Stephanie joins the Sunstone family as our Internal Medicine Assistant on Dr. Tobin’s team. She feels privileged to join the Sunstone team and to continue working with Dr. Tobin and her technician, Jen. She worked in general practice for 5 years before she felt compelled to transition into internal medicine, where she could provide more personalized quality care to her patients and their humans. She graduated from Eastern Washington University in 2012 with her degree in Wildlife Biology and spent several years volunteering and interning at zoos in Europe and the U.S. She is also currently in school to become a licensed veterinary technician.
Stephanie and her husband have “his and hers” dogs. Stephanie’s dog is the most beautiful, most perfect Siberian husky on earth named Tasha, and her husband John has an Australian Kelpie named Sam.
In her free time, Stephanie likes watching and identifying birds, taking leisurely strolls with Tasha, hiking and watching tennis and Lifetime movies.
Dr. Regina Tobin attended veterinary school at Cornell University. Following her graduation in 1994, she completed a one year internship in small animal medicine and surgery at Angell Memorial
Animal Hospital in Boston. Dr. Tobin then spent a year in general practice in the Boston area before starting her small animal internal medicine residency at UC Davis. She became board
certified in small animal internal medicine in 1999. Dr. Tobin has worked in clinical practice in Oregon since 1998, with the exception of a two year period when she worked as a
consultant for a major diagnostic lab.
Dr. Tobin's areas of interest within small animal internal medicine include liver disease, kidney disease, gastrointestinal disease, immune mediated disorders and hormonal diseases.
Dr. Tobin feels strongly that her role as a small animal internist is to offer clients all diagnostic options that are available for their pets, provide compassionate high quality care to her patients and support her clients through difficult decisions.
When she is not working, Dr. Tobin enjoys camping, reading and traveling. She has started horseback riding, an activity she enjoys with her daughter.
Dr. Tobin is very excited to be joining the staff of Sunstone Veterinary Specialists in September 2017. She is looking forward to working with her clients and patients in the personalized setting that Sunstone offers.
Help! My vet told me my dog needs a TPLO! What is that, exactly?
Cranial cruciate ligament (CCL) injury is one of the most common reasons for dogs to have a hind leg limp. The CCL is one of the major ligaments in a dog’s knee, it is the same as the ACL in humans. Its main job is to keep the shin bone (tibia) from sliding forward in relation to the thigh bone (femur). Partial or full tearing of the CCL results in an unstable and painful knee which causes a limp.
Some dogs tear their CCL completely and may suddenly stop putting weight on their injured leg. But the most common story I hear from clients is that the limping comes and goes. Their dog might have been limping off and on for weeks to months (or sometimes years). At the beginning, the limping would get better with rest and pain medications, but the latest episode of limping is worse than before, or didn’t get any better with rest. Worsening of limping often happens when a long-standing partial CCL tear becomes a full CCL tear. Or when dogs with a CCL tear also tear their medial meniscus. The medial meniscus is one of the shock absorbers in the knee. About 50-60% of dogs with full CCL tears and 5-7% of dogs with partial CCL tears will also injure their meniscus.
Diagnosis of a CCL tear is based on finding cranial drawer (instability between the shin bone and the thigh bone) during an orthopedic exam. While most dogs are able to be examined awake, some dogs may be too painful, tense, or anxious to allow a complete exam without sedation.
There are many procedures available to treat CCL tears in dogs. One of the most common CCL surgeries is the TPLO (Tibial Plateau Leveling Osteotomy). The purpose of a TPLO is to change the forces going through the knee so that a dog WITHOUT a CCL can have a stable joint to walk and run on. This is done by making a curved cut in the shin bone (tibial osteotomy). Taking the cut piece of bone, rolling it down the curve that was made, and stabilizing it in the new position with a bone plate and screws. By flattening the top of the shin bone, the thigh bone has a more stable platform to rest on, and other muscles and ligaments are recruited to help keep the knee stable.
Having performed and assisted in over 500 TPLOs, I consider the TPLO to be a very good and very reliable surgery. In the hands of an experienced surgeon, most dogs that have a TPLO have a good to excellent chance for a full recovery with a low likelihood of complications. But, as with most things in life, the TPLO is not perfect and certain individual factors may influence the success of the surgery.
To accurately plan for a TPLO surgery, specifically positioned and calibrated x-rays of the knee and shin bone are taken. Precise measurements of the shin bone are made and our bone cut is planned before surgery. That way I know what size saw blade I will use, where on the shin bone to make my cut, and how far I should rotate the joint surface to achieve a TPLO. Depending on the shape of your dog’s shin bone, whether or not they have torn their meniscus, or if they have other problems in addition to their torn CCL (i.e. a dislocating kneecap), changes may need to be made to the surgery. In some cases, a different procedure may be recommended.
Cost for TPLO surgery can differ (usually based on cost of living where you live, anesthesia protocol used, and whether or not your pet stays overnight after surgery). At Sunstone Veterinary Specialists, a TPLO for one knee will typically cost $3000 plus the cost of the surgical implants (plates and screws). Implant costs will range between $350-500 depending on the size of the dog.* The initial exam and consultation with Dr. Su and any additional diagnostics (such as bloodwork) are not included.
*Extra-large or giant breed dogs (>120lbs) would have extra fees to cover the additional medications, disposables, and resources required. This estimated cost includes the surgical visit (which includes a night in hospital) and routine follow-up (2 and 8-week post-op rechecks).
Lillian Su, DVM, MVSc, CCRP, Diplomate ACVS-SA
Board Certified Small Animal Surgeon
Hi! I'm Jenne and I'm very excited to be joining the team here at Sunstone. I've lived in Portland since the 90's, when I relocated here for school. I graduated from Reed College in 1999 and worked as a field orinithologist (songbirds/raptors) for several years before I decided to settle down and work with non-wild animals. I managed a doggy daycare for 4 years before I started in veterinary medicine. I have worked in the back as an assistant and in the front as a client care specialist, and I've worked both general practice and specialty medicine. I have also been on the other side of the desk when my own pets have required urgent specialty care, so I know how scary it can feel when something is wrong with them.
I live in Milwaukie with my husband, Michael. We have 4 dogs: Dewey the Golden, A.J. the mini schnauzer, Sparrow the corgi/chihuahua mix and Cricket the jack russel/chihuahua mix. We also have 3 cats: Kestrel, Myst and Vajra. We keep chickens and have considered getting a goat or two. In my spare time, I am a big reader (every genre esp history) and gardener, and I love food and cooking/grilling. We also like to play online games and just hang out as a family.
Patient Care Advocate
James is the overnight Patient Care Advocate here at Sunstone. She strives to leave the best impression possible with her patients with the hope that if their paths were ever to meet again, that pet would remember her as a friend. She takes great pride in providing the most comfortable environment possible while pets are away from home.
As a teenager, she worked as a “pack kid” scrubbing medical instruments at a 25 doctor, 24 hour Emergency Animal Hospital. She immediately fell in love with it and, through hard work, began ascending to different positions. From pack kid to doctor's assistant, then surgery assistant, and finally ICU technician. She is now celebrating her 18th year in Veterinary Medicine taking some time off to earn an Associates degree in Applied Science at Mt. Hood C.C in 2013. She has spent the last 4 years at a SW Washington ER/Specialty Animal Hospital dividing her time between assisting in ER, ICU and Oncology and along the way developing a special interest in palliative and hospice care.
In her spare time, she enjoys hanging out at home with her partner and their 3 small dogs, enjoying nature, watching good movies and believing in Bigfoot. She loves bugs, the smell of used comic books, and the sound of Leon Redbone. We are thrilled to have her with us at Sunstone, and we are so grateful for the ownership she has taken over our overnight care.
What has certainly been a LONG winter will soon be coming to a close. Colorful blossoms and sunny days are more than welcome and hopefully will be here soon. Spring is right around the corner! Unfortunately, parasites and other seasonal risks can put a damper on all the fun. However, you and your furry friend can still look forward to this wonderful time of year by following some of these basic springtime pet safety guidelines.
Road Trips and Outdoor Activities
One of the first things you may want to do as the weather turns warm is travel. This may include a day trip to a beautiful outdoor park or a vacation to a new destination (spring break, anyone?). When traveling with your pet, keep the following safety precautions in mind:
· Make sure the destination is truly pet-friendly and that your pet is travel-ready. When in doubt, consider a good boarding facility.
· For road trips, don’t forget your pet’s crate or seatbelt harness. Bring plenty of water and other daily care essentials.
· If your plans include hiking, avoid a wildlife encounter by keeping your dog leashed, vaccinated, and supervised. Remember, skunks, coyotes, and other animals can transmit deadly diseases.
· Microchip your pet and keep ID tags updated.
Lawn and Garden Care
Spring is a great time to tackle the yard and clean up the garden. But wait! Many products can be toxic to dogs, cats, and other animals. Before beautifying your backyard, be aware of the following poisonous products:
· Mulch containing cacao bean hulls
· Slug and snail bait
· Rose care products
· Compost (often contains potentially toxic foods and dangerous molds)
· Plants such as lilies, sego palms, and crocuses
· Fleas, Ticks, and Mosquitoes…Oh My!
Although parasites can threaten the health of pets (and people) any time of year, spring can be when most fleas, ticks, and mosquitoes come out in droves. That’s why it’s critical to keep your furry pal on a year-round preventive. Remember, administering an over-the-counter product without consulting your veterinarian can place your pet in harm’s way.
Another springtime risk to keep in mind includes protecting your pal against allergies. If you notice your pet itching, losing fur, sneezing, or developing hot spots, please contact your Veterinarian. There are many great treatment options available to ease the discomfort of your pet’s seasonal allergies.
In general, spring means more outdoor time with our pets, which means greater distractions and more risks. If you are in doubt, remember to contact your Vet about any products that could be harmful to your pet.
We hope these tips can help you spend more quality time with your pet and enjoy a much deserved springtime. Remember awareness and preventative action is everything!
With the 2017 Academy Awards coming up on Sunday, I have been thinking about one category that is missing from the festivities: Best Animal Actor. Animals with careers are becoming increasingly more common in our culture, from seeing-eye dogs to therapy animals to canine police officers, and it only seems right that they be rewarded as much as their human counterparts. For me, it is often the animal in a movie who produces the biggest laugh or the most tears. In honor of all of the talented animal actors, I made a list of five dogs who I think earned a stroll down the red carpet and an Oscar of their own.
1. Spike, from Old Yeller
Spike, a yellow Labrador Retriever/Mastiff mix, was featured in a number of movies in the 1950s, but is best known as Old Yeller. One of the most classic and well known animal movies of all time, Old Yeller stills brings a tear to the eye even 60 years after its release.
2. Rin Tin Tin
Rescued as a puppy from France during World War I, Rin Tin Tin embarked on a long and impressive film career. With an astounding 28 feature films over 9 years, Rin Tin Tin is credited with saving an almost bankrupt Warner Bros. Pictures. He is one of only 3 animal actors who has been awarded a star on the Hollywood Walk of Fame.
3. Abbey, from I Am Legend
While Abbey only has one feature film credit, this German Shepherd is a personal favorite of mine. In the zombie movie I Am Legend, she has easily the most emotional scene and manages to steal the spotlight from one of the biggest names in Hollywood, Will Smith.
4. Beasley, from Turner and Hooch
While Beasley received the main billing for the title role in the beloved 1989 Tom Hanks film, there were actually four dogs cast to play Hooch. Beasley shared the screen with three fellow Dogue de Bordeaux (French Mastiffs)- Barry, Vigor and Cristo.
5. Enzo, from My Dog Skip
This Parson Russell Terrier stole my heart as the faithful, ever friendly pet in My Dog Skip, but he is also a successful TV actor. As the son of Moose, who was the original Eddie Crane on the long-running series Frasier, Enzo took over the role when his father retired from show business. What a talented family!
This list was very difficult for me to whittle down and could have included so many more wonderful animal actors. Hopefully, as the number of non-human film stars continues to grow, more recognition of their accomplishments will follow.
Internal Medicine Assistant
My husband Cory and I recently adopted a 10 week old Labrador mix puppy! This is our first foray into dog ownership together and his first dog ever. To say that Hank has changed our life for the better is an understatement. While there are challenging moments, (do you have to chew on EVERYTHING??) Hank has enhanced every aspect of our life.
Hank came to us from California. His mom was found as a pregnant stray and was taken in by a foster family down there. She gave birth to 11 puppies (!!) and they all lived in their foster home for about 8 weeks. Some of the pups were adopted in California, and the rest came up here for adoption via the Oregon Dog Rescue. My friend Alysse ended up fostering two of the male puppies for them. She knew we were in the market for a puppy, but that I wanted to adopt one instead of buying from a breeder. So, when we got the text with the adorable photo of the one she thought we would like, we had to go meet him!
We met him one night at her team's flyball practice. I was surprised at how tiny he was! We fell in love and adopted him 2 days later on a snowy Saturday morning. Since we have brought him home, he has more than doubled in size from 10lbs to over 21 now! He is such a sweet friendly guy who loves people, kids, dogs and cats (though our cats Mama and Zoe are not too sure about him and would prefer that he went back to where he came from.) I am extremely lucky that he gets to come to work with me every day. He was not a fan of being in a kennel, but he is now the Sunstone mascot and lives up front with our referral coordinator, Sarah. Our clients love him and Aunt Sarah even plays him animal videos!
We have been going to Puppy Kindergarten classes at Dog Days NW in Vancouver, WA. At our first class, Hank got put into the "Small and Shy" play group, where he promptly bowled over a little Cavalier King Charles puppy. He now plays in the "Rough and Tumble" group and fits in much better! He loves the obstacle courses they have and has learned sit, down, stay, roll over, shake, and spin! Hank has taken a week-long trip to Trout Lake with my friend Alicia and I where he got to play in his favorite thing - snow! He also had his first beach trip last weekend. He is pretty sure the beach is the best thing ever!
He is now about 99% potty trained and is almost sleeping through the night. Potty training was definitely challenging but with consistency and positive reinforcement, he caught on pretty quick! We will also be happy when he outgrows the “puppy teeth chew on everything phase”, though I know that this phase of life will pass all too quickly. Being a veterinary technician, I work with dogs all day long. I typically see them when they are older and sick so I know all too well how fast the time goes by. Hank makes Cory and I laugh every single day and has brought so much joy to our lives. We are so grateful to everyone involved in bringing us together and also to my work family who loves Hank and puts up with his shenanigans.
This is only the first installment of the Hank Chronicles. Stay tuned for more…..
Anyone who knows me knows my love for Abraham Lincoln and my love for animals. I’ve been wondering, how can I incorporate these two into my blog?! It just so happens that Lincoln’s birthday is in a few days, on February 12th (born in 1809)! So, in honor of his birthday, I thought it would be fun to take a look back at all the crazy animals that presidents have had as pets!
