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THE ART OF MEDICINE

the art of vet medicine

Medicine is an art, good medicine that is, both in Veterinary medicine and human medicine.

In Veterinary medicine this art is more difficult as the patients can’t tell the doctor what is bothering them.

Therefore, a complete physical exam, and a detailed history is imperative in order to achieve a diagnosis.

Of course, an experienced eye with many years in practice is an essential element.

Unfortunately medicine has become in some instances not an art, but a blanket approach in which based upon algorithms–and not critical thinking–a myriad of tests are done, and these tests can be costly.

I believe in diagnostic tests; they are essential, but I also believe in a logical approach and fine tuning the tests to the case in front of me.

I regard in many cases the art of medicine to be like a detective work in which a methodical and logical approach is applied.

Yet, always remembering that the first rule of medicine is do no harm.

And, always remembering that in front of me is a pet that feels and is a member of the family.

The Art of Medicine is not just a cliché but something to strive for and always practice.

And like any form of art, there are good artists, not so good artist, and exceptional artists.

In medicine the exceptional doctor has that additional spark of compassion and wisdom that sets him apart.

Dr. Ehud Sela

954-972-5900.

© Dr. Ehud Sela. No work herein may be reproduced in any way without expressed permission from the author.

WHEN ADOPTING A NEW PET

dog-adoption-shelter

Adopting a new pet is a wonderful act of love.

Often, and sadly, these pets come from difficult circumstances and need an adjustment period.

I often see new adopted pets that are shy at the beginning and at times do not have the greatest appetite or interact slowly with their new family.

If the physical exam is normal I often advise patience rather than performing multiple tests that can be stressful to the new pet and at times unnecessary.

Plenty of love and reassurance and perhaps offering a very palatable pet food can improve appetite.

I always advise a follow-up within a week, and of course if any signs of illness develop to return immediately.

Often: “The tincture of time” and being patient is very important.

Tests should be done wisely and correctly, only if needed.

It is a wonderful act of kindness and love to bring a new pet to the household, and like every new relationship it takes time to develop.

Dr. Ehud Sela

The Gentle Vet

954-972-5900

© Dr. Ehud Sela. No work herein may be reproduced in any way without expressed permission from the author.

Cat & toy Mouse

Baxter is a 15 yrs old cat very sweet very friendly, with a few health issues.

Firstly, Baxter is a diabetic. Baxter watches his diet very carefully and his diabetes is due to his genes—the genes we come to this world with, they haunt us, alas. Anyway Baxter handles his diabetes very well and understands that he needs to get insulin injections twice a day to maintain his health.

Over the weekend sweet Baxter developed some serious neurological issues, unrelated to his diabetes. Baxter has dealt with his problem bravely and with a positive spirit, and with the excellent loving care of his owners and best friends, Baxter is walking again, slowly, but steadily improving.

And here are the best news of the day: Baxter is a pacifist and will not hurt a living thing, yet Baxter has a collection of toy mice that he controls and makes sure they are well behaved. Every night about 11 pm, Baxter will carry them in his mouth, bring them to the bedroom and declare in a loud meow that all mice are accounted for and the lights can be turned off and the family can sleep in peace. Baxter stopped doing it the last few nights due to his health problems, but the world can sleep in peace again, last night Baxter has returned to his toy mice duties. Who needs Superman, even more, who needs NATO; we all can sleep in peace as sweet Baxter is guarding the world’s night sleep.

I thought these are very worthy news and need to be shared….

Dr. Ehud Sela

954-972-5900.

© Dr. Ehud Sela. No work herein may be reproduced in any way without expressed permission from the author.

old black cat

 

Target is a 17 years old spayed female cat that reaching this senior age, developed a few health issues.

Target is very particular about her privacy, so I will protect her name by calling her Patient T. Oops… I just realized I have already called her Target, oh well, I’m sure she will be OK with it, I will send her a nice email apologizing, but we’ll continue calling her Patient T, as it sounds so much more mysterious.

Patient T hasn’t been feeling very well lately. She was losing weight, was vomiting and was hiding a lot at home. Also, Patient T, is very vocal and expects her owners to wake up at a certain time in the morning and freshen up her food; giving her the well-deserved attention she needs and expect.

