in two. Am I the Grinch or what? Fear not, good toys for good dogs are out there. Excellent toys are made by Kong, Gumma Bone and, my dog's personal favorite, the Orbee Ball. I found it at a pet shop in Sunnyvale, For Other Living Things (under Links we Love at losaltosvet.com).

For naughty pets and nice owners I suggest the Bissel Spot Bot carpet cleaner, available at a Target store near you( also featured on Links We Love). I got mine a few months ago and use it more often than I want to admit.

For cats I like catnip. OK, some cats don't love catnip but if yours does I suggest you buy high-quality Capt. Cosmic brand or some other potent variety. I spreadout newspapers on the floor and dish out about half a teaspoon of catnip, sit back with an eggnog and the party starts itself. I also love laser pointers for cats, especially cats who are under the influence of catnip. You want to go big? I like cat condos. Pick a spot so they can see out a window and get one about 3 1/2 to 4 feet tall- cats like to scratch and those wimpy little 1 foot tall scratching post don't cut it  for most cats.

For dog owners I recommend the book on dog behavior by the Monks of New Skete called The Art of Raising a Puppy or another one they wrote on adult dog training called How To Be Your Dog's Best Friend. 

If you just want to read about dogs I like Daniel McCaig's book Emminent Dogs and Dangerous Men about border collies in Scotland.

The best gift for any pet is face  time with its owner. That's all they really want for Christmas. Skip the funny hats and sweaters and take some time to walk around downtown with the dog and see the lights. Bad weather? Find a nice long book or maybe get a Kindle for Christmas (Thanks Mom!!), a comfy chair and a wool blanket and chances are your cat and dog will come find you.  I just might stay there with them till 2011.

During the holiday season many of us travel to visit family and friends and want to bring our pets with us. We love our pets. Many of our pets love us. It is only natural we would want to share the joy of the holiday season with our pets, our family and our friends simultaneously. The problem is most pets don't like change. They like the same thing the same time every day.  

It takes cats about a week to adapt to a new scenario, dogs are generally faster but even they take a couple of days to get used to a new household.  If your trip is less than a week it is probably not worth the trouble to bring your pet along no  matter how much you love him. Leave the dog or cat at home with somebody who can live with them in your own house if possible. Boarding kennels are my next best choice. Plan ahead.  Many/most boarding kennels are already booked up for the holiday season. Make sure your pet's vaccinations are up to date and check with the kennel to see what they require as these requirements vary from one place to another.

If you take your animal with you on a trip there are things you can do to make the trip easier. Airlines require animals to be kept in a crate the entire time they are on the flight. I see no advantage to having that crate with you in the passenger cabin as animals seem to do fine checked in the luggage compartment. The whole plane is pressurized, the whole plane has oxygen and I've never seen a problem with hypothermia or any other unpleasantness from checking a pet at the gate. Make sure your papers are in order, many airlines require a letter from the veterinarian saying that your pet can withstand very low temperatures for very long periods of time, a requirement that can border on the ridiculous- to the point this veterinarian may refuse to provide such a letter. Most airlines also require a USDA health certificate signed by a veterinarian- which requires an exam within 10 days of the flight, a healthy pet and a current rabies vaccination. 

Some patients benefit from sedation when traveling in a plane or a car for an extended period of time. In general I prefer to avoid drugs for about 90% of my patients. Speak with us and we can tell you ways to avoid medicating pets unnecessarily. For sure some animals really need sedation but in general I think tranquilizers are overused and doses we used to give animals of drugs like Acepromazine are likely about 10 times higher than they need to be. I suggest getting the medication 2 to 3 weeks before the trip. Try different doses, working up to the lowest dose that does what you wanted to do. 

Better than drugs is conditioning your pet to travel. The simplest way is to buy a crate and take your pet for short drives in the car every day for a week or so. Eventually they learned that nothing really bad is going to happen. I buy a few fleece blankets and put them in the crate - I saw them at Walmart the other day for a dollar each. I do not put food or water in the the crate. If it is a really long flight I will put some water in a dish and freeze it because I know the animal will either spill it or drink it all right away given half a chance.

If I have not successfully talked you out of traveling with your pet this holiday season I wish you well. Please call us if you need help preparing for your trip and have a safe and happy holiday season!

 Lipomas are the most common lump we see on dogs and the other vet was probably right. My best guess is about 90% of the time you're right guessing lipoma when you feel a lump under the skin of a dog. The 10% of the time you're wrong is a really bad day day for the dog. 

