Tiffany Hills Animal Hospital

Dog

Surgical Suite at our Animal Hospital

Tiffany Hills Animal Hospital has an up-to-date surgical suite, and the equipment to handle most routine procedures. For complicated surgeries, Dr. Fortney believes your pet should be in the hands of a specialist like a Board Certified Surgeon. We are lucky in Kansas City because we have two specialty practices that have the experience to handle these difficult cases. Blue Pearl Veterinary Specialty and Emergency and VCA Mission Med Vet both have outstanding board certified specialist.

Let’s look at the elements of our surgical suite:

Preparation wet table where the pet is anesthetized and prepared for surgery. To give you an idea of the expense involved, this table cost about $2000.

The Anesthetic machine utilizes an oxygen delivery system, CO2 scrubbing system, and an anesthetic gas vaporizer, usually Isoflurane and/or Sevoflurane. We have both types of vaporizers because each has specific advantages over the other. The expense for an anesthetic machine is $4000.

The surgical table needs to be flexible for positioning as well as heated to prevent hypothermia during surgery. This type of surgical table cost $3000.

Surgical lights illuminate the surgical area so the surgeon can discern the surgical site better. Surgical lights usually come in a pair, costing about $2500. There is also one surgical light over the preparation wet table.

Surgical instruments are needed to perform the surgery and depending on the surgery there are different instruments needed. There is always a general surgery pack for opening and closing the site, then there may be special instruments needed for the actual surgery; orthopedic, ophthalmic, or soft tissue. The total cost of instruments can be about $2000.

Before we can begin our surgery, we have to make sure the instruments are sterile. Most sterilization is done with an autoclave. Steam and pressure insures that no contamination will occur during surgery. Autoclaves are expensive, with a cost of $3000.

During surgery the patient’s vital signs need to be monitored. We have a monitor that incorporates a pulse oximeter, electrocardiogram, and blood pressure. This instrument cost about $2500.

Many patients need supportive care during surgery and recovery. We may put an intravenous catheter and run fluids to insure blood pressure and vital organs have good perfusion. The least costly piece of equipment, about $200.

Then there is all the disposable items used during surgery, gauze sponges, bandages, sterile gloves, gowns, drapes, suture material, iv fluids, and surgery masks.

Once the surgery is completed and appropriate pain medications have been administered, there are the recovery kennels. An array of kennels can cost $12,000.

So we have safely prepared the patient, preformed surgery, and had an uneventful recovery, now we can discharge the patient. All in all, the investment for the above equipment is about $31,000. That does not include the cost of the building, technicians, or doctor’s time. There can be no compromise on using the above equipment; to do so would increase the risks and outcomes.

When you look at the virtual tour on the web site, see if you can spot all the equipment mentioned above.

 

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Pet Food, Part 3: Special Cases

This will discuss the special cases that take the above information and tweak it. There are circumstances like age and diseases that warrant changes in the pet’s diet. There are tombs of books on the different diseases of the pet; my intent is to make suggestions once the diagnosis is obtained.

The first circumstance I mentioned is age. I have already covered juvenile, adult, and senior pets, but I want to mention one subcategory of juvenile pets, the little tiny puppies and kittens that lost their mother. These orphans need to be fed, but the obstacle is finding something they will eat. Kittens and puppies less than 4 weeks will probably need to be bottled fed. There are several good milk replacers on the market and baby bottles. The trick is having the hole of the nipple be big enough for suckling, with a little encouragement from the bottle holder. The second trick is feeding numerous times (5-6) in a 24-hour period. The third trick is to get the orphan on canned puppy/kitten food as soon as possible. This is usually accomplished starting at 4 weeks of age.

There is one more young pet consideration. I have seen numerous small breed puppies come into my exam room, just obtained and are skinny. Almost always the problem is, they are being fed dry puppy food and do not have any idea how to eat. Usually it is a multi-fold problem: improper weaning and wrong form of food. The solution is usually simple, canned puppy food. Warning, do not put your finger with a dollop of food in front of the puppy, they will bite it trying to get to the food. The canned puppy food is temporary. After several weeks to one month, dry puppy food can be introduced slowly reducing the canned puppy food.

