Dr. Nelson's Veterinary Blog

February is Pet Dental Month

2012-02-08T15:44:06Z

The American Veterinary Medical Association has declared February "National Pet Dental Health Month". Pets struggle with a variety of dental problems including periodontal disease, alignment issues, and fractured teeth in carnivores and overgrown teeth making it difficult to eat in herbivores. Besides causing pain, infection from the mouth may spread throughout the body infecting everything from heart valves to the kidneys. Therefore, it is vital to check your pet's mouth frequently and perform home care. Remember, "Pets need dental care, too."

Pictured below is a cat with a painful, fractured lower canine tooth that I found on physical examination.

You Make The Diagnosis: Name The Rare Blood Disorder Found In Irish Setters

2012-02-03T17:30:16Z

This beautiful girl is Liddie, an Irish setter with a big personality. Liddie brightens any room she enters with her expressive and friendly face. For this photo, she ignored me and listened to a dog in the room next door. What a character!

Irish setters have a rare but fatal genetic disease that causes fever, anorexia, recurrent infections, slow wound healing, weight loss, umbilical infections, gingivitis, lymphadenopathy, pododermatitis and osteomyelitis. Name this inherited disease.

Dx: Canine Leukocyte Adhesion Deficiency (CLAD)

Canine leukocyte adhesion deficiency is an inherited disease caused by a mutation in the leukocyte integrin CD18. It is an autosomal recessive which means that dogs with only one copy of the gene will be asympotomatic carriers while those with two usually die young. The disease is also seen in humans and cattle. Since CLAD is a devastating disease, I recommend testing all Irish setters prior to breeding. Your veterinarian will collect a blood sample and send it to Optigen for testing. More information is available at http://www.optigen.com/opt9_test_clad.html.

Resources:
"Gene therapy for CLAD with lentiviral vectors using the murine stem cell virus and human phosphoglycerate kinase promoters" Human Gene Therapy, June 2011; 22(6): 689-96.
"Frequency of the canine leucocyte adhesion deficiency (CLAD) mutation among Irish red setters in Germany" Journal of Animal Breeding and Genetics, April 2005; 122(2): 140-2.

Arizona Humane Society Releases Distemper Alert

2012-01-30T03:22:20Z

I was going to write about food bowls in this post until I received a pet health alert from the Arizona Humane Society regarding distemper in dogs. Normally, the virus affects young, unvaccinated puppies every spring. But this year, the Arizona Humane Society has noticed a difference in the disease. Both puppies and adult dogs with questionable vaccination histories are getting the disease. Clinical signs include lethargy, runny nose and eyes, anorexia, coughing, vomiting and diarrhea. After the initial phase, affected dogs often develop hyperkeratosis of the pads on their paws and seizures. Georgia, Florida and Ohio are also seeing this phenomenon. According to the news release, "There is also evidence to suggest that two new strains of distemper indigenous to Europe have made their way to the U.S. and while the typical incubation period for distemper is one to two weeks the new stains may have even longer incubation periods."

Since there is no treatment for distemper, prevention is a must. Keep your dog up-to-date on their distemper vaccination or blood titer checks. Remember, it takes time for immunity to build in response to a vaccine. Avoid dog parks, pet stores and other dog places for at least two weeks. Also, the virus can be spread by physical contact so wash your hands and change your clothes after contacting dogs with unknown vaccination histories. More information is available at https://www.azhumane.org/PDFs/2012_ahs_issues_valley-wide_pet_health_alert.pdf

Plastic Allergy In Dogs And Cats

2012-01-26T03:03:25Z

It will surprise many people to learn that animals may become allergic to plastic. Areas of skin that contact the plastic become inflamed and often bleed. Once the normal dermal barrier is damaged, bacteria and fungi often develop secondary infections. Pictured below is the chin of a dog who received an automatic plastic feeder for Christmas. The lesions often start on the chin and spread to the lips and nose.

Treatment involves removing the plastic exposure and treating the secondary infections. In this case, I recommended placing a metal or ceramic pan in the automatic feeder. Given appropriate therapy, most patients will recover within two weeks.

Unfortunately, there can also be problems associated with metal bowls (shocks from static electricity) and ceramic bowls (easily broken and lead paint). Please see my next blog for the pros and cons of the different materials used in food and water bowls.

