Friday, June 19, 2020

Zoe's Summer Adventure

Written by Dr. Gloria Ku

Every summer, I will see something that sticks in my mind and I feel I must share. One summer, years ago, it was Zoe: a sweet young Weimeraner, full of energy and curiosity. One day, shortly before I was going on vacation, she came to our office after swallowing a wooden skewer at a weekend gathering. In fact, her mother explained, she actually witnessed her swallow one skewer whole, and had pulled it out of her throat. The second time, however, the skewer was swallowed before it could be retrieved. Zoe appeared unaffected by this event, and for the next few days, although she was a bit quieter than normal, she ate and did her business as usual. Zoe's owners watched for evidence that she had passed the skewer, and when they didn't see anything after a few days, they decided to have her checked by us.

On physical exam, Zoe was bright, alert and happy. Her abdomen did not appear painful or distended. Her lungs were clear; she wasn't coughing. Her tonsils were not swollen and she seemed to act just fine. We took abdominal and chest xrays just to be sure we could not see evidence of an obstructive pattern, and none was found.

The next day, Zoe didn't eat her breakfast, which for our nearly 1year old pup was very unusual. She returned on our advice for a barium GI series, as to our knowledge she had still not passed the skewer or skewer pieces. After several hours documenting the passage of barium through her GI tract through a series of radiographs, we saw what appeared to be pieces of the skewer outlined by the adherent barium. After some deliberation, we decided to go in surgically the next day and remove the pieces in case they were having trouble passing on their own.
By morning Zoe had spiked a fever of 104.0 (normal for a dog is usually 100-102). This convinced us further that we ought to attempt an exploratory procedure as a skewer piece could have perforated through a bowel wall and caused infection to spread within the abdominal cavity. We started her on IV fluids to keep her well-hydrated, and intravenous antibiotics for any potential infection. At the time of surgery, we explored her GI tract from the stomach to the colon, and to our surprise, we found nothing that resembled the skewer pieces seen on the radiographs. We could only assume that the skewer pieces had either passed in her morning stool and we had missed them, or that they had softened and could not be felt through the intestinal wall. Either way, they were unlikely to cause a perforation at that point, so we closed her up and sent her home the next day.

A few days later, Zoe came back with a firm swelling on the side of her chest by her ribs that seemed to have appeared just after her surgery. At first we thought it might have been a bruise from lying on her side, but as it increased in size, it was clearly not that. It was far enough away from the surgery site not to be related, but oddly appeared just after that event. She was already on oral antibiotics post-operatively, and so we asked her owners to cool compress the site and continue her antibiotics.

Unfortunately, Zoe did not improve as we hoped. The swelling on her side continued to grow and within a few days it was about 6-7 inches wide. She remained active, appetite was good, passing normal stool, but also had developed a slight cough. We decided to radiograph her chest again to see if we could pinpoint the cause of her coughing, and identify any correlation with the swelling since they were concurrent. Oddly enough there was a very small amount of fluid in the chest cavity that had not been present a few days earlier. The swelling appeared to be outside the chest wall musculature. Armed with this new information, it seemed possible that Zoe had a migrating foxtail that was trying to exit on her side, a relatively common site for them to migrate out of the chest cavity. No evidence of skewer could be seen, and it was highly unlikely that a skewer piece would migrate like that, as they do not have the prongs that a foxtail has to pull it along.

That afternoon we anesthetized Zoe for the second time, and we drained the abscess forming on her side. As the fluid drained away, I could feel a slight protuberance at the center and decided to probe this site for a possible exiting foxtail. I clamped onto something firm, yet mobile, and to my surprise, out came an 8 inch segment of wooden skewer, completely intact and unharmed. The skewer must have migrated out of her esophagus, managed to miss penetrating any major blood vessels and exit between the last few ribs of her chest cavity!