Her owners noticed that she was much more silent and hardly complained to them. Mind you, when she complained she was always right, she has been on this planet for 17 years and she knows what to expect.

Her concerned owners brought her to my office and we brought her back to her usual vocal self with reasonable appetite and enjoyment of life: watching the birds and lizards, and those so very dangerous squirrels….

Patient T sees me often, she was coming twice a week, but now we are on a once a week schedule and her health needs are addressed and treatments added and modified if needed.

I treat her as an outpatient as I think more often than not pets do much better treated like this, staying at their home environment; that they know and feel secure.

Last but not least, if you come across Target, please call her Patient T, as she thinks, and I agree, it adds a certain level of sophistication to her.

Dr. Ehud Sela-The Gentle Vet.

www.thegentlevet.com

Phone: 954-972-5900

© Dr. Ehud Sela. No work herein may be reproduced in any way without expressed permission from the author.

Standard Poodle

Sweet Rosie, an eight weeks old Standard Poodle puppy has reached her loving new family.

Rosie is an amazing dog, tender, loving, intelligent and within the first few hours bonded with her new family.

Rosie’s owners called me very concerned the day following her arrival because Rosie has developed what they thought were severe orthopedic and possible neurological problems. Rosie every few steps would pull one of her hind legs forward, trying, and at times reaching her body with her paws. “The owners conducted extensive research consulting Dr. Google,” and it was clear and obvious that poor Rosie had something severely wrong with her.

Upon presentation Rosie appeared happy and content and an amazing Puppy. Rosie whispered in my ears as I was examining her, that she thinks her new family thinks there is something wrong with her, but she senses that she is doing very well, and with a lick on my face asked me to tell her family that she is just fine, and that she would love to be a member of the family for many years to come.

Rosie was right! Her physical exam revealed no abnormalities at all, but when we went to the lobby and let her run with her owners, she definitely would stop every now and then and presented the above mentioned symptoms. As Rosie is still a little puppy, and a little klutzy, she would sometimes trip over and it was a little humorous, but not to offend Rosie, I kept a stoic expression.

It appeared that Rosie was trying to itch her body, but no skin lesions were seen. Why Rosie would be itchy? I asked myself, and mainly while running and playing? I further pondered, then, like in all great mysteries, the truth become apparent to me: it was her collar. Rosie received her new collar yesterday evening, and she was trying to remove it, as it was mainly bothering her while running and playing.

I removed Rosie’s collar, and all symptoms were resolved, no more neurological, orthopedic, or skin problems.

As good old Sherlock Holmes would have concluded the case, he would have called it not the “The Hound of the Baskervilles,” but The Case of Rosie’s Collar.

One final note: upon leaving the office content with all her problems resolved, Rosie told me that if the collar had diamonds, she might consider it in a much more positive light.

Dr. Ehud Sela, the Gentle Vet

954-972-5900

© Dr. Ehud Sela. No work herein may be reproduced in any way without expressed permission from the author.

Ridgeback Puppy

The cycle of life in my veterinary practice is constantly visible to me.Last month, sadly, I’ve had a few geriatric and middle age patients, dogs and cats, that due to illness of a severe nature, and a grave prognosis, I had to perform euthanasia for them.

Death always deeply pains me, and in my practice I give a strong battle when the angel of death shows—and alas he does make his presence known.

Yet knowing that for these patients of mine, euthanasia can be done in a humane form, in a compassionate form, with the owners present, if they wish, brings me some solace.

But life goes on. Today Olive the Rhodesian Ridgeback puppy walked into my exam room, happy; full of life.

She placed her paw in my hand looked at me with her big puppy eyes and introduced herself. She told me with her big trusting puppy eyes: Life begins and ends for all of us, accept it Doc, it’s the cycle of life; it’s the river of life.

Dr. Ehud Sela

The Gentle Vet

954-972-5900

© Dr. Ehud Sela. No work herein may be reproduced in any way without expressed permission from the author.

cat

Dolly the cat comes to visit me in my practice on a quarterly basis. Dolly has some health issues that require routine follow-ups.

Dolly is one of the most amazing cats I have met in my 25 years career as a Veterinarian.

Dolly is friendly and outgoing and trusting. When she comes into the cats-exam room, she can’t wait to get out of her carrier. First thing she’ll do is give a nice and potent head butting to me and my nurse. Next she’ll proceed to lick our hands, and a small friendly nibble on the nose is a must.