Fecal Mats On Dogs And Cats

2012-01-22T22:26:28Z

Dogs and cats with long, furry coats are prone to a condition called 'fecal mats'. The term is a polite way of stating that feces are stuck in the hair over the anus.  With time, the feces cause a terrible infection that actually destroys the skin and underlying tissues. A few years ago, I removed a fecal mat on a dog and found maggots. Yikes, I hate maggots!

The following pictures are of a long haired cat with a fecal mat. If you have a squeamish stomach, I recommend skipping the pictures.  Please remember to perform regular hygienic shaves on all hairy animals to prevent fecal mats.  I commonly see this condition in Old English sheepdogs, Collies, Shetland sheepdogs, Shih- tzus, Poodles and Lhasa apsos, Bichon frises, and Samoyeds. In cats, Persians, Himalayans and their mixes are most commonly affected. If you live with a hairy animal, check their rear ends daily and keep them groomed to prevent fecal mats.

Photo 1) This is what the cat's rear end looked like before treatment. Please note that you cannot see the anus because it is covered by the fecal mat. Although the picture is gross, trust me, the smell was even worse.

Photo 2) After treating the cat with fluids, antibiotics and medication to block pain, he allowed us to shave off the fecal mat. Note the inflamed skin surrounding the anus.

Photo 3) Here is the cat all nice and clean. The picture isn't great because the cat was tired of having his rear end treated.  After a rest break, he was a good boy for a bath and brush. He went home purring and smelling great. I wish I could say the same for our bath tub.

Photo 4) For the really brave people, the next picture is of the mat. This is the underside of what you saw in photo 1.

Sunburn, Cancer & Pets

2012-01-20T04:43:42Z

I find people are often surprised when they learn that animals can get cancer from sun exposure just as we can. Pink skin is much more susceptible to developing squamous cell carcinoma than pigmented skin. Pictured below is a Jack Russel Terrier mix named Chewie who has an area of pink skin on the bridge of his nose. Although Chewie's markings are really cute, I worry about the pink area getting sunburned and eventually developing cancer. Other breeds that share this problem are Brittanys, Collies, Shetland sheepdogs, German shepherds, German shorthaired pointers and Siberian huskies.

Squamous cell carcinomas may develop in species other than dogs. I have personally diagnosed this condition in cats, rabbits and an albino ferret. In all of these cases, the ears where effected.

To prevent this aggressive cancer, protect pink skinned pets from the sun. Avoidance is the best approach if possible. Limit sun exposure from 10am to 4pm. Watch sun loving pets who look for sunbeams for a nap. When outdoors, pets may wear protective hats and t-shirts or sunscreen. Use zinc-free sunscreen with a high SPF. I do not recommend sunscreen in cats because most contain salicylates which is toxic if ingested chronically or in high doses.

National Animal Shelter Appreciation Week

2012-01-17T02:19:33Z

Last November I announced a contest for National Animal Shelter Appreciation Week. I am pleased to announce the honorees of the donations to the Animal Humane Society in Minnesota, the Humane Society of Seattle/King County and the Arizona Humane Society. I was born and raised in Minnesota, graduated from the University of Minnesota College of Veterinary Medicine and it is the site of my book. My undergraduate degree is from Seattle Pacific University. I now reside in Arizona. Hence, the three humane societies receiving a check.

Animal Shelters provide a (regrettably) essential service both to the animals and to our communities. Most of the time, animals are there because of the people who initially took them home. Seldom is a shelter animal in that situation due to their own temperament. In fact, I always counsel people to consider adoption from a shelter. In my experience, these are the most grateful animals - they seem to know they've received a second chance.  They are generally also quite healthy. I typically only see them for annual physicals.

Volunteers and donors at shelters are special people. It is a privilege for me to support them just as the employees and retirees of the following firms supported me and the book Coated With Fur: A Vet's Life. First are the honorees and then the humane society who will receive a check in their names:

3M Company                             Animal Humane Society in Minnesota
Microsoft                                   The Humane Society of Seattle/King County
US Airways                                Arizona Humane Society

You Make The Diagnosis: Is This A Wild Or Domestic Cat?

2012-01-14T03:05:48Z

Pictured below is a handsome cat named Cheetah. He was a little shy at first but awfully nice. It turns out he is a very sweet fellow. Although to some he might look like a wild feline, his family tree includes only domestic cats. According to the Cat Fanciers Association, this breed is a mix of Abyssinian, Siamese and American Shorthair. The CFA recognizes twelve different color varieties. Name this rare breed of cat.

