To Pee or Not To Pee, That Is the Question

                                                                             

"Buddy" the Bassett's Urinary Bladder Stone X-ray

                               Urology,  or the study of urinary tract health,  is a topic near and dear to my heart. My Welsh Corgi, "Bunny," enjoyed good health until she developed chronic kidney disease at the age of twelve.  During our nine month journey with Bunny's kidney failure, she taught me a lot about  treating  patients with her condition.  While I do not enjoy diagnosing kidney failure in pets, managing this condition gives me the opportunity to  utilize both my experience and  training to improve the quality of life for patients that face this terminal disease.

                                Besides managing kidney failure patients, another enjoyable area of urology for me is correcting urinary incontinence in pets.  Surprisingly, this condition is quite common, especially in dogs. One of the best ways for a dog to get its parents' attention is to literally wet the bed. An incompetent bladder sphincter is usually the culprit. With a little help from oral sphincter control medication or hormone replacement therapy, a pet's leaky plumbing can be readily treated so Fido will be invited back into the bed again.

                                Perhaps the most fun and satisfying area of veterinary urology is diagnosis and treatment of bladder and urethral stones. While urinary stones are not fun for the patient, seeing the "treasures" that  grow inside an animal's urinary tract can be quite amazing. "Buddy," the Basset Hound, reminded me of this recently when I surgically retrieved over 140 stones from his bladder, varying in size from millimeters to the size of a plum. His diagnosis was actually made by feeling the grating "bean bag" that was his urinary bladder during his physical examination.

                                Dogs and cats get a variety of urinary stone types, the two most common being struvite (magnesium ammonium phosphate) and calcium oxalate stones. Urates are the third most frequent stone type, and similar to oxalates, are usually genetic in origin. Struvite stones, on the other hand, are unique in that they are formed secondary to bacterial infections of the urinary tract, and may be treated surgically or by feeding diets designed to dissolve them (Hill's Prescription Canine or Feline s/d or Feline c/d). 

                                Once  urinary stones have been removed, analyzed and identified, veterinarians will prescribe an appropriate dry diet with added water or a canned formula to help prevent stone re-occurrence. Feeding the recommended diet exclusively is essential!

                                Unfortunately,  urinary stones can become a life-threatening emergency if they become lodged in the narrow outflow tube of the bladder or "urethra."  In addition, in male dogs, the urethra is very long and makes a "U-turn" at the back end of the dog's body  before it reaches the tip of the penis. This bend in the urethra is a likely site for stones to get hung up, and is difficult to reach during stone removal attempts.

                                Please be aware that if your dog strains to urinate and no urine is produced, it is experiencing great discomfort associated with either obstruction of the urethra, an over-distended bladder or bleeding and inflammation of the lining of the urinary tract. Likewise, cats that are frequenting the litter pan more than usual, standing or lying in the litter pan for extended periods, or urinating blood are in distress! If your cat or dog experiences any of the above symptoms, please seek immediate advice from your veterinarian.

                                Finally and sadly, cancers also occur in the urinary tract of pets.  The most common urinary cancer is transitional cell carcinoma of the bladder or urethra. These tumors are initially difficult to detect and their symptoms may mimic a urinary tract infection. For this reason, it is important to do regular urine testing, especially for senior pets, to provide early diagnosis, when cancers are most treatable.

                                Prostate cancer in un-neutered male dogs is yet another concern.  This cancer may cause difficult to treat urethral obstruction and is preventable with routine neutering at an early age. Both urinary and prostatic cancers are treated and palliated with oral chemotherapy drugs that are also non-steroidal anti-inflammatory medications, including  piroxicam and meloxicam. 

                                Lastly, don't wait for "Tommy" or "Toto" to have to make the decision "to pee or not to pee" inappropriately. Ask  your veterinarian to perform blood wellness testing for kidney health on your pet regularly because, as always, an ounce of prevention is worth a pound of cure! 

