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October 31 The Bimini BulletTo those of you who may be a little squeamish, this post contains some graphic pictures. Saturday night as we were getting ready to find some dinner and a cold beer, one of the islanders brought a young dog to us. She was emaciated, pale and weak. He didn’t know who owned her (although we did get some conflicting reports on that). Dr. Grant examined her. She was a pit bull mix. There are now more pit bulls than there used to be on Bimini, and the pups born to potcake/pit bull matings are called ‘pitcakes’. This little girl was either a pit bull or a pitcake. As perhaps you may be aware, pit bulls are sometimes used in dog fighting. This is a horrible and cruel ‘sport’, illegal in most places. Some of the people who fight these dogs have their ears cropped short so the ears cannot be bitten during a fight. Even if they don’t plan to fight the dog, some people have the ears cropped to make the dog ‘look tough’. Most veterinarians won’t do this procedure on pit bulls. However, sometimes people will attempt to crop the ears themselves. This is just what happened to this little girl – someone wrapped fishing line around the base of her ears so tightly they rotted and fell off. The left ear was gone, the right was hanging by dead tissue. Here are the pictures:  
We were horrified. The smell of the wounds was awful, and this poor girl was so sick. Yet she was very gentle and quiet. She let Dr. Grant and Martha examine and clean her a little (we gave her some pain meds first). Then we attempted to get permission to either treat her or euthanize her. Initially the police thought they could locate the owner, but when they couldn’t, they basically turned her over to us and we went to work. We anesthetized her and Martha and Dr. Grant each went to work on an ear.  
It was painstaking work to debride all that dead tissue, but after 2 hours, this was the result: 
She recovered well, and we dewormed her and gave her antibiotics and medication for the diarrhea she had. We went and scrounged up some food for her and us (by then all the restaurants were closed) and got some sleep. The next morning, she seemed a little more alert and comfortable. The question now was not whether she would survive – we felt she would. But what were we going to do with her? Taking her home with us was not a good option – as you may know, homeowner’s insurance is very difficult to get now if you have a pit bull, and although we all loved her, getting her a place to stay on such short notice seemed a tall order. Nowdla came to the rescue – she called the staff at the Sharklab. They came to visit this little girl Sunday night, and agreed to take her in. They seemed charmed by her quiet, gentle nature despite her horrific wounds. The Sharklab staff helped get us and all our equipment to the airport on South Bimini Monday morning, and picked up the little dog at the same time. 
We said good-bye to her – it was hard to believe how attached we had gotten to her in such a short time. We said to one of the Sharklab staff members that at least if they could foster her, we could work on finding her a home in the States. He said to us, “you’re going to have a hard time getting her away from us.” We knew then that she was with people who already loved her. The next day, this post was on the Sharklab’s website: http://www6.miami.edu/sharklab/news.html. Notice the handpainted sign with her name. I think Bullet has found her forever home. What do you think? ps. Even if for some reason in the future the Sharklab cannot keep Bullet forever, we will make sure somehow that she has a loving home. October 30 BiminiWednesday, October 18th: I fly from Columbus to Orlando. Martha, Consie and I complete organizing and packing our equipment (Martha, Consie and Martha’s technician Jessica had done most of that previously).
Thursday October 19th, 6 am: Martha, Consie, Martha’s nephew Danny, Jessica and I pile into Consie’s truck for the drive to Ft. Lauderdale. We arrive in Ft. Lauderdale at about 10am, scrounge up some breakfast, and check in for our flight to Bimini. We greet our plane and pilot: 
(yikes! That’s a little plane!)
The pilot loads all our stuff into the plane, and off we go. This is the south Florida coastline: 
We fly over Bimini. Bimini is actually 2 islands – most of the population lives on North Bimini, an island that is about 7 miles long and less than 700 feet wide at its widest point. South Bimini is home to the Bimini Biological Field Station, aka the Sharklab, a research station for sharks, particularly lemon sharks. The airport is also on South Bimini.
We clear immigration and customs. The immigration officer looks at our papers and asks us why we are visiting Bimini. When he finds out we are ‘the vets’, he smiles and tells us we will be seeing his Chinese “pub”. And here is his little Pug with his mom (also an immigrations officer), and Dr. Grant, the Bahamian veterinarian on our team. 
Nowdla and her daughters Shannon and Kaila pick us up in their boat for the short trip to North Bimini. Nowdla and her husband own and operate Bimini Undersea. They also love the potcakes, and have helped coordinate our trip (and the team’s previous trips) to the island. Nowdla has posted these signs around the island: 
We unload our equipment and pack it on a golf cart to take it to our makeshift clinic (most people get around in golf carts on this tiny island). There are two roads, ‘the high road’ and ‘the low road’. One person drives the cart to the clinic, the rest of us walk the short distance.
