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Kibble for Techs, Summer 2012: Massage for your patients, diagnosis by nose, right-handed or left-handed pets?, Addison’s disease & more

Published: June 24, 2012

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Pet massage

By Amee Grise, CVT, LMT

(Massage is) … the healing manipulation of soft tissues.
- Amee Grise, CVT, LMT

Our health is no joking matter and, as humans, we know the benefits of massage. Massage has the ability to reduce pain, discomfort and inflammation. Massage also can increase energy and promote blood and lymph circulation, which facilitates the overall healing process. So, do these same principles apply to pets? Of course they do! Most people view massage as a means of pampering; however, pet owners should understand that massage isn’t a form of glorified petting, but the healing manipulation of soft tissues.

Performed by a skilled professional, massage can provide significant benefits to the health of pets.

Massage affects the whole body, even in dogs and cats. Beyond the obvious effects of relieving muscle tension, it can be a strong tool for aligning the spine, ultimately improving flexibility. Massage aids in relieving pain caused by hip dysplasia and arthritis. It provides faster healing from surgery and/or trauma. And finally, it provides psychological benefits, creating a healthier, happier environment for the pet. The recuperative and rehabilitative effects of massage therapy make it ideal for geriatric pets.

Amee Grise, CVT, LMT, and her happy patient

Many studies suggest that massage stimulates the release of neurotransmitters that flood the brain, reducing anxiety and stress, and therefore increasing the sense of well being for pets. In this respect, teaching clients how to massage their own pets can provide an emotional and social atmosphere, increasing the connection between owner and pet and giving the pet more self confidence. This effect is priceless for those adopted pets with an unknown history who may have suffered abuse. For these pets, it is so important to implement the touching experience as soon as they become members of the household.

Overall, studies prove that massage therapy has multitudes of beneficial attributes; it’s a win-win situation for everyone. The increased circulation generated by a basic full canine body massage equates to a 30-minute leisure walk in the park.
Pet massage is slowly increasing in popularity throughout primary care veterinary practices in the US. The more we can educate pet owners and increase their awareness about this modality, the more job opportunities we will have as technicians!

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Take a whiff…and diagnose your patient?

How good is your sense of smell? Odors released from your patients can sometimes help in diagnosing their illnesses.  Would you recognize these distinctive odors in your patients?

  • Kidney failure toxins
  • Yeast infection of the ears
  • Ketones in diabetic patients
  • Anal sac problems
  • Parvo virus infection
  • Pseudomonas bacterial infection
  • Toxic alcohol ingestion
  • Urinary tract infections

Is your pet a southpaw?

In 2009, researchers at Queen’s University Belfast in Northern Ireland reported in the journal Animal Behaviour that female cats tended to use their right paw to perform complex tasks, whereas male cats preferably used their left paw. For simple tasks, the cats would use either paw interchangeably.

So how did they figure this out? Forty-two neutered cats were given a series of performance tests. When performing simpler tasks, such as grabbing a toy mouse that was being dragged by a string or suspended in the air, the cats used both their left and right paws interchangeably.

Male cat or simple task?

However, when it came to more complex tasks such as retrieving a piece of tuna from a small jar, all 21 female cats used their right paws whereas 20 of 21 male cats used their left paws. One male cat used both paws interchangeably. Age did not to play a role in the choice of favored paw. The authors theorized that feline hormones may have influenced the preferences found in their study. In humans, testosterone has been linked to left-handedness.

How about dogs? Studies have not produced consistent results. Some have suggested that female dogs favor their right paw, whereas males tend to use their left. The paw preference in individual dogs has been reported to change during repeated tasks, possibly suggesting a learned or trained behavior.

Is this left-handed shake because the dog is a male, or is it the result of a learned behavior?

Did you know that in humans, men are more likely to be left-handed than women.

Do you know which paw your pet prefers to use?

  1. Determine which paw your pet uses to reach a treat placed in a hard to reach place, such as under the couch, in a cubby, or in a small container (such as a Kong).
  2. Determine which paw your pet uses to remove a piece of adhesive tape stuck to his or her nose.

