Flea Allergy Dermatitis: Lacey's Story

Lacey’s Story: Flea Allergy Dermaitis – Diagnosis and Treatment Options

BEFORE

AFTER

Diagnostics:

Physical exam: Reveals a pattern consistent with flea allergy dermatitis and secondary pyoderma (skin infection). 

Skin Cytology: Reveals overgrowth of cocci bacteria, rare yeast 

Skin Scrape: No mites are found (ectopic mites can cause lesions similar to flea allergy and are treated differently, thus they must be ruled out)

Blood screening – baseline: Reveals an increase in eosinophils (a specific white blood cell) supporting the diagnosis of flea allergy dermatitis. This panel also allows the Doctor to determine if steroid therapy is a safe option for your pet by giving us a good idea of internal organ status, specifically the liver and kidneys.

Treatments:

Flea Killer/Prevention: Trifexis. (Revolution if this were a cat)

àKills fleas and each dose prevents fleas for 1 month. The best treatment for flea allergy and flea dermatitis is prevention!

Antibiotic: Amoxicillin or Simplicef

à Treats secondary skin infection due to bacterial overgrowth

Steroid Anti-inflammatory: Dexamethasone Injection or Natural Hydrocortisone Capsules

à Provides comfort by decreasing inflammation and calming down the hypersensitivity reaction. **Steroid anti-inflammatories are used with extreme caution at Lombard Animal Hospital.  Each patient is assessed as an individual to determine if the benefits of steroid therapy outweigh the risk of side effects.  Patients at Lombard Animal Hospital must be current on lab screening of a complete blood count, liver and renal values before receiving steroid therapy.

Medicated Shampoo: Epi-soothe and/or Shampoo with Chlorhexidine Shampoo

à Provides topical comfort and Chlorhexidine decreases the number of bacteria

Omega Acid Supplementation: OFA granules

à Provides comfort and prevention by supporting the integrity of the skin layers and decreasing reactivity. Speeds healing.  Improves haircoat.

Nutritional Supplement: Immune Support or Dermal Support by Standard Process

àProvides “food” for the immune system and skin. Speeds healing. Balances the body.

Specialty Services offered at Lombard Animal Hospital

Acupuncture and Chinese Herbal Medicine, Western Herbal Medicine:

àIdentifies and treats both the acute “excess” problem of heat and irritation as well as the underlying pattern of immune system imbalance and deficiency. 

àHelps the body to process pharmaceutical treatments.

àReduces the chance of recurrence

Food Therapy and Nutritional Consulting:

à Provides a cost effective, DIY option (home cooked toppings) to compliment the above treatment options and/or a change in formulated diets as many pets do much better on specific meat choices and specific formulas.   Yes, food is medicine!

à Brings the body back into balance so that the chance of recurrence is greatly reduce.

            Yes, you are what you eat!

If you would like to schedule an appointment for your itchy pet or prevent your pet’s next itchy episode, please call Lombard Animal Hospital at 503.285.2337.

We are located at 607 NE Lombard Street in beautiful Northeast Portland, Oregon

Allergies are frustrating. Let us help!

--Preston Turano, DVM

--Nell Ostermeier, DVM, IVAS CVA (Certified Veterinary Acupuncturist)

--The Team at Lombard Animal Hospital

www.lombardanimalhospital.com

Our mission is to improve the lives of pets and their people through education, nutrition and wellness!

Veterinary Acupuncture...HOW it works and WHAT to expect!

For more information on Dr. Nell Ostermeier and her acupuncture services...

please give us a call, visit our website, or check us out on Facebook!

Lombard Animal Hospital

607 NE Lombard St. 

Portland, OR  97211

503.285.2337

www.lombardanimalhospital.com

Microchips and Success Stories at Lombard Animal Hospital

How Pet ID chips work:

Simply put - microchips give lost pets the best chance of reuniting with their families! 

Pet microchipping is a simple procedure. At Lombard Animal Hospital, a veterinarian injects a microchip, about the size of a grain of rice (12mm), beneath the surface of your pets skin between the shoulder blades. The process is similar to a routine vaccination and takes only a few seconds, thus no anesthetic or pain medication is required. 