Our very lucky, if not overly zealous dog, Zoe, managed to fight the remaining infection left in the wake of the migrating skewer after several different courses of antibiotics. Now she is back to being the happy little dog she was before, and I imagine skewers are no longer a summertime picnic option at her house!

Saturday, February 01, 2020

BECOMING A VETERINARIAN: Questions Answered by Dr. Brian Chen


What prerequisites during college did you focus on?
                
All veterinary schools require a strong foundation in the sciences (chemistry, biology, microbiology, etc) and some also require other classes related to economics and/or business management. I majored in Biotechnology, but you can major in anything you want as long as you complete the prerequisite courses prior to applying to veterinary school.

Did you gain any experience prior to applying to vet school?
                
I worked for a year as a veterinary assistant prior to attending vet school. Most applicants have 2-3 years of full time work experience prior to applying. Most programs only technically require a few hundred hours, but you really need 2-3,000 hours to be competitive.

Did you pursue further training?  Can you elaborate on what jobs are available in veterinary medicine for vet school graduates?
                
I personally did not pursue further training after veterinary school. There is the option to apply for an internship and residency, but admission to these programs is EXTREMELY competitive. There are still a wide range of careers available for those of us that do not choose to specialize. Most veterinarians tend to go into general practice after graduation, but there are also options in academia, government, and industry.

How did you begin your veterinary career?
                
I started my veterinary career working for a corporate owned practice. I stayed with this practice for about 5 years before transitioning to Hatton. My goal is to eventually become a practice owner.

What have you learned in your veterinary journey?

The relationship between clients and their pets is a very special bond and one that I am happy to help reinforce by keeping pets healthy. Each pet is an individual and requires individual care; there is rarely a ‘one size fits all’ way to treat pets and their illnesses.

What is this career like?
                
As a general practice doctor, every day is different. You never know what may walk through the door. Some days are very routine and mundane while others are extremely hectic. There is hardly ever a ‘boring’ day.

What skills are needed?
                
The most important skills that help me in day to day practice are empathy towards pets and their owners, an ability to multi-task, and critical thinking. For example: not everyone is able to afford thousands of dollars of care for their pets, and so I always try to offer a plan B and plan C if plan A is unrealistic.
  
What is the pay?
                
Despite popular opinion, veterinarians are one of the lowest paid professions in the medical field. Starting pay for a new graduate in small animal general practice in California is typically $60-80k a year. Most employers seem to offer benefits as well including PTO, health insurance, 401k, continuing education stipend.

What is the career outlook?
                
It seems that the career outlook in veterinary medicine is good. One source I read anticipated that there will be 18% job growth over the next 10 years.

What education is required?
                
A degree from a 4 year university as well as GRE scores. A GPA of at least 3.6 or higher to be competitive for admission. Veterinary school is another 4 years; the first 3 years are book work and labs while the last year is clinical (working with residents and clinicians in the hospital). Students must pass the national licensing exam (NAVLE), and some will also need to pass a state licensing exam (California included) prior to obtaining their veterinary license.
The cost of school varies, but most students have $150-300k in student loan debt when they graduate.

How do I know veterinary medicine in the right career for me?
                
I think the best way to answer this question would be to volunteer/work in a veterinary hospital/environment and see if you feel that this is something you could do for the rest of your life.

Can I apply to vet schools outside the United States?
                
There are veterinary schools in the Caribbean and New Zealand that you can apply to (without having to take any extra exams for licensing). Some will also apply to schools in Canada and Europe.

How competitive is vet school?
                
It can be as competitive as you make it. If you are trying to pursue an internship +/- residency then you’ll have to be at the top of your class (at least a 3.7 GPA!) and thus school may seem much more competitive to you than to someone who is planning on going into general practice.

Want to learn more about the veterinary application process, click the link below!

Tuesday, January 07, 2020

One Who Licks & Scratches

Written by Dr. Gloria Ku


"Missy" came in frequently to our clinic because we loved to see her, and also because she got allergy shots. It wasn't until we started the shots, that her non-stop scratching, rolling and rubbing slowed down. At times it flares up again, but for the most part, she was a much happier little Cocker Spaniel.