John Quincy Adams (1825-1829) had one of the more unusual and dangerous pets: an alligator that had been gifted to him by the Marquis de Lafayette. Not to be outdone by her husband’s eccentric pet, First Lady Mrs. Louisa Adams kept silkworms as pets!
William Henry Harrison, the 9th president, and the first president to die while in office (he was only in office for 32 days), had a billy goat and a Durham cow named Sukey!
James Buchanan, our 15th president, and the only president to never marry, was the lucky recipient of a herd of elephants-given by the King of Siam. He kept one at the White House, along with his pair of bald eagles, his large Newfoundland, and his toy terrier!
It can be said that this president brought the Siamese cat breed to America. Siam, a Siamese kitten was given to him as a gift and was the first Siamese to reach the U.S. This would be our 19th president, Rutherford B. Hayes. He also had a small menagerie that included Jersey cows, a goat, canaries, a mockingbird, several carriage horses, a greyhound, and an English mastiff among quite a few other dog breeds.
Benjamin Harrison, our 23rd president, had a collie named Dash, a billy goat for his grandchildren named Old Whiskers, and two opossums, Mr. Reciprocity and Mr. Protection. It’s said that the goat would often pull the grandchildren around the White House lawn in a cart! Interesting fact: Harrison got the nickname “Little Ben” by the Democrats because of his small stature; he was only 5’6” tall!
Our 26th president, Theodore “Teddy” Roosevelt, had quite the zoo! Along with his 6 kids, he had “normal” pets that included dogs, cats, horses, birds, rats, and guinea pigs. And then the more extravagant animals included; a lizard named Bill, a one-legged rooster, a flying squirrel, a hyena, a lion, a wildcat, a coyote, bears, a zebra, a barn owl, Baron Spreckle the hen, a raccoon, Josiah the badger, a pig, and Algonquin the pony. And don’t forget his oldest daughters snake, Emily Spinach! Random interesting fact: The teddy bear is named after Theodore “Teddy” Roosevelt!
Calvin Coolidge, our 30th president, took after President Roosevelt and also had quite the zoo! He had a wide assortment of dog breeds, a few cats, and had a number of bird species which included canaries, a thrush, a mockingbird, and Enoch the goose. Rebecca and Reuben were their raccoons, and one is said to have walked on a leash. There was Smoky the bobcat and Ebenezer the donkey. Finally, given to them by dignitaries from other countries, there was also lion cubs (named Tax Reduction and Budget Bureau), a wallaby, a pygmy hippo named Billy, and a black bear!
Now we’re on to my favorite, Abraham Lincoln, the 16 president! He was most definitely an animal lover! His family had two goats, Nanny and Nanko. Nanny and Nanko even rode with President Lincoln in the presidential carriage. He had rabbits and a horse he named Old Bob. Old Bob was the rider-less horse with a pair of boots turned backward in the stirrups in Lincoln’s funeral procession. He had his dogs, Fido (who stayed at home in Springfield) and Jip. Honest Abe was also the first president to have a cat in the White House! He loved cats and could play with them for hours. When Mary was asked if her husband had a hobby, she replied “cats”. He had two named Tabby and Dixie, and at one time he fed Tabby from the table during a formal dinner at the White House. When Lincoln’s embarrassed wife later stated that the action was “shameful in front of their guests,” the president replied, “If the gold fork was good enough for former President James Buchanan, I think it is good enough for Tabby.”
In 1865, as the Civil War was winding down and the enormous task of reuniting the country lay ahead, Lincoln would frequently sit at the telegraph office so he could send and receive messages easily. While there one day, Lincoln noticed three stray kittens. He picked them up and set them on his lap and asked about their mother. When he learned that the kittens’ mother had died, he sat with them on his lap for a few minutes and before he left, he made certain someone there was committed to taking care of them.
President Lincoln’s compassion extended to turkeys too! They had Jack, the turkey, who was originally on Lincoln’s dinner menu. But when his son, Tad, became fond of the turkey and pleaded with his father to spare Jack’s life, Lincoln’s compassion once again came through and Jack soon became a part of the family household as a pet and not dinner!
Those are the main presidents who had the most wild and extravagant pets! Pretty crazy huh?!
Happy Birthday Lincoln!
“In the end, it’s not the years in your life that count. It’s the life in your years.” -Lincoln
My friends recently got an adorable new puppy who is just the sweetest little girl who caught onto potty training very quickly. She is now about 3 months old; and, as soon as she comes inside from going potty, she'll go pee on the carpet by their bedroom. Not a lot but it was really starting to annoy them. I received a text recently asking what they should do as they were just about at their wits end and had gone through more carpet cleaner than they'd like to admit. I smiled reading her text as I knew exactly what they were going through all too well, having been there 3 times with my dogs when they were just wee little ones that liked to wee in places they knew they shouldn't.
Why, oh, why does she still pee inside?
It sounds as though your pup may not fully have control of her bladder. She is a puppy still, and though she has the basics down, she may not be completely emptying her bladder when outside. So when she goes back inside, she realizes this and just finishes up. Here are some tips to help get you through those piddle situations!
Tip 1: Stay outside a bit longer and see if your pup pees again. If she does, that's a sign that she doesn't empty enough the first time. Some pups may do this even 3-4 times given the opportunity. If your puppy pees quickly and then runs off to play in the yard, keep her on leash.
Tip 2: Take her to the same potty area each time. This will help to teach her that when she is taken to this specific spot, pottying is what needs to be done. No playing or other shenanigans in this area.
Tip 3: Don't be a distraction. If she is outside peeing and you are too fast in praising/rewarding with a treat, you may be interrupting the urine flow. Don't praise and/or give her a treat until she is completely done peeing and is moving away from the potty spot. And don't walk away while she is peeing! Stay stationary as she may stop mid stream to try to follow you.
Tip 4: If she is treat motivated, and knows which hand/pocket/bag/etc they are in, she may not finish up doing her business completely because she wants that treat. And, at this point, reward her only when you are headed inside and you are sure that she has completely emptied her bladder.
Basically, your pup peeing inside after you've recently been outside is COMPLETELY NORMAL and just means her body is still learning, growing, and may need a bit more time outside (with some modifications).
On occasion, some pups may develop a bladder infection causing them to piddle inside more. If you believe this may be the case, please consult your regular veterinarian.
Happy potty training!
For this week’s blog, I have decided to touch on some important tips for maintaining your pet’s health so they can live a longer, happier life. It’s always important to stay on top of new ways to improve your pet’s health. Here are just a few important considerations of which to be aware:
1. Blood Work: Some of you may ask, what’s the importance of blood work? Sometimes pets can appear completely healthy that actually have hidden health problems that could go undetected. These issues can lead to serious and even life-threatening conditions. Blood tests are an essential diagnostic tool for identifying underlying health conditions or diseases at the earliest stage possible, and ideally when they are the most treatable. One must also consider that pets may have adverse reactions to certain types of medications, particularly if there is an underlying problem involving kidney or liver disease. For senior pets, you may see that your veterinarian wants to check blood work more regularly to ensure their white blood cells, red blood cells, and platelet counts stay in their normal range, and that their organs are functioning properly.
2. Human Medications Can Be Toxic To Your Pets: Did you know that many major pharmaceutical drugs are pet toxins?! Over-the-counters like ibuprofen and naproxen are the most common pet-poisoning culprits, but antidepressants, decongestants, muscle relaxants, and acetaminophen also pose health risks to your pets. Human drugs can cause kidney damage, seizures, and cardiac arrest in dogs and cats. Medications that humans can digest usually ARE NOT safe for your furry friends! If your pet is experiencing pain or something is noticeably wrong, the best option is to call your veterinarian. If you suspect your pet has consumed people medication or anything else toxic, contact your veterinarian or local Animal Poison Control Center.
3. Pets Need Dental Care: As you all know, taking care of one’s own teeth is extremely important, and just like us, our pets need dental care too. Your pet can suffer from gum disease, tooth loss, and tooth pain. Regular brushing and oral cleanings can help keep your pet’s teeth strong and healthy. Dental disease is one of the most common preventable illnesses in pets. Dogs and cats can show signs and symptoms of dental disease by age 3! Dental disease can lead to abscesses, multiple tooth loss, and chronic pain. Regular dental cleanings by your vet can help avoid periodontal disease. Owner care includes brushing your canine or feline’s teeth at home. You can buy a pediatric tooth brush from a grocery store or a pet toothbrush from your local Veterinary hospital. I recommend getting dog or cat toothpaste from your Vet. They generally do not like the taste of human toothpaste, and isn’t good for them to swallow. Oral rinses and dental treats can help too. Purchase those at your Veterinarian’s Hospital as well.
These are only a couple of items to be aware of when thinking about your pet’s health. Hopefully, they can help you give your pet a happier, longer life. If you would like more information on keeping your pet healthy, see your veterinary team, and they will likely be more than happy to answer any and all questions you have.
One of the most common things I hear from clients calling to schedule with Dr. Elliott, the internal medicine specialist here at Sunstone, is that their primary care vet is recommending an ultrasound as the next step for their pet. Indeed, the ultrasound is one of our most valuable tools for diagnosing the pets we see, but many people are surprised to hear that it is an option and may not know why it can be so useful.
There are several different options for imaging when a pet gets sick. The most common is the X-Ray, which most veterinary practices have located right in their clinic for easy use. Less common are ultrasound, CT and MRI. CT and MRI are considered more advanced imaging and are usually only found in a few specialty practices. Ultrasound machines are more common than CT and MRI, but not every veterinarian is trained to use the machine or feels comfortable interpreting the images, so they may refer their patient to a specialist like Dr. Elliott.
The key to deciding which form of imaging a pet needs lies in where the doctor is trying to look. X-Rays work by sending a beam of radiation through the body at undeveloped film for a very brief moment to create a single image. These pictures are very useful for evaluating bones, lungs and giving a general view of soft tissue structures within the body. Ultrasound, on the other hand, uses sound waves to create images. Very similarly to the echolocation used by bats, the ultrasound machine can interpret how the sound waves bounce back, forming a picture. Air and dense structures like bones bounce back the sound waves, while soft tissue structures like the liver and kidneys let some bounce back and some pass through. Because bones and air don't let waves through at all, ultrasound is not a good tool for looking at/behind bones or within air-filled areas, like the lungs. However, it is excellent for looking within the abdomen.
One of the biggest differences between these types of imaging equipment is that ultrasound produces a live video stream of images as the doctor moves the probe around. This lets the doctor see organs from many different angles, which gives them a lot of detailed information. Sometimes there are visible changes, and being able to see those changes gives us a diagnosis. However, in many cases these changes could happen for a variety of reasons and the only way to tell the cause is to look at the tissue on a cellular level. For these times, Dr. Elliott can use the ultrasound as a guide to take a small sample of the organ in question, which is then looked at with a microscope.
In my two and a half years with Dr. Elliott, I have probably helped with somewhere between 1-2000 ultrasounds, so I have seen firsthand how much information can be gathered with this tool. I have also seen when the answer was found with an X-Ray, or a blood test, or a stethoscope. These are all important tools, with their own strengths and weaknesses, for gathering information to piece together the puzzle of what is happening inside each pet.
Internal Medicine Assistant
“Prior planning prevents poor performance.” This is a quote my father has told my siblings and I growing up, and still tells us to this day. It’s a quote that you can apply to many areas of your life and goes well with the topic I am about to discuss.
For the past few years, we’ve been hearing about this massive earthquake that can hit the PNW at any time and that there’s an impending disaster coming this way.
Question is, are you prepared for whatever is headed our way? Better yet, are you prepared for your animals? The best way to protect your household from the effects of a disaster is to have a disaster plan. And if you are a pet owner, that plan must include your pets. Being prepared can save their lives.
In the event of a disaster, if you must evacuate, the most important thing you can do to protect your pet is to evacuate them too. If it’s not safe for you to stay behind, then it’s not safe to leave pets behind either.
I’m going to go over a few things you can do to be more prepared for your animal in case of a disaster.
First, if you don’t already have one, you should start putting together a pet emergency preparedness kit. This could include the following: Medications and medical records (stored in a waterproof container), first aid kit (animal specific), sturdy leashes, harnesses, crates/carriers, current photos of your pet and even a picture of you and your pet together. A collar with an ID tag, enough food and water for several days, bowls, cat litter/pans, manual can opener, small poop bags, trash bags. Other sanitation necessitates like paper towels, household chlorine bleach (it can be used as a disinfectant if diluted correctly) and newspaper. Don’t forget bedding, towels, treats, and their favorite toys if easily transportable. It would also be a good idea to have information on feeding schedules, medical conditions, behavioral problems, and the name and number of your veterinarian in case you have to foster or board your pets. Keep all of this in a storage container so you can just grab and go when needed. There are some pet emergency checklists out there that you can use to guide you that I will include at the end of this article.
Second, know a safe place to take your pet. Never assume that you would be allowed to bring your pet to an emergency shelter. Contact hotels and motels outside your local area to check their policies on accepting pets and restrictions on number, size, and species. I would also ask if “no pet” policies can be waived in an emergency. Keep a list of “pet friendly” places, including phone numbers, with your disaster supplies. You can also ask friends/relatives outside the affected area whether they can shelter your animal. Make a list of boarding facilities and veterinary offices that might be able to shelter animals in disaster emergencies (include their 24-hour telephone number). Check with your local animal shelter. Some shelters may be able to provide foster care or shelter for pets in an emergency. Just keep in mind that shelters have limited resources and are likely to be stretched thin during a local emergency.
Another important tidbit to keep in mind; in case you’re away during a disaster or evacuation order, make arrangements well in advance for someone you trust to take your pets and meet you at a specified location. Make sure you show them where your pets are likely to be if they hide when they’re nervous or scared and show them where your disaster supplies are kept. Go over their feeding schedule, and medications if they’re on any.
Third, make sure your pet(s) have current ID. Double check that their tags are up to date and securely fastened to your pet’s collar. I would also consider microchipping your pets. You’ll increase the chance of being reunited with pets who may get lost by having them microchipped; make sure the microchip is registered and up to date, and that it’s in your name.
I would like to reiterate, if you evacuate your home, do not leave your pets behind!!! Pets most likely cannot survive on their own and if by some chance they do, you may not be able to find them when you return.
We don’t know when the “big one” is going to hit and it’s not pleasant to think about but we need to. So, remember the five p’s; Prior Planning Prevents Poor Performance. Take action now so you know how to best care for your furry friends when the unexpected occurs.
For help identifying pet-friendly lodging, check out these websites:
Here are two websites you can use as a guideline for making your checklists and being prepared:
Alicia, AA, AAS, LVT
The Veterinary Technician is an indispensable part of your pets medical team yet it seems that many people outside of the veterinary world have no idea what we do. Do we simply hold animals for the doctors we work for? Do we snuggle puppies and kittens all day long? (No, though that doesn’t sound bad...) Are we similar to human nurses? Have we gone to school? Are we licensed or registered? How are we different than Veterinary Assistants? This blog post is here to dispel all these myths and to hopefully answer your questions!