Some of the common diseases that I want to mention are: kidney, liver, pancreatitis, diabetes, bladder stones, feline lower urinary tract disease, and food allergies. This is not a dissertation on veterinary medicine, but some dietary suggestions. Always consult your veterinarian first.

Kidney disease usually requires diets that are low in sodium and low in protein. Kidney disease is usually monitored with blood pressure readings and blood parameters. Sodium retains water; too much sodium causes too much water retention. Look at your feet the next day after eating a bunch of salty snacks. Too much water retention causes high blood pressure. So this compounds the hypertension already caused by the kidney disease. One of the blood parameters is blood urea nitrogen (BUN) and kidney disease usually has high BUN. Urea comes from protein metabolism. So if the patient is fed a high-protein meal, this increases the urea level. A high BUN level makes the patient feel worse, decreasing appetite and water consumption, ultimately making the kidney disease worse.

There are two general liver disease states that are treated differently with diet. Chronic liver failure requires a very high-quality diet, but again, restricted protein. High protein metabolism can cause elevated ammonia levels that affect the brain. Acute liver problems (normal liver but the organ has been insulted and enzymes are elevated) require a very high-quality, easily-digestible diet.

Pancreatitis is usually complicated by high fat content. Once the disease has been treated and the crisis is over, this condition responds very well with a low-fat diet. I personally prefer the low-fat, high-fiber diet. This disease is very controllable if the owner is very strict with the specific diet. Or conversely, relapses are very common if the owner is not strict. Chronic pancreatitis patients may end up with diabetes requiring insulin and/or digestive enzymes every meal so the pet can digest their food.

Diabetes mellitus is a disease in which the patient requires insulin supplementation. Consistency is the cornerstone for successful treatment. For dogs, the best diet seems to be a high-fiber diet. The fiber slowly releases the carbohydrates into the blood, therefore causing less glucose spikes. Cats on the other hand require more of a high-fat diet. Be very consistent with everything, because at some point your veterinarian is going to have to figure out why the blood sugars aren’t being controlled. The fewer variables you give your veterinarian, the easier it is to figure out.

Bladder infections in cats are a unique disease. Many variables like genetics, stress, diet, and sometimes bacterial infection all play a part. Again, I have found that a strict diet used for feline urinary disease not only treats the disease, but usually prevents re-occurrence. In dogs, there are other non-dietary predispositions that cause their bladder infections. Diets can help dogs a little, but not as well as diets can help cats. Bladder stones are another issue in dogs. Bladder stones can be dissolved with a very strict specific diet and can also be prevented with a very strict specific diet.

The last disease is food allergies. Food allergies are not that common; 4-10% of all allergies are food related. Food allergies are caused by the protein source in the food. It is very difficult to test for food allergies. There is no skin test or blood test that tests for food allergies. The only test is a food trial. Food trials must be conducted for 8–12 weeks and must be very strict. With a little guidance, is does not have to a hit or miss type of proposition. Hydrolyzed protein diets are very good at proving if a pet has food allergies, again, over a strict trial period of 8-12 weeks. The hard part is finding a diet the food allergic pet can eat. Again, with a little guidance from your veterinarian, there are numerous choices.

Nutrition directly impacts the health of your pet – whether normal feeding or using special diets for special cases, whether treating for, or preventing, disease. Please consult with your veterinarian about what is best to feed your pet.


Pet Food, Part 2: Feeding Pets

Last blog I talked about pet food in general, our goals are to feed our pets a safe and balanced diet. But, I always get the question, “How much?” I wish the answer was as simple as follow the guidelines on the bag; unfortunately that is not the case. There are so many unique circumstances for each pet, which all contribute to equation: age, size, activity, gender. So how could there be a “one-size-fits-all” answer?