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The great pretender: Discovering Addison’s Disease

Colleen Ruderman, RVT, VTS (SAIM)

Introduction

Hypoadrenocorticism (Addison’s disease) is an endocrinopathy in which there is a lack of glucocorticoid (cortisol) and mineralocorticoid (aldosterone) secretion by the adrenal cortex.  The lack of these hormones causes a wide range of clinical symptoms and laboratory abnormalities.  The symptoms can be non-specific and include anorexia, lethargy/depression/weakness, weight loss, vomiting/diarrhea/melena, collapse, and a generalized waxing and waning illness.  Although Addison’s disease can be seen in any dog, it is more common in young female dogs and several breeds have been identified to be at higher risk (including Standard Poodles, Rottweilers, Labrador Retrievers, and Nova Scotia Duck Tolling Retrievers).  Addison’s disease has been reported, but is rare in cats.

Laboratory abnormalities

The classic electrolyte abnormalities seen with Addison’s disease are hyponatremia and hyperkalemia.  In addition, hypoglycemia, hypercalcemia, and hypoalbuminemia are common.  Typically the ratio of sodium to potassium is evaluated and a suspicion for Addision’s should be high if the ratio is below 23.

Diagnostic testing

The test of choice for diagnosing Addison’s disease is the ACTH stimulation test.  Either the ACTH gel (compounded) or Cortrosyn can be used.  Cortisol levels (serum or plasma) are obtained before and 1-2 hours after (depending on protocol) the administration of ACTH.  Dogs with Addison’s disease have low values that do not increase with stimulation.  Steroids, especially prednisone, cross react with the cortisol testing and will cause falsely elevated values.  Although this only evaluates patients for the glucocorticoid deficiency (cortisol), we generally assume mineralacorticoid (aldosterone) deficiency if there are concurrent electrolyte abnormalities.

Treatment

The treatment for Addison’s disease consists of supplementing both missing hormones.  Glucocorticoid supplementation is accomplished with prednisone or hydrocortisone.  Generally these medications are given to effect to limit the signs of Addison’s disease.  Generally a higher dose is used at first (and during times of stress) and then weaned to limit side effects such as increased thirst and urination.  Aldosterone can be replaced with either oral fludrocortisone  (Florinef 0.02mg/kg BID) or injectable desocycorticosterone (DOCP/Percorten 1 ml/10 kgs q 25-28 days).  Florinef has some glucocorticoid action as well and can sometimes be used as a sole therapy.  DOCP has no glucocorticoid properties and most dogs require supplementation with prednisone.

Addisonian crisis

Dogs in Addisonian crisis can present with signs of hypovolemic shock as well as the typical laboratory abnormalities and history findings.  Aggressive fluid support is needed to resuscitate these patients.  Most patients’ electrolyte abnormalities will respond to fluid therapy and hormone replacement is not needed during the initial stages of therapy.  Ideally the ACTH stimulation test should be performed prior to administration of steroids which can interfere with cortisol testing.  If steroids are required, dexamethasone can be used as it does not cross react with the cortisol assay.

Colleen Ruderman is a registered veterinary technician and has worked for four years at Georgia Veterinary Specialists, a BluePearl hospital.  She is also certified in small animal internal medicine from the Association of Internal Medicine Veterinary Technicians.

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Patient monitoring: Temperature matters

Despite all the technology, there are still other patient parameters you need to watch. The simplest one is the patient’s temperature. How harmful can a low temperature be? After all, the patient will warm up after the procedure. Well not so fast. Body temperature is very important.

Examples of warming tools

Most chemical reactions that occur in the body require an optimum temperature. To survive, the body relies on these chemical reactions, such as those responsible for ensuring nerve conduction as well as those required to maintain muscular and respiratory function, cell membrane health and even blood clotting. As the body temperature drops, metabolic processes in the body slow down. Cardiovascular function is adversely affected resulting in a drop in blood pressure and a slowing of the heart rate. Cardiac output and blood perfusion to the tissues becomes compromised depriving internal organs of the nutrients and oxygen they require to function properly. Gastro-intestinal motility slows. The metabolism and excretion of anesthetic agents becomes delayed, prolonging the sedation. A low body temperature is a common reason for excessively prolonged recovery in anesthetized patients. As the body temperature continues to drop it becomes more difficult to reverse the trend as metabolic processes start shutting down.

This thermal burn case was referred to BluePearl. We are happy to report that the pup survived!