 

By Dr. Bonnie Jones

Dr. Bonnie Jones is co-owner of Delphos Animal Hospital which she operates with her husband, John H. Jones, DVM .  She was valedictorian and Outstanding Senior Clinician of The Ohio State University College of Veterinary Medicine Class of 1985. 

 

 

 

 

 

 

                               

The Moments That Matter

                                              

                                                       

Dr. D. O. Jones deworming a sheep

            "Do you remember me?" asked the lady as I examined her new puppy. I must admit, I was at a bit of a loss. She was nice looking, with a pleasant smile, and sparkling blue eyes, but I really had no recollection.

            "You came to my house about eight years ago and put my old Boxer to sleep."

            That did jostle a brain switch. "Did you bring him here a few weeks before, wanting a second opinion?" I replied. She nodded in agreement.

            "I do remember. I wrote a column about you!"

            The column, "Laughter is the Best Veterinary Medicine," told of my feeble attempt at humor to help this woman with the sad situation she found herself in. Her dog, an ancient Boxer, had been having some difficulty getting around, and she was feeling pressure from others to have him euthanized.

            I could tell as soon as I entered the exam room she was quite upset- the already huge pile of tissues was a good indication. Yet, through her tears, she made it very clear that she didn't want any more testing or medications, she only wanted a second opinion. So after examining the dog, I gave her one.

            "I think your dog looks pretty good...but, you're too emotional."

            This comment was followed by what I described as "pin drop silence for a very uncomfortable eight or nine seconds." Fortunately, she finally did laugh at my joke. Although the laughter temporarily lightened the mood in the room, it was still dampened by the sadness.

            Following a quick reminisce of this moment, and of the euthanasia call to her house, which was much sadder, I realized why I didn't recognize her. I had never seen her happy before. But she was happy now. She had a new Boxer puppy. Who wouldn't be happy with one of those?

            When I excused myself to check on the puppy's stool results, I actually printed a copy of the column. She had never read it. I didn't use her or her dog's name in the column, and figured she likely wouldn't see it anyway, so I didn't seek her approval to publish it, like I usually do.

            After I handed the column to her, she put it in her purse, smiled shyly, and said she'd read it once she got home. Upon my return from really checking on the sample, I found her with the  puppy on her lap, the column in one hand, and a tissue in the other. The tears were back, but this time she said they were happy tears. And she was right. As I've become somewhat of an expert on her tears, there was quite a distinct difference. Apparently, puppies have a way of brightening our lives, and making even sad memories more tolerable.  

            I suppose most of us who become veterinarians do so because of a love for animals, though some may aspire to the profession because they like the science or medicine aspect of it. I wanted to be a  veterinarian, not only to help people with their animals, but to also have a career full of memorable moments like this one with the lady and her puppy - a simple interaction between two people that defines and bonds us as humans.        

            This trait I probably garnered from my dad. He was a people person. He was also a veterinarian. For over thirty-five years he taught at Ohio State, and had a rapport with his students few other professors could match. I feel blessed to have had him as one of my teachers. Sadly, he developed lymphoma during my senior year of veterinary school and died five months before graduation.

            One thing I learned from his death, is how precious those special moments can be. During the last few weeks of his life, I was able to visit with him often, listen to his stories, and learn his philosophy about life, including hearing about his unwritten book, "Don't Rock the Boat." More than thirty years later, these truly are the moments that matter the most. This may be the most important lesson he ever taught me.

            Many thanks to all of you, and of course your animals, for providing so many wonderful moments and memories over the years. And thank you, Astro's mom, for giving me one more. Happy Father's Day.

By Dr. John H. Jones

Trust Them To Be Dogs...

                                                                     

 

I was driving home from vet school late one Saturday night and, after three hours in the car and only ten miles from home, as I drove through a sharp curve, something was suddenly in front of me. It was fawn in color so I thought coyote immediately, but I realized it was a dog. I stopped short and the dog ran off. I pulled over in the nearest driveway and got out hurrying to the nearest farm house to see if they were missing a dog. They weren’t and had no clue whose dog it might be that had dashed in front of my car.