Missy would come in for the same problem again and again: she was itchy! I would look her over and find not one flea. I would comb through the fur carefully and find not one speck of dander or even a pimple. We tried oral antihistamines of varying size, shape and color, vitamins in various forms, diet changes, sprays, ointments, and still, she scratched and rubbed and rolled.

Now if any of you have ever lived with an itchy pet, you know exactly what Missy and her owners were going through. At night there is the constant thump, thump thumping of the leg as it reaches over to scratch the itch. The slurpy licks that go on as quietly as possible so as not to waken the wrath of the owner. The rubbing up against the blankets for some - any - amount of relief! And the horrible feeling one gets, that one's pet is terribly miserable.

Sacramento, like much of California, enjoys many types of beautiful flowering trees, shrubs, and plants that unfortunately contribute to high pollen and mold counts much of the year. Many people in Sacramento suffer from allergies, and so do their pets. While we sneeze and rub our eyes, they primarily scratch, bite, and chew on their skin. Inhalant allergies are probably the most common cause of what is known as pruritis (or better known as "itchiness") in our pets, second only to flea allergies. Food allergies can also cause itchiness, but this represents a much smaller percentage of cases. Many novel protein and carbohydrate sources in diets have been developed to address this problem, and prior to embarking on allergy shots, we usually do a trial elimination diet to see if this will help. If it works, the difference is remarkable, but unfortunately, only about 20% of the time will this result in a more comfortable pet.

Luckily, there are several new products that are very effective at controlling fleas, with minimal pesticide exposure and minimal effort on our part. The allergic dog or cat that doesn't have fleas, is a bit more challenging. Often antihistamines can alleviate much of the discomfort and are generally safe to use on a regular basis. We use many of the same antihistamines in animals that we use in people, but the dosages differ. Benadryl is one such antihistamine used in both dogs and people. We would start with approximately 1mg/lb. in dogs, or in Missy's case, a 25 mg adult capsule three times a day. We also tend to use them in combination with fatty acid vitamin supplements, which seem to improve our results.

Occasionally, as with people, antihistamines are not as effective alone, and periodic use of steroids or other anti-inflammatory agents may be helpful during severe flare-ups. Allergy testing and allergy shots are available for both cats and dogs, and are often very effective. They do require a fair amount of patience; however, as the goal is to desensitize the animal to the allergens over time.

In Missy's case, her shots take care of 90% of her itchiness. Occasionally she needs a topical spray, and she still takes her vitamin supplements, but overall, her comfort level, and therefore that of her people, is much improved!

If your pet is itchy, don't assume that this is normal grooming behavior for most pets. In Sacramento, it is often the result of allergies, but there are things that can be done to minimize the urge to scratch! If left untreated, allergies can also lead to secondary bacterial and/or yeast infections that can make the solution more difficult. In any case, please consult with you veterinarian if you have any questions about your itchy pet!

Monday, November 25, 2019

Toxic Foods: Did You Know?

Written by Dr. Gloria Ku

Grape FruitsGrapes and raisins could be potentially toxic to dogs, and probably cats as well. It is currently unknown what part of the grape causes renal failure, but some animals are particularly sensitive to ingestion of grapes and raisins, to the point that a small amount can lead to kidney failure in some susceptible animals. Not all dogs and cats are susceptible, but those that are can become very ill. Until more is known about this potential danger, it is best to avoid giving them to your pet in appreciable amount, and to be sure they are not available through refuse containers, countertops and well-meaning visitors.