Diagnosis: Ocicat

Ocicats have beautiful, wild markings that make them look like ocelots . . . hence the name. But don't let this name fool you. They make wonderful pets and can be taught to fetch, walk on a leash and respond to verbal commands. In my experience, ocicats like company from humans, cats and even dogs. If you work from home, this is a good breed for you.

Treatment of Hyperthyroidism in Cats

2012-01-11T03:00:43Z

There are several options for treating hyperthyroidism in cats. Since each treatment has its own set of benefits and drawbacks, it is vital to match the treatment to the individual cat. Please discuss these options with your veterinarian before deciding on a course of therapy.

1) Thyroidectomy: Surgical removal of the diseased tissue was the treatment of choice for cats with hyperthyroidism until radioiodine was discovered.  The procedure requires a skilled surgeon to avoid damaging the parathyroid gland which rests adjacent to the thyroid gland.  It is also very difficult to find and remove ectopic tissue (tissue outside the normal gland) that is often found inside the chest cavity.

2) Radioiodine: Radioiodine or I-131 is injected into the cat's blood stream, absorbed by the thyroid glands and then destroys the thyroid tissue. The advantage of this procedure is that it gets the ectopic tissue as well as the thyroid glands.  It does not require anesthesia which is another benefit. Thyroid function usually returns to normal within 30 days. Before using this treatment option, make sure the cat has good kidney function. As I discussed in the prior posts, hyperthyroidism may mask kidney disease. More information is available at radiocat.com.

3) Anti-thyroid Drug Therapy: Methimazole which goes by the trade name of Tapazole is an anti-thyroid drug commonly used in veterinary medicine. It is important to note that this medicine does not cure hyperthyroidism. It just blocks the synthesis of thyroid hormone.  The drug is dosed in one of two ways, oral or transdermal in cats who are difficult to pill. Unfortunately, there may be many unwanted effects associated with methimazole including hepatopathy (liver disease), blood disorders and auto immune disease. I had one patient develop dermatitis on his face. The poor guy rubbed his cheek into a bloody mess. Most of these problems occur within the first three months of treatment. It is important to perform blood work every two to three weeks in newly treated cats to catch these problems early.

4) Hill's YD: YD is an iodine deficient diet that is the newest treatment for hyperthyroidism.  Without enough iodine in the diet, the thyroid gland cannot make as much thyroid hormone and blood levels fall. According to Hill's, thyroid health will be restored in three weeks as long as no other foods are given.  I know Hill's to be a wonderfully responsible firm. They do a great deal to assist us as veterinarians in caring for animals. That said, this new diet leaves me with a few questions. Since cats are obligate carnivores meaning they must eat animal protein in order to maintain good health, I am concerned about this diet. Most of the protein, especially in the dry form, is from plants. In addition, I am concerned about the carbohydrate level which I worry could potentially lead to diabetes mellitus and/or pancreatitis. Here is the company's website for more information, http://www.hillspet.com/pd-feline-yd-dry.pdf. I hope Hill's is able to satisfactorily answer these questions as it is exciting to have food as an option for this condition.

After Effects of CODOX-M/IVAC Plus Rituxan

2012-01-06T04:52:51Z

I am taking one more break from animal related topics to help people who are recovering from the CODOX-M/IVAC plus Rituxan protocol (Modified MaGrath).  As a patient, I was frustrated by the lack of information regarding this protocol.  I didn't know what to expect. This post will cover what I experienced the year after finishing chemo. Please remember, every person will react differently. Just because I experienced it, does not mean you will.

1) The First Six Weeks:  It took two weeks for my bone marrow to kick in after the last chemo treatment. I finished chemo on December 6th and had my last transfusion on December 24th, 2010. Thank you again to everyone who donates blood.  You saved my life! Once I was done with blood and platelet transfusions, my strength improved and the nausea disappeared.  Although I was still weak and needed to sleep a lot, I felt so much better.  My appetite returned although I had to eat small portions.  Against my oncologist's advice, I made plans to return to work in February part time. Little did I know, what was to come.