I wandered down the side of the road in the dark with a cell phone that was almost dead in a dress suit with no jacket, looking for the dog in the freezing cold. It took some searching, but I finally found the dog, which turned out to be a young Mastiff standing over another dog that was clearly injured. The other dog growled at me as I approached threatening to bite, so I backed off and called 911 to send a sheriff. I managed to get a leash off one of my two dogs, who were both in my car, and a collar to put on the dog that wasn’t injured to prevent her from running back into the road. It turns out the dogs hadn’t strayed far from their home and the sheriff came quickly, but not before their owner arrived.

Their owner was heartbroken of course to see her dog had been hit by a car and kept saying her dogs didn’t leave the yard normally. The sheriff arrived and we got the dog into her car and off to the veterinarian.

The owner’s words — they normally don’t leave the yard — kept running through my head. Unfortunately, that night they did and crossed a dark highway at the wrong moment and someone hit one of them. The situation reminded me of an article I read once about dog training and doing it safely. It discussed how even the best trained dogs can go tearing across a parking lot after a squirrel if off-leash at the park or in the right situation could behave in a manner that could threaten their lives. That is the truth. Dogs can get distracted and momentarily forget training. At the wrong moment, that can cost a dog its life. 

I love my two dogs and we do train regularly in obedience as well as other disciplines several of which involve working off a leash. Most of the times my girls are great, responding to my cues to come when asked. When I visited family not long ago my girls came along and whenever they needed to go out I would put them on leashes and go out into the yard. My family was amazed that my dogs that I show and compete with needed leashes. I told them it wasn't that they aren't trained, it is that I trust them to be a dog. I trust them to leap at the sight of the squirrel and maybe momentarily forget there is a road between them and said squirrel. I trust them to see someone running down the road that they want to visit. I trust them to be what they are, dogs, and as their owner I need to do what I can to keep them safe.

By Dr. Jill Dentel

"Bark Loud, Bark Proud" By Dr. Bonnie Jones

                                                                     

                               

                                I've often wondered, if dogs could talk, what would they say?

                                I take the responsibility to advocate for dogs and all animal species that cannot speak for themselves very seriously. But, if dogs could talk instead of bark,  I think they would say "Take care of my people."

                                After all, pets are dependent on people to provide their veterinary care as well as their basic needs of food, water and shelter. On more than one occasion, I have witnessed pet owners sacrificing their own needs, health care and otherwise, to care for their pets. Also on more than one occasion, I have advised pet owners NOT to make these sacrifices for their pets when it involves their own health  care.

                                Through 31 years of studying and caring for animals, I've come to the conclusion that what I have really been tasked with as a veterinarian is to care for pets AND their people. I am certain that early in my career this epiphany was not on my radar.  However, as I have grown older, what has become strikingly clear is that in order to care for animals, I must first  focus on making sure their people are well educated and...well, just plain "well."

                                Possibly one of my greatest opportunities to care for pet owners  as a veterinarian has come about in the last few years as the chairperson for the American Cancer Society's (ACS) Delphos Relay for Life mini-relay called "Bark for Life."  This fundraising event is described by the ACS as "honoring the life-long contributions of our Canine Caregivers." 

                                While celebrating the human-animal bond, Bark for Life "presents an opportunity for people to be empowered through their canine companion partnerships and to contribute to cancer cures through the mission of the American Cancer Society." It's easy to see why  Bark for Life is a win-win for me.  By celebrating the care-giving qualities of canine companions, it gives me the amazing chance to help fight the fight against cancer that has or will touch all pet owners at some time in their lives.

                            Bark for life is my passion for these reasons and more.  With Father's Day just around the corner, my investment in this ACS fundraiser is also a very personal one.