The clinic is a building that unused and locked. There is no water and electricity, but Nowdla is working on that. We arrive at the clinic to find this: 
Some poor homeless man has set up camp on the porch. And unfortunately, he has used the porch and steps for his bathroom as well. He is nowhere to be seen, but we will have to deal with this before we can get to work.
However, we get to play a little first. Bill and Nowdla have offered to take us out to swim with the wild dolphins! We eagerly take them up on this offer, and spend a beautiful and relaxing 4-5 hours in the warm sun, looking for dolphins. Unfortunately, the dolphins did not want to come out to play with us that day (we did see a few on our way back in), but I hope to see them on a future trip. Here is sunset from the boat: 
7am Friday: We head to the clinic to get set up. We ask our homeless guy to move across the way to another spot. We feel bad for him. This is when I wonder if helping the animals is how I should ‘give back’. Maybe we should be helping him instead of the potcakes. Jessica brings up a good point: Do what you know how to do best. She is right, and we proceed to clean the porch and the rest of the clinic.
Friday we have no running water, and we do not have electricity until the afternoon. We make do with getting buckets of water out of a well for cleaning, and with bottles of water for washing/prepping for surgery. We spend all Friday morning cleaning and setting up. Here is our surgery room ready to go: 
Notice the phone books used to get the table to the proper height. Nothing fancy here!
Then our first patient shows up: Pooh. 
Pooh is very sick – not the way we expect to start our spay/neuter clinic. He is very cold and very pale – he needs a blood transfusion. So Nowdla rounds up a friend’s dog, Duke, and we draw blood from Duke and transfuse it into Pooh. Pooh perks up over the afternoon, even starts wagging his tail and eating for us. (Unfortuntely, Pooh passed away a few days later.)
Martha’s first surgery patient is Midnight. Midnight is a 10 year old dog who had been making babies all over the island for a long time – Martha knows him from her previous trips here. His owners consented to finally have him neutered. Here is Martha and Midnight after the ‘deed’ was done: 
The rest of Friday and Saturday are spent getting dogs (and a few cats) in the door, setting up our makeshift recovery room, and spaying and neutering (Martha did all the surgery, I did anesthesia and other tech work, Jess and Danny took care of intake and recovery, and Consie organized everything else). Dr. Grant and his volunteer assistant, Arietta, see many patients for vaccines, heartworm preventative, etc. Here is our recovery room: 
Late Friday, Dr. Grant and Arietta are called out to check on an injured stray dog. She had been shot 6 months previously and paralyzed in her hindquarters. It was sad and disturbing for the islanders, but they have no veterinarian on the island (Dr. Grant can only visit every few months). She has been dragging herself around, is very thin and has wounds on her back legs. They trap her, and with all of us gathered around speaking quietly to this brave girl, Dr. Grant euthanizes her. We then take her to a beautiful site on the island, and bury her. Nowdla’s daughter, Kaila, asks that we put these flowers on her grave, and we do. It is a somber moment that brings tears to my eyes. 
At 7am Saturday morning, we start in again, and really get into a better groove and get a bunch of spays and neuters done. We still have no running water, but we do have electricity. We make do.
These surgeries are more challenging than your average spays and neuters in the US. Many of these dogs have heartworms, some have a tickborne disease called Ehrlichia, and many are pregnant or in-heat. All these things combine to make them bleed more than normal. Even their skin is tougher than the average US dog. They are hardy dogs! This picture is a dog under anesthesia - the little black spots are all the ticks crawling off her! 
Martha and Consie have set these clinics up to give these dogs the best care possible – they all get IV catheters and fluids, they all get intubated (a tube into their trachea to deliver oxygen and gas anesthesia and to protect their airway) and pain medications post-operatively. This is not the case for all of these types of low-cost clinics in other locales. We get donated what we can to help cover the costs.
Late Saturday evening, as we are ready to pack it in for the day (after 12 hours of surgery), we get another sick patient surprise. I’ll talk about that in my next entry. October 28 Just another spay in paradiseSeveral years ago, a woman named Judy Troiano was diving on the small island of Bimini (in the Bahamas) and saw that the island had a large stray dog population. Most of these dogs are Royal Bahamian Potcakes. Potcakes are basically mixed breed dogs, and the name potcake is derived from a popular Bahamian dish, beans and rice. The “cake” that stuck to the bottom of the pot was thrown in the yard for the dogs, hence the name potcake was born. It is an officially recognized breed in the Bahamas.