2) Neuropathy of Feet: In February, my feet started to tingle. The tingling progressed until I felt sharp pain with every step. I put cushions in my shoes which helped a little. Eventually, I bought a new pair of New Balance running shoes. The cushion built into these shoes made the pain tolerable.  The discomfort peaked at the end of February and then slowly diminished until it was gone by April.

3) Abdominal Pain: In mid-February, the pain returned in my abdomen. It started small with slight discomfort in the evening and progressed. By late March, the pain was overwhelming. I was back in the hospital for diagnostics but the cause was never identified.  I think I had neuropathy in my intestines that disrupted the flow of ingesta through my body. The pain slowly diminished and was gone by the end of June.

4) Fatigue: I greatly underestimated how tired I would be after the CODOX-M/IVAC or Modified MaGrath protocol. For months, I napped in the morning and afternoon when not working. Even with those naps, I was exhausted by 7 pm. By April, I was only taking a two hour nap in the afternoon. My energy was improving until Arizona summer hit. The extreme heat really wiped me out. I felt like I took two steps backward in my recovery.  I began to worry about recurrence until I spoke with a wonderful chemo nurse named Debbie. She told me that was normal and I would feel better when the temperatures broke. Thank goodness, she was right. Thank you Debbie for your care and support throughout this journey. You are an awesome nurse!

I am a year out now and my naps only last for thirty minutes. My energy isn't quite back to normal but it is much, much better. On days when I can't nap, I need to go to bed early. Debbie told me that rest is the key to recovery from chemo. My personal experience backs up her statement. Give your body time to rest. It has been through a lot and needs time to recover.

5) Hair: When my hair was gone, my husband said "Don't worry, I'm suddenly into bald chicks!" I highly doubt it. He seemed particularly excited when my hair started to grow back at the end of January. The first growth was a few course pieces of hair that felt like whiskers. It hurt to put my head on a pillow. Thank goodness, all of that fell out in about two weeks. By the end of February, a shadow of gray and black hair covered my entire scalp.  By May, I had an inch of curly hair. Faint traces of brown appeared in July.  A year later, my hair is still full of curls. Since I had straight hair before, I am enjoying the new look. They told me hair grows about 1/2 inch per month and that seems about how it went for me.

6) Skin:  My skin, especially on my feet, was what I would term 'fragile' for months after chemo.  Shoes that normally felt great would cause blisters after an hour of wear. Be particularly careful of heals. I had to give an hour and one-half speech at a convention in March and thought my feet would be mush when I took off those shoes. Heals three months after chemo were a very bad idea.

7) Chemo Brain: For many months after chemo, I felt like my brain was in a fog. My memory wasn't normal and I seemed to process information more slowly. One year later, my memory has returned and I am thinking quickly again. However, I still use the 'chemo brain' excuse when it's helpful:)

In closing, I would like to emphasize the importance of rest in the process of recovery. After I finished chemo, my oncologist wanted me to take three to six months off before returning to work.  In retrospect, he was correct. I could not have handled a full time schedule for at least six months. Working part time was perfect for me during those early months because it gave me a chance to do what I like best . . . interacting with animals. For me, it was the perfect therapy and way to celebrate life. But, it took a toll as well.

I sincerely hope these two posts are helpful. You can beat cancer! Keep the faith, be kind to your caregivers and embrace animals throughout the journey!

2012 Animal Charity Grant

2012-01-02T04:09:22Z

I'm happy to announce the 2012 Animal Charity Grant. It is open to animal and wildlife nonprofits in all 50 of the United States. Details are at veterinarycreative.com on the Animal Charity Grant tab on the left hand side. Please let the director of your favorite nonprofit know about this opportunity.

Congratulations again to the 2011 winner - Spay Neuter Project of Los Angeles!

One Patient's Experience With CODOX-M/IVAC Plus Rituxan

2011-12-28T15:46:29Z

Normally, this blog is dedicated to providing information that will improve animal health. Well, the next two posts will focus on humans and helping people with cancer. When I was diagnosed with double hit lymphoma (non-Hodgkin's large B cell lymphoma and Burkitt's lymphoma), the lack of information surprised me. So, this post will focus on what I experienced during the CODOX-M plus Rituxan with IVAC protocol (also known as the Modified McGrath protocol). The next post will address the delayed effects that occurred after the chemotherapy was over. I hope this helps all the patients and their care-givers get through this tough protocol. Please note, this is my experience and yours will likely vary. If you have questions or information to add, please comment. I want to do everything possible to help other people who are battling cancer. My prayer and best wishes are with you! As you walk this trail, I hope you are surrounded with love including that of animals - both at home and the hospital, they helped me enormously.