                            My father died because he was a smoker...not just any smoker, but a smoker of unfiltered cigarettes from an early age.  He was also a father of nine so a good income was a necessity.  My dad spent most of his working years as a roofer whose main responsibility was being the "kettle man." As such, he worked  closely with hot asphalt he prepared for roof applications, exposing him to asbestos and other aerosolized toxins.  Hot tar AND smoking set him up for an all too early death due to lung cancer.

                                The other father in my life was my father-in-law, Dr. David O. Jones. His legacy is long, but his life was too short. "D.O.," as he was affectionately known,  was a Professor of Veterinary Preventive Medicine at The Ohio State University.  His passions were teaching and public health. I now realize that he was also my mentor for being a servant of animals AND people.

                                "Davey" was my husband's moniker for the man he also called "Dad." Davey suffered the crippling pain of rheumatoid arthritis (RA), a probable sequela to a brucellosis infection he acquired from cattle. 

                                This great man found adequate RA pain relief from a drug called Chlorambucil.  While it improved Davey's quality of life, this medication also may have shortened it. The revered man who taught so many veterinarians and touched the lives of even more, died of lymphoma within three months of his diagnosis while my husband and I were seniors  in veterinary college.

                                Watching both of these patriarchs pass due to the ravages of cancer made my passion to fight merciless, ever-changing cancers of all kinds even stronger. Through Bark for Life, I have the tools and focus group to raise funds to help "Finish the Fight" in my lifetime. I will continue to "Bark Loud and Bark Proud" to all who will listen that collecting pledges to walk your dog in a lovely park for the ACS fundraiser, " Bark For Life," is a win-win for people AND animals.

 

Dr. Bonnie Jones is co-owner of Delphos Animal Hospital. The DAH Bark for Life Team has raised over $27,000 for the ACS. Dr. Bonnie invites you to collect pledges and join the BFL walk at Delphos' Leisure Park, Saturday, June 11, 2016 from 2-4:00 pm.

Canine “Bloat” --- When Bigger is Not Better

                                                                                        

                          Many dog owners have a strong affection for the larger dog breeds.  For some, the bigger the better is the rule. Besides having a higher grocery bill, large and giant breed dogs are unique in another way. Lima Police K-9 Officer “Aron” reminded me of this when he developed a life threatening emergency one evening.   

                        Aron, a 90 pound German Shepherd, along with three fellow K-9 officers, has done his share to provide safety and service to the City of Lima.  All four K-9 officers are highly trained by police handlers whose bond to their four-legged partners is among the strongest I have ever witnessed.  As a result of the closeness that these canine and human officers share, the handlers have a keen sense of when something is very wrong with their canine partners. 

                        Such was the case late one evening when Investigator Jason Bugh discovered that Aron was in trouble as he began wretching persistently.  Investigator Bugh quickly realized that Aron was also having extreme abdominal discomfort. The next vital realization the handler had was that Aron’s abdomen was beginning to bloat.

                        K-9 handlers receive frequent training, including first aid and emergency care for their dogs.  Having known Investigator Bugh for a long time, I have always found him to be a conscientious and perceptive dog owner.  So when he paged me just after midnight and expressed that he thought Aron might die, I knew he was right.

 

                        From Investigator Bugh’s description of Aron’s symptoms, it was clear that his partner was experiencing gastric dilatation and possible volvulus (GDV), better known as “Bloat.”   This condition is dreaded by many large or giant dog breed owners because its symptoms are fast, furious, and deadly.

                        GDV occurs in large, deep-chested dogs when their stomachs fill with food, fluid or air.  The stomach of these dogs is C-shaped and often pendulous in their large abdomens.  Over-filling of this type of stomach, especially if the distention is followed by activity, can result in bloating and swinging of the organ within the abdomen.  With enough swaying motion, the stomach then flips over on its long axis, causing obstruction of the stomach at both ends. 

                         This anatomical abnormality sets off a chain of events that quickly become life-threatening, ranging from progressive distention of the stomach with air, to torsion of the spleen, decreased cardiac output, shock, and death. Because of the seriousness and rapidity of these events, treatment needs to be immediate and aggressive, and usually consists of surgical intervention to correct the stomach distention and torsion.