The first determination is the age of the pet. Pets that are less than six months old need twice the calories, a third more protein, twice the vitamins and minerals than adults. Fortunately, pet foods come in juvenile choices. Puppies and kittens have this tremendous metabolic need because of daily activities and growing phases. It is very common for puppies to eat 2-3 times a day and kittens all day. So how much do we feed puppies and kittens? All they want! Slowly increase the amounts with each meal if they are tearing through the meal in seconds. As they get older approaching 6-9 months of age, you might see a skipped meal occasionally. It is not due to boredom. Pets eat when they are hungry, and don’t eat when they are not. At this time there is less growing, therefore, less metabolic need, therefore, less appetite.

Adult pets usually require diets that fulfill the daily needs of living. So, we chose an adult food that is less intense than juvenile diets. Most adult pets will only eat if they are hungry. Therefore, an occasional missed meal may be common. However that theory goes out the window with special circumstances. Multiple pets create competitive eating and hoarding. Hunger is not the driving force for this behavior. The owner must feed separate, don’t leave bowls down for free access, and serve measured portions. Measured portions can be adjusted to maintain optimum weight. Another circumstance, some pets like to eat. They are always hungry and never satisfied. Use measured amounts to maintain optimum weight.

Senior pets, usually between seven and ten years of age, have their unique needs. Senior pets are usually less active, therefore, need fewer calories. Because of the inactivity, they need more fiber to help with bowel elimination. Healing and immune system are not working as well, so most senior diets increase vitamins and minerals. Kidney function can start to falter, so less salt and protein are usually incorporated in senior diets. Some diets may add joint supplements like glucosamine and chondrotin. The surprising point is how little senior pets need to eat to maintain optimum health and weight.

Another consideration is activity of the pet. Most pets adapt to the life style of the owner. Running, hunting, Iditarod dog sled racing, sleeping, and lounging all require different amounts of calories. As mentioned above, most dogs eat when hungry. An active pet will have a bigger need requiring more calories, therefore eat more food. FYI, the food source that has the most calories is fats. Long chain fatty acids have more carbon/hydrogen bonds than the six carbon sugar. The mushers use concentrated fats to fuel their sled dogs. Protein is a horrible energy source because the amino acid is broken down into sugar and ammonia. Ammonia is toxic to the body and is converted to urea and excreted out the kidney.

Gender usually does not play an important part, unless the female is pregnant. Then she has a huge metabolic demand called embryos and babies. There is a lot of growing that will take place over the 16 weeks from conception to weaning all at the expense of the mother. We usually recommend feeding the mother juvenile food starting mid-pregnancy and continue through lactation. Even then, she will lose weight and have a dull hair coat once all the puppies have gone.

The goal when feeding is optimum health and weight. Whatever amount of food it takes to accomplish that outcome is the right amount for your pet. And I promise you it will be different from: the bag instructions, your Aunt’s pet’s eating style, and the recommendations of the clerk at the pet store.

My next blog on food will be: Special Circumstances


Pet Food, Part 1: So Many Choices

There are so many choices of pet food and there are so many opinions about pet food. A pet owner is paralyzed trying to decide what to feed their pet. I have some basic points to help with the decision. So let’s first concentrate on the pet’s side of the equation.

The simplest choice is to feed food made specifically for your species of pet. Dogs eat dog food, cats eat cat food and people eat people food. If you own a rhinoceros feed what rhinoceri eat. These diets are formulated by nutritionists that have studied for years the nutritional requirements for animals.

The next simple choice is safety. This is why I do not like raw diets. However, we have seen just about every manufacturer deal with tainted food products and recalls. No company can cast a stone and say they have not had issues with their products. But safety includes the product at home. Keeping food too long will cause rancidity and spoilage. Temperature and humidity will affect the diet’s quality. An opened can of pet food in a refrigerator will grow mold.