A Registered Veterinary Technician (or Certified or Licensed depended on what state you live in) is a technician who has passed the VTNE, the Veterinary Technician National Exam. They will also have satisfied the additional requirements their particular state and/or province may have. The VTNE is a rigorous examination encompassing both small and large animal medicine. Most states and all provinces require that VTNE candidates be graduates of a Veterinary Technology program accredited by the American or Canadian Veterinary Medical Association. There are a few states left that allow technicians to “grandfather” in, meaning they can use on the job experience in order to qualify to take the test however, this is going out of favor.
Most RVT’s have graduated from either a 2 year or a 4 year Veterinary Technology program where they studied everything from anatomy and physiology, pharmacology, surgical nursing, anesthesia, radiology, parasitology, medical math and more. During these programs students typically complete externships where they gain on the job experience and many students work at veterinary practices too. Upon graduation and successful passing of the VTNE, a person can be lucky enough to call themselves a Registered Veterinary Technician. There are many different avenues a technician may choose to go into such as working with laboratory animals, food animals, zoo animals, equine medicine, small animal general practice or emergency practice, specialty medicine and more!
There is another level of expertise that Registered Veterinary Technicians can pursue and that is to obtain their Veterinary Technician Specialty certification. There are a variety of specialties a technician may pursue such as Small Animal Internal Medicine, Emergency and Critical Care, Anesthesia, Dentistry, and more. This is an extremely demanding process that requires many hours of experience in their specific field (3 years or 6000 hours as an example), letters of recommendation, continuing education, case logs and case reports, as well as passing another rigorous examination. There are only about 700 VTS’s in North America. Becoming a VTS is a great way for technicians to advance in the veterinary field and to gain advanced skills and knowledge.
So, now that you know about the education level of RVT’s, lets delve into what they do all day at work. A technician will likely wear many hats during the course of a typical day. Legally, we are not allowed to perform surgery, prescribe medications or diagnose a disease or illness. These are tasks left to the Veterinarian. Aside from these, we perform the majority of patient care tasks. One of the biggest things that RVT’s do is induce, maintain and recover patients from anesthesia. When your pet has a dental cleaning, surgery, endoscopy, or any other anesthetized procedure, the anesthesia is likely done by an RVT. A technician will also be taking radiographs (x-rays), drawing blood, placing IV catheters, placing urinary catheters, performing dental cleanings, running laboratory tests, giving medications, educating clients,
assisting the veterinarian, and many more tasks. A RVT is similar to a human nurse and there is a push in our field to start calling all licensed or registered veterinary technicians, Veterinary Nurses. We will see if this change comes about.
A Veterinary Assistant does many similar tasks that a Veterinary Technician may do however, they have not completed a Veterinary Technology program or passed the VTNE. Legally there will be a few things that they cannot do, such as induce anesthesia, give rabies vaccines, give IV injections without an IV catheter, etc. Many Veterinary Assistants are very knowledgeable and experienced. I know that I could not live without the assistant on my team! They are equally as indispensable as Veterinary Technicians, but they do not share the same title or credentials.
I hope that this blog post has cleared up a little bit about what a Registered Veterinary Technician is and does. Next time you see the technician at your pet’s veterinary office, make sure to give them a big hug and a thank you for all of the personal care they provide to your beloved pet!
My littlest fur baby (Jensen a 1.5 year old Red Heeler) experienced his first snow last week, and it was one of the funniest things I have ever seen. After running in and out of the room 3 times trying to get my attention, I finally got up to see what it was that he wanted. He ran to the living room and stood there growling in front of the bay doors that lead into the backyard. Curious, I got down to his level to see what he was growling at, there was nothing but giant snowflakes falling from the sky. I opened the door and he darted onto the patio, threw his head back, and howled! After a dramatic pause, he bowed to his new found toy, barked, and began to jump and snap at the air to catch these mysterious white flakes falling from the sky. I must have been laughing so hard because Jensen would pause to look at me, ears like satellites, head tilted to the side in wonderment at my silly noise making. His sisters, Sadie and Lola, joined him after a few minutes. They all continued frolicking around the yard making puppy angels, tossing the icy flakes around with their noses, and playing chase while bouncing around like little foxes in the snow.
As I played with my dogs in our little PNW winter storm, and after having to trick Jensen into going inside before he turned into a little pupcicle, I began to think about all of the things I needed to do to keep my dogs safe while playing outside in the cold/snow:
WATCH OUT FOR ICE!
Here in the PNW we tend to get snow, then that all so lovely freezing rain. Be on the look out for ice patches when your pooch is outside as dogs can easily slip and break their bones or strain a joint just as people can. Also, be careful when walking your dog on a leash because when they slip on ice, you both may fall!
NO SNOW CONES FOR FIDO
As much as your dog may love eating the snow or catching flying snowballs, like my Jensen likes to do, this can prove to be unsafe for your pet. Antifreeze can smell sweet and taste even better to animals, but it is HIGHY TOXIC. Rock salt, while not toxic to your pet, can easily get mixed in with the snow and can cause an upset stomach. Lastly, eating large amounts of it can also dramatically lower your pooch’s core temperature and trigger hypothermia.
PROTECT THEIR PAWS
Some dogs are made for colder weather (i.e Huskies have thicker pads as well has coarser hair); however, if your dog is not designed for this, limit their time outside and be sure to dry their paws when they come inside. Treat any cracked pads with a moisturizer specifically made for your pooch's pretty paws, or try a cream made for cow udders to sooth their pads.
CLEAR SOME SNOW!
To make potty time quicker and easier, shovel an area where your dog likes to do their business so they know where to go (and your house stays piddle free). If they do have an accident in the house, try taking them out more often and rewarding them when they come back inside (essentially you will be potty training your dog again as this crazy white stuff falling from the sky is a new situation for them, which requires a new routine).
If your pups are like mine, they require a ton of exercise! It can be difficult to get out and get moving with your dog when it is cold out; but, staying inside may lead to pent-up energy which can potentially lead to destructive or nervous behaviors! Once my dogs were acclimated to the cold and they were used to wearing their fancy new winter coats, we started back up on our regular walks and they have been spending more time outside each time they go out. When it snowed, I built Jensen a little obstacle course which he just loves and his sisters tried to destroy! If it is just too cold for your dog, try puzzle feeders, peanut butter or other treat filled Kongs, or simply playing hide and seek in your house; anything to keep them busy and entertained on these cold days!
There really is nothing more heartwarming than watching your dog play in the snow! Best of luck with our up coming winter storm!
At some point in our careers as veterinary professionals we will be asked by a pet owner: what would you do if it was your pet? Often, we are asked this question when a client (or family member, or friend) is trying to wrap their head around the disease or injury that has inflicted their beloved dog or cat. It can be troubling to weigh the options of a life saving surgery or the overwhelming details of chronic disease management. As someone who has worked in veterinary medicine for 10 years I can tell you that the decision is not always clear cut, even for those of us in the field.
A large driving force behind the decisions we make regarding the care of our pets has to do with the relationship we have with that particular animal. As an owner of four cats, a dog and a horse, I can tell you that I have very different relationships with each of them. I share a stronger bond with some and would address certain health issues differently with each one. For example, one of my cats is a very nervous and skittish creature, she hides most of the day and only comes out to socialize at night. You can't reach down to pet her or pick her up without causing her distress. Because of this, I am not as closely bonded to Pearl as I am to my other pets. If Pearl is ever diagnosed with an illness that requires a lot of medical management and daily handling I do not know if we would be able to handle that level of care. She would be terrified as I tried to administer medications and treating her disease would put a huge strain on our delicate relationship. Now on the other hand if Pearl needed a life saving surgery (perhaps she gets a blockage in her intestine, for example) that procedure would likely be a one-time event. Once she was recovered from the surgery Pearl could return to her recluse ways and be happy in her solitude. In her case, I would likely opt for the one-time surgery than I would for something like Diabetes which could require twice daily injections and frequent veterinary visits.
I had an experience a few years ago where I chose not to pursue additional treatments and diagnostics for my cat Raspberry and instead opted for the hard choice of euthanasia. This was my first personal pet that I have had to make that final decision for. I adopted Raspberry when I was working as a veterinary assistant at an animal shelter. She came into the shelter with terrible skin disease that was proving hard to manage. After 3 months in the shelter and yet to be available to the public for adoption, I decided to foster her at my home. Long story short, she never went back to shelter and I officially adopted her some months later. Her skin allergies were always a problem (she wore T-shirts and little sweaters to keep her from scratching), and then down the road she also developed IBD (Inflammatory Bowel Disease).
For seven years I cared for Raspberry. She was the best darn cat, so sweet and easy-going, I loved her so much. She required many veterinary visits, medications, injections, x-rays, ultrasounds, special food but despite all that I believe she had a good quality of life with us. Her IBD was hard to control and it was a progressive disease, always getting a little worse. Towards the end Raspberry started to visibly look thinner and was vomiting more frequently, but she was still having more good days than bad. We continued to alter and adjust medications as necessary to keep her happy and comfortable. One night she was having some vomiting and I gave her some medication and separated her from the other cats so she could rest in peace (some times my other cats would bully poor Raspberry), I didn't get too worried about vomiting since this had been an on-going issue.
The next morning when I woke I went to check on Raspberry, she was surrounded by little vomit piles, dehydrated, hypothermic and too weak to even stand. I rushed her into a 24-hour emergency hospital. I gave the vet her medical history and said that I didn't want do any extensive diagnostics or imaging, just supportive care to see if we could get her through this episode. Despite warming up her body temperature, providing IV fluids, anti-vomiting medication, Raspberry was still very weak, she still had low blood pressure and started having an abnormal heart rhythm. At this point the veterinarian let me know that we needed to do some more diagnostics to help guide treatment, but at that point, after seven years of high maintenance care, I was done and I felt that Raspberry was done as well. I let the doctor know that I was instead opting for euthanasia.
I called my husband and he came down to the hospital, we were both there when Raspberry passed very peacefully in our arms. In the following weeks I struggled with regret, that I should have done more to try and save her. But once the acuity of her absence had worn off, I came to realize that I made the right choice for myself and Raspberry. In the months leading up to this event, she was declining. The vomiting was increasing in frequency despite medications and her energy and weight were trending downwards. I was emotionally drained even before she crashed and we don't know what would have happened afterwards even if we had been able to pull her through the crisis.
I am sure there are plenty of pet owners who would have continued medical care in this situation, and that's ok. I am sure there are plenty of owners who would have struggled to provide the long-term care that Raspberry needed, and that's ok too. The decision to pursue treatment or surgery is so circumstantial, it can differ between pets, it can change based on financial situations, or on the amount of time and effort an owner is able to dedicate to at-home-care. So, my dear clients and fellow animal lovers, when you ask me what I would do in your situation, I will always answer you honestly. But just know, that the decision you make is entirely yours. You know your pet, you know yourself and what you are realistically able to handle. It's never easy to make these medical decisions, but it's the burden we bear for the love our furry family members.
Katie, BS, AAS, LVT
Patient Care Technician
A few years ago, I had to say goodbye to my beloved Great Dane “Jolie” after she was diagnosed with bone cancer. I adopted her at 8 yrs old knowing from the start that I wouldn’t have that long with her. The life span of Great Danes are typically 8-10 years, and I only was able to spend 3 wonderful months with her. I wasn’t ready to say goodbye so quickly, and it took me a while to move on from the loss.
Looking back at my memories with her, I still tear up knowing how happy I was those last months with her. It’s never easy having to say goodbye to a pet whether they’ve been your life long companion or only with you for a few months. Our pets become such a major part of our families that it’s hard to deal with the loss of a loved pet. Even though there is no right or wrong way to get over the loss, here are a few suggestions that could help you cope if and when you’re faced with such a situation.
For many, a pet is not simply a dog, cat, or reptile. Our pets are beloved members of the family, and when they pass away, you can feel traumatic loss. Much like when dealing with human loss, everyone grieves in their own, sometimes deeply personal way. Some find that grief comes in stages where they experience a series of feelings like denial, anger, guilt, depression, and eventually acceptance and resolution. Others find that grief is more cyclical, coming in waves or a series of highs and lows. Some people start to feel better in weeks or months, but for others, the grieving process can be measured in years.
Whatever your grief experience, it’s important to be patient with yourself and allow the healing process to naturally unfold. Reaching out to others who have lost their pets can also help. Expressing your feelings with someone who truly understands what you’re going through can be a great alternative to holding feelings inside. It’s ok to cry or not to cry, but it’s also ok to laugh and find moments of joy.
If your friends or family members do not work well with the grief of pet loss, you can try other resources such as online message boards, pet loss hotlines, and grieving support groups. Other helpful alternatives include expressing your feelings in a poem or letter, telling a story about your pet, or rearranging photos and making a memorial collage.
Pet owners may ask the question, “Will my pets grieve?” Pets observe every change in a household and are bound to notice the absence of a companion. They often form strong attachments to one another, and the survivor may grieve for its companion. You may need to give your surviving pets a lot of extra attention and love to help them through this time. Maintaining their daily routine or even increasing exercise and play time will not only benefit the surviving pets but may also help elevate your own outlook too.
I hope this has provided some useful techniques for helping cope with the loss of a pet. I still miss Jolie, but I now celebrate her life and the joy she brought to me and others.
This Thursday, Sunstone will close its doors and our employees will have the privilege of spending the weekend celebrating, giving thanks, and overeating with family and friends. It can be easy to take having holidays off for granted when all of Portland seems to shut down for the day (at least until midnight shoppers head out for doorbuster deals) but what about when the unexpected happens to a beloved pet? Veterinary emergencies always seem to find the worst time to strike and for some, this Thanksgiving will be no exception. Luckily, there will still be a number of outstanding human beings available to help.
Coming from an emergency background, I have worked through several holiday seasons in the past. It can be emotionally taxing to tell your family that you won't be able to spend the day together, and sometimes you face the heart-wrenching question, "Can't you just ask for it off? It's Thanksgiving!" A fluctuating schedule is an unavoidable part of working at a 24 hour or overnight care facility, but staff members accept this challenge because of the devotion we have to our patients. If you happen to face the unfortunate reality of needing to visit an emergency vet on a holiday, keep in mind that everyone working there is making a sacrifice in order to take care of your furry family member.
Holidays are often much busier than normal days in an emergency clinic. Not every patient that comes through the door is necessarily in critical condition, but they do all need prompt attention. Since most primary care clinics are closed, problems that normally could have been addressed with a trip to your primary vet may need to be rerouted to one of the few practices with holiday hours. This can lead to busy lobbies, long waits, and frustration on top of an already scary situation for worried pet parents. Trust me when I tell you the staff is working as hard as they can to care for each patient and get you both home as quickly as possible. Nothing is more disheartening than spending an entire shift trying to keep up with an intense caseload, only to hear that there were complaints about wait times. A kind word from a grateful client has the ability to completely turn around an otherwise hard day. Having faith in the staff can be a game changer; a busy workload for a veterinary team can be made much better, or much worse, depending on the attitude and behavior of those waiting.