1) Hair Loss: After watching videos of women upset by shaving their heads prior to chemo, I decided not to shave my hair off. I let it fall out until it started to bother me and then my husband shaved off the remainder. My hair started falling out after the second part of the first A regimen. Every time I combed my hair, the brush was full. Although it was thin, a lot of hair hung in there until after the second cycle of the second A regimen. After a shower, the drain was covered. My cat saw it, hissed and ran out of the bathroom. He wouldn't come into the shower again after seeing that scary monster. (I'll cover hair re-growth in the next post.)

2) Bandana's and Hats: After trying a variety of head coverings, I found that the bandana's with an elastic cinch on the back worked the best for me. Baseball type hats rubbed my scalp, knit caps were too warm and regular scarves were hard to keep in place. I bought them from Tina's Treasures located in the Virginia G. Piper Cancer Center. Although I hated being bald, there was one benefit. Strangers were really nice to me when I was out in public with a bandana. Too bad we don't treat each other that way all the time!

3) Metallic Taste: After the first B regimen, I developed a horrible metallic taste that was unbearable.  The nausea was excruciating.  My husband and friends gave me all kinds of things to try. Black licorice, maple syrup, Williams-Sonoma Peppermint Bark and grapefruit juice worked the best.  What's interesting is that before chemo I didn't really like any of those items except the Peppermint Bark. Be careful with grapefruit juice because it may interfere when your other medications. Ask your physician for specific instructions.

Thankfully, the metallic taste only lasted for two weeks. It was really bad but hang in there, it will go away.

4) Nausea: Nausea was my constant companion. It was unbearable after the first part of the A regimen and then got better after that. I'm not sure if it really got better or I just got used to it. I tried every anti-emetic known to human-kind without much success. The medicine kept me from vomiting and lessened the nausea, but did not take it away completely. According to the Mayo website, people who haven't used much alcohol have more nausea than those who drink on a regular basis. I guess I should have partied more in college.

I also get motion sick. As if the intrathecals (in the spine chemo) weren't bad enough, I would get sick when they wheeled me on the gurney to radiology for these treatments.  Have the nurses get you meclizine if you suffer from motion sickness.

A word about medicine, I learned that you need to order ahead as the hospital pharmacy can get slammed (a highly medical term we professionals use). Particularly for pain and nausea medications, it is wise to plan ahead. I generally needed to give pharmacy a 45 minute lead time.

5) Mouth and Teeth: A common unwanted side effect of chemotherapy is dry mouth. Since teeth are designed to live in a moist environment, this causes a lot of dental problems. After the first part of the A regimen, my mouth went dry. Thanks to the advice of my dentist, Dr. Bartel at Carefree Dental, I avoided any long-term problems. He told me to use Biotene mouth wash to keep my mouth moist and also prescribed a toothpaste that contained fluoride. Please consult your dentist for help before starting chemotherapy - this is an area the oncology community may neglect.

6) Tumor Lysis or Necrosis Syndrome: During the second part of the first A regimen, I experienced tumor lysis syndrome. This syndrome is caused by the rapid death of the tumor cells. The good news is that chemotherapy medications are working. The bad news is that it can be life-threatening. I spiked a high fever, had difficultly breathing from pleural effusion and had horrible pain under my sternum. Thank goodness, the difficult breathing and high fever only lasted for 12 hours. Lying on a cooling blanket with an oxygen canula in your nose is no fun. The sternal pain lasted for a long time. I will address that next.

7) Sternal Pain: As I mentioned above, I developed severe pain under my sternum after experiencing tumor lysis syndrome. According to my physicians, esophagitis is common during the CODOX-M plus Rituxan and IVAC protocol. They treated me for it even though no ulcers were seen on endoscopy and the upper GI was normal. Unfortunately, the pain worsened. The pain medications did nothing. The only thing that helped was swallowing Miracle mouth wash. The viscous lidocaine in the mouth wash anesthetized my esophagus and numbed the pain. It truly was a miracle for me.  The cause of this pain was never identified. It waxed and waned during the course of chemo and stopped when I finished.

