2016 WINTER: Feline Aggression | Obesity & Osteoarthritis | E-cigarettes | Laparoscopy | Canine Demodicosis | Meet Mason Savage, DVM, DACVR | Continuing EducationM
The Tiger in Your Waiting Room: Understanding Feline Aggression
By nature cats prefer not to fight! Domestic cats are solitary hunters. Social behaviors have evolved in cats to avoid conflict; this strategy is very different from humans and dogs. Once cats are aroused, they have very poor skills for resolving conflict, unlike dogs.
Passive avoidance is a cat’s first response to an uncomfortable situation; just leave the room. Setting a household up for peaceful feline living includes enriching the environment with an abundance of toys, resting places, litter boxes, food and water bowls distributed throughout the house; there is no need for anyone to fight over anything.
When dealing with feline behavioral health, always ask, “Am I meeting the needs of this animal based upon his/her behavioral evolution and natural needs?” The answer is often “no.” Many home environments are sterile and non-stimulating for cats. Treatment of aggression in cats frequently includes environmental enrichment, providing opportunities for cats to exercise their predatory behavior with acceptable toys, etc.
To ensure healthy behavior and treatment for many forms of aggression in cats, it is important to first look at the home environment. Start by making the cat’s indoor space more like a natural space. Suggestions include visual stimulation with fish tanks, bird feeders out side windows, even robotic prey-like toys (www.Hexbugs.com). Add perches and cat trees; introduce novel toys (wand toys are particularly interesting); and satisfy the predatory need of cats. Hunting instincts can be satisfied by putting dry food in puzzle feeder balls or tubes instead of dishes.
Reading Feline Body Language
Unfortunately, humans don’t often do a great job reading feline body language in order to de-escalate a stressed or aggressive cat. Understanding feline body language can help with avoiding conflict, its escalation and aggression.
Cats use a combination of visual, olfactory and audible communication to communicate and to avoid confrontation. Threatening feline body postures include hissing, piloerection, arching of the back and side presentation. Ear position is also a helpful stress barometer. Cats that are restricted in movement (i.e. cages, transport boxes) may choose to fight when unable to flee. The ability to get away, hide under something or jump up high can influence the expression of the aggressive responses.
The most frequent basis for aggression from cats to people revolves around fear, anxiety, frustration and misdirected predatory behavior. Fearful cats learn that aggressive stances are effective at maintaining distance between them and people, and the behavior can evolve to a preemptive strategy. Repeated unpleasant interactions in a veterinary hospital contribute to the development of negative behavior in these cats.
Play-based aggression may arise from predatory play, which is an integral part of feline behavior and learning. Treatment is focused on finding outlets for play and directing the cat toward appropriate activities and toys. Playing with hands should be discouraged.
Redirected aggression occurs when a cat faces an agitating circumstance and is unable to vent aggression. Stimuli include loud noises, odor of another cat, unfamiliar people or environments and pain. Agitated cats should be placed in a darkened room with food, water and litter box and left there with the door closed. If the aggression was directed at another unsuspecting feline, very SLOW reintroduction must be done.
Punishment is contraindicated in all cases as this will lead to a worsening of the behavior. Medication may be warranted and may include pheromones, nutraceuticals and drugs such as fluoxetine. Always evaluate the cat for medical problems first, followed by evaluation of the home environment before turning to medication.
We would like to thank our colleague, Jill Sackman, DVM, PhD, DACVS, from BluePearl in Michigan for allowing us to use this article for Companion.
Obesity and Osteoarthritis
The incidence of obesity is continuing to trend upwards, with the most recent AAHA weight management guidelines for dogs reporting that as many as 59% of our canine patients are obese. Obesity is defined as excess body fat capable of causing or exacerbating disease. When a body condition scale of 1-9 is used, each uptick in score beyond ideal is equivalent to 10-15% excess body weight.
Osteoarthritis (OA) affects at least 20% of dogs over one year of age. It can be very difficult to discuss weight management with owners; however, it is one of the most effective (and safe) treatments for OA in dogs. The take-home message for the owners of any obese dog with OA is that dogs are expected to live longer and more comfortably if they are a healthy weight. Labrador retrievers kept at a lean body weight (BCS 4-5/9) lived, on average, two years longer than their overweight littermates (BCS 6-7/9). In addition, continual pharmacologic treatment for OA is necessary in obese animals three years earlier than in those kept at a healthy weight.