Despite the many challenges that come with working on the holidays, the dedication of these incredible people is unrivaled. They offer themselves and their considerable skill sets, regularly going above and beyond without expectation of reward. It is thanks to these hard workers that practices like Sunstone can take the holidays off and trust that our patients will be in good hands should the worst case arise.
Veterinary Holiday Workers, you have our unending gratitude.
Internal Medicine Assistant
November is National Diabetes Awareness Month for humans but also for our furry friends too! Many people are not aware that dogs and cats can have diabetes just like their human counterparts. While the disease process can be slightly different in pets, there are many similarities too. This article will provide a brief simplistic overview of canine and feline diabetes. Remember, if you suspect there may be an illness in one of your pets, don’t hesitate to make an appointment with your family veterinarian!
Diabetes mellitus (DM) is a disease that results in persistently elevated blood glucose (blood sugar) levels. In humans, this is caused by either a lack of insulin production from the pancreas (Type 1) or a developed insulin resistance (Type 2). Type 2 is the one typically linked with obesity, other disease process, decreased activity, and poor diet. Diabetes mellitus in a cat is more similar to human Type 2 diabetes. Diabetes of the dog is more similar to human Type 1 diabetes.
The most common symptoms in a pet with diabetes are excessive drinking and urination, weight loss and increased appetite. A complication of diabetes is a condition called Diabetic Ketoacidosis (DKA). This is a very serious condition that may have symptoms such as depression, lethargy, anorexia and vomiting. This is most commonly seen in newly diagnosed diabetics or those with concurrent disease processes. As always, if you notice any abnormal symptoms in your pet, have them seen by a veterinarian as soon as possible.
Your vet will first perform a physical examination on your pet and get a detailed history from you. They may want to run blood tests such as a blood glucose level and perhaps a full lab panel including a CBC, blood chemistry, electrolyte panel and urinalysis. They may also recommend a blood test called a fructosamine, which looks at the average blood glucose level over time. This is done to try to rule out influences such as stress that can artificially raise the blood glucose level as many patients are stressed at the vet clinic. They may recommend doing radiographs (x-rays), abdominal ultrasound, urine culture or other specialized tests. You and your doctor will come up with a plan specific to fit your pets and your family’s needs.
Once a diagnosis of diabetes is obtained, your doctor will likely recommend starting your pet on insulin therapy. This typically consists of twice daily subcutaneous injections of insulin, given after your pet eats a meal. Your veterinarian or their staff will show you how to give these injections and how to make it a positive experience for your furry friend! It is important to note that if your pet is not eating, you do not want to give them insulin as they may develop low blood sugar. If your pet is not eating, call your veterinarian right away for help. It is also important to make sure that the type of insulin syringe you are using, matches the type of insulin you are giving. Be sure to ask your doctor to explain the difference to you. There will be other details for them to teach you such as how to store and mix up insulin. Lifestyle and diet changes may also need to be made depending upon your pets case.
When your pet is first diagnosed there will likely be frequent visits to the vet to make sure they are on an appropriate dosage of insulin and are responding favorably. The majority of diabetic patients are easily managed by your family veterinarian. If they are having trouble regulating the blood glucose or your pet is still showing signs of illness, they may refer you to a specialist, such as an Internal Medicine Specialist.
When pets have difficult to manage diabetes, they often have concurrent underlying diseases that a specialist can help to uncover and treat. Controlling this underlying disease process can then help to control the diabetes in the long run. Occasionally, patients may go into remission and no longer insulin therapy. This is seen more commonly seen in cats. The majority of patients however will need lifelong insulin therapy and veterinary management.
Your dog or cat with diabetes can live a long and happy life with proper management from your veterinarian and of course, dedication from you!
Cheers to National Diabetes Awareness Month!
Katie, BS, AAS, LVT
A Thank You to the awesome team at Sunstone Veterinary Specialists:
Lupe first met Dr Su this summer when she developed a perineal hernia and was uncomfortable both peeing and pooping. Dr Su helped us put together a plan for two staged surgeries to get her back to health. The team members at Sunstone were always so kind and gentle with Lupe. They always made her feel safe and pampered, which is really how she likes things! Dr Su, Alicia, Sarah and the entire team at Sunstone always made me and my husband always feel cared for too. The professionalism, kindness, patience and compassion extended to us through this whole journey has been top notch. We are so thankful.
Lupe healed beautifully from her procedures and is back to being the queen of our household. She goes on walks to check her pee-mail and even goes to work several days a week to supervise or act as a greeter at the front desk. She is healthy, happy and sassy – all thanks to Dr Su and the team at Sunstone!
Katy Felton DVM and Alex Simpson CST
Puppies and kittens are the best, right? They’re cute, cuddly, full of energy. Even just looking at a kitten makes my day a brighter and better day. Who wouldn’t want one? There’s another population of pet potentials that gets overlooked though and it’s unfortunate that every day in our communities, beautiful loving pets are being euthanized. Why? They’re older, and because they’re older, they’re not considered adoptable. They’re passed over for those cute and cuddly puppies and kittens.
Most often, older animals are left behind in shelters as prospective adopters want a pet that they can raise and have for a long time. This means that older canines and felines have higher euthanasia rates than the younger ones, or are left to live the rest of their lives out in a shelter kennel. It’s a sad fact, but one that needs to be discussed.
November is a great month to bring awareness to this issue; it is National Adopt a Senior Pet Month! Any dog and cat 7 years or older is considered “senior.” Walking into a shelter, you’re bound to see older dogs and cats sitting patiently awaiting a soft voice, a kind hand, or even a friendly glance, a glimmer of hope that maybe this is their day that they get chosen to be a part of a loving family. They sit and wait, often scared, depressed, and almost always overlooked by potential adopters. Yet, ironically, they are often the perfect candidates for adopters; quiet, calm, housebroken, good with kids, affectionate and easily acclimated to a new home. They sit there patiently, waiting for someone to love them, until many times, it’s too late. I know this is a depressing topic, but it’s a topic that has become more and more important to me.
There are definitely pros and cons to adopting an older pet, but the same goes with puppies and kittens. One hesitation for a lot of people is that they don’t want to get attached to an older animal because they’ll have fewer years to live out. But turn that around. Think about it. You can give that older sweet lab, or that geriatric skinny black cat or even the Chihuahua with the overbite who’s so ugly that he’s cute the best life for their remaining days. That could be one year, it could be five or even ten. The point is, these animals are just looking for love and a forever home. You would be saving a life that someone else threw away. You would be a hero to that animal.
Here are a few other reasons you should adopt an older pet:
-Older pets tend to be calmer than younger ones, which often make them easier to train. They are more mellow and relaxed and ready for a new home. Most senior pets are just happy sitting at your feet or curled up next to you on the couch, just happy to finally have a place to belong. This brings me to reason number two:
-Senior pets are great company for senior citizens. Many elderly people find the calm presence of an older pet very comforting. They don’t mind hearing the same stories over and over again and are content to move through life at a slower speed. The perfect pairing!
-Senior pets are typically less demanding. Older animals have their routines and, while they still love to play, they love to relax, cuddle, and nap as well. As a result, they tend to fit in more easily into your daily routine. Senior pets also take the guess work out of a dog’s potential size, the nature of a cat’s adult personality, or the energy level of an adult. You get what you currently observe!
-Senior pets demand no huge lifestyle change. You don’t need to worry about kitten and puppy proofing your house and constantly training them. And older pets let you get a good night’s sleep! They don’t demand the time and attention that a younger dog and cat does and are satisfied with casual walks, cuddling, and a short play time. Many senior pets will snooze the day away inside while you’re at work and are waiting calmly at the door for you when you return.
-Senior pets are stress relievers. Life can be hectic and studies have shown that animal guardianship can decrease blood pressure levels and reduce stress. Senior pets enjoy leisurely walks and gentle play, which will encourage you to take a nice stroll through the neighborhood even just for a few minutes on your busiest days.
-Adopted senior pets are grateful. Somehow, older pets seem to know you gave them a second chance, when no one else would. Many new owners form a close bond very quickly with their senior dog or cat, because the pet shows them a level of attention and loyalty that is unique in adopted animals. You have become that animal’s saving grace.
Those are just a few reasons why everyone should look into adopting a senior pet. Kittens and puppies are fun, but don’t overlook the senior pets; they need love just like puppies and kittens do. Love has no age limit. Why not give them the best life possible? Adopting a senior pet changes not only their life for the better, but yours as well.
We are on the brink of the holiday season. What better time to provide a loving home for a shelter pet? Help one less animal spend the holiday season in a shelter. Be their Christmas miracle. You will be their forever hero.
Alicia, AA, AAS, LVT
We had so much fun blogging for Veterinary Technician Week, and the response from our friends and family was so warm, we've decided to make it a weekly event!
Every Tuesday, one of our amazing support staff members will post a short blog, giving us a glimpse into their jobs and life as technicians and assistants in the world of specialty veterinary medicine.
Our support staff has an especially amazing ability to connect and engage with our clients and patients, and we'd like to share that with you, our readers!
As a Veterinary Assistant, there have been days where you’re covered in so much sweat and dirt that it forms a paste on your skin. You’ve wondered, “What’s that smell?” then realized it was you. Prior to working as a Veterinary Assistant, no one ever told me how this job can be so dirty and gross. There are days where you get FILTHY!
I remember when I was first starting out as a Vet Assistant, I was driving home one night and smelled poop. I looked everywhere, and I couldn’t find it. After arriving home, I changed my clothes, brushed my teeth and BAM! There was diarrhea streaked through my hair. How it got there will still be a mystery, but I remembered I was trying not to panic. I immediately cleaned myself off knowing that all I could do was go about my evening and think that tomorrow was a new day. Want to know what Veterinary Assistants deal with throughout their day?
Here’s some of the “lovely” smells Veterinary Assistant’s must encounter on any given work day.
1. Diarrhea : For that matter, any type of animal feces can be smelly to deal with, but diarrhea can be the worst of them all
2. Anal Glands: Just a part of the daily routine. I would advise one to carry waterless shampoo for both owner and pet. (YIKES!)
3. Abscesses: There’s nothing like a big, nasty abscess to tickle the nostrils..
4. Grade 4 Periodontal Disease: You can smell it coming from a mile away! (Free kisses for everyone!)
AND.....Last but not least...
5. Vomit with chocolate mixed with peroxide and activated charcoal: Man! I’ll tell you; this one will knock you off your feet or could make you loose your lunch.
Even though these can be some pretty dreadful smells, at the end of the day, I wouldn’t trade being a Veterinary Assistant for the world! Helping furry critters one step at a time!
Often when I meet people for the first time and they discover that I am a Certified Veterinary Technician, the first question they ask upon hearing my job is: Do I plan on becoming a veterinarian? Or, did I want to be a vet? The short answer is: Nope.
I know that people are well intentioned in their interest of my job, but I wonder if they understand that by assuming I want to be a veterinarian they are discrediting my career choice (and I bet that I am not the only CVT who feels this way). I also wonder if our human counterparts in the medical world (i.e., nurses) get this type of question when discussing their career with new people? I would imagine that they get that question far less than veterinary technicians, who are essentially animal nurses.
My choice to become a vet tech was an educated one. I wanted a job that kept me busy and challenged me on a daily basis. I’ve always loved animals and have great empathy for them and their well-being, but it takes more than a fondness of furry creatures to be a career veterinary technician. I say ‘career’ because the sad truth is that most graduates of a veterinary technology program do not stay in the field for long (the average time working as a CVT is 5 years). In addition to my love of animals, I loved science, biology, anatomy and physiology. For me, those interests put me on the path for a career in veterinary medicine.
But WHY wouldn’t I want to become a veterinarian you ask? It seems like if you love animals you should WANT to be a DVM, but I did not have that desire. I wanted to provide the nursing care, collect the blood samples, run the lab work, use the microscope, place the IV catheters, monitor anesthesia, perform the ‘hands-on’ tasks with the patients. My job keeps me engaged and my duties can change daily depending on the needs of the animals I am caring for.
Another aspect of my job that I enjoy is connecting with the clients; addressing their concerns, answering questions, demonstrating how to give medications, or providing reassurances when their pet is ill or injured. When you first start out as a vet tech you do not realize initially how much of your job is actually working directly with people and not just the cats and dogs.
In summary, I love being a veterinary technician. Would I love my job if I was a veterinarian? I don’t know. DVMs and CVTs are complimentary, we work toward the common goal of increasing the well-being of our patients, there are times when our responsibilities overlap but we are not interchangeable. Veterinarians examine, diagnose, prognose, prescribe and perform surgery; all things that a CVT cannot do. But that does not mean that being a technician is ‘less than.’ It is a different job with a different skill set. I have heard some CVTs refer to themselves as ‘just’ a technician. But we are not ‘just a technician,’ we are a vital part of the veterinary medical team and we should be proud of our career choice.
Katie, BS, AAS, LVT
Patient Care Technician
“Change can be scary, but you know what’s scarier? Allowing fear to stop you from growing, evolving, and progressing.” –Mandy Hale
The process of change can be hard and challenging. Leaving your comfort zone is scary, especially for someone like me who loves their comfort zone!
In my career as a CVT, I have been extremely fortunate to have worked in an amazing general day practice for the past 8 years. I then transitioned to Sunstone Veterinary Specialists, an incredible specialty clinic, earlier this year. That was a hard and scary change for me for multiple reasons. It may seem like a small change to some people, but for me it was huge.
I have always been a general practice technician and I loved where I was. It was a super small clinic with 1 doctor, 1 technician, 1 receptionist, and 1 very spoiled clinic cat. Working at such a small clinic, they became my family. I developed a really special bond with the clinic cat, and that clinic became my life. You also develop friendships with clients and their animals, and when they come in as puppies and kittens, you get to see them grow up! That was something I was going to miss; the relationships I made along the way.
So when this opportunity presented itself to me, I was hesitant, and here’s why: Being a general practice technician was all I knew. As a GP tech, you deal with wellness exams, sick patients, vaccines, spays/neuters, ultrasonic scalings (dentals), mass removals, and emergencies here and there with more in depth surgeries sporadically thrown in. No day was ever the same and that was great. I loved it, but it also became a huge comfort zone crutch for me. I had a routine and I liked it that way.
But, I also knew I had so much room to learn and grow as a technician, which is another reason why I was hesitant to switch to a specialty practice. I’ve never worked at a specialty practice before. Would I catch on quickly? Would I fit in? What if I don’t do well? A lot of "what ifs" went through my mind. It was fear, fear of the unknown and we all experience this throughout life. A lot of the time, fear stops us from taking that chance and seeing what else is out there.