Of course grooming us is essential for the visit. My nurse has long hair and she’ll gladly groom her hair. With me, she’s somewhat puzzled, as I have no hair on my head, alas…. But yet, Dolly is a very tactful cat and she never made an issue from the fact that her Doctor is bald.

Before we can proceed to a complete physical exam, Dolly must have some tummy rubbing; it’s protocol.

I always sing to Dolly her favorite song “Hello Dolly,” and she purrs in delight as she is being serenaded.

I have seen many cats and dogs throughout my long career. It’s amazing to me how they all have their own personalities, they are all individuals that love and want to be loved.

Dr. Ehud Sela

Phone: 954-972-5900.

© Dr. Ehud Sela. No work herein may be reproduced in any way without expressed permission from the author.

Rabies Disease.

Rabies is a highly contagious viral lethal disease, that affects all mammals including humans. In South Florida the disease is present in many localities. The disease once contracted is usually fatal. The symptoms of the disease in animals can be grouped into two major groups: Dumb rabies, and Furious rabies. We all have in mind the latter form of the disease, with an animal that runs furious and drooling, and attacking everybody in sight. But the Dumb, or Paralytic form is also very dangerous. By Dumb, we refer to an animal, mainly a wild animal, who is acting strangely, for example loosing its fear of man. A wild Raccoon, or Fox, should not be coming to a person all happy, and letting you pet him; something is wrong with this animal, and although it’s rare, a non-bite exposure: contact with infectious saliva, or neurological tissue, can be a source of concern. Therefore, we should not feed or come in contact with wild animals; it’s not good for them, or for us. Prevention of the disease in our pets is extremely easy, and it entails a preventive vaccination. In Florida all pets are required to be vaccinated for the disease, including indoor pets. Given the deadly nature of the disease for both pets and people, it’s imperative that you keep your pets vaccinated for this deadly disease.

Please call our office at: 954-972-5900 if you have any questions regarding your pets’ health.

There are many disease processes that can cause heart failure in dogs and cats. These processes can be congenital: such as a pet being born with an abnormality in the heart, or acquired: such as a disease due to infectious agents, or parasitic agents, or the passage of time–getting old. No matter what is the cause of the disease, if it becomes advanced, and or untreated, it can lead to heart failure. The symptoms of heart failure depend on the severity of the failure and they may include: lethargy, anorexia, coughing, shortness of breath, collapse, and death. Heart failure is a serious disease, and early diagnosis can improve the length and the quality of life of our pets. A complete physical exam by a veterinarian, can help in the detection, and early treatment of the disease. In my office I recommend that senior patients should have a complete physical exam at least every quarter, and non senior patients, at least twice a year.
Please feel free contacting our office at: 954-972-5900 if you have any questions regarding your pets’ health.