Weight loss may be a daunting process for many owners. Start with small, achievable goals. Positive reinforcement is key – encourage the owners to stop by for a weight check on the clinic scale every 2-4 weeks, and make adjustments as necessary. It has been experimentally demonstrated that as little as 6% weight loss in obese animals can increase weight bearing and quality of life in dogs with osteoarthritis. Encourage moderate, controlled exercise. Gradually increasing distance of leash-walks, especially during the cooler times of day (dawn and dusk) will help maintain joint comfort and muscle mass and facilitate shedding the pounds. This time of year, swimming is also a fantastic means of exercise. Encourage owners to get into the water up to their knees to prevent their pets from running into and out of the water. Finally, professional physical therapy in conjunction with weight loss has shown more benefit than weight loss alone.
The first step to achieving weight loss is to determine exactly what is being fed. Encourage the owners to keep a journal of everything that is offered over a week’s time. Remember to keep it simple. Owners are less likely to be compliant if a “crash diet” is recommended. In addition, dogs that lose weight gradually are more likely to keep the weight off than those that quickly drop weight.
Calculate the patient’s energy requirement, and ensure that the owners are weighing the food at mealtime or using an eight-ounce measuring cup for precision and repeatability. Encourage low-calorie treats or breaking treats into multiple small pieces. Fruits and vegetables make excellent low calorie snacks (no grapes or raisins). It is important to remember that the nutrient composition of any food is calculated to provide balanced nutrition of all essential nutrients when fed based on caloric density. Therefore, if appropriate weight loss is not achievable on the diet the patient currently eats, it is recommended to switch to a weight control diet rather than substitute large volumes of food with green beans, pumpkin, etc., as deficiencies may result.
Finally, a multimodal approach to OA therapy including use of neutraceuticals, chondroprotectants, specific joint diets, NSAIDs and other analgesics is key in helping these animals be as comfortable as possible while achieving their weight loss. If an owner feels that their pet is exceedingly uncomfortable after exercise, they are unlikely to continue. When sedentary, these animals gain weight, become increasingly lame, and continue on a downward spiral.
We would like to thank our colleague at BluePearl in Kentucky, Patricia Sura, MS, DVM, DACVS, for allowing us to use this article for Companion.
The Dangers of E-cigarettes
With the increased popularity of the e-cigarette, as an alternative to the more popular and conventional cigarette, has also come an increase in the number of hospital admissions to many veterinary emergency clinics. Our colleague at BluePearl in Illinois provides information regarding e-cigarette ingestion/exposure risks to to pets.
The primary concern with the ingestion of e-cigarettes has to do with the ingestion of its ingredient, nicotine. While the e-cigarette may seem relatively harmless, each cartridge packs a powerful punch, containing anywhere from 6 to 24 mg of nicotine; in contrast the average cigarette only contains approximately 9 mg of nicotine. Although the e-cigarette resembles the traditional cigarette, e-cigarettes work by atomizing liquid (containing nicotine) into a vapor that can be inhaled. Many people who use these products also enjoy the different flavors and varieties that these products come in, ranging from peppermint to cherry. The aroma or scent of these e-cigarette cartridges is what makes them a popular target among pets. Pets are drawn to these different scents and in many reported cases ingest the flavored nicotine liquid.
In addition to the increased nicotine content of these products, vials of liquid nicotine, called “e-juice,” are often available to refill cartridges. Moreover, pre-filled cartridges are often sold in packs containing up to 20 or more individual cartridges. This added danger makes intoxication almost guaranteed, whereby pets are likely to show severe clinical signs up to and even including death. According to Pet Poison Helpline, a 50-lb dog ingesting a single cartridge will often show clinical signs; whereas consumption of the same quantity by a 10-lb dog will often result in death. On the other hand, signs may vary with partial consumption. In addition, consumption of e-cigarettes, and or any of their parts may result in severe gastroenteritis or gastrointestinal obstruction.