After thinking through everything, I did decide to take that leap of faith, and as hard as it was, I don’t regret it. I definitely miss my old co-workers and that crazy spoiled clinic cat, but life is about learning and growing. You need to change and step out of your comfort zone in order to grow in every aspect of your life.
I have learned so much already being at a specialty clinic, working in the surgery department, and have had some amazing surgery cases that I wouldn’t have had at a general practice. I have been able to expand my knowledge and skills as a technician, and I’m excited to see what else I can do to keep sharpening my skills. I’m developing new client relationships and I absolutely love my surgery patients! I am also very lucky to have gone from one amazing clinic to another. Everyone at Sunstone has been so welcoming and I am extremely grateful they gave me this opportunity. They have been nothing but kind, caring, and supportive throughout my transition.
Each and every day, I am learning to step out of my comfort zone and I encourage you to as well. It’s not easy, but you need to take chances. “In any given moment we have two options: to step forward into growth or to step back into safety.” Choose the option to step forward into growth - you never know where that may lead you!
Alicia, AA, AAS, LVT
My name is Colleen, and I am the internal medicine assistant here at Sunstone. One of the questions I am most often asked about my job, right after “what is the weirdest animal you see?”, is what I do as a part of the Internal Medicine team. As a client, you spend most of your time with the doctor, so you may not see much of what Katie, the Internal Medicine technician, and I do every day. As Dr. Elliott’s team, we do everything we can to let him focus on figuring out what is going on with your pet and making them feel better.
Before each appointment, we sort through the medical history, making sure he has all of the puzzle pieces at his disposal. Katie or I then meet with you, the client, to hear the full story from the person who has been by the patient’s side at every step. This gives Dr. Elliott a more complete picture to base his conversation with you off of.
Once his exam is complete and a treatment plan has been decided on, Katie and I jump into gear. We take X-Rays for Dr. Elliott to evaluate, administer medications and draw blood, which we may test ourselves in our clinic or we may send out to a lab. Some patients need more advanced imaging or procedures which require Dr. Elliott to be involved. In these cases, we set up everything Dr. Elliott will need. One of my favorite parts of my job is mentally rehearsing each procedure to think through anything that could possibly be useful to have on hand. We also prepare the patient, sometimes setting an IV catheter, giving sedation, or fully anesthetizing the animal. Once all the testing is done, we fill any prescriptions, give demonstrations you may need to continue their care, and send them home with you.
Once your fuzzy friend is at home, there are often questions that arise. We hope that you will not hesitate to call us for answers. Katie and I are always happy to chat, sort out any confusion or get an update on the progress being made. We pass these messages on to Dr. Elliott to make sure the pet is responding the way he expected. The Internal Medicine team does not often see simple cases, and treatment changes may be necessary along the way. Good communication with our team is key to making sure your pet is getting the best care possible.
Now that you know a bit about what I do, you should also know that I really, really love my job. I have been told that this is somewhat unusual, but I can’t seem to help myself. I am happy when Monday morning rolls around and, my husband will attest, it took some convincing to get me to agree to a week-long vacation away from Sunstone this summer. There are lots of reasons why I am lucky enough to feel this way, but one of the biggest is that I am blessed to be a member of an amazing team of people. I have worked with Dr. Elliott and Katie for about two and a half years now, and I could not admire them more. When Dr. Elliott decided to start his own practice, I was more than happy to follow my fearless leader. This practice, Sunstone, has been a wonderful place to work, with staff who respect each other immensely, and who care deeply about both pets and their people. It’s hard not to love your job when you are surrounded by this environment day in and day out, and I hope that passion is clear every time you walk through our door.
Internal Medicine Assistant
I had a hard time deciding what to write about for this Vet Tech week blog post. It got me thinking about my last 10 years in the field and what has stood out to me the most. I thought about writing about the unique position that technicians are in right now given the tech shortage and the state of the veterinary field. I thought about discussing my new ventures as Head Technician and all that has come along with that. I thought about all of the interesting medical cases that I have had the pleasure of being a part of, but none of these things felt quite right to me.
I finally realized that I wanted to write about the thing that keeps me coming to work every single day; the thing that drives me even when I get peed on, bitten or scratched, lose a patient I love, barely have a chance to eat all day, or get told by a scared, worried client that all we want is their money. That thing is YOU, dear client, and the bond you share with your beloved pet. This human animal bond is what keeps me in love with this job.
I love getting a chance to know you and hear your stories. I love hearing about how you got your old dog as a puppy and all of the adventures you have shared. I love being able to be there for you in your time of need. In my line of work (Internal Medicine) we don’t see any healthy patients which means when you come to see us, you are probably worried, stressed and scared. I love that I get to talk with you and even hold your hand or hug you at times while we try to figure out what is going on with your beloved friend. I love when you come back to see us and your pet is doing better on their new food or medication or treatment. I love celebrating when the cat with intestinal disease finally gains weight! I love when the chronic respiratory patient gets on treatment and starts to breathe easier. I love the few times we actually get to completely fix something, like the time we pulled a sewing pin out of a puppy’s stomach.
And finally, I want you to know that when you leave your pet with us, whether for a short period of time to take x rays or to do an ultrasound, or whether they stay for a few days with us while they recover, they are treated like family. We are the “stand-in family” for them and yes we baby talk them, carry them around if we can, make sure they go potty when they need to, and make sure they have a fluffy bed, or something to perch on or hide under. We warm their food up to try to get them to eat and even hand feed them. We try to get the medical things done with the least amount of stress possible for your pet. We try to handle them in the gentlest way possible and use tools like sedation if needed. We know that we are no substitute for being at home with you, the person they love, but we do everything in our power to make their time with us as easy as possible.
I am lucky enough to work with a group of people who feel the same as I do and who consider you and your pets to be family. In fact, one of our owners just put up our company vision on our wall. It says “Work is love made manifest.” I think I speak for all of us in the veterinary field when I say that this is a job we do because we love it, because we all know it ain’t for the money! This love for you and for your pets is what being a Veterinary Technician is all about and I am PROUD to call myself a Vet tech. Cheers to all of you working hard every day to provide the best care possible and for keeping the love alive.
Katie, BS, AAS, LVT
Internal Medicine Technician
My name is Kathryn and I am excited to be the new Veterinary Assistant here at Sunstone! I will start off by telling you a little bit about myself. I have gone by Kat since I was young and I’m from far away Springfield, Missouri. Over the past ten months, my boyfriend and I have been planning a move to Portland. Neither of us have visited before, but it’s somewhere that we wanted to be and something we wanted to try while still young. So, we packed up our bags and took off! I have two cats named Winston and Izzy who may be a little spoiled. In my spare time I love spending time with my kitties. I also enjoy hiking, camping, horseback riding and traveling.
I am an enthusiastic Veterinary Assistant who wants to provide the highest quality care to both pets and their people. I believe my passion for animals and awareness for their needs allows me to succeed. I have always loved working with animals and have been a Veterinary Assistant since 2011. One of my goals I have planned for myself is to become a Certified Veterinary Technician one day. I love working as part of a team and helping others out in any way that I can. I am very excited to be joining Sunstone Veterinary Specialists this year and I look forward to what the future may bring.
One of my dogs had extensive dental work recently, including the extraction of two canine teeth. With major extractions, veterinarians frequently use incisions in the gums to gain access to the bone surrounding the roots of the teeth. This usually allows for better exposure and makes it easier to remove the whole tooth. This also frees up gum tissue to use to close over large open sockets after the tooth is removed. While the mouth and gums typically heal well, it is an area of the body that is under constant motion and use which can put a lot of strain on healing incisions. Unfortunately, one of my dog’s incisions came apart a few days after his extractions. Luckily, this complication was easily resolved by sedating him and re-suturing the incision.
Complications are a regrettable, yet inevitable part of working in a medical field. Everything we do, everything we learn, everything we train for is to be able to provide the best of care while minimizing complications. While I wish I could give clients my guarantee their pet’s diagnostic work up, anesthesia, or surgical procedures will be complication free; and that with treatment their pet has a 100% chance of an ideal outcome, unfortunately that would not be true. Even the simplest of medical procedures, such as a fine needle aspirate or an injection of medication, procedures that are performed thousands of times daily across the country, carry some risk of complications.
While we cannot make these guarantees of zero complications or perfect outcomes, what we can do, and what we strive to do here at Sunstone, is to ensure we are well prepared, trained, and equipped for the procedures we offer our clients. We communicate with our clients so they are aware of the procedure(s) we recommend for their pet, what the procedure involves, any common complications which might occur from undergoing such a procedure, and the likelihood of complications occurring based on the research available and our clinical experience. We want our clients to have a realistic understanding of their pet’s disease process, diagnostic and treatment options, and what risks might be involved in order to make the best decision for their pet and their family.
When evaluating risk for my surgical patients, I tend to look at complications based broadly on a few categories.
(1) Anesthetic complications:
While we use safe anesthetic practices and tailor each patient’s anesthetic plan individually, any patient undergoing general anesthesia (or even heavy sedation) is at risk for potential complications. Most complications associated with general anesthesia are mild and easily managed (i.e. decreases in respiratory rate, decreases in body temperature, decreases in blood pressure). However, with any anesthetic event, more serious complications (up to and including death) can occur. The reported peri-anesthetic mortality rate in dogs and cats is pretty low (0.1-2%) but a patient’s individual anesthetic risk is dependent on their overall health status (i.e. do they have concurrent disease, are they systemically ill), why they are undergoing anesthesia (i.e. is this an elective or emergency procedure), and how they as an individual handle and process their anesthetic drugs.
Anesthetic complications can occur at any point in time starting with sedation/premedication, at induction of general anesthesia, during maintenance of anesthesia, and within 24 hours after recovery of anesthesia. Late onset effects of anesthesia such as airway irritation, aspiration pneumonia, or esophageal stricture can also occur.
To maintain individuals under anesthesia safely, it is important that patients undergoing general anesthesia are closely monitored during and after their anesthetic event and recovery. For that reason, animals undergoing anesthesia at Sunstone are under the direct care of a certified veterinary technician whose primary job is anesthesia monitoring. Almost all patients having surgery at Sunstone will spend the night after their procedures in hospital under the care and supervision of an experienced, certified veterinary technician.
If a patient is deemed to be at significant risk for anesthetic complications, we might recommend bringing a board certified anesthesiologist in to work with us in managing the anesthesia aspects of the case.
(2) Surgical complications:
Any time an animal or individual has surgery, there is the potential for complications with the procedure. These can typically be broken down into surgical complications, early post-surgical complications, or late post-surgical complications.
With every surgery comes the risk of bleeding, focal tissue trauma, nerve trauma, or complications associated with the specific procedure. The type of procedure and exact body region will influence the likelihood of certain complications. Having surgery performed by someone who is knowledgeable, trained, and experienced in the specific procedure your pet is having can decrease surgical risks.
(3) Post-surgical complications:
Complications that occur within two weeks of surgery are considered early post-surgical complications and are often related to the incision, such as infection, seroma formation (fluid accumulation under the incision), dehiscence (separation of the incision / failure of the incision to heal). However, early complications may also be more serious or require additional intervention, such as post-operative bleeding or early implant failure / fracture after orthopedic surgery.
Most early complications following routine, elective procedures can be avoided with appropriate post-operative care and monitoring; thankfully, most complications are mild and easily managed. However, the nature of complications is that even if we and our clients do everything right with their pet’s procedure and post-op care, complications may still occur. And unfortunately, some complications can be more severe.
Late surgical complications are problems that arise multiple weeks, months, or sometimes years, following a surgical procedure. The types of complications which can occur later include delayed healing, implant complications, or late surgical site infection.
At the end of the day, my expectation in talking with clients about the potential for surgical complications is not to scare them away from choosing to pursue treatment, but instead to educate and prepare them for what could happen, should complications occur. I always tell my clients if I don’t feel we can anesthetize a pet or perform a procedure safely, then I would not recommend it. Additionally, my desired outcome with any surgical procedure is to ‘first, do no harm’ and ideally to improve some aspect of that animal’s life. Whether the goal of surgery is to provide a diagnosis, resolve a problem, or to relieve pain, I strive to provide a realistic assessment to my clients about whether or not surgery will benefit their animal and what risks may be involved. This way, we can work as a team to come up with the best plan for everyone involved.
Summit, a 9 month old Labrador mix, recently found himself faced with the difficult decision as to whether or not he should consume a sewing pin. With the confidence of a puppy, Summit chose to ingest the pin.
Summit’s owners discovered his dietary indiscretion and promptly took him to his primary veterinarian’s office. Upon arrival, he was x-rayed and the pin appeared to be in his stomach. This was great news as it indicated retrieval was potentially non-surgical and could be removed safely with a flexible endoscope, a machine Dr. Elliott uses regularly.
Summit’s primary veterinarian’s office gave us a call at Sunstone to see if we were able to perform this procedure the same day, and explained the situation. We were able to see Summit quickly that afternoon, so his owners brought him right over. We recommended taking an additional x-ray to verify the location of the pin. Upon reviewing the x-ray, the pin still appeared to be in the stomach, which makes for a convenient retrieval. Summit was placed under anesthesia and we proceeded.
Much to our surprise, the pin was not found in the stomach (although some cardboard was). Dr. Elliott looked down into the duodenum (the first part of the small intestine, immediately beyond the stomach) and found the pin about 10 inches into the duodenum. Dr. Elliott was able to carefully grab the tip of the pin and guide it safely through the open lumen of the duodenum and back into the stomach, where he could reposition it and remove it from Summit safely.
Summit is enjoying being at home, back to his puppy shenanigans without the need of surgery.
In veterinary medicine there is a general feeling, a superstition if you will, that things tend to happen in threes. Recently the Sunstone Surgery service has been getting inquiries about, giving advice for, and treating cats and dogs with a condition called chylothorax. So far we have heard about or treated two cases of chylothorax in recent weeks and we thought that as we wait for the next case to present we would take this opportunity to give our clients and readers an overview of chylothorax – what it is, how it is diagnosed, treatment options, and overall prognosis.
Chylothorax is a condition where chyle leaks into the chest cavity; if enough fluid accumulates in the chest, the lungs cannot expand effectively making it difficult to breathe.
But, what is chyle exactly?
To understand what chyle is, we have to look at how fluid flows in the body and what happens to fat when it is digested and absorbed.
While most people understand that veins and arteries conduct blood to and from the heart, few remember that there is a third type of vessel in the body called lymphatics. The lymphatic system has three main jobs:
(1) It helps maintain fluid balance in the body by providing a way for fluid that leaks out of blood vessels to get back into the bloodstream.
(2) It plays a major role in immune function by making and transporting immune cells, and providing a way for immune cells to get into the bloodstream.