This Month we are happy to bring to you the latest information about canine influenza, by one of the nation’s leading experts: Dr. Cynda Crawford, co-discoverer of the virus and Maddie’s Clinical Assistant Professor of Shelter Medicine.
Canine Influenza Frequently Asked Questions by Sheltering Organizations Dr. Cynda Crawford, Maddie’s Clinical Assistant Professor of Shelter Medicine
1. What is canine influenza? Canine influenza is a highly contagious respiratory infection of dogs caused by a novel influenza A subtype H3N8 virus first discovered in 2004.
2. Where does canine influenza occur? Canine influenza has been documented in 30 states and the District of Columbia. Canine influenza virus (CIV) has been very prevalent in many communities in Colorado, Florida, New Jersey, New York, and Pennsylvania.
3. What type of infection does CIV cause? Similar to influenza viruses that infect other mammals, CIV causes an acute respiratory infection in dogs. It is one of several viruses and bacteria that are associated with canine infectious respiratory disease, or what’s commonly referred to as “kennel cough.” CIV infection can cause respiratory disease by itself or in conjunction with other respiratory pathogens such as distemper virus, respiratory coronavirus, parainfluenza virus, adenovirus, and Bordetella bronchiseptica. It is important to note that influenza virus is not related to parainfluenza virus, and vaccines containing parainfluenza virus do not induce cross-protective immunity to CIV.
Unlike human influenza, canine influenza is not a “seasonal” infection. Infections can occur year round.
4. Who is susceptible to CIV infection? Dogs of any breed, age or health status are susceptible to infection. Vaccination with DA2PP or the “kennel cough” vaccine for Bordetella does not provide any immunity to canine influenza.
Canine influenza outbreaks are most likely to occur in facilities where dogs are housed together and there is frequent introduction of new dogs into the resident population. Canine influenza outbreaks have impacted many sheltering facilities and organizations around the country since 2004, including open admission shelters, limited admission shelters, and foster homes or rescue/adoption groups in California, Colorado, Delaware, Florida, Georgia, Kentucky, New Jersey, New York, Pennsylvania, South Carolina, Utah, Virginia, and Wyoming. Many of these outbreaks have resulted in increased euthanasia due to the overwhelming number of sick dogs or the severity of illness.
CIV does not infect people, and there is no documentation that other species have become infected by exposure to dogs with canine influenza. However, ferrets are very susceptible to influenza virus infections in general and should be protected from exposure to dogs with canine influenza (and people with human influenza). We recommend that other species such as cats, birds, small mammals (rabbits and rodents), and pot-bellied pigs also be protected from exposure to infected dogs.
5. How is canine influenza transmitted? As with other respiratory pathogens, the most efficient transmission of CIV occurs by direct contact with infected dogs and by aerosols or very fine mists containing virus that are generated by coughing and sneezing dogs. The virus also contaminates kennel surfaces, food and water bowls, collars and leashes, and the hands and clothing of people who handle infected dogs. Influenza virus can remain viable on surfaces for up to 48 hours, on clothing for 24 hours, and on hands for 12 hours. In a shelter environment, CIV is mostly spread by aerosols that move throughout the kennel ward and by staff members that handle infected dogs, then handle other dogs without washing hands and changing clothes.
Important risk factors for introduction of CIV into a shelter population include 1) location in a community where the virus is prevalent, and 2) transfer of dogs from shelters where the virus is prevalent to other shelters, foster homes, or rescue adoption groups. The virus has also been transferred from infected dogs in shelters to pet dogs at home by staff carriage of virus on hands and clothing.
CIV is easily inactivated by washing hands, clothes and other items with soap and water. Quaternary ammonium disinfectants, bleach, or Trifectant will kill influenza viruses in the environment.
6. What are the clinical signs of canine influenza? Similar to other respiratory pathogens, CIV causes a transient fever, cough, sneezing, and nasal discharge. Persistent coughing is the primary clinical sign.
Virtually all exposed dogs become infected; about 80% develop a flu‐like illness, while another 20% do not become ill despite being infected. Once CIV is brought into a facility or foster home by an infected dog, all dogs in the facility or foster home should be considered exposed and likely will become infected, whether or not they develop clinical disease.
Influenza virus replicates in the respiratory tract from the nose to the lungs. Virus replication destroys the tissue barriers that normally protect the respiratory tract from bacterial infection, and it may take 3 to 4 weeks for these barriers to regenerate. Therefore, dogs infected with CIV are predisposed to secondary bacterial infections from the nose to the lungs, resulting in purulent nasal discharge, productive cough, and even pneumonia. In addition to secondary bacterial infections, there is an intense inflammatory response to CIV infection; this inflammation persists for several weeks and contributes to the persistence of the cough.
Fortunately, most dogs recover within 2 to 3 weeks without any further health complications. While the overall mortality rate for canine influenza is low, the secondary pneumonia that occurs in some dogs can be life-threatening without proper treatment, usually in a hospital setting. There is no evidence for age or breed susceptibility for developing pneumonia.