The onset of clinical signs is rapid, with pets showing signs such as vomiting, diarrhea, tachycardia, tachypnea, neurologic signs like tremors, ataxia, weakness, and seizures, in as little as 15 minutes. Cardiac arrest and even death is observed as well. Delayed signs have been documented especially with cutaneous exposures. Below is a listing of clinical signs by the system affected:
- Gastrointestinal: vomiting, hypersalivation, diarrhea, abdominal pain/discomfort
- Cardiovascular: hypertension, cardiac arrhythmias
- Neurologic: ataxia, weakness, mydriasis, seizures
- Pulmonary: initial tachypnea followed by respiratory depression
The diagnosis is often made possible by a history inclusive of exposure to nicotine and is often suggested by the combination of clinical signs with their acute onset. Differential diagnoses should include other potential toxicants with similar clinical signs. Metaldehyde, bromethalin and methylxanthine products; insecticides (carbamates, organophosphates), strychnine, mycotoxins, and toxic mushrooms are among the most common. Bloodwork is often non-specific, with some pets showing hyperkalemia. More advanced laboratory analysis of blood and vomitus, such as HPLC, or mass spectrometry is possible, although often not feasible given the time it takes to send off these samples to a reference laboratory.
Although there is no specific antagonist treatment for nicotine intoxication, treatment is aimed at controlling signs of respiratory distress, cardiac arrhythmias, cardiovascular collapse, shock and general supportive care with intravenous fluids, gastroprotectants, anti-emetics and oxygen therapy. Cutaneous or ocular exposure should include decontamination of the affected surface with copious amounts of a lavage solution (ocular), or bathing with soap and water (cutaneous).
If a known ingestion occurs, immediate veterinary care is recommended. At-home care is not recommended due to the rapid onset of clinical signs and severity of symptoms. It is recommended that owners take their pets to the closest emergency clinic and or contact either, Pet Poison Helpline (800.213.6680) or the ASPCA Animal Poison Control Center (888.426.4435) for further advice.
Small Incisions, Big Dividends
Human technology continues to work its way into the veterinary field. One such technology presently being performed at our hospitals is laparoscopy. Laparoscopy entails passing a small camera and surgical instruments into the abdomen or thoracic cavity of the patient through two or three small 1 cm incisions. The structures present within the abdomen or chest can be seen magnified on a television screen.
Laparoscopy is performed with the patient under general anesthesia. After the procedure is completed, the incisions are sutured. Most patients go home the following day.
What are the benefits of laparoscopy?
Laparoscopy is considered a minimally invasive procedure and has many advantages over other procedures.
- Because the incisions made for laparoscopy are much smaller than those associated with surgery, there is less patient discomfort, a faster recovery time, fewer complications, and a more rapid return to activity.
- The magnification associated with laparoscopy enhances visualization of lesions involving organs such as the liver, pancreas, intestines and lungs, which might not be seen as easily with the naked eye during surgery or with ultrasound.
- Larger biopsy samples can be obtained compared to percutaneous biopsy methods thereby maximizing the chance for getting a correct diagnosis while minimizing the risk of complications.
- Laparoscopy is slightly less expensive for clients because the time required for the surgeon to perform the procedure and the patient to recover is shorter compared to that associated with conventional surgery.
Why is diagnostic laparoscopy performed?
- Abdominal and intrathoracic masses
A definitive diagnosis is required for most tumors before appropriate treatment can be recommended. Laparoscopy can be used to obtain tissue for histopathology and to determine whether an intracavitary mass can be completely resected.
- Fluid in the abdomen
Sometimes the cause of ascites or pleural effusion can only be determined by looking within the abdominal or thoracic cavity. A small incision, as with laparoscopy, would be desirable in such circumstances.
- Organ disease
When lab tests indicate the presence of disease within the liver, kidney or other body organ, a biopsy is frequently required to direct the patient’s treatment. Laparoscopy is one of the safest and easiest ways to obtain tissue for diagnostic evaluation.
- “Better look” procedure or cancer staging
Information regarding the status of a disease, such as cancer, can be helpful in determining the best course of treatment or to assess the efficacy of treatment. The presence of metastatic lesions, especially those on the surface of the organs or lining of the body cavity, sometimes can more easily be confirmed by laparoscopy.