Xylitol, a natural sugar alcohol that has recently been used in some sugar-free chewing gums, candies, and baked goods can be harmful to dogs as well. It is somewhat dose dependent, but can cause marked hypoglycemia (low blood sugar) and seizures in as short as 30 minutes.
 Chocolate pieces on aluminum foil
Chocolate contains theobromine which is toxic to dogs as well. Fortunately for most dogs, milk chocolate contains a relatively small amount of this product, whereas baking chocolate or dark chocolate, contain much larger amounts. Theobromine can cause heart arrhythmias, tachycardia (fast heart rate) and even seizures. It is somewhat dose dependent, but a small dog (such as a Chihuahua) would only need to eat an eighth of a bar of baking chocolate to ingest a potentially fatal dose. What makes chocolate so dangerous for most dogs is that they will often consume large amounts at once (having no fear of weight gain or acne to stop them!), and the added ingredients of fat and sugar in many chocolate products can also cause severe gastroenteritis.
Onions Beside Sliced OnionsAnd don't forget about onions. Onions (and garlic) contain a chemical which both dogs and cats are susceptible to that can cause severe anemia and blood in the urine. Whether or not onions are cooked does not necessarily lessen the toxic effect, and ingesting as little as 0.5% per kg body weight can be toxic. That translates to less than 1 tablespoon for a 5 lb. pet (e.g. Chihuahua), 1/4 cup for a 20 lb. pet, and 2/3 cup for a 60 lb. pet. Dogs and cats are likely to eat more if onions are cooked because they often carry the flavor of whatever they were cooked in as well. Kittens and cats seem especially susceptible to the toxic effects and can be affected by onion and garlic powders. The anemia can be profound and may even require a transfusion. The effects tend to be most pronounced 2-4 days after ingesting onions, and can be cumulative too (i.e. smaller amounts on a regular basis can also lead to toxic effects). Garlic is less likely to be consumed in larger quantities, but again, when used in cooking they can be ingested in larger amounts more readily.
The important thing to keep in mind is that not everything we eat is good for our pets, and often it is exactly the opposite. A covered garbage container, and extra care to put our food out of reach of our pets can do a lot for preventative health care. Remember, their keen sense of smell will lead them to it - every time!
Orange Tabby Cat Beside Fawn Short-coated Puppy

For more information about pets and toxic foods, plants and household products, please click this link:
Looking for a mobile app with a database on pet toxins?  Check out ASPCA's Animal Poison Control App!

Monday, October 28, 2019

Meet Our Team: Dr. Ku & Dr. Chen

Dr. Gloria Ku

What part of your work do you enjoy most?  
I enjoy the challenge of figuring out the best way to keep the pet as healthy as possible while meeting the goals of the owners and the reality of how we can make that all happen.  And of course, I enjoy seeing the pets do well and thrive with great care, no matter their age or issues!

What is the most exciting change you've seen in veterinary medicine?
The improvements in dental care and how we address dental issues has really been a big change from when I first started in practice 28 years ago.  So many dental issues are treated with more care for the patient’s comfort and recovery now.  Also, the accessibility and improvement in technology with abdominal ultrasound has been a great non-invasive diagnostic tool. This has made identifying internal medicine problems a lot easier from the patient’s perspective, and more straightforward from the client’s perspective.

What change(s) in veterinary medicine do you hope will occur in the next 50 years?
The cost of veterinary care is rising and the cost of running hospitals is getting really expensive as well.  Because each hospital has to have all of the expensive equipment needed to do lab work, take X-rays, do dental work and dental xrays, and a surgical suite, it makes more sense to have these procedures only at certain facilities, and routine office visits at doctor’s offices like the human model.  The drawback is that the patient has to potentially go to multiple or larger facilities and owners currently are used to only going to one. It’s costly to reproduce a full hospital without having bigger practices to justify the expense, so unfortunately something is going to have to change to keep costs from continuing to rise and squeeze out smaller practices.  I feel fortunate to have practiced at a time when we can still do most things under one roof. I suspect that will not continue into the next 50 years as the cost of care continues to rise, and we can, and want to, do more to optimize our patient’s care. 