7. What is the incubation time and how long are dogs contagious? The incubation period is the time from infection by a pathogen to onset of clinical disease. The incubation period for CIV is 2 to 4 days. Peak viral shedding from the upper respiratory tract starts during the incubation period; therefore, dogs are most contagious prior to showing obvious clinical signs. Dogs with subclinical infection also shed virus and are contagious.
Virus shedding decreases substantially after the incubation period, but continues for 7 to 10 days. Once virus shedding ceases, the dog is no longer contagious. Therefore, it is unlikely that dogs pose a significant infectious risk by 10 days after onset of clinical signs.
Knowledge of the virus shedding times is important to selection of diagnostic tests and to management of an outbreak.
8. How is canine influenza diagnosed? Canine influenza cannot be diagnosed by clinical signs because all of the other respiratory pathogens cause similar signs of coughing, sneezing, and nasal discharge. Many sheltering organizations believe that they have canine influenza, when in fact, the dogs are infected with other respiratory pathogens.
The best approach for diagnosis of canine influenza is collection of nasal swabs and serum samples. The swabs are used for detection of virus in dogs at the time they start coughing, and serum samples for detection of CIV‐specific antibodies in dogs that have been ill for more than 7 days. For dogs that have been ill for less than 4 days, veterinarians can collect nasal and pharyngeal swabs for submission to a diagnostic laboratory that offers a validated PCR test for CIV. The PCR tests are very sensitive in detecting virus, but the swabs must be collected during the period of high virus shedding (first 4 to 5 days of infection only). Positive PCR results are most likely correct, but negative results may be “falsely negative” due to swab collection when virus shedding has significantly decreased. In a population of dogs such as in a shelter or foster home, swabs should be collected from sick dogs as well as dogs that have been exposed but are not yet sick. This increases the probability of virus detection.
Serology is the most accurate and reliable diagnostic test for diagnosis of canine influenza in dogs that have been ill for more than 7 days and for confirmation of CIV infection in cases where the PCR test is negative but the index of suspicion is high. Paired acute (sick for <7 days) and convalescent (10 to 14 days later)serum samples are preferred for diagnosis of recent active infection based on seroconversion
9. How is canine influenza treated? Since canine influenza is a viral infection, treatment consists mainly of supportive care based on clinical signs and laboratory tests. Although there is no specific antiviral treatment for canine influenza at this time, a variety of secondary bacterial infections may play a significant role, and antibiotics are indicated for dogs with fever, productive cough, and purulent nasal discharge. Nasal discharge usually responds within days to treatment with a broad spectrum bactericidal antibiotic, but cough may persist for 14 to 30 days. Antitussives (cough suppressants) are not very effective in reducing the frequency and duration of coughing, and should not be used on dogs with productive cough.
Dogs that develop pneumonia based on clinical signs and chest radiographs often require hospitalization for intravenous fluids and parenteral antibiotics. Ideally, a tracheal wash or bronchoalveolar lavage for bacterial culture and antibiotic sensitivity testing should be performed to target the choice of antibiotic. For dogs in which cultures are not performed, empirical treatment with a broad spectrum combination of bactericidal antibiotics to provide 4‐quadrant (gram positive, gram negative, aerobic, anaerobic) coverage has worked well. For more severe cases of pneumonia, oxygen supplementation and nebulization with coupage have been very beneficial.
10. How can a canine influenza outbreak be managed? The most important factor contributing to transmission of CIV within a facility is the failure to promptly remove sick dogs from the general population. The magnitude of canine influenza outbreaks has been amplified in those shelters that leave sick dogs in the population and treat them with doxycycline based on the assumption they have “kennel cough” due to Bordetella.
The cornerstones of influenza management strategies are to reduce virus transmission between dogs and reduce virus load in the environment. The overarching goal is to effectively create a break between sick and exposed dogs in the facility or foster home and the unexposed dogs that will be entering. Since most dogs fully recover from canine influenza, it meets the definition of a treatable-rehabilatable disease based on the Asilomar Accords. To reduce virus transmission and virus load in the environment, sick dogs should be promptly isolated in a separate physically enclosed area, and exposed dogs quarantined from newly admitted or unexposed dogs. Staff should care for unexposed dogs first, followed by the quarantined dogs, then the sick dogs in isolation. Staff should wear protective clothing and gloves to care for the quarantined and isolated dogs, including protective footwear such as rubber boots (not booties) to cover the lower leg. Footbaths are not very effective and may provide a false sense of security. Hands should be washed with soap and water after removing gloves.
Each sick or exposed dog should be isolated or quarantined for 14 days to allow for cessation of virus shedding. Following this period, they should not be an infectious risk and can be moved forward in their pathway to adoption.
11. Is there a vaccine for canine influenza? The cornerstone for prevention of influenza viral diseases includes reducing the number of susceptible individuals and increasing community immunity. This is best achieved by vaccination.

Please call our office at: 954-972-5900 if you have any questions regarding Canine Influenza or any other questions regarding your pets’ health.

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