- Treatment of numerous conditions
Finally, many procedures can be performed or assisted with the use of a laparoscope instead of more aggressive surgery. Laparoscopy has been used to remove foreign bodies from the stomach, stones from the urinary bladder, relieve fluid accumulation around the heart, and to prophylactically tack the stomach to prevent gastric dilatation volvulus.
What complications can occur?
Any procedure requiring incisions can have complications. The most frequent complications associated with laparoscopy are bleeding and infection. Infrequently, injury to the abdominal organs, intestines, urinary bladder or blood vessels may occur.
In a small number of patients the laparoscopic procedure is determined to be inadequate or too risky to safely achieve its goals. While the patient is still anesthetized the surgeon may subsequently decide to convert the laparoscopic procedure to a conventional surgery.
Canine Demodicosis: Review and Exciting News
Canine demodicosis is a cutaneous disorder that predisposes dogs to develop secondary infections of the skin. Our dermatology colleague in Texas, Dr. Valerie Fadok, discusses our understanding about this parasite.
Discoveries about new treatments tend to be serendipitous, as these mites cannot be grown in vitro.
In the past, we recognized what we thought were three distinct species of mites: D. canis (the traditional mite we find in the hair follicles of dogs), D. injai (the long-tailed mite we associated with seborrheic conditions), and D. cornei (the short, stubby mite similar to D. gatoi in cats). Molecular analysis has shown that while D. injai is a separate species, but D. cornei is just a different morphologic form of D. canis.
We recognize localized demodicosis as a disorder than can be associated with spontaneous resolution. Generalized demodicosis in young dogs has been attributed to a genetic predisposition, and for that reason, it is recommended that these dogs be neutered. Neutering also prevents the relapse of the mange often associated with estrus in females. Adult onset demodicosis suggests the development of an underlying disorder that changes the skin biology or skin immune system in such a way that mites overgrow. We look for endocrine diseases, such as hyperadrenocorticism or hypothyroidism; any systemic disease that weakens immune function, including neoplasia; and the use of medications including steroids and possibly oclacitinib (Apoquel®), whose use can be associated in some dogs with mite overgrowth.
It is important to recognize that for some dogs, we don’t find an underlying cause. We simply treat the disease and recommend maintenance therapy to prevent relapse. A perfect example is adult onset generalized demodicosis in shih tzus. These dogs often develop deep pyoderma, particularly in their feet. Any adult shih tzu that develops pyoderma of the feet, even if they have a past history of atopic dermatitis, should be evaluated for demodicosis. We find that hair plucks are very effective for this purpose.
The most exciting news about canine demodicosis is the discovery that the new isoxazoline flea and tick control products, afloxalaner (Nexgard®) and fluralaner (Bravecto®) appear to be very effective in treating demodicosis in dogs. When used according to the label instructions for flea and tick control, these products appear to kill Demodex mites very quickly and result in rapid resolution of the disease. There is one publication available for Bravecto at this time, but I anticipate that more will be published on both medications in the foreseeable future. I am currently treating dogs with Nexgard every 30 days. After one dose, the mite counts are dropping from adults, juveniles, and eggs too numerous to count to 1-2 dead mites in one month! Truly amazing.
These products will provide not only effective treatment, but also easy maintenance for dogs with chronic demodicosis, while providing great flea and tick control! Please feel free to contact BluePearl GVS with any questions.
Reference: Fourie et al. Efficacy of orally administered fluralaner (Bravecto) or topically applied imidacloprid/moxidectin (Advocate) against generalized demodicosis in dogs. Parasites and Vectors (2015) 8:187.
FROM THE MEDICAL DIRECTOR
Did you get a favorite gift this year for the holidays? Perhaps some kind of new technological gadget to help make life more organized or efficient? At BluePearl in Georgia we think we have some new “gifts” to offer that will enhance and optimize the experience with us for both you and your client.
- BluePearl Portal
24/7 password-protected access via our website to medical records of your patients – past or present – that have been seen at BluePearl
- Labs and prescriptions
- Images plus resulting imaging reports
- Surgery and other clinical reports
- Discharge reports
- Saturday Appointments
- Outpatient ultrasound (Sandy Springs)
- Internal medicine (Sandy Springs)
- Surgery (Gwinnett)
- A second board-certified radiologist and a new 16-slice GE CT scanner
(Read the SNIFF profile on Dr. Savage for more info.)