Microchips provide reliable, permanent ID for your pets. When your pet is found and brought to a Vet or shelter, the chip is read by passing a microchip scanner over the pets shoulder blades. Microchips DO NOT act as GPS locating devices ( your pet is not being followed by the "eye in the sky"). The scanner emits a low radio frequency that provides the power necessary to transmit the microchips unique cat or dog ID code and positively identify the pet. The microchip company stores your information in a secure data base. When we call with the pet's ID number, they provide us with your contact information and we (the vet or shelter) contact you.  This service  and information is only available to licensed rescue groups, animal shelters and veterinarians. 

Microchip Success Stories at 

Lombard Animal Hospital:

Lost dogs and cats have been found near and far from their homes, without ID tags.  Good Neighbors have brought them to Lombard Animal Hospital for scanning and we have been able to contact their worried owners.  Reuniting a pet with his or her family is rewarding for all involved!

Microchips have allowed pets to enter a new and better suited family situation. When a Good Neighbor finds a lost pet and is hoping to adopt them as a new companion, they need the assurance that the pet does not already have a good, stable home.  At Lombard Animal Hospital, we can scan for a microchip.  If one is found, we contact the owners to find out if they would like the pet back or if they would rather relinquish the pet to a new home.  In cases where the original owner is unable or unwilling to care for the pet, this is a winning situation for both the found pet and his or her new family!

Lost pets are found injured or ill by Good Neighbors and brought in as emergencies to Lombard Animal Hospital, we are able to contact the owners for permission to treat beyond basic stabilization.  This means faster treatment with a better chance of recovery for the pet!

In some sad cases, deceased pets are found after being hit by a car or sustaining other traumatic injuries.  At Lombard Animal Hospital, we have been able to provide closure for families by identifying their microchipped pets and calling to deliver the sad news.  
On a lighter note, microchips simply save time.  Many times, we are able to identify and contact the owners of lost pets before they even have time to print out fliers for the neighborhood! And, microchips save time for the "finder" because they don't have to look for the owners by posting photos and knocking on doors.

At Lombard Animal Hospital we increase the quality of life for pets and their people through education, nutrition and wellness.  To support our mission and community, 

we are offering $5 off all microchips this March.

Please call to schedule an appointment for your pet today: 503.285.2337

Visit our website: www.lombardanimalhospital.com

Gracie's Story: Her Dental Day at Lombard Animal Hospital

The following is a photo-documented summary of 

Gracie’s Story: Her Dental Day at Lombard Animal Hospital 

located in Portland, Oregon

Gracie’s teeth were assessed during her annual exam.  At that time, Dr. Preston noted moderate tartar and plaque on most teeth, with some teeth more heavily affected than others.  Plaque was pushing up against the gum line causing some gingivitis. Dr. Preston recommended an anesthetic dental procedure to assess the teeth thoroughly for periodontal disease beneath the gum line and to remove the plaque, preventing further damage to the teeth.

Gracie checks in early this morning (7:30 am) with Alese and Lauren, Lombard Animal Hospital Veterinary Assistants, for pre-operative preparations. :

•  Blood draw and analysis – helps determine the patient’s health status and ability to process anesthetic drugs and medications.
• Pre-medication: pain medication and a mild sedative given before placing an IV Catheter.  Provides relaxation and pain relief for the patient. An antibiotic and anti-inflammatory injection are also given in most cases. 
•  IV catheter placement – provides a port for anesthetic drug administration, supportive IV fluids, and emergency medications if necessary.

Once the IV catheter is in place and all of the equipment is ready to go, Dr. Preston administers the IV medication necessary to put Gracie under anesthesia (pictured below).

 Dr. Preston intubates Gracie with an endotracheal tube (pictured below) in order to:

•   Maintain consistent anesthesia with gas and oxygen
•   Provide an open airway at all times
•   Prevent backflow of saliva and fluids into the trachea and lungs

During the entire dental procedure, an Assistant or the Doctor measures and records Gracie's vital signs: Heart Rate, Respiratory Rate, Capillary Refill time, Temperature.  A heated water blanket is used to keep the patient's temperature as close to normal as possible.  Blood pressure is monitored using a Doppler machine.  IV fluid therapy helps to keep blood pressure normal, hydrates the patient and flushes anesthetic byproducts from the system.  