Marketing, marketing, marketing makes us all make choices. People love variety in their lives. Consistency in our daily living would “bore” us to death. Leftovers gag us, reruns on TV bore us, mono-themed cloths would embarrass us. We tease people that live that way. So it is natural for us to want the same with our pets. We are inundated with pictures of pet food that look like our meals. Colors of orange and greens and shapes of beef steak and fish all to look like something we would eat. Words are on cans and bags reading like fine restaurant menus. So the question is, ”What’s wrong with this picture?” Your pet is color blind, so all the colors look gray. Your pet has no idea what any of the ingredients are like: beef, peas, carrots, sweet potato, rice, or chicken. Pets have no idea what vitamins and minerals are. Ask your pet, ”Chippy, what are the essential amino acids and fatty acids?” All Chippy does is cocks his head to one side and wags his tale because he heard the word, “Chippy.” Everything is marketed to the owner, not the pet.

I have to diverge a little now and talk about dogs first. What do they like to eat? I know they like any type of poop, and sometimes other dog’s poop. I know they like rotten stinking carcasses, garden mulch, garbage, tomatoes off and on the vine, most insects, anything I am eating, and most dog foods. So what about the finicky dog, who only wants to eat table food and different varieties of canned food? First I will admit that I have seen two dogs in my entire years in practice (I graduated in 1979!) that would have starved if the owner did not forcibly stuff food down the dog’s throat daily. Otherwise, all other dogs will be OK if they don’t eat occasionally. The wild canid only eats every third day. One day for hunting and gorging, the other two days devoted to what wild dogs do; chewing something up, playing with the other dogs, sleeping, barking at intruders, pooping, marking their territory, and/or making babies.

Dogs eat when they are hungry and don’t eat when they are not hungry or have a digestive problem that diminishes their appetite. Can you make a dog eat that is not hungry? Yes, if you entice it with something greasy and/or salty. The next time you are sitting at the Thanksgiving table, had your fill of turkey, potatoes, dressing, green bean casserole, and rolls and finally push your plate away because you can’t swallow another bite. Out comes the pumpkin pie with whip cream, yessiree you eat a piece.

Let’s talk cats now. They have different patterns of eating. Cats usually are more discriminate eaters than dogs. Dogs are scavengers: eat first, question later. Question later being vomiting or diarrhea if the scavenging resulted in something bad they have ingested. Cats will sniff and smell before eating. If the food does not pass the sniff test, they will walk away. Cats graze throughout the day taking small portions. Because of the grazing, a lot of pet owners think there cat is finicky because the entire dish was not devoured in one sitting. Out comes the smorgasbord of canned foods and dry foods only to be thrown away because the food was not eaten in a timely matter.

What do cats like? Instinctively, cats like smelly fish and fatty smelly meats. Not much on the vegetables, but they like new green grass. They like to catch rodents, snakes, and birds, but usually do not eat them. Cats are particular concerning the shapes and textures of their food. Those little dry food shapes are meant for nibbling corners. Canned food has a particular texture and shape to entice the cat to eat.

Marketing does not care about dogs and cats and their unique peculiarities, they want the product to appeal to you. Your inclinations of how you eat are manipulated into buying food for your pet. Vegetarians believe their pet would be healthier with a vegetarian diet. People afraid of gluten or any food allergies want their pet food devoid of gluten or any other allergy causing product. There are those that believe their pet is a carnivore and should eat an all meat diet. Those who believe big business pet food manufacturers dupe the pet owner and they want to feed either homemade diets or some small boutique diet.

Here is the good news. Most, if not all, the diets made are balanced, palatable, and safe. Most of the diets have met the nutritional needs for your pet. There is a watch dog group called AAFCO, Association of American Feed Control Officials. They are like UL. UL is a global independent safety science company. We all look for the UL label on electrical devices, assuring us that that device has been tested by an independent laboratory. So, look for the AAFCO initials on your pet’s food.

Part two will talk about feeding your pets.


What is All the Confusion with Vaccines? Part One

For the last several years, the veterinary and pet communities have been turned upside down with revelations about vaccinations and pets. I can assure you I have been studying, reading, and attending seminars on this very subject. So let’s look at the subject of vaccines and try to decipher what is best for our pets (yes, veterinarians have pets).