Please note that Miracle Mouthwash is a general term for a mix of drugs. Each prescriber has a slightly different formula. For me, the formula from my oncologist filled at Walgreens worked better than the one I was given in the hospital. It also tasted much better! In case I did not give this enough emphasis, let me be clear - Miracle Mouthwash was a lifesaver in getting me through the treatment.

8) Reaction to Rituxan: I was one of the lucky ones who did not react to rituxan. However, let me thank my nurse Dan who on the graveyard shift had to oversee this infusion. He was ready for anything! I am forever indebted to him and the other nurses for their constant vigilance and care.

9) Neutropenia: The B regimen does a number on your bone marrow. After each B cycle, I was severely neutropenic which means no white blood cells to fight off infection.  I followed all the neutropenic precautions recommended by my oncologist. Please take their advice seriously because contracting an infection while neutropenic is life-threatening.  Early on, the medical staff told me that they can get patients through the chemo (please keep that in mind as it inspired me) but where they lose them is to infection.

10) Anemia: After both B regimens, I required multiple red blood cell transfusions.  Even though I was cross-matched every time, my body started to react after a while. I think it was after the 10th unit, but my memory could be wrong. I went into rigors which means uncontrollable shivers. The first time, my nurse treated it right away so I only shivered for 15 minutes. The second time, it took 45 minutes for pharmacy to prepare the demoral.  My teeth chattered so violently that I loosened a crown. Bummer!

11) Thrombocytopenia: Again after both B regimens, my platelets bottomed out and I required multiple transfusions to keep me from bleeding out.  During this period, my skin had a strange mottled gray look. This is a good time to thank blood donors - you are truly sharing life with patients like me!

12) Post B round bonus hospitalization: According to the study I read, 100% of patients experienced neutropenia after the B regimen with many requiring hospital care. After both B rounds, I spiked a fever which landed me back in the hospital for 7 to 10 days. After the first time, I was really depressed because I thought I was going to have two weeks at home to recover. For me, it would have helped to know this ahead of time so I could prepare mentally.

13) Attitude: A positive attitude will make the Modified Magrath regimen a little more bearable. A lot of funny things happen in the hospital and at the oncologist's office if you are open to it. Embrace humor whenever you can. When my hair fell out, my husband said, "I'm into bald chicks." We had hospital "dates" which meant he pushed my IV pole down the hall to a window with a view of the mountains. One chemo patient in the infusion room (and I don't recommend this but it was hilarious) told the nurse that the chemo pills made her sick to her stomach. So after two nights of staying up all night near the toilet, she decided to try something else. She threw the pill in the trash and poured herself a large scotch to achieve a medicinal effect. Try to count blessings, laugh when you can and be creative. It will help pass the time.

14) Chemo Brain: During the chemotherpy, my thought processes became dull. I had trouble remembering things and felt foggy all the time. In retrospect, I think this is a good thing because it helps you get through the protocol and forget the bad experience. Just be patient with yourself. Your brain function will return to normal with time.

15) Sleep: While in the hospital, I had difficulty sleeping because of all the interruptions. 10pm and 2am vitals followed by the 4am blood draw with another vitals check at 6am. It made me wonder if the hospitals were trying to make me feel better or worse?  After awhile, I started to sleep in four hour increments.  For months afterwards, I still woke up at 2 and 4 am. Hang in there and rest as much as you can. Your sleep habits will return to normal eventually.

16) Early Menopause: The chemotherapy knocked me into early menopause. I started experiencing hot flashes or personal "tropical vacations" as I like to call them during the second part of the first A regimen. Sometimes it was hard to tell the difference between a hot flash and a fever. I learned when I hit the cool down phase, I shivered from fevers but not with hot flashes. Take an oral temperature if in doubt.

17) Supplements, Vitamins and Other Neutraceuticals: My advise is to ask your oncologist about anything you consume. Some of these substances will interfere with your chemotherapy drugs and lessen their effect. Others may increase their effect or cause other organ damage when combined with chemotherapy drugs. I saw a patient in the chemo ward suffering with horrible kidney damage because they decided to undergo hypervitaminosis C therapy while on traditional chemotherapy. Please be careful!

18) Intrathecal Injections: The CODOX-M part of the protocol includes six intrathecal injections. For this procedure, the patient lies on their stomach and the radiologist uses fluoroscopy to insert a needle into the space around the spinal cord. After withdrawing a sample of spinal fluid, chemotherapy drugs are injected. After the procedure, the patient must lie flat on their back for four hours to allow the fluid to equilibrate. If the patient sits up too soon, horrible headaches ensure. The nurses and assistants roll the patient onto the gurney for transport and then into bed.