The only way to truly assess your pet’s mouth is to perform an examination while your pet is under anesthesia.  The veterinarians at Lombard Animal Hospital in Portland, Oregon use a dental probe (pictured above) to measure any loss of attachment around each tooth. In Gracie’s case, a slab fracture was discovered in one of her right upper premolars.  It was also noted after scaling the plaque away from the teeth that her gingivitis was more severe than noted during her annual exam 5 months ago.  Her gums bled very easily due to the inflammation.

 If there is loss of attachment, a pocket of infection, a fracture, or other dental lesion, we take

  digital dental radiographs (X-rays, pictured below) to assess for bone loss, abscesses, unhealthy roots and other problems. The radiograph determines whether or not extraction of the tooth is the best choice for your pet.  In Gracie’s case, the the radiograph revealed an enlarged pulp chamber (pulp/root infection). Due to infection and the likelihood of pain, Gracie will benefit from extraction of this tooth.  

Extractions are performed using sterile dental tools and/or a high speed dental drill (drill pictured below). Drills are not as scary as they sound. In fact, they allow the veterinarian to extract the tooth more quickly, with less damage to surrounding tissue. In teeth with multiple roots, like Gracie’s premolar, the tooth must be divided by the drill (below, right)  so that it can be extracted with the least amount of damage to the pet’s gum. Many times the extraction sites will heal on their own. In some cases, sutures (stitches) may be required. 

Extraction Site Pictured Below 

Once all teeth have been evaluated by the Doctor and the necessary radiographs and extractions performed, a veterinary assistant finishes scaling and polishing the teeth.  The mouth is thoroughly rinsed and inspected one more time by the veterinarian.

BEFORE AND DURING SCALE AND POLISH (ABOVE AND BELOW)

AFTER SCALE AND POLISH (BELOW)

Now that Gracie’s dental procedure is finished, anesthesia is turned of and she enters the  Post-Operative or Recovery Period.  During this time, her vital signs (heart rate, respiratory rate, temperature) are closed monitored by the Doctor and Assistant.  Once she is alert and able to swallow, the endotracheal tube is pulled out and monitoring continues until she is fully awake.  Most pets stay with us at Lombard Animal Hospital until between 3:30 and 5 pm.  This way we can ensure that they are fully functional before heading home to spend the evening with their people. 

Gracie is bright-eyed and ready to go home!  She will feel much better without that infected tooth and her breath will be fresh too!

During Gracie's discharge appointment, the Doctor goes over the procedure with her owner.  

They discuss lesions, X-rays and extractions.  

The Assistant goes over post-operative pain medications and antibiotics that will be administered at home.  Preventative dental health measures, such as tooth brushing and supplements, are recommended. 

We also prepare the owner on monitoring for abnormal swelling, discharge or other symptoms that may indicate a complication.  Most pets are groggy for the first 24 hours after an anesthetic procedure, but should perk up and eat normally within 36 - 48 hours.  Most patients are able to eat their usual food, but if not, diet recommendations will be made.  

An assistant will call in the morning to check on Gracie. At Lombard Animal Hospital in Portland, Oregon, we always offer one complimentary post operative exam to ensure that the gums and extraction sites are healing appropriately.  

We'll be happy to see Gracie again in 5-7 days. She is a wonderful patient!

February is National Pet Dental Month.  At Lombard Animal Hospital in Portland, Oregon we offer 10% off the entire procedure for each pet, whether they require only a prophylactic cleaning or major extractions. 

 Please call us at  503.285.2337 to schedule your pet's exam or dental procedure. 

 We would love the opportunity to provide a "pawsitive" experience for you and your pet!

Lombard Animal Hospital

607 NE Lombard Street

Portland, Oregon 97211

www.lombardanimalhospital.com

**The contents of this article are not intended to replace professional medical advice.

Case Study: The value of one feline's annual wellness exam

 “Princess”  Presented for an annual wellness exam.

13 Year-Old, female, Domestic Long Haired Cat. Stays indoor except for short excursions into the backyard on sunny days. 100% dry, grocery brand diet.

On paperwork, Owner responded that the pet had been drinking “a little more water” than usual.

The owner has no concerns and reports that the patient is “slowing down a bit” but is otherwise happy at home.

Physical exam: Mild weight loss noted with slight muscle atrophy of the hind limb muscles.

Eyes, Ears, Nose and throat:  normal.  Gums a little dry, but nothing remarkable.

Abdominal palpation:  normal, abdominal organs are normal size and shape.   Lymph nodes: normal size.

Heart: normal rate and rhythm.  Lungs: normal sounds.