(3) It is responsible for taking up and transporting fats absorbed by the gastrointestinal tract.
As everyone knows, oil (fat) and water do not mix well, however in order to transport fats within the body to where they need to go, they have to! To allow fat to be transported within fluid, the small intestine packages digested fats into molecules called chylomicrons. Chylomicrons are essentially fat surrounded by protein so that the fat can be ‘dissolved in’ and easily carried by lymph fluid and blood without trying to separate out. Normal lymph fluid is clear, however after a meal the intestinal lymphatics will be full of milky appearing fluid which is simply intestinal lymph fluid with chylomicrons, or chyle.
The intestinal lymphatics drain into an abdominal structure called the cisterna chyli – a reservoir and gathering place for all of the intestinal lymph. From the cisterna chyli, lymph flows forward into the chest via the thoracic duct and then the thoracic duct empties directly into the major veins entering the heart.
So, how or why does chyle leak into the chest?
The short answer is: we usually don’t know. Chylothorax occurs when fluid leaks out of the thoracic duct before it empties into the venous system. This can occur secondary to any disease that makes it harder for the thoracic duct to empty appropriately (i.e. heart disease, pericardial disease, lung lobe torsion, abscesses/granulomas, cancer, etc.). However the vast majority of the time in dogs and cats, chylothorax is idiopathic; meaning we can’t find a definitive cause for the condition. It is poorly understood how or why some dogs and cats just start leaking chyle into their chest with no apparent trauma and no apparent disease process preventing chyle from flowing normally.
How would I know if my dog or cat has a chylothorax?
Again, the short answer is: you might not know. If your pet is happy, healthy, eating, drinking, breathing, and acting normally – it would be very, very, unlikely for them to have a chylothorax.
Animals with chylothorax can vary in their presentation, some present on emergency due to the acute inability to breathe and some will just have a vague history of decreased appetite, lethargy, and weight loss.
On physical exam most have animals have findings consistent with fluid within their chest cavity: changes to their mucous membrane color, decreased lung sounds or heart sounds in certain parts of their chest, an elevated respiratory rate, difficulty breathing with restraint or when being placed in certain positions. X-rays of the chest would show fluid around the lungs. However without further testing, we would not be able to tell what kind of fluid was causing the problem.
Thoracocentesis (chest drainage) is usually indicated in animals that are having trouble breathing and have fluid in their chest. The good thing about this is that by drawing fluid off the chest, this usually gives their lungs more room to expand, improves their ability to breathe, and allows us to get a fluid sample for analysis. While the appearance of the fluid can give us an idea of if it is blood or pus or chyle, submitting the fluid to the lab for specific testing is really the best way to definitively diagnose what type of fluid it is.
Chyle can range from clear to cloudy and milky or pink tinged in color. Although chyle is not the only cloudy fluid that can accumulate in the chest, and if the pet hasn’t been eating, it might look clear. There are many tests that can be performed on fluid taken from the chest that can help identify what kind of fluid it is. To definitively diagnose thoracic fluid as chyle, we take a fluid sample from the chest and a blood sample taken at the same time and compare the amount and type of fat (triglyceride and cholesterol levels) in the fluid to the levels in the blood. Chyle will have high triglycerides and low cholesterol when compared to blood.
My pet has fluid in their chest that was diagnosed as chyle…now what?
If your pet has a chylothorax, your vet’s first priority will be to make sure they are stable and able to breathe. Depending on how much fluid your pet is producing into their chest, this may involve repeated thoracocentesis (chest drainage). Then their next steps will be to try to determine if they can identify a cause for the chylothorax. This will usually involve baseline bloodwork (CBC, Chemistry panel, perhaps a coagulation panel), appropriate infectious disease testing (heartworm, FeLV, FIV), a complete cardiac work-up including cardiac ultrasound, and imaging of the chest (either x-rays or CT scan). If there is a primary cause identified, that should be addressed as part of the treatment plan.
However it is not uncommon for all the testing to come up negative, resulting in a diagnosis of idiopathic chylothorax. Given that chylothorax is a relatively rare condition in dogs and cats, the number of studies conducted and our ability to make definitive evidence-based treatment recommendations is limited. In order to manage and attempt to cure chylothorax, there are a variety of surgical and non-surgical treatment options, but most commonly a combined approach yields the best results.
How do you treat chylothorax without surgery?
Non-surgical treatment of chylothorax typically consists of some combination of the following:
- Intermittent chest drainage (thoracocentesis). Removing fluid from the chest cavity via thoracocentesis or by placing a chest tube allows for temporary improvement in respiration. This helps with the immediate symptoms of chylothorax but does not address the underlying cause. Use of chest drainage alone only has an approximately 25% success rate for resolution of chylothorax.
- Use of low-fat diets. Feeding a low-fat to animals with chylothorax decreases the fat content in the chyle which may decrease the overall inflammatory effect that chyle has on the lungs and other tissues in the chest. However there is little evidence to support low-fat diets decreasing total lymph flow through the thoracic duct. Based on this, use of low-fat diet as the only treatment is not recommended.
- Octreotide is a drug that decreases flow through the thoracic duct and has been used to treat traumatic chylothorax in people. Results of treatment in dogs and cats with octreotide are variable and the available literature states a success rate of approximately 40%.
- Rutin is an over the counter nutraceutical made from the Brazilian fava d’anta tree. We do not know exactly how Rutin works to help resolve chylothorax but some theories include: increasing fluid uptake by lymphatics, decreasing the leakiness of blood vessels, and increasing immune activity to scavenge protein from the fluid in the chest. While there have been no published studies in dogs, cats treated with rutin showed an approximately 65-70% response rate.
When is surgery indicated and what does it do?
Surgery is definitely indicated if a chylothorax persists with high-volume effusion for more than 4 weeks despite non-surgical treatment (these animals typically require frequent chest drainage and continue to have large volumes of fluid at each tap). However early surgical intervention is frequently recommended to try to reduce the secondary effects of chylothorax which can include: low blood protein levels, decreased immune function, dehydration, and weight loss. Additionally, chyle in the chest acts as an irritant and can result in irreversible thickening and scarring of the surface of the lungs (pleuritis) and pericardium (pericarditis) both of which in their advanced stages can be life-threatening.
The primary surgical procedure performed for chylothorax is thoracic duct ligation (TDL). By tying off the thoracic duct right as it enters the chest, we are attempting to prevent chyle from getting to the chest cavity and forcing new connections to form between the lymphatics and veins further upstream. Success of getting chylothorax to resolve with TDL alone is not great – current literature reports likelihood of resolution in dogs to be between 50-60% and in cats between 15-50%.
As such, most surgeons will combine TDL with other procedures to help re-route or decrease resistance to chyle entering the bloodstream. The most common secondary procedure to TDL is a subtotal pericardectomy or pericardial window. This procedure involves removing some or most of the sac around the heart (pericardium). By performing a subtotal pericardectomy, we are able to relieve any restrictions to expansion of the heart, decreasing pressure on the veins and improving flow of lymph back into the bloodstream. By combining TDL with subtotal pericardectomy, we have a reported improvement in our chances of resolving the chylothorax to 80% in cats, and between 60-100% in dogs.
Additional surgical techniques that have been used to treat chylothorax address the condition by trying to decrease pressure on the thoracic duct (cisterna chyli ablation), trying to improve absorption of fluid (thoracic omentalization), trying to eliminate space around the lungs for fluid to accumulate (pleurodesis), and trying alternate methods to block lymph flow (cisterna chyli and thoracic duct embolization). However most have not been proven to definitively improve the chances of resolving the effusion.
Even with surgery, some dogs and cats continue to leak fluid into their chest for several weeks to months after surgery; and some that have resolution may have recurrence of effusion several months to years later. As such, adjunctive drainage devices to help with continued evacuation of the chest may be needed to manage the fluid build-up.
Because successful treatment of chylothorax is highly individual, it can be a difficult and frustrating disease to manage, however surgical treatment of chylothorax is typically our best chance at achieving good short and long-term outcomes. Without treatment, or in animals that do not respond to medical or surgical treatment, humane euthanasia is often chosen to prevent an affected dog or cat from suffering through repeated respiratory emergencies and chronic illness.
While we at Sunstone wish no animal would have to face this condition, we are available to discuss and help guide you through your treatment options if you ever find one of your furry family members in need of our assistance.
Lana had been slowing down for a few months before refusing to put weight on her hind leg. As an eleven-year-old Boxer, it appeared to be progressive arthritis, until the lameness appeared. When x-rays didn’t reveal any major injuries and cold laser therapy treatments didn’t work, we were referred to SunStone. From the moment we walked in, I knew Lana was in great hands! Sarah made us feel warmly welcomed, and Colleen and Katie were so caring and professional as I shared what brought us to SunStone.
Dr. Elliott’s exam and joint taps zeroed in on a couple potential diagnoses, and the pathology work he ordered confirmed one of these, a bacterial infection in her knee. We began treatment immediately, and anxiously awaited the effects of the antibiotics. Within a few days, Lana began tentatively standing on the leg. Over the next few weeks she regained her full mobility. She is back to being excited to take neighborhood walks and play in the yard, things we could not have imagined just a few weeks earlier. We feel so blessed to have landed in the expert care of Dr. Elliott and his wonderful team. Thank you, SunStone Vets!
- Jon Shervey, owner of Lana
Written by: Lillian Su, BS, DVM, MVSc, CCRP (Practice Limited to Small Animal Surgery)
Anyone who has dogs or knows someone with dogs will eventually run across a dog like this. Those of you who have owned them know the sheer frustration of trying to contain them, as well as the fear and anxiety that strikes when you first realize they’ve gone. Those of you who haven’t yet had the privilege of hosting one these independent creatures in your home feel a little lucky that your dogs seem so well behaved in comparison.
Yes, I’m talking about the canine equivalent of Houdini – escape artists that tirelessly work to escape their homes or yards regardless of your attempts to keep them secure. My own personal Houdini is a dog named Goose. Goose was originally an intact male dog found running at large in Saskatchewan. Being the charming dog that he is, he happily let himself be caught and he was turned in to the Saskatoon SPCA. From there, he was brought to the clinic where I worked for medical care. Goose showed himself to have one of those very charismatic canine personalities – he loved people, got along with other animals, was food motivated (but often couldn’t decide between cuddling or eating), and he had a tail that never seemed to stop wagging. By the time his hold period was up, Goose had wiggled his way firmly into my heart.
Little did I know that his charming exterior hid the likely reason for him having been found running loose in the first place…this dog has a serious case of wanderlust! And he knows how to capitalize on any minor mistake I make to take himself on a solo tour of whichever neighborhood we happened to be living in at the time.
Let me be clear, I feel I am a responsible owner, I leash my dogs anytime they are out of the house and I have only had my dogs off-leash at home in fenced yards or in fenced off-leash dog parks. The very first time Goose escaped from the yard, I honestly didn’t know he had done it until he came home…to the front door!
In the years since that very first escape, I have lived in (and, despite my best efforts, Goose has escaped from) several house and fence designs – I learned a lot about Goose, ‘fenced’ yards, and myself along the way.
Over the years, I have compiled a list of things to do or to think about that may be helpful to those of us that are in a battle of wits with our escape artist dogs.
1) Know your dog! Knowing their favorite ways to escape will help you put steps in place to prevent them from doing so.
2) Make sure your dog has appropriate levels of exercise and enrichment. Sure, some dogs have a desire to wander even with long walks, hikes, and tons of social time. But some do it because they are cooped up and bored. Set them up for success by making sure they are exercised regularly.
3) Make sure your dog is appropriately identified and that they are up to date on their vaccines! The tags they wear should, at the very least, include: an ID tag with your contact information, their current city or county dog license, and their current rabies vaccination tag. Other identifiers such as a microchip or tattoo are extremely helpful, but only if you register your pet’s identification with a recognized, nationally searchable database and update the information regularly.
4) Make sure your dog is wearing a snug fitting collar, martingale, or harness. Attaching a leash to a loose fitting collar or harness might allow your dog to slip out of them when you least expect it!
5) Always leash your dog before going outside. The natural rider to this statement is that there should be a responsible person on the other end of the leash.
6) Fenced yard? Make sure you are checking regularly that the area is still secure. Address any safety concerns before allowing your dogs to roam freely in the yard. I try to make the effort to walk the perimeter of my yard each time I let my dogs out so I can be the one to discover if the gate is latched or not!
7) Do you have a digger? Both DIY and commercial solutions for fence diggers exist. Usually this involves extending your fence underground with chicken wire or other mesh in an L-shape to keep your dog in even if he decides to try dig his way out. Regularly checking your fence line is imperative to being able to find and fill any potential tunnels as soon as possible.
8) Do you have a jumper or a climber? The first question is, is your fence tall enough? The height of the fence needed to contain a jumping dog is dependent on a few factors: the size and athletic ability of your dog, the amount of room available for a run-up, and any structures in the yard that might aid them in getting over the fence (i.e. a chair, picnic table, play structure, or climb-able tree). A 6 foot fence is usually sufficient to contain most dogs, but for super jumpers or in a yard with features that might give a dog an advantage to getting over the top, a taller fence or modifications to the fence might be needed.
Again, there are many DIY and commercial fence extension products out there. Fence extenders can be straight or angled in to make it even harder for pets to get up and over. Coyote rollers on the upper inside border of your fence can also increase the difficulty of jumping or climbing a fence. For a select few dogs who have a tremendous standing leap, a full enclosure (with a ceiling panel) might be the only way to contain them. I would encourage you to stay away from barbed wire or razor wire as a way to keep your dogs in the yard – too often, they will still try to escape but may end up with nasty lacerations as a result.
9) Do you have a door or gate rusher? Work on training them to stop, wait, and walk calmly on all entries and exits. As an additional safety measure, you can try to separate them from the doors, gates, or entry ways with a double entry system like you see at dog parks.
10) Consider instrumenting them with a GPS enabled collar. Several companies now offer collar mounted GPS tracking devices designed for dogs. Most are used for dogs out in the field but they can also be used for dogs that like to roam. A GPS tracker can help you pinpoint your wayward dog faster than randomly canvassing your neighborhood. And they could be invaluable if you ever have your dogs off-leash in wilderness areas. The collars only work if they are charged, your dog is wearing them, and you have access to the tracking device or app.
11) Continue working on and strengthening their recall. Practice, practice, practice, in a controlled environment, having your dog come to you with lots of positive reinforcement. And then practice some more. If you need help teaching your dog these skills, seek out basic obedience classes or the assistance of a private trainer.
12) Remember you don’t know what they have done, eaten, or encountered while they were on walkabout. When they return to you, don’t scold! Reprimanding them for coming home will only make them apprehensive about coming to you in the future. Instead, praise them, check them over for plant debris, ticks, or obvious injuries, and don’t hesitate to get them checked out by your vet if you suspect them to be ill or injured.