Cats showing up with vaccine related fibrosarcoma started the whole reevaluation of vaccines and vaccination schedules. Across the country cats were being diagnosed with cancerous growths where vaccines were given. These growths were very aggressive and life threatening. The incidence was 1 cat in 10,000 cats. Throw in the internet and panic ensued.

Up until then vaccines and vaccine schedules were dictated by the drug company’s research and development and labeling for the vaccine. All vaccines were labeled for 1 yr, so we gave boosters yearly. We worried if the patient was overdue, and if exposed to the viral diseases, that they would become sick. Years of vaccinated pets not getting sick and overdue pets getting sick dictated the rational. Reactions did happen with vaccines. Mainly veterinarians saw allergic type of reactions, hives, lethargy, swollen muzzles, vomiting, and/or diarrhea. These reactions were easily treated and easily prevented at the next vaccination. In my experience less than 1% of vaccinated dogs and less than .1% of the cats had a reaction.

So what have we learned?

1. The cats that got the fibrosarcoma were genetically prone. They were reacting to the adjuvant which is an additive in the vaccine.

2. Not all dogs and cats have the same risk. A strictly indoor pet using a litter box or papers has a less exposure rate than an indoor/outdoor pet. Pets under stressful circumstances (shelters, boarding/grooming facilities, show circuits) have a higher risk. Pets having close proximity to feral dogs or cats have a very high risk.

3. Geographical areas have their unique endemic viruses. Salmon Poisoning is endemic to Washington State, but not here in Missouri. Therefore, pets need to be protected for the diseases unique to their area.

4. Not all vaccines deliver what they promise. Ringworm vaccine was a failure. In the beginning bordetella vaccine was barely good for 3 months despite the year labeling. In the beginning Parvovirus vaccine was only good for 6 months. Now given time, a lot of the failures will be weeded out and the kinks in the other vaccines will be worked out.

5. Vaccines last longer than originally thought. Now we have 3yr canine distemper and feline distemper. We also have 3 yr rabies vaccines.

6. Vaccines can be triggers for autoimmune diseases. CAN Be, not will be. Autoimmune disease is a disease of one’s own immune system attacking normal tissue and causing damage.

In conclusion, know your pet’s risk and know your area’s potential diseases. Customize a vaccine plan to protect your pet and stick to it. It is the owner’s responsibility to maintain the conditions they and their veterinarian outline. You can’t say your cat is strictly indoors if the window and screen doors are open and feral cats are being fed outside. Or the dog is strictly indoors except for going to the groomers once a month.

Part 2 will cover titers and part 3 will cover puppies and kittens.


What is All the Confusion with Vaccines? Part Two

The pet’s immune system protects from diseases. The immune system is a very complicated system divided into two parts, cell mediated and humoral (blood) mediated. Each of these parts has many components working to protect our pets from getting diseases. There are parts of the immune system that react indiscriminately to a threat. Look at any abscess, the pus cells (white blood cells) are fighting the infection no matter what the bacteria causing it. And there are segments that are very specific to the threat. Vaccinate a pet against distemper and that segment of the immune system is primed for distemper only.

The pathogen (bacteria, parasite, or virus) can be fought at the exposure site, in the blood, and/or in a lymph node. Basically, the pathogen enters the host, certain cells release chemicals as a call to arms. The pathogen is tagged by either another cell and/or chemical (antibody) and presented for destruction or neutralization by another cell. Then certain times another cell is encoded with memory of this pathogen. Most memory is finite and some is lifetime.

A vaccine is an altered disease pathogen. A vaccine should not produce the illness if the pathogen has been altered correctly. So we get the benefit of protection without having to go through the disease.