So why does the body temperature drop in anesthetized patients?

There are numerous reasons for a drop in body temperature. Anesthetics inhibit muscular activity, especially the shivering reflex, and metabolic processes which are primarily responsible for heat production within the body. Furthermore, many anesthetics cause vasodilation increasing blood flow to the body surface where heat can be more rapidly lost from the body. Anesthetized patients can’t seek out a warmer environment or assume a curled posture to stay warm. Heat is also lost when a body cavity, such as the abdomen, is surgically opened exposing the warmer internal organs to room temperatures. Lavaging the abdomen with cool fluids only worsens the heat loss.

What you have to remember is that the optimum body temperature for our patients approximates 101 o F whereas room temperature approximates 74o F.  When you interfere with processes responsible for heat production and heat conservation, the body temperature will immediately start dropping toward 74o F.  Studies have demonstrated that an anesthetized patient can lose up to 10 o F (6 o C) during a 120 minute procedure. The smaller the patient the more rapidly the temperature drops. The longer the anesthetic procedure the more body heat is lost.

Keeping them warm

It is a lot easier to maintain the patient’s body temperature than try to raise it after it has dropped. This is because a drop in body temperature causes the body to shunt its blood supply to the internal organs away from skin to conserve heat. The application of external heat is therefore not initially transferred to the blood stream where it will be delivered to the rest of the body. With the continued application of external heat, peripheral vasodilation will start to occur. Blood will start to flow to the peripheral tissues of the body which are still much colder than tissues within the body core. Cooler blood flowing from the peripheral tissues will cause the core body temperature to drop further until these peripheral tissues can be more thoroughly warmed.

It is advantageous to not let the patient’s body temperature drop.  Numerous tools and techniques are available to help maintain a satisfactory body temperature in anesthetized and post-anesthetic patients. These include:

  1. Placing a warm water circulating blanket under the patient
  2. Wrapping the body in warmed radiant fabrics (Hotdog Warming Device)
  3. Using devices which blow warmed air into an air blanket that has been wrapped around the patient (Bair Hugger)
  4. Covering with towels and blankets parts of the body which don’t need to be exposed
  5. Wrapping the extremities with plastic wrap or fabric
  6. Warming the IV fluids
  7. Using only warmed fluids for abdominal lavages

Be careful

Caution should be taken if you are using warm water bottles, electric heating blankets, solar lamps and microwaved rice bags. These items are more likely to cause accidental thermal burns to the skin if they are too hot and not buffered by the presence of a towel placed between the heat source and the skin. Skin burns are more likely to occur in anesthetized patients because they cannot move away from excessive heat. In addition, peripheral vasoconstriction present in patients with low body temperatures does not allow for blood flow to the area to wick away the local heat. Burns are more likely to occur in areas of thin skin and those that lack insulation from hair.

It is also important not to overheat the patient. External warming steps should be reduced once the body temperature reaches the low normal range. The body temperature in these patients should continue to be monitored to make certain it does not drop again. If the patient’s temperature begins to fall during or after the recovery period the veterinarian should be alerted.

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A day at the beach or why do cats use litter boxes?

Why does a cat do anything? Certainly, not even the experts can claim what goes through a cat’s mind. So why would a cat choose to eliminate in a litter box when there are so many other interesting sites in the owner’s house to choose from?

The theory is that this behavior is a survival instinct learned in ancient times. Cats prefer to eliminate in sandy or gritty substances because it will absorb urine and its odor. Sandy ground also provides cats the opportunity to bury their solid waste where it is less likely to be found by predators. The fear is that the elimination odors may lead hunters directly to them and their young. This is also the reason that cats won’t defecate or urinate near their ‘dens’.

What’s the ideal litter box? That seems to vary with the cat. Most cats prefer to eliminate in a larger area, i.e. use larger litter boxes. Clean litter is a must as dirty litter does not serve the cat’s instinctual purpose. The litter should be deep enough to allow burial of the waste. The consistency of the litter desired by each cat may also vary and appears to be a personal choice.  Materials commonly used for litter includes clay, recycled paper “pellets” and silicon based “crystal” variants.

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CE Schedule

We have an outstanding schedule of CE offerings over the next few months. Please check our calendar for more details.