For some patients, this procedure is uncomfortable but not horrible. For me, it was an ordeal. Since my cancer was located in my abdomen, lying on my stomach caused a great deal of pain. When the radiologist inserted the needle, the pain was unbearable. I almost passed out.  When the pain subsided, the nausea set in.  I told my husband I didn't think I could handle anymore treatment after that first injection (day one of four months of chemo).  It was that bad!

To make a long story short, the next one was much better.  The anesthesiologist pre-treated me with stronger drugs.  The procedure was still painful, but nothing like that first one.

19) Problems With Medications: One of the interesting things I experienced were problems with how I took some medications.  Diphenhydramine (Benadryl) was a problem for me. If the nurse gave it to me through an IV, the room started to spin and I felt sick for several hours. I had no problems with the pill form.  If you feel funny after receiving any medication, talk to your nurse or doctor right away. They may be able to use a different form.

20) Nails:  After the first B regimen, my nails developed a cloudy band above the cuticle that continued to grow in size until I finished chemo. I was lucky though as my nails stayed intact throughout chemo and recovery.

21) Perspective: About halfway through the ordeal, my world shrunk to three places, home, the hospital and the oncologist's office. I began to wonder if this was it. Would I ever feel normal again? The answer is yes. While I was in chemotherapy, I was a cancer patient named Kris. I am now Kris, a person who had cancer.  So hang in there and soon the entire ordeal will be in your rearview mirror.

The next post will cover the side effects after finishing the CODOX-M plus Rituxan and IVAC protocol.

You Make The Diagnosis: Listen and Name This Costa Rica Monkey

2011-12-23T04:40:02Z

In early December 2011, I had the privilege of going to Costa Rica. Wow, what a great country! It is beautiful and filled with amazing animals. If you enjoy watching wildlife in their natural environment, I would strongly recommend a trip to Costa Rica.

During a boat trip through a national park, I recorded the following video. Please listen closely and name this monkey.

Diagnosis: Mantled Howler Monkey

Mantled howler monkeys are known for their eery vocalizations. This male started calling after he heard another male across the river. According to the Rainforest Alliance, howler monkeys are strict vegetarians eating flowers, fruits and leaves. They use their long tails to hang on to branches as they search for food. Once they have had enough, they sleep with their front and back legs straddling a branch. They spend their time in the forest canopy, rarely touching the ground. Seeing a family of monkeys in their natural habitat is something that I will never forget.

Chihuahuas Need Socialization

2011-12-18T20:26:23Z

Yesterday, I met a wonderful Chihuahua named Belle. She is a two pound, kissing machine. The pup wiggles her entire body when she meets a new person and then showers them with affection. I wish all Chihuahuas were as well-behaved as Belle. Unfortunately, this is not the case. I learned that the hard way.

Isn't Belle photogenic?

I met my first chihuahua on an emergency visit. Carlotta came into the clinic in full blown seizures after whelping two puppies. She had eclampsia caused by low blood calcium levels from producing milk for her offspring. Carlotta responded well to treatment. The seizures stopped and her body temperature returned to normal. Six hours later, she was ready to go home. When I opened her cage door, Carlotta charged my hand with her teeth barred. I managed to close the door before the little "land shark" made contact with my hand. With my ego bruised, I retreated to the lobby, hoping she would be better with her family. When her owner opened the cage, Carlotta leapt into his arms and covered his face with kisses. On the way out of the clinic, she spotted me walking behind her family and gave me one last growl for good measure. What a character!

All chihuahuas need socialization. Socialize, socialize and socialize some more to keep them well-behaved. Correct aggressive behavior immediately with gentle but firm commands. Growling is just as much of a problem in a toy breed as a giant breed.

Holiday Greetings To All

2011-12-15T19:23:51Z

To my family and friends,

Please enjoy this holiday message made for you!

You Make The Diagnosis: Name This Costa Rica Animal

2011-12-10T14:51:02Z

Costa Rica is a beautiful country filled with amazing animals.  During a recent vacation to the Guanacaste Province, I took a river tour to observe flora and fauna. My guide, Olmon Sosa, pointed out the creatures pictured below. I would have never found them on my own.  Name this well camouflaged animal.