What books are you reading now?  What book would you recommend?  
I enjoy reading a lot of different things.  Recently I’ve read and liked The Sixth Extinction, Americana, Becoming, and Crazy Rich Asians! ;)

What makes a good veterinarian?
A curiosity for how things work, patience, and a big heart with enough grounding to let our emotions thrive without consuming us. 



Dr. Brian Chen

What part of your work do you enjoy most?
I enjoy the fact that being a veterinarian at Hatton Veterinary Hospital allows me to meet and build relationships with my clients and patients. It is also extremely rewarding to see staff members develop and foster an interest in the veterinary profession.

What is the most exciting change you've seen in veterinary medicine?

The quality of medicine and quality of care we are able to offer our pets compared with even 5-10 years ago.

What changes in veterinary medicine do you hope will occur in the next 50 years?I hope that veterinary school will be more affordable for future generations (it costs over $300,000 for undergraduate and vet school studies).

What favorite musicians or songs would you include on your personal jukebox?Anything by Jason Mraz. Classic rock is a favorite genre as well.

What makes a good veterinarian?  
A good veterinarian must be able to show empathy for both their patients and clients. They should enjoy working in a fast paced environment and work well with others. And of course they have to enjoy playing with all the dogs and cats (and other pets) that come in to see us.


Saturday, September 21, 2019

Is it Mange or What??

Written by Dr. Gloria Ku

Mange is a scary word because it has connotations of disease, infestation, and being contagious!  So naturally, we all sort of recoil from the thought of it being an issue for our pets.  Turns out there are several types of mange.  The one that we can catch is called Sarcoptic Mange and is thankfully less common than Demodectic Mange.

Mange is caused by a mite, and most mites are associated with a specific species and do not cross over (i.e. cats get cat mites, dogs get dog mites, etc.).  Unfortunately Sarcoptic Mange can cross over, and that’s why we can get it too.  But luckily, it is far less common in our practice than Demodectic Mange. 

Demodex mites cause Demodectic Mange.  These mites are microscopic and live deeper in the skin below the surface, so they cannot be seen with the naked eye.  Cats have their own species of this mite, as do people. Most of the time, in cats and people, the mite is harmless and in relatively low numbers.  Dogs also have their own species of this mite (and therefore it is not contagious to people or cats). Most of the time it is also found naturally on your dog, in low numbers.   But sometimes it can lead to hair loss, secondary skin infections, and itchiness, particularly in young dogs with an immature immune system. 

A diagnosis is usually made with a technique called a skin scraping.  A small amount of the surface of the skin is disturbed with a blunt blade, and the material that is lifted is examined under a microscope.  The mite has a distinctive look and is not hard to find if present.

In young dogs, we  often will treat small lesions with a topical ointment, or if it is more widespread, we can use an oral medication like Bravecto or Nexgaurd for a few months to control the infection until the puppy’s own immune system can control the mite population and the secondary skin lesions resolve.  Some breeds seem to be more susceptible in general, such as Staffordshire Terriers, Staffordshire Bull Terriers, and Shar Pei dogs.   But it is important to realize that any dog can be affected, especially as a puppy.  In some cases, adult dogs may also have symptoms with Demodectic Mange and require treatment.  In these cases we will often look for other underlying causes for immunosuppression in case that is making the dog more susceptible, and try to treat that as well.  In cases where secondary bacterial infection is present, antibiotics may also be required.   

In most cases, the mites can be treated, and although it may take a few months, the skin and coat should return to normal.  At least in this case, the mites are not contagious, and there is no need to recoil from the diagnosis, should your pet be given one of… Demodectic Mange! 


**THANK YOU KALI FOR LETTING US SHARE YOUR PICTURES!**



Saturday, August 10, 2019

Meet Our Team: Veterinary Assistants

Our veterinary assistants are helpful all around the hospital!  You may have seen an assistant helping one of our veterinarians in an exam room. When you board at our hospital, our vet assistants are the heart of our boarding facility--they take care of greeting our clients and boarders, taking care of the pets staying with us, and make sure to get pet belongings together for their trip home.  Vet assistants are also a major help for our technicians as they assist in blood draws, communicating with clients about pet care, keeping our technicians safe with great pet handling techniques, and more!  If the assistants aren't helping in our treatment area or boarding, you may also see them helping to answer phones and charge out clients in our front desk area.  Our veterinary assistants are a very friendly and helpful team!