When Judy went to Bimini, there were many packs of dogs roaming the island. They were not spayed or neutered, and were multiplying. Many of the owned dogs on the island were also not spayed or neutered, and those litters were adding to the stray dog population. To combat the problem, the dogs were being hunted and shot, or occasionally poisoned. Sometimes an owned dog would be mistaken for one of the strays and killed. The stray dogs were often fed by the islanders, making them easy prey for hunters.
Judy was determined to help these dogs. She formed a program called the “Bimini Love Program”, through All-Paws Rescue, a rescue organization she founded in her home state of Massachusetts. She coordinated volunteer veterinarians and staff on the island to hold a spay/neuter clinic on the island in June of 2000. This was a significant logistical feat, as the island had no veterinary clinic or equipment (a visiting veterinarian from Grand Bahama visits every few months to care for owned pets). That clinic was the first, and my friend and colleague, Dr. Martha Kehoe, was one of the veterinarians on that trip. She and the other volunteers spent long hours in the heat trapping, examining, treating, and spaying and neutering dogs. She was also captivated by the hardy potcakes, and became devoted to helping them.
During that trip, Consie von Gontard was on a diving trip to Bimini. Another animal lover, Consie was also concerned about the plight of the strays. She heard that “the vets” were on the island, and she went straight to the makeshift clinic they set up, asking “How can I help?” Consie spent the rest of her vacation trapping dogs, running errands, coordinating, and doing anything she could to help the vets help the potcakes. A short time after this first clinic, Judy passed away. Consie then volunteered to take the program on, and became a tireless supporter of animals in need. Since then, Consie has spent innumerable hours helping the animal victims of Katrina, the Tsunami of December 2004, and many others. She and Martha and many other volunteers have made multiple trips to Bimini to help the potcakes.
I became lucky enough to help the potcakes when Martha and Consie asked me to join them on the latest spay/neuter trip to Bimini last week.
Next entry – our trip to Bimini.
ps. If you want to help the potcakes, you can send a donation to:
All Paws Rescue
925 Bunker View Drive
Apollo Beach, FL 33572.
The check should read "All Paws Rescue-Bimini Program". The donation is tax-deductible.
October 15 Treating fleasI am going to interrupt the series on cat heart disease for a couple of posts - this one is not a happy one.
A little kitten came in the other night - the owner had accidentally put her dog's flea product on the kitten. The kitten was starting to have tremors.
This is something we see with some frequency. These are products bought over the counter, and they have an insecticide called permethrin in them. This is a product that is generally well-tolerated by dogs. However, cats are not small dogs, and cats do NOT tolerate this medication - they are much more sensitive to it. Some people accidentally put the dog tube on the cat, some people actually think well, just a little should be ok, and try it on the cat. I've even had people figure that since it was bought over the counter, it should be safe, and they've put the whole large dog tube on a cat. The more the cat gets, the bigger the problem. The ironic thing is, there are products available that are much safer and in my experience work a lot better. (Most of the cats that come in with this toxin still have fleas running around on them!).
Permethrin in cats causes potentially severe tremors and seizures. The worst of these last anywhere from 24-72 hours. We bathe the cats to get the product off, then treat them with a muscle relaxant called Robaxin first, then we move on to other drugs as needed (there is a limit on how much Robaxin we can use). Sometimes the tremors are quite challenging to get under control, and we really have to work at it with multiple drugs, lots of TLC and nursing care, etc. Once the tremors are controlled, the cats generally start eating, but may have residual twitching for a week or so.
Until today, I had not lost one of these that I tried to treat. But for some reason, this little kitten's tremors were very bad, required lots of medication. I don't know if he had a side effect from the medication, or if he had some other problem on top of the medication. But we lost him today, and it just tears me apart because this is so preventable.
So, DON'T put your dog's flea medication on your cat. (BTW, these medications are clearly labeled not for use on cats). Better yet, get Frontline or Advantage from your vet (I think you can get these online too). I am not one to push specific products here, but these two products are so much safer and so much more effective. A warning though - the dog product Advantix is NOT safe for cats (causes tremors as well). So don't confuse Advantage with Advantix. Better yet, always double check the label before applying the product.
Oh, and if you do use one the permethrin products on your dog (check the label), don't let your cat around your dog. The cat can rub on the dog and get sick just from that.