Cysts and tumors often look like lipomas and it's usually easy to tell the difference with cells under the microscope. That is what I did, I poked the lump with the needle and sucked some cells out to look at under the microscope. I'm glad I did.

 Yes, there were some fat cells present but there's also a lot of cellular debris and inflammation that I did not expect to see with a lipoma. Unfortunately there were not a lot of other cells to look at so I am sending the slides I made here to a pathologist at my lab, Idexx, to see if the dog will really need surgery. We should know something tomorrow. Meanwhile my patient is on an antibiotic called baytril  in case it turns out to be an infection of the fat called steatitis. I am also running some pre-op blood tests just in case we need to go to surgery later this week.

 If even  the pathologist cannot tell us what we are dealing with we may need to biopsy this mass by taking it off under general anesthesia. 

 Fine needle aspirates are great because they're a quick, easy and inexpensive way to diagnose many lumps. That said, if we don't see cancer cells go we can never say for sure it is not cancer because " the absence of evidence is not evidence of absence."

This one is a little unusual, one of the little mysteries that make up my typical day at the office. Stay tuned!

Last week there was an excellent radio interview about aging changes in dogs on the NPR program Fresh Air. You can listen to the interview or download the transcript here  . In the interview Dr. Dodman  covers many areas of concern for older pets and their owners, mostly things like mobility and house soiling. Of particular interest to me was his comparison of the dementia many of our older pets acquire with humans with  Alzheimer's disease. We have a name for this in veterinary medicine, Canine Cognitive Syndrome

Your dog does not recognize you

Your dog barks at night for no reason

Your dog no longer runs to greet you

Your dog wanders the house and get stuck in corners

Your dog doesn't wag his tail

Your dog turns away when you try to pet him

Your dog appears confused

If your dog seems to be showing the symptoms it is time to talk to your veterinarian. We certainly want to rule out other problems that might be causing behavior changes, things like arthritis or hormone problems that are common in older pets. If dementia is the diagnosis there's even a  drug, anipryl, that can help many pets although I must admit I've been skeptical about its use.

 Sometimes it's best not to treat these dogs if their quality of life is not what we want for them. It is a deeply personal decision to euthanize the dog and I believe many dogs are euthanized needlessly because an owner perceives them as "old". 

 Old age is not a disease but it is a time of life for many dogs and cats start acquiring diagnoses that may  benefit from treatment.

  While dental extraction sounds like a minor procedure extracting teeth can be a major undertaking in veterinary practice. Unfortunately it's almost a daily occurrence here my small practice. 

    The majority of cases have extractions because of periodontal disease but today I had a beautiful beagle in the office for routine teeth cleaning. Ten years old, she'd never really let me look in her mouth during exams and she even tried to bite me. We had to anesthetize her to get a better look. Once we got her asleep we scaled and polished her teeth  and found under all that tartar that she had cracked the two biggest teeth in her mouth, the upper left and right fourth premolars. These injuries are common and are called slab fractures, usually acquired by chewing on rocks, bones or in this case olive pits that fell from a tree in the backyard- she loved them. Surprisingly she had no real symptoms.

  Dental radiographs showed that in addition to cracks in the crowns of her teeth she had also exposed the pulp canal to oral bacteria and predictably a nasty infection ensued. She had evidence of bone loss and abscessation at the roots of her broken teeth. 

   Using local nerve blocks we were able to freeze the nerves thus minimizing the amount of gas anesthesia she required- that's safer. I made incisions around the gumline to elevate flaps away from the work area. I used to drill to cut the teeth into three parts, one for each root. Using an instrument called an elevator I was able to elevate each root until I could remove it with just my fingers. This took the better part of an hour. After removing the roots I took a follow-up x-ray, everything looked good and I closed the incisions with tiny sutures.

   She went home on some antibiotics and a generous dose of pain medicine. I expect her to do fine.

 

This morning we got a little good news about Sparky, the dog who had the fine needle aspirate yesterday. I'll post his lab reslults , his owner kindly gave us permission to do so.

  Occasionally for fun I will go into a pet store not tell them I am a veterinarian. I try to find the most intelligent staff person in the store and ask some vague question about what I should feed my dog. Invariably they go into a long  talk about the digestibility, palatability, lack of byproducts and lack of filler in their fine foods. They often will find a way to say something bad about some other brand, a food so far beneath contempt they are shocked anyone would feed it. Not one of them has ever told me anything about how many calories are in a given portion. The pet food label is  worthless- it does not say anything about calories.  To make matters worse the amount of food the label suggests I feed my dog is usually double or even triple how many calories a normal pet dog is able to burn in a day.