Why do you like being a Veterinary Assistant?

  • I actually LOVE being a Veterinary Assistant.  I love meeting all of the new furry friends that come visit us here at the hospital.  Also, making sure all of the animals are comfortable and taken care of is very important to me and drives me to be the best veterinary assistant I can be.   -Sami
  • Wearing the same uniform each day makes morning routines easy, haha! But seriously, it's been an amazing experience to get to know our clients and patients that I've met these past 14 years.  This position challenges both mentally and physically which makes each day different and interesting.  I've learned a lot about animal behavior, pet health, and many useful techniques.  And of course, it's so much fun to see new puppies and kitties!    -Danielle
  • Being able to help with sick and healthy patients is very rewarding.   -Laura
  • I like being a veterinary assistant because I have always had a passion for animals.  I love seeing different personalities in different breeds and enjoy working with them.   -Maleah
  • I love working with the animals!  My goal is to make their experience enjoyable.  My heart breaks when my patients are anxious or scared.                     -Rhea
  • I get a closer look on what the doctors and technicians do.  I also form relationships with the animals.   -Sophia


What skill did you learn that makes you feel the most proud of?

  • My favorite skill I have learned at Hatton Veterinary Hospital is being able to assist on surgeries.  This is a skill I take a lot of pride in because it is important that I do my very best and pay attention to many different things in order to ensure the safety of our patient.   -Sami
  • I am one of the assistants that takes care of our Facebook page and helps Dr. Ku with our monthly blogs.  I am proud to be a part of our social media presence!   -Danielle
  • Drawing blood and learning how to take care of patients.   -Laura
  • Throughout my time at Hatton Veterinary Hosptial, I have learned a lot about animals and their behavior.  I am able to identify when an animal is in distress and handle the situation accordingly.   -Maleah
  • Skills learned: behavior and obedience training.  I have gone through many years of obedience training for my own dogs (smart, difficult Border Collies and Australian Shepard) and have learned a lot.  Those skills have helped me understand the behavior of dogs and have make my animal handling skills better.  I've also taken many CE (continuing education) classes on animal behavior which I'm able to implement with my job.  Over the past 19 years of working at Hatton Vet and taking CE classes, I have learned many skills to give my kitty patients a positive experience.  I adopted a kitten a few years ago named Banshee.  We named him that because he would scream for attention.  While growing up, we noticed if he did not want to do something, he would get aggressive with us and try to bite and attack us.  We tried multiple traditional behavior training techniques that were not successful.  After many conversations with Dr. Ku, we figured out a way to correct his behavior enough that I can now trim his nails and he stopped attacking us.  He still has a hard time when he has to come in for treatment, but I am able to handle him.  This experience and my years of training has made me a better kitty handler and I am able to educate my patient's parents on behavior training.   -Rhea
  • How to communicate with the animals and help them have a better experience.   -Sophia


If you could travel anywhere, where would you go and why?

  • I would love to travel to Dubai because it's known for luxury shopping, ultra modern architecture and a lively night scene.   -Sami
  • Any Disney Parks!  The dream is to go to Disneyland Paris one day...in the meantime, my Husband and I love going to Disneyland or Disney World--our favorite places to have fun, enjoy good food and escape reality; Hakuna Matata!   -Danielle
  • I would love to travel the world!!!  There is so much to see and explore.                         -Laura
  • If I could travel anywhere, I would go to Paris because I have always been amazed with their sights.   -Maleah
  • Hawaii; I've never been and I want to explore and see all of the different animals.   -Rhea
  • Anywhere in the Caribbean because it's the right amount of tropical and warm weather and I love beaches.   -Sophia