                        Depending on the duration and severity of the torsion, the dog may also need to have its spleen and/or parts of the stomach or intestines removed if there has been compromise of the blood supply to these organs. The mortality rate associated with GDV may be as high as 28%, but if diagnosed and treated swiftly, GDV dogs can survive. 

                        Aron was very fortunate that his handler acted fast and appropriately.  I advised him to take Aron immediately to a 24 hour emergency surgery service provided by the Northeast Indiana Veterinary Emergency Services in Fort Wayne. A highly skilled veterinary team corrected his GDV and removed his compromised spleen.

                        As I reflect upon Aron’s crisis, I want to prevent others from repeating his experience. Aron most likely developed GDV because he was on a feeding regimen of four cups of food fed once daily.  This is a common practice for police dogs whose jobs make it inconvenient to feed them more often. For GDV-prone dog breeds, once daily feeding and feeding from elevated platforms, definitely sets them up for failure.

                   

                        While the absolute cause of GDV is unknown, I have always taught pet owners who own large breed, deep-chested dogs to feed their pets at least three smaller meals daily.  I also instruct them to never exercise their dogs for at least an hour after eating or drinking.  Even swallowing a lot of air during barking or play can contribute to a gastric dilatation episode.

                        Some large breed dog owners may choose to have their dog’s stomach “tacked” to the inside abdominal wall at the time of neutering in an effort to prevent GDV.  This surgery, called “gastropexy,” can prevent the stomach from twisting, but it will not stop it from bloating.

                        While Aron’s story has a happy ending as he continues to improve after surgery, I hope to never receive that dreaded after hours GDV phone call again.  If you own a large, deep-chested dog breed, talk to your veterinarian about GDV prevention and know what action you should take in the event that it happens to you.


 

By Dr. Bonnie Jones

 

This column is in honor and memory of Investigator Jason Bugh

(deceased 5/1/10) and Canine Aron (8/18/00-12/8/12).

Embarking on a Professional Journey

                                                            

 

          For many kids growing up, their dream is to become a veterinarian. However, things like organic chemistry, eight years of college, endless biology classes, GPA's, family and more, often steer many onto a different path leading them to become a doctor, engineer, teacher, etc. My life path never deviated though, from my initial dream to be a veterinarian. So, here I am today, writing this column, one day after graduating.

 

          For those who aren’t familiar, veterinary school is usually an eight year process. The first four years are typically spent obtaining an undergraduate degree while completing the prerequisite classes and hundreds of shadowing hours with veterinarians. Then the application process begins. We take the GRE (Graduate Record Exam) and complete a lengthy application. After that, the waiting begins as we hope a school will call to offer us an interview.

 

          Assuming someone gets an interview, they go to that school (which can be a few hours drive or a long flight across the country) and are interviewed by two or three faculty members to further assess their candidacy. Once that day is over, all an applicant can do is wait. We wait to hear if we will be offered a spot, put on a waiting list, or denied altogether. If you are lucky enough to be offered a spot like I was, then the real work begins.

 

          Veterinary school is four years of grueling class work, labs and clinical rotations. It is not unusual to spend 35-40 hours a week attending classes and labs, with equal or more time spent outside of classrooms studying. The first year...oh, how it drags on, making it seem like the four years will never end. The second year, well it is the most intensive of the four as far as book work and being a challenge in itself.

 

          Then, suddenly, third year arrives, flies by, and now you are a fourth year, seeing patients in the clinic and studying for "Boards."( a lovely experience of 6-7 hours of multiple choice questions to determine your worthiness to practice veterinary medicine). Some of those 18 hour days spent at school made it seem like clinics would never end, especially with studying for boards. But, overall, I can say they did fly by.

 

          That leaves me here. I have student loan debt that could buy a house (literally, a house!), but I also have a diploma that presents me with a Doctorate of Veterinary Medicine degree and a letter stating I passed my board exam. Now, I stand at the beginning of the next step in my education — practicing veterinary medicine. I say the next step in my education because, in all honesty, as the Veterinarian’s Oath states, this profession and its practice require life long commitment to learning.