13) If they don’t return, get the word out as soon as possible that they are lost! Post flyers with a recent picture of your dog and your contact information. Indicate a reward if you can give one. Contact your local animal services, the humane society, and your veterinarian. Notify any identification registries with whom your dog is registered and update your contact info if it’s out of date. Utilize online resources like Facebook and Pet FBI to let people in your area know to be on the lookout.
Personally visit any organizations in your area responsible for stray intake every day. Most animal service organizations are doing the best they can, but often they are overwhelmed with the number of animals being surrendered or turned in as strays and they are frequently understaffed for the number of animals in their care. Your best chances of knowing if your dog has been turned in to a shelter is to go in person and look at each animal in each facility.
I am lucky that I have been able to keep Goose’s solo adventures over the years to a minimum, and that the times he has taken himself on walkabout have been brief and without any major incidents. But even as he approaches the ripe old age of eleven, it still requires vigilance to keep him safe. Have any of these techniques helped you and your Houdini? Do you have other tricks that work for you to keep your furry friend from wandering the streets alone? Let us know in the comments!
Sarah joins the Team at SunStone Vets as our Referral Coordinator. With a background in client services for emergency & specialty veterinary medicine, she has a "been there, done that" approach to client care. In her words, "I've been on the other side of the counter, and I know how helpless you feel and how scary it can be. If I can make an owner's day even just a little brighter, then I've done my job." She is beyond excited to be joining us!
In addition to working at SunStone, she runs a successful network marketing business as an Exclusive Black Status Presenter for Younique Cosmetics. She is passionate about helping women from all walks of life feel confident and empowered to have a sense of ownership over their future.
Sarah grew up just outside of Atlanta, Georgia. She and her husband fell in love with the beauty of the Pacific Northwest, and when he retired from the military they chose to raise their family here. She lives in Camas with her husband, their two daughters, and a very spoiled Boxer named Jethro.
With any "down time" life allows, she enjoys taking her family on exciting adventures, gourmet cooking, and turning off her brain with a glass of good red wine and the latest episode of one of her favorite shows.
Written by: Lillian Su, BS, DVM, MVSc, CCRP (Practice Limited to Small Animal Surgery)
Since graduating from veterinary school, I have made cross-country moves with my canine and feline family members six times. My oldest cat, Alexander, has made every single one of these moves with me…unfortunately, Alex hates carriers and he hates car rides – he has a sensitive stomach and gets sick when he’s stressed. Most recently, I made the trek from Ohio to Portland with Alex, his feline sister, and his two dogs. Figuring out a plan to minimize stress for all of my pets while making progress towards the west coast took some planning.
Moving with animals is stressful for people and pets alike. There are many things to consider when making big moves with Fido or Fluffy.
Before you travel… Will you need health certificates? Additional vaccinations? Blood tests?
Crossing between the US and Canada with adult dogs and cats just requires proof of current rabies vaccination. Traveling between states in the contiguous 48 states is also very easy but will sometimes require a current Health Certificate. Valid Health Certificates can only be issued by a federally accredited veterinarian (https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/nvap/ct_locate_av) and must have been issued within 30 days of travel. Additionally, some municipalities have limits on the number and types of animals one person may keep on a single property. Know the rules and regulations before you move!
If your pet has not been to the vet within the last year, you should at least schedule them for a check up before the move or get a current Health Certificate. Make sure to look into the local and regional animal ordinances so that your pets are in compliance with the law with regards to required vaccinations when you arrive in your new town. If your pet has not been microchipped, it may be a good idea to implant them with permanent identification. If they are, make sure all of your contact information is up to date!
Is your pet crate-trained? The safest (and usually only) way to transport animals by plane, train, or commercial service is in a crate. This minimizes the risk that they will get loose during transport, allows them to have a dedicated space to bed down, and prevents them from being flung about the vehicle in the event of an accident. If your pet is not crate-trained, it might be helpful to acclimate them to the crate they will be traveling in well before you plan to transport them. If you are not certain how to get started with crate training, or if your dog is very stressed by any aspect of crating or travel, you may wish to seek out assistance from your veterinarian or a veterinary behaviorist to help you formulate the best plan for your pet. This will usually include a behavior modification and training plan and possibly drugs to decrease anxiety during training and traveling.
Domestic or International?
Luckily, all of my moves have been within the United States and Canada and therefore I have not had to deal with the rigorous forms, vaccinations, and blood testing that are often required when moving animals overseas.
Many foreign animal agencies and Hawaii require vaccination and testing well in advance of the move and may require quarantine periods before or after moving. Some states and countries have restrictions on certain species, some have different rules for transporting juvenile animals (i.e. puppies and kittens). If you are moving overseas, give yourself as much time as possible to familiarize yourself with all the requirements and to complete each step as some can take multiple months to schedule or might require very precise timing. If you are looking for information on regulations for moving your pet with you out of the US, go to: www.aphis.usda.gov/aphis/ourfocus/importexport/animal-import-and-export/travel-with-a-pet or seek out a veterinarian experienced with import/export of pets. Even if you are using a company to transport your animals, get everything lined up as early as possible!
Land or Air?
Flying vs. driving with your animals each have their own headaches. Flying with pets requires that they be small enough to be taken as a carry-on (small dogs and cats) or identifying airlines that will fly live cargo. All animal transport will require fees in addition to your own airfare. Airline, time of year, size of animal, size of kennel, type of aircraft, origin and destination cities, and whether there are other animals on the flight already are some of the factors that may play a role in flying with your pet. Most airlines that allow transport of pets on their commercial flights have a webpage detailing rules and regulations for transporting animals on one of their flights or at least a contact number to call. It is always advised to check with the airline before finalizing flight arrangements for your pet.
For me, the idea of giving up control over my animals’ well-being during a move is very difficult so I chose to drive for all of my moves. Driving your animals long distances requires having the time to make the trip, having a reliable vehicle that is able to safely accommodate you, your animals, any driving companions, your animals’ supplies (think food, beds, water dishes, litter boxes, toys, crate, etc.), and your own luggage for the trip.
Are your animals good travelers? Or does being in the car stress them out? If you are traveling with more than one animal, do they all get along? If you have enough time, acclimating or counterconditioning your pets to their travel carriers and to the car is highly recommended. Also, speaking with your veterinarian or having a consultation with a veterinary behaviorist about whether or not anti-anxiety and/or anti-nausea drugs might be helpful in easing the stress of travel may be helpful.
Next you need to consider your route and the weather – is it very hot or very cold during your travel days? Does your vehicle have air conditioning to keep the interior of your car cool and comfortable enough for your animals? Are there any road conditions or traffic that you expect might prolong your travel time? Do you have all the supplies your pets will need? You should always bring at least a few days more than you think you will need. Do you have a basic first aid kit to deal with any minor ailments or injuries on the road? Are there veterinary facilities in the towns you are passing through?
Most towns with hotels these days have at least some accommodations that are pet friendly. However, every pet friendly hotel has different rules which may include what kind or how many animals they allow, fees associated with your pet staying with you (deposits, additional per pet room fees, cleaning fees, etc.), and rules about animals being left unsupervised in the room. Some may have changed their rules but may not yet have updated their website. When traveling with animals, it is always best to plan ahead, map out your overnight stops, and call ahead to confirm that the place you want to stay is still pet friendly and that your pets are allowed. It is best to make reservations instead of risking needing to drive on later than you anticipated or having to sleep in your car in an unfamiliar place.
Thankfully, my most recent move went swimmingly. One of my dogs is the ultimate couch potato in the car and slept most of the time we were on the road. The other one has a love of gazing out the windows and would lay down whenever he needed a break. The cats are on friendly terms and they were kenneled in a large wire crate together. While I cannot say they were happy about traveling, with a combination of some anti-nausea meds and a light sedative, neither of them got carsick and they only occasionally scolded me for taking them away from the home they had known.
We drove along major interstates, took frequent breaks at rest stops with pet elimination areas and we stayed at pet friendly hotels that I had chosen and called ahead for each day. While I love road-tripping, I viewed this trip as a means of getting my animals from Home A to Home B as efficiently and free of stress as possible, so I drove as far as was reasonably safe every day but we did not take any side trips or detours. At each overnight stop, the cats were free to roam the hotel room and the dogs and I took a much needed walk to stretch all of our legs.
While every animal will respond to the stress of travel differently, you can help to minimize your pet’s and your stress by getting to know them, doing some basic training / acclimation, checking in with your vet for health certificates or a medication regimen, and planning your trip with them in mind. My herd and I are glad to be settling in Portland and we do not plan on any long trips any time soon, although we are old hands at it by now! Best of luck to all of you out there planning to hit the road with your furry companions. Safe travels!
One of the most common orthopedic injuries affecting dogs today is canine cranial cruciate ligament disease. The cranial cruciate ligament (CCL) in a dog is equivalent to the ACL (anterior cruciate ligament) in people. The CCL is one of the major stabilizers of the canine knee – it’s main job is to prevent front to back motion of the tibia (shin bone) in relation to the femur (thigh bone). Rupture of the CCL results in an unstable and painful joint which causes your dog to limp. Also, approximately 50-60% of dogs with complete CCL tears will have medial meniscal tears which can increase the pain associated with this injury.
While we don’t know exactly why so many dogs tear their CCL, we do know that CCL disease is considered to be a degenerative process - once begun, it will typically progress over time. If your dog is diagnosed with a CCL injury, your vet and most veterinary surgeons (myself included) will recommend surgery to stabilize the knee. Which exact procedure is recommended for your pet will depend on your goals, your pet’s specific anatomy, and which procedures your surgeon is most comfortable performing. Surgery allows us to evaluate the joint, to remove any torn portions of meniscus (if it is injured), and to stabilize the joint. It is the quickest way that we know how to get dogs and cats back to as close to normal as possible after a CCL injury.
ACL tears in people who are not pro-athletes are often treated non-surgically (bracing, rest, physical therapy) and so one of the most common questions I get is “Do I have to do surgery?”
The short answer to the question is no – surgery for CCL tears is highly recommended but not required. Your pet can live with a torn CCL. However, surgery will significantly help your pet slow the progression of arthritis in their knee, and decrease the likelihood of them having a lifelong lameness.
Cece, a dog we recently evaluated for the Willamette Humane Society (WHS), is the perfect example of what happens when CCL tears go untreated. Cece is an adult pit bull and was noted to have an abnormal hindlimb gait when she was surrendered to WHS. The medical staff at WHS wanted to see if surgery would be an option for Cece and brought her to Sunstone for an orthopedic evaluation.
Cece is a happy, friendly girl and can walk on all four of her legs, but she stands and walks with her weight shifted towards her front legs, limps on both hindlimbs and is bow-legged and partially squatting because she has suffered bilateral CCL tears. Based on her physical exam and x-rays, we know that Cece’s CCL tears happened multiple months to, possibly, years ago. Both of her knees are thick with scar tissue and bone spurs from severe progressive arthritis – a natural consequence of her body trying to stabilize her knees. She has a funny posture and gait and her knees are a little creaky and occasionally sore, but she is able to get up and about and to run and play. Is surgery an option? Yes. Would surgery have helped when she was originally injured? Absolutely. Would surgery help her significantly now? I’m not sure. With the amount of arthritis and secondary change to her knees, it is hard to say how much benefit she would get from the traditional surgical procedures we use to stabilize the knees after CCL injury. After further discussion with her care team, we decided Cece would be best off with some concerted efforts in medical management for her arthritic knees rather than surgery at this time.
In general, for small dogs (less than 10-15 lbs) with CCL tears, I give them an approximately 50% prognosis for being able to develop enough scar tissue and arthritis to have a fairly function knee. In larger dogs (more than 40 lbs) that number drops to about 20% or lower. For patients that are not good surgical or anesthetic candidates, medical management or bracing and medical management may be the right choice. All dogs are capable of making scar tissue around their knees and making some improvements on their own, but how well they do is really variable from dog to dog. Most dogs with CCL tears will do much better if we are able to surgically stabilize them sooner rather than later.
If your family vet suspects or has diagnosed your dog with a CCL tear, Dr. Su would be happy to meet with you, to examine your pet, and to discuss your treatment options with you! Our goal at Sunstone Vets is to find the treatment that best fits your pet’s and your family’s needs.
*Sunstone is thrilled to hear that since her visit, Cece has found her forever home! We wish Cece and her family all the best!*
When your dog or cat has a serious medical problem or is facing a big procedure, knowing what to do or how to deal with it can be sometimes be stressful and overwhelming.
Having practiced veterinary medicine for over 11 years, I have a clear vision for the best ways to help my patients and their people but when it comes time to make big decisions for my own animals, my training goes out the window. I can be just as worried and emotional about the decisions I am making for my own animals as my clients are when considering a big surgical procedure for theirs. This is precisely the reason why any time I have concerns about one of my animals, I rely on the advice and expertise of my trusted colleagues – my pets need me to be their mom, not their doctor.
Here at Sunstone Vets we firmly believe that our pets are the family we choose. As pet owners and animal lovers ourselves, we know what it is like to be in your shoes. Your family veterinarian may have referred you to us for a second opinion or for advanced care they do not provide. We are on your side, a part of your pet’s care team, and we are here to help you understand what is happening with your pet. We want to work with you and your family veterinarian to find the best way forward for you, your animals, and your family.
Making decisions as to how to treat will depend on your pet, their diagnosis and prognosis, your goals for treatment and what treatment options are available, your finances, and your ability to manage ongoing care. As veterinarians, we want to help you make the right decision for your pet and your situation.
The best way to partner with your veterinarian, with us, is to be honest – communicate openly about what you are hoping to achieve, what resources you are able or willing to invest, and whether or not caring for your animal and their current condition is feasible given your schedule and lifestyle.
We will also be honest with you about your pet’s disease process, their prognosis, our expectations for what might happen with each of the options we present to you, how much it will cost, and how much on-going care will be required. We will also honestly support you in making the best decision for your pet and your family – whatever that decision may be. Our goal is to be your partner in maintaining your pet’s health and quality of life, trust us to provide guidance and to support you through the care your pet needs.
Just like people, dogs and cats can suffer from arthritis. Arthritis is any condition that results in inflammation within a joint. Joint inflammation typically causes progressive irritation and thickening of the joint lining, bone spur formation, and erosion of the cartilage surfaces. These things result in joint pain which leads to decreased range of motion and decreased function.
Most commonly in dogs and cats, osteoarthritis develops as the result of injury to, instability of, or disease within the joint. If we can identify a specific cause of osteoarthritis, we may have surgical treatment options that could improve comfort and function of the joint and slow the worsening of the arthritis. However, once arthritis has started, it cannot be reversed and requires lifelong medical management to maximize your pet’s quality of life.