Diagnosis: Brazilian Long-nosed Bat (Phychonycteris naso)

The Brazilian Long-nosed bat is found along rivers from Mexico to the norther half of South America. This small bat, one and one half inches at maturity, eats insects associated with slow moving water. During the day, the bats roost in small colonies often in straight lines as pictured above. Their camouflage is amazing! This is one of the cutest bats I have ever seen.

Reference:
    Plumpton, David and Knox Jones, J. Jr. "Phynochonycteris naso" Mammalian Species 423, December 10, 1992, pp. 1-5.

You Make The Diagnosis: Hawk Found In Southeast Arizona

2011-12-05T14:21:00Z

Last month, I toured the Arizona-Sonoran Desert Museum in Tucson. During the free-flight raptor show, I took these pictures of a beautiful hawk. Name this Arizona Hawk and the large cactus behind it.

Diagnosis: Gray Hawk

This is a female Gray Hawk, a tropical hawk that is between 14 and 18 inches in length with bright yellow cere and feet. They live along streams lines by cottonwood trees where they eat small lizards, rodents and birds. Gray Hawks are most often found along the coasts of Mexico but some migrate into southeastern Arizona to breed in the summer.

The giant cactus behind the hawk is a saguaro cactus. If your travel takes you to Tucson, I highly recommend a trip to the Arizona-Sonoran Desert Museum. The free-flight raptor show is one the best I have ever seen.

You Make The Diagnosis: Jaw Problem In Dogs

2011-12-01T14:23:08Z

Dogs may inherit a variety of dental problems from missing teeth to malformed jaws. Examine the pictures below and then name this common dental problem.

Diagnosis: Mandibular Prognathic Bite (Undershot Jaw)

Notice how the lower jaw (mandible) protrudes past the upper jaw (maxilla)? This condition is commonly referred to as an underbite. It is further classified into three different categories depending upon the severity. In mild cases, the upper incisors extend pass the bottom incisors but the lower canine teeth contact the upper third incisors instead of the upper canine teeth. In moderate cases, the incisors meet each other in what is termed a level bite. The most severe category of underbites is called reverse scissor bite. The teeth are the reverse image of a normal mouth.

The goal of therapy is to give the patient a pain-free bite. The teeth that interfere are shortened or extracted. If your pet suffers from any form of malocclusion, please have a veterinarian examine them for abnormal points of contact that may cause pain and/or tooth damage. With proper care, these dogs will enjoy good health with their unique bites.

The Arizona-Sonoran Desert Museum

2011-11-28T02:36:45Z

Last month I visited the Arizona-Sonoran Desert Museum, an organization designed to "inspire people to live in harmony with the natural world by fostering love, appreciation and understanding of the Sonoran Desert." My friends raved about this place that combines a zoo, botanical garden and natural history museum all in one gorgeous setting. The animals and plants, which are all native to Arizona, are displayed in large, natural habitats. All the animals looked calm and comfortable. I did not observe any abnormal, stress related behaviors. Please enjoy the pictures and visit their website, www.desertmuseum.org for more information. Better yet, visit this special site in Tucson in person!

Diagnosis Of Hyperthyroidism In Cats

2011-11-23T16:31:48Z

Diagnosing hyperthyroidism (too much thyroid hormone) is much easier than hypothyroidism (too little thyroid hormone).  A blood sample is collected and analyzed for the total amount of T4. In general the normal range of T4 for a cat is 0.5 to 4.7 micrograms/deciliter, although this might vary slightly depending upon the lab.  A T4 greater than 4.7 is indicative of hyperthyroidism. Cats with values in the upper end of normal might require additional testing to detect hyperthyroidism.

Because hyperthyroidism is often associated with other medical problems, I always include a complete blood count (CBC), chemistries and a urinalysis with the total T4. We also check blood pressure as many older cats suffer from hypertension. Lastly, the ocular pressure is measured.

The results of these tests will determine the treatment options available for the cat. Because hyperthyroidism may mask kidney disease, it is extremely important to monitor kidney function. Before pursuing a permanent treatment for the excess T4, I like to perform a therapeutic trial of methimazole, a medicine that binds thyroid hormone. When the total T4 is within normal limits, I recheck blood and urine to make sure the cat's kidneys are functioning well.