 

          As I prepare to practice, I am grateful to many people for their help along my journey, but at the top of that list are the private practitioners who took so much of their time to teach me during the many hours I spent shadowing them. They steadied my hands as I learned new procedures and as I sutured. They taught me as I analyzed blood work and worked through cases. They are who helped to shape me into the veterinarian I have become today. I do not know where this profession will take me, but I look forward to every step of the journey as I continue to fulfill my dreams.

 

By Dr. Jill Dentel

For The Lima News

Dr. Jill Dentel has just joined Delphos Animal Hospital.

 

 

A Day They Will Never Forget

                                                                      

            "Surreal" is the only word that could describe the moment. I was knelt down on the exam room floor next to a dead dog and a sobbing teenage girl. Her mother and two sisters were in a similar state of despair as another family dog lay dead on the table.

            I haven't done many multiple euthanasias in my career, and I'm thankful for that. They're really sad. In this case the one dog was eighteen, older than any of the girls, and had simply run out of time. The other dog was only eight, but being of a large breed he was physically older than that, and was suffering from the effects of cancer. To lose both at the same time was devastating to the family.

            Wanting to give them some time alone with their pets, I slowly backed out of the room. Then as I closed the door, I was struck with the realization that this was a day those girls would never forget.

            Why do we even have pets? The whole notion of them is kind of silly, really. First we "adopt" them and make them part of our families. Next we pamper them, tend to their every need, spend a ton of money on treats, the finest food and, yes, veterinary care , only to have them die way too soon and break our hearts.

            Moreover, as if once is not enough, many of us are adamant about repeating the process over and over again. To top that, some insist on dragging their kids into the madness. Ultimately, however, this might be the best decision a parent ever makes.

            Nothing teaches a child more about life than does caring for a pet. So much can be learned about responsibility, patience, compassion, and, especially, the finality of death. And in turn, sometimes those kids can teach even a jaded old vet like me something about life as well.

            Often when I get together with friends or business  associates, most of us being "baby boomers," invariably our conversation leads to talking about the younger generation, including even their own children and grandchildren. The consensus is that today's youth care only about themselves, and have a real need to seek instant gratification in virtually every aspect of their life. Exceptions abound, of course, and to be fair, I have no doubt "the greatest generation" felt the same about us. Still, the perception remains.    

            Recently, just days apart, two young men showed me that to think this way is to be wrong. Each was attached to an old dog with a serious medical condition. One had cancer, the other heart disease along with a  degenerative spine. Alas, the dogs had reached "the end of the trail."

            Like the girls who lost their two dogs, these boys decided to be present for the euthanasia, even though each had a parent who left the room. Both took the euthanasia hard, but they took it bravely, and stayed with their pet until the end.

            When I was with the three girls, the grief in that room was so overwhelming I was almost numbed by it. With the boys, I was better able to observe the relationship each had with their dog with more clarity, at least for awhile.

            Although there were other people in the room, including myself and my technician, each boy and dog were focused solely on the other, through touch, through voice, and through tears. The rest of us didn't even exist.

            Though the euthanasias were an exceedingly sad experience, I can only describe the power of the bond I witnessed between each boy and dog, seen through my own blurry eyes, as "beautiful." I hope someday they'll be able to fully appreciate the beauty in that farewell moment.

            Apparently, when a child is allowed to have a pet in their life, they don't just care about themselves. Much credit to their parents for giving them the opportunity to love and be loved by a pet.

            I have no idea whether those kids will remember me, or my role in their day, but I do know I will never forget them or the courage they showed as they said good-bye to their pets, and experienced the loss of something they loved.

             Nor will I ever forget those who taught them what may be the most valuable lesson they will ever learn. Thank you Sunshine, Brutus, Cisco, and Max.

 

By Dr. John H. Jones