Musculoskeletal system: normal other than low back and hind limbs.  The low back is sensitive to pressure and the hips have decreased range of motion.

Clinical impression based on physical exam and history:

The patient has a mild increase in water intake which could indicate abnormalities of the renal (kidney) system, liver, thyroid, or adrenal glands. Diabetes is unlikely based on symptoms, but can not be ruled out without lab testing.  Increased water intake can also occur with discomfort or pain.  Muscle wasting, sensitivity and decreased range of motion in the hind end can indicate arthritis.  The slightly dry gums, despite increased water intake, indicate mild dehydration.   This increases suspicion of early renal disease.

Plan presented to owner:

Health Screening Profile to the Lab – Complete Blood Count (CBC), Serum Chemistry Panel, Urinalysis.

Fecal Float to the Lab – screens for intestinal parasites (part of LAH Healthy Pet Plan)

Subcutaneous fluid treatment – to boost hydration, regardless of reason for mild dehydration – it helps and it makes the pet feel better!

No additional recommendations until the lab results are in.

Wait on vaccines that are due until lab results are in. 

Total Cost of Appointment - approximately $240.00

Results:

CBC: Red blood cell (RBC) count - normal, White blood cell (WBC) count - normal.

Chemistry panel: Mild elevation in BUN/Creatinine (45/2.0) the 2 main values use do evaluate the kidneys. These values increase when the kidneys are not performing at least 2/3 normal function.  Blood Glucose - normal (makes diabetes unlikely). Liver values - normal. Thyroid value - normal.

Urinalysis:

Lower than normal urine concentration (Specific gravity 1.020): dilute urine, combined with elevations in BUN/Creatinine supports the diagnosis of early to middle stage renal insufficiency.

Fecal Float: No parasites or pathogenic bacteria seen.

Diagnosis: Early to middle stage renal insufficiency. (The kidneys are not performing at a high enough level to keep the patient well hydrated through adequate urine concentration. They are insufficiently clearing BUN/CRET, the end products of protein digestions, from the bloodstream.)

Treatment Options/Plan:  Discussed results with owner over the phone.  Advised owner that since the patient’s vital signs and quality of life are stable, there are some good conservative options for slowing down the progression of renal insufficiency.  These include:

·       A 100% canned, moderate protein level, but high quality food

o   The canned option provides the increased moisture to aid with mild dehydration.

o   The moderate protein level prevents muscle wasting while not making the workload on the kidneys too intense.

o   The high quality protein results in less end-byproducts of digestion, which helps to keep BUN/Creatinine at a reasonable level.

·       Feline Renal Support Supplement ($17.00 for 60 Tablets = 1-2 months of treatment depending on dose)

o   Nutritional support specifically targeting the kidneys.

·       Subcutaneous fluid therapy at home: 1 treatment per week. ($23.30 for 1 Kit = 6-10 treatments)

o   We can teach the owner how to administer fluids under the skin. This results in increased hydration and perfusion (circulation) of the kidneys. This is not required at this stage of renal disease, but could definitely slow down progression into the later stage in which they will be necessary for quality of life. 

·       Recheck a smaller lab screening panel in 1 month to see if the patient’s health status is improved, or at least maintained, by our treatment protocol.  This panel will be recommended every 3-6 months depending on patient’s health status and how they respond to treatment ($58.62).  The full panel presented earlier in this plan will be recommended at each Annual Exam, as it is for all senior patients.

·       Alternative medicine consult or Acupuncture: Discussed in more detail if owner interested. ($74.00 initial consult/treatment, $55.00 each follow up. Most renal insufficiency patients receive a treatment every 3-4 weeks.)

Prognosis: Each pet is unique, but many cats diagnosed in early renal insufficiency can live several years without progressing into the next phase if treated with a protocol as described above.  Appropriate nutrition is paramount to increasing their quality and length of life. 

(More time with your healthier, happier pet … Priceless!)

We present the best available options, the owner makes the decisions!  You decide which options fit with your beliefs, your lifestyle and your budget. As doctors and advocates for the patient, we’d like to do it all. However, we realize that is not always possible. At LAH we strive to enhance the quality of life for pets and their people. If we can move toward this goal, we consider it a success.

*This content in this article is not intended to substitute for veterinary medical advice.  

**The patient's name has been changed for the purpose of anonymity.