The components to the medical management of osteoarthritis include:
(1) Keeping your pet at a lean body weight. It has been repeatedly proven that in animals (and people!) that being overweight will increase the likelihood and speed of progression of a variety of diseases, including arthritis. Keeping your pet lean (or weight loss if they are overweight) will help to reduce the stress on their joints.
(2) Maintaining moderate levels of low-impact exercise. Too little activity can lead to stiff, painful joints and loss of muscle while too much activity can lead to injury – finding the right balance is the key to maximizing strength and mobility while limiting stress or strain on arthritic joints. Walking and swimming are great ways to exercise arthritic pets!
(3) Medications to manage symptoms. Typically, this means starting with a non-steroidal anti-inflammatory drug (NSAID) – there are many NSAID formulations that are designed specifically for dogs and cats. NSAIDs are commonly used to decrease the discomfort associated with arthritic joints. They are usually a safe starting point when it comes to trying to improve joint comfort but like any drug, they can have side effects and should only be given when prescribed by a veterinarian. [Most NSAIDs you can find in human drug stores are dangerous for your dog or cat. Please do not give any over the counter medications unless specifically directed to do so by your vet.]
(4) Joint supplements. Glucosamine, chondroitin sulfate, omega-3 fatty acids (fish oil), avocado soy unsaponifiables (ASU) and many others are used either by themselves or in any number of combinations to make both veterinary and human formulated nutraceutical supplements. Some (omega-3 fatty acids, ASUs) have good evidence that they help decrease symptoms or slow the clinical progression of osteoarthritis. Others have anecdotal evidence of helping to decrease pain associated with arthritis and have at least been proven to not worsen arthritis. In addition to oral supplements, your dog or cat may benefit from an injectable supplement (i.e. Adequan). For recommendations, please ask your vet.
(5) Regenerative medicine therapies. Use of stem cells, platelets, and other specialized protein products is one of the fastest growing areas of medicine. There is some data supporting the use of stem cells and platelet products for decreasing pain and slowing the progression of arthritis and these therapies can be applied to pets as well. Platelet and stem cell therapy is available at Sunstone.
If you have a dog or cat who is limping or slowing down or stiff from what you suspect is arthritis and you would like to have them evaluated or you would like to explore options for making them more comfortable, please feel free to schedule an appointment with Dr. Su. Appointments are available Monday – Thursday, 8am-6pm.
Katie was born and raised in Portland and attended the University of Oregon where she obtained a Bachelor's degree in Psychology. After graduation and moving back to Portland, Katie was unsure of the next steps for her career and future. She took a part time job as a receptionist for a local veterinary clinic, which then led her to a position as a veterinary assistant at a feline shelter. Through her experiences working with the stray and abandoned animals, Katie decided to further her education and pursue a career in veterinary medicine.
In 2009 Katie graduated from the PCC Veterinary Technology program and has never looked back! She loves helping the animals (and their people) through challenging times and takes a special interest in animal behavior in order to help reduce the stressors that come along with veterinary visits. Katie also loves the life-long learning that is made possible through a career in the medical field and is very excited to be joining the Team at SunStoneVets!
During her 'down time' Katie enjoys spending time with her friends and family (both two-legged and four-legged), reading, hiking, camping, bowling, and running in obstacle course events. She also relishes a nice Fall or Winter weekend of doing nothing but lounging at home, enjoying the rain, napping, snuggling her furry babies and binge watching a new TV show! Katie shares her home with her husband, four cats and a tenacious Cattle Dog mix.
Spring has sprung in Portland! With warmer temperatures and longer days, many people and their pooches are taking the opportunity to get out for longer walks and more activities.
Most of our pets seem to have no problems going from laying on the couch to a romp through the woods or racing around at the dog park. However, if your dog doesn’t get much activity over the winter or if they tend to be pretty sedentary during the week, you may want to consider a gradual ramp up of their activity to build strength and endurance. Easing them into a more active lifestyle will allow their muscles, bones, tendons, ligaments, heart, and lungs to get stronger and more accustomed to doing more vigorous exercise.
Just like people, dogs that are out of shape can be more prone to injuries or health issues and most would benefit from a controlled conditioning period before engaging in athletic activities. Depending on your dog’s current level of activity and fitness, it might just take a few weeks or as long as several months to get them well-conditioned for vigorous activity.
If your dog is a total couch potato and gets very little exercise or if you are uncertain if your dog is healthy enough for a specific activity or sport, please have them evaluated by a veterinarian before beginning a new exercise program.
A pre-exercise evaluation would involve a complete history and physical exam to evaluate your dog’s general health status, listening to their heart and lungs to screen for obvious cardiovascular or respiratory disease, and a thorough orthopedic evaluation to make sure their bones and joints are comfortable and stable enough to take on the activity you have planned. Depending on your dog’s history, health status, and exam findings, your vet may recommend additional tests.
If you would like your dog evaluated before hitting the trails this spring or if you are looking for advice on how to safely increase your dog’s activity, please schedule an appointment with your Primary Care Veterinarian.
Gastroduodenoscopy or GI endoscopy is endoscopy of the stomach and small intestine. GI endoscopy is a minimally invasive procedure that allows direct visualization and biopsy of the stomach and descending duodenum (the upper intestinal tract). We pass a long camera in through the mouth, through the esophagus, pass through the stomach and in to the first foot or so of the intestine. The intestines are extremely long, even in a small dog or cat, so the full length of the intestine is not visualized. GI endoscopy is only recommended in patients that have had previous testing that indicates that the diseases in question are likely to be found in these areas. Pinch biopsies can be taken in either of these tissues to evaluate the mucosa and submucosa.
There are four layers to the intestinal thickness. If one visualizes the intestine as a tube, the four layers of the tube thickness are made up from “inside” the tube to “outside” the tube by the mucosa, sub-mucosa, muscularis and serosa. The mucosa and submucosa are the layers of the intestine that are primarily involved in digestion, absorption and redistribution of nutrients. The majority of the immune monitoring of the intestinal tract is also found in these layers. Biopsies of these layers usually give our diagnosis. The muscularis layer is comprised of smooth muscles that allow contraction and relaxation for “movement” of intestinal content. The serosa is an extremely thin layer of cells that works as a wrapping or surface separation from the other abdominal organs.
GI endoscopy is usually looking for microscopic diseases that invade the mucosa and sub-mucosal layers. Initial diagnostics lead to the recommendation of GI endoscopy. This is not a test that we perform without strong supporting evidence.
GI endoscopy can be performed with rapid anesthetic recovery and patients may be discharged to their owners care, within a few hours of anesthesia. Endoscopy has a significantly reduced impact to the body of our patients. Endoscopy is performed in an effort to avoid surgery. GI endoscopy takes advantage of the mouth and throat to be able to see and take samples from tissues that are otherwise inaccessible.
Recovery of foreign objects from the stomach can be both frustrating and rewarding. Some objects are unsafe to retrieve via endoscopy (e.g. sharp objects that may further damage the esophagus with retrieval). Any patient with a gastric foreign body can be evaluated for possible endoscopic retrieval. There needs to be clear evidence of foreign material in the stomach or throat. If this is the case, some of the other initial testing (related to primary microscopic intestinal disease) becomes unnecessary. Foreign objects in the intestine cannot be removed safely with GI endoscopy. We need to be sure that anything we remove is not attached to the stomach/intestinal tissue and this is not possible for anything that has passed in to the intestine.
Foreign bodies of the esophagus or throat are a serious emergency since they often cause severe damage to the esophagus in a short period of time (hours to days) and their clinical signs (symptoms) are virtually identical to a gastric foreign body. Persistent/severe retching, uncontrolled vomiting, unable to swallow even saliva, coughing, etc., should be evaluated by a veterinarian promptly.
Appropriate case selection and pre-anesthetic work up are vital to the success or failure of endoscopic procedures.
Diabetes mellitus is a common disease process of dogs and cats. Diabetes is defined by insulin deficiency and/or insulin resistance leading to elevated blood sugar
values. Increased sugar in the urine leads to frequent urination and patients drink more to stay hydrated. Because sugar is staying in the blood stream and not being delivered to body cells by
insulin (as it is supposed to be) these pets are functionally starving. They have ravenous appetites and despite eating large volumes they lose weight rapidly.
There are several notable differences between dogs and cats with diabetes mellitus. Dogs become obligated to insulin therapy at the time of diagnosis. Diet is important in supporting blood sugar management but they almost always need lifelong injectable insulin therapy. In contrast, a fair percentage of cats will become regulated with diet alone. This is because often times cats are still producing some insulin and are somewhat insulin resistant. Effective diet therapy can “over come” this insulin resistance and restore normal blood sugar and metabolism. This resolution of diabetes can sometime last years, but some of these cats will ultimately need supplemental insulin injections.
With appropriate insulin therapy dogs and cats can have a complete life span with diabetes mellitus. Consistent and well managed care helps maintain this as good quality of life. Most veterinarians can establish good diabetic management within a few months of diagnosis.
Occasionally patients have complicating factors that cause poor regulation of diabetes mellitus. Common causes of poor regulation include urinary tract infections, pancreatitis and cancers. If the underlying cause (a bladder infection for example) can be identified and treated, then it will not cause long term impact to the diabetes mellitus. However, some chronic diseases like Cushing’s syndrome, hyperlipidemia (high cholesterol and high triglycerides) and some benign tumors will cause hormone secretions that actually block insulin function.
I generally see diabetic patients with chronic or complicating disease processes. Often times the cause of insulin resistance is not clear. If I can make a secondary diagnosis and try to minimize the impact of this disease, diabetic management can improve significantly.
Many of the diabetic patients I manage seem like I am trying to “hit a moving target.” For these patients perfect diabetic control is not realistic but I can often improve their quality of life and work to minimize the long term impact of poorly regulated diabetes.
Patients with uncontrolled/unmanaged diabetes mellitus can develop a syndrome called diabetic ketoacidosis. This is a life threatening emergency that requires immediate veterinary attention. Patients with diabetic ketoacidosis are sick. If your diabetic dog or cat is feeling sick, it is always a good idea to have them evaluated by a veterinarian.
If you are managing a patient with complicated diabetes mellitus and things are not going as well as you would like, please call to speak with Dr. Elliott. I am always happy when I can make a difference in a patients quality of life.
SunStone Vets would like to send a huge thank you to Dr. Patti Van De Coevering of Guide Dogs For The Blind. Last week she invited Dr. Elliott and his technician Katie to come out and tour their amazing facility in Boring, Oregon. We learned a ton about this wonderful non-profit group and met some fabulous four legged friends too! We are so very impressed by the work that Guide Dogs for the Blind does and hope to be of service to them in any way we can.
Last week Dr. Joshua Elliott of SunStone Vets gave a continuing education lecture at Der Rheinlander restaurant in Portland, OR. It was called “Around the Glands in 50 minutes” and was geared towards being a practical review of endocrine disease. He shared his “pearls of wisdom” regarding topics such as diabetes, thyroid disease, Cushing’s and Addison’s disease, calcium disorders and more. We are very grateful to all those that attended and participated including Dr. Lambert of Broadway Veterinary Clinic who won a night at the pet friendly Adrift Hotel in Long Beach, WA! Congratulations Dr. Lambert!! We would also like to thank Dechra Pharmaceuticals and MWI Veterinary Supply for generously sponsoring this event. We hope to see you all at future CE events!
I wanted to take a moment to thank the owners of SunStone Vets, Dr. Joshua Elliott and Marie Xavier for making Vet Tech Week truly special for the staff at SunStone. Being appreciated by your employer is such a wonderful feeling and is one of the many reasons I am so happy to be working here! Every day of Vet Tech week they made sure to do something special for me and the other veterinary professionals we work with. One day they took myself, our receptionist, a Portland Cardiology technician, and our local IDEXX representative out to a delicious lunch at the food carts on Belmont. They presented me with a heartfelt card expressing their gratitude for my work as well as a very thoughtful gift. Every day that week we had some sort of yummy treat, including chocolate chip cookies that Dr. Elliott baked himself for us. They even delivered delicious cupcakes to fellow veterinary staff at a local clinic. Josh and Marie know that ALL members of the veterinary team, from receptionists to assistants to technicians to laboratory professionals and more, are VITAL to providing our clients and patients with the level of care that we do. In a field that is often demanding, it is nice to know that your hard work is appreciated. Thank you SunStone Vets for making Veterinary Technician Week truly special!--Katie LVT
WELCOME ALICIA !
We are very excited to announce the addition of another Sunstone family member, Alicia Doubrava! Alicia is a Certified Veterinary Technician who will be working in our Surgery Department. She has been in the veterinary field for 11 years and has been working as a CVT for the past 7 years at a busy veterinary practice in Canby, OR. She and Katie, our Internal Medicine technician, went to school together at the Portland Community College Veterinary Technician program. Alicia is an accomplished technician with a passion for animals and the people that love them. We are so very excited to have her join our team! Welcome Alicia!
Winston's MPL - stabilizing the knee cap
Winston came to us for a second opinion surgical evaluation. He had been limping on his right hind leg for about a month and had been diagnosed with bilateral medial patellar luxations (dislocating kneecaps) and a possible cranial cruciate ligament (ACL) rupture by his family veterinarian. After a complete orthopedic exam, we agreed with Winston’s previous evaluations – his right kneecap dislocated as he walked, his left kneecap could be dislocated but wasn’t currently causing a problem, and he had some signs compatible with a possible cranial cruciate ligament injury but his knee was not unstable enough to suspect a full tear.
Based on those findings and Winston’s lameness, we recommended surgery to evaluate his right knee, to surgically stabilize his patella, and to surgically stabilize his right knee if his cranial cruciate ligament was torn. We discussed all the options with Winston’s family and they decided to proceed with surgery at Sunstone Vets. At surgery, we found some good news – Winston’s ACL was intact and looked very healthy! However, Winston still needed surgery to stabilize his kneecap.
Looking inside Winston’s knee, it was easy to see why he had been so sore. With his kneecap constantly slipping out of place, Winston had worn a pea-sized divot in the cartilage surface of his kneecap. To stabilize the kneecap we used a combination of 4 procedures: (1) we deepened the groove where the kneecap was supposed to be living to make it more difficult to slip out of joint, (2) we moved the insertion point of the patellar tendon to re-align the patella, (3) we released tissues along the inside of the knee to allow the kneecap to sit more centered at the knee, and (4) we tightened the tissues along the outside of the knee to help hold the patella in the correct position.
While this combination of procedures will stabilize most patella luxations, occasionally dogs have significant angulation to their hindlimbs and may require additional corrective procedures to fix their limb alignment.
At his most recent check-up with his family vet, Winston’s incision was all healed up and he was walking well for this stage after surgery. We will continue to follow his progress and support Winston on the road to recovery! Our goal at Sunstone Vets is to provide exceptional care, service, and communication. We work with your family vet to provide specialty care with your pet’s well-being as our first priority. Dr. Su is available for referral consultations for all types of surgery Monday – Thursday 8am-6pm.