- Improved parking in Sandy Springs with the completion of our parking expansion
- Coming in mid to late 2016…
- Larger (1.5 T) MRI
- Westside midtown 24/7 hospital
We look forward to continuing to partner with you in 2016 to provide remarkable care for pets.
Mark Dorfman, DVM, DACVIM
Meet our specialist
Mason Savage, DVM, DACVR
Dr. Savage joins us from North Carolina State University, where he completed a residency in diagnostic imagining and an internship in small animal medicine. He received his DVM from the University of Georgia.
The son of an “amazing veterinary technician,” Dr. Savage grew up helping whenever needed at the clinics where his mother worked, and soon became enamored with anatomy, physiology and the prospect of being able to help animals. He was drawn to diagnostic imaging because it allows him to solve complex diagnostic problems while collaborating with the entire animal care team to include owners, primary care veterinarians and veterinary specialists, to give the best care to patients.
Described by others as friendly, excitable, persistent and scientific, Dr. Savage is as passionate about his profession as he is his hobbies – movie editing, graphic design, playing guitar, running, biking and swimming. Clearly he doesn’t let the grass grow under his feet.
What was your first job?
My first job was at a gas station. I filled the ice bags with ice, put the beer cans into 6-pack rings, and I froze the squid for bait for the small-time fishermen of Savannah. After doing that for one summer I learned that sometimes hard work isn’t glamorous, and sometimes it smells really bad, but even from a young age I was able to appreciate the sense of accomplishment after having worked a long hard day.
What is something people might be surprised to know about you?
I helped work on a Grammy award winning album with a close friend of mine.
What’s cutting edge in diagnostic imaging that you can offer?
At BluePearl Georgia Veterinary Specialists we recently acquired a new and faster CT machine. One of the significant benefits of this CT is that we can now look at more of the patient in less time. While this directly translates into shorter anesthetic times, we are also able to do cutting-edge imaging procedures with this, including sedated scans for certain bone malformations, respiratory conditions and spinal diseases. We are also able to do more advanced angiographic studies, such as looking for the blood supply to a liver tumor, looking for portosystemic shunts and evaluating for pulmonary thrombi and embolisms. These new techniques translate into more precise planning for surgical procedures, less or sometimes no time under anesthesia, as well as opportunities for client education (e.g. 3-D models created from scans of limb malformations).
What one item can you not live without and why?
Shamefully, it’s my laptop. It stores all my textbooks, journal articles and fancy software for making 3-D reconstructions of CT scans. When it runs out of battery, a little bit of me dies with it.
Outside of veterinary medicine, what do you consider yourself to be an expert at?
I’m really into making coffee, and I’m a bit too interested in all the gadgets that go with that. I try not to drink coffee often, but I really love the craft of making a good cup of coffee.
Is there a case that stretched you as a clinician and taught you something meaningful?
There was a case that I saw during my internship that I will never forget. Pippin was an older terrier with a multi-month history of severe salivation, retching-like behavior, swollen salivary glands and severe weight loss because he was unable to eat. Pippin looked miserable, and the owners were at the end of their rope, having exhausted nearly every diagnostic and therapeutic avenue. Through guidance from my mentor and a strange stroke of luck (Google corrected a word I misspelled and led me to some obscure manuscripts), I ended up presuming Pippin had sialoadenosis, a rare disease with an unclear cause. When I began treating Pippin for this with an oral anti-epileptic, he became normal over the span of minutes, right before my eyes! I will never forget how much better he looked and how happy this made his family.
If you knew then what you know now, what would you do differently?
Relax a little bit more. I’ve come to realize that there are things you can control and things you can’t. If you can control them, do it. If you can’t, worrying about them won’t help the process much at all.
Continuing Education: Come Learn with Us!
BluePearl is strongly committed to the veterinary community. One of the ways we demonstrate this commitment is through our continuing education program, which is subsidized in part by our Partners in Education. Please check our online calendar regularly for the most current information about courses, dates and locations.