Out of all this complicated immune system and all the cells interacting with each other, the only thing that can be measured are the antibodies in the blood. That measurement is called titer. A titer is a measurement for a specific antibody and specific disease. There is no other test that can measure all the cellular activity or the chemicals released to communicate between the cells, just the antibodies in the blood. There even is no test for antibodies that line mucous membranes like the nose, mouth, or gut. Therefore, most of the immune system that protects us is “invisible” to testing.

So what does titer testing tell us? That there are antibodies produced from some sort of exposure (natural or vaccine). As many immunologist and internist say “the numbers are meaningless.” There are no standards for what is protective and what is not. Vaccine companies do not use titers for testing their product, they use exposures. The vaccinated animal is exposed to the disease. Results are a simple “ got sick” or “did not get sick.”

So now what do we do?
​1. Testing for several diseases in more costly than vaccinations.
​2. As of right now, testing takes several days for the results.
​3. No standard for interpretation of the titers.
​4. Some diseases, the protection is local antibodies (IgA) which can’t be tested. Any intranasal vaccine stimulates the local immunity.

Pet owners want titers instead of vaccines. What is the best thing for the pet?
​1. A lot depends on the pet’s family medical history. Or, breed predilections if the family medical history is unknown.
2. Risk assessment and environment is important to consider.
3. Three year vaccines are safer.
4. I have witnessed overdue pets getting sick.
5. Puppies and kittens need a series of vaccinations (see Part Three).
6. If pet owners want titers, then they are falsely assuming their pet will be protected based solely on titers.


What is All the Confusion with Vaccines? Part Three

Puppies and kittens have unique set of circumstances that needs to be addressed so ultimately they will be protected. Puppies and kittens are born with a pure untainted immune system, no antibodies or memory cells. If they are exposed to disease, they get sick. So in order to protect newborns, an amazing phenomenon happens. The mother’s milk contains all of her antibodies. This first milk is called colostrum. The first 24hrs of nursing, the infant’s gut will absorb these large protein molecules directly into their blood stream. After 24hrs, the milk is digested. So, it is very important for newborn puppies and kittens to nurse the first 24hrs. It is also important the mother be current on her vaccines before breeding.

So what does this maternal immunity do? It protects the puppies and kitten from all the diseases the mother is protected against. But there are two catches, it is temporary and it cannot tell the difference between vaccine pathogen and the disease pathogen. These two “catches” dictates the puppy’s and kitten’s vaccine schedules.

Statistically, 95-99% of the 6 week old puppies and kittens that nursed are protected by the maternal antibodies. At 8 weeks of age about 80-90% of the puppies and kittens are still protected by the maternal antibodies. At 12 weeks of age 10% of the puppies and kittens are protected. And by 16 weeks of age the maternal antibodies are gone. Any attempt to vaccinate puppies less than 12 weeks of age has a chance the vaccine will be neutralized by the maternal antibodies and the puppy and kitten will get no benefit.

An immune system needs stimulation from at least two injections. The first vaccine starts the process and then 3-4 weeks later the second stimulates the memory response. Then each booster rekindles the memory cells.

So how do we vaccinate puppies and kittens? The vaccine schedule is made by using the statistics of the maternal antibodies. So any vaccine given 6 weeks or earlier did not hurt the puppy or kitten but did not help the puppy or kitten either. Most veterinarians start the vaccines at 8 weeks of age, give boosters at 12 weeks of age, and finish the series at 16 weeks of age. This is the least amount of shots that ultimately stimulates the puppy’s and kitten’s immune system for a full year. Whether the puppy gets a 100 vaccines or 3 leading up to 16 weeks of age, the outcome is still the same.

Boosters are given 1 year later. Evaluating the pet’s environment and exposure dictates what vaccines to give. This is also another good time to use 3 yrs vaccines.

Rabies vaccines are handled a little different. Each municipality dictates the vaccine schedule for puppies and kittens. Rabies vaccine can be given as young as 12 weeks of age. Dogs and cats are then revaccinated 1 year later. Again, the municipality will dictate whether 1 or 3 year vaccines will be recognized. Only licensed veterinarians can give rabies vaccine to be valid.