October 12 Mike's heartIn the last entry, I talked about Mike's diagnosis of HCM (hypertrophic cardiomyopathy).
What is this exactly?
'Cardio-' means heart, 'myo-' means muscle, and '-pathy' means disease or disorder. 'Hyper-' means increased and '-trophic' means growth. So basically, HCM is a disease of the heart muscle in which it grows too much. In other words the heart muscle becomes too thick. This is the most common type of heart disease in cats.
As you all may be aware, the mammalian heart has 4 chambers. Blood comes from the body into the right atrium, then to the right ventricle which pumps the blood into the lungs to pick up oxygen. The blood then flows into the left atrium and down into the left ventricle, which is the main pumping chamber - when this chamber contracts, it pumps blood into the aorta (the big main blood vessel leaving the heart) and out to the body.
Here is a link to a site with a picture and more detailed information on the normal heart: http://www.nhf.org.nz/index.asp?PageID=2145828141
HCM causes the heart muscle to thicken, specifically the left ventricle, which is already the thickest part. (See this picture to get an idea of the effects on the left ventricle.) When this chamber gets too thick, it can't relax enough to fill properly, the blood coming into the left ventricle from the lungs has a tendency to 'back up.' In response to this, the left atrium can enlarge. So sometimes you see a big heart or big left atrium on x-rays, but sometimes you don't. Echocardiogram (ultrasound of the heart) is the best way to see what is happening with the heart. This is the test that Mike and Mitch both had with the veterinary cardioligist.
In most cases, we don't know the exact cause of HCM, but there are a few underlying conditions that can cause similar changes in the cat's heart, such as high blood pressure, hyperthyroidism (hyperactive thyroid gland), and some congenital disorders of the heart.
Ok, so Mike's heart is a little thick already, and probably will get thicker, and his left atrium may enlarge. What does this mean?
Cats with this condition can do one of several things:
In the next posts, I'll go into more detail on the above conditions and how they present to us in the emergency hospital. (This post would get way too long if I tried to do them all at once.) October 09 The heart of the matterHey, after a 2 month break, it's about time I get back to writing, no??? (I really hope to do a better job of keeping up this time!)
I wrote a few months ago about the two new additions to my house, Mitch and Mike the kittens. The have grown like weeds, and continue their kitten antics (taking all the toilet paper off the roll is Mitch's particular favorite).
A couple of months ago I was getting ready to neuter them. I noticed one day that after racing through the house (as kittens will do), Mike was panting. He had been playing with Mitch, who was running just as hard, but Mitch was not panting. Hmmm, I thought. I tried to listen to his heart, but he was squirmed and purred and it was tough (I suppose you could also say I don't have that much control over my own animals...)
As you may know if you have cats, they are considered obligate nasal breathers. In other words, they don't normally pant like dogs. There are a few things that will make cats pant. The bad things that can cause panting are lung disease or injury, and heart disease. If they get too hot they will pant until they cool down. And I've seen a few other things (for example, a diabetic cat that gets too much insulin may pant). Some cats pant in the car on the way to the vet - this is from stress. Usually that type of panting settles quite quickly. And sometimes very, very sick cats may pant in the absence of obvious lung or heart disease - in my experience this is a bad sign.
And of course, a crazily playing kitten might pant briefly, and this is what I figured was up with Mike.
So I took both Mitch and Mike into the office one day, planning to take chest x-rays of Mike just to make sure everything was ok, and then neuter them both.
I got one of my techs to hold him, and listened to him with my stethoscope. And then I heard it - a definitely abnormal heartbeat. I ran an ECG (electrocardiogram) on him - he was having something call premature ventricular contractions (PVC's, sometimes called VPC's). This is NOT normal in a cat. So Mike and Mitch got appointments with the cardiologist for an echocardiogram (ultrasound of the heart).
It turns out that Mike has a type of heart disease called 'hypertrophic cardiomyopathy', or HCM for short. This is the most common type of heart disease in cats, although to have it diagnosed at such a young age is quite uncommon. HCM causes the heart muscle to become abnormally thick. Unfortunately there are no proven ways to slow the progression, so how long Mike can last with it depends on how fast his disease progresses. The fact that he has VPC's so young is concerning.
Mitch's screening was normal, and he will be rechecked in 6 months.
BUT, all is not bad - he does not know he's sick - he still runs around like crazy. My friend and colleague Barb neutered him and Mitch for me without any problems (anesthesia can be a little tricky in an animal with arrhythmias). He is now on medication to try to keep his heart rate controlled.
In the next post, I'll talk about potential problems in Mike's future. |
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