Separation is key!

Do you know the different between isolation and quarantine? Does your staff, board members or architects understand what a holding ward is? If the answer is no–you are not alone. These terms are commonly misused by shelter workers, and it is important that we define each as a separate space. This is particularly poignant during renovations or the creation of a new facility. Let’s take a look at what these words mean for your organization:

1) Holding refers to a space for healthy, not yet adoptable animals. You may be familiar with holding spaces in the context of stray or health department holds. Holding is a place where non-infectious animals can wait for the next step in their shelter journey. They may be waiting for a medical check, spay-neuter, or their owner to reclaim them. Holding is further broken down based on species and age. It is important to separate based on these factors in the event of a disease outbreak and to reduce stress. In general every shelter should have four holding spaces: kitten, adult cat, puppy and adult dog.

2) Quarantine is confusing term due to overlap between holding and isolation. Strictly speaking, quarantine is for currently healthy animals which have been exposed to infectious disease. For example quarantine should be used for transfer of dogs from another organization which is experiencing a kennel cough outbreak. These dogs were exposed, may become ill, and shouldn’t be put in the general population (holding) in case they become sick. Quarantine is useful when there is a history or known high risk of disease exposure. Once again, quarantine spaces should be broken up by species and age, but also by origin. If you take in transfers from multiple organizations at the same time, it is ideal to quarantine them in separate spaces.

3) Isolation is where sick animals are held for the duration of their treatment. Another term you may have heard is infirmary or hospital. In general, isolation is for animals with contagious disease (e.g. URI, parvovirus, ringworm). A hospital or treatment area may refer to a space where non-infectious diseases are treated (e.g. injuries, recovering from surgery). Isolation should be broken up by species and disease. The disease categories we tend to use are respiratory (URI), gastrointestinal (GI or diarrhea) and derm (ringworm). At a bare minimum shelters should have one isolation ward per species. However, it is best to keep the diseases separate, as you do not want your URI cats to develop ringworm or panleukopenia, etc. With dogs, kennel cough is further complicated by distemper, necessitating a separate distemper area if your shelter chooses to treat.black-and-white-cat-in-shelter-cage

Wow, that’s a lot of spaces. You may be thinking that it is impossible to provide enough spaces for all the diseases, species and age groups described above–and you are right! In the real world shelters have limited space and resources. So how do you determine how much of each type of space your shelter needs? Ask yourself the following questions: What species do you keep? How many at a time? What diseases do you see commonly? Which diseases will you treat or not treat? What spaces do you have available?

If your shelter does not treat ringworm, parvo, panleukopenia or distemper, then those diseases can be ignored. Frequently we are left with URI and diarrhea (Giardia, coccidia) for dogs and cats. Having flexible spaces, i.e. small rooms, allows a shelter to shift the purpose of a room. For example, when taking in a transport of puppies, a room can turn from adult dog URI to puppy holding. Of course, it is important to clean and disinfect appropriately, as some diseases can stay in the environment (e.g. parvo, ringworm). In many instances rooms can be combined due to necessity, e.g. ringworm houses cats and kittens. Now that you know the basics, let’s summarize:

  • Holding (healthy animals)
    • Adult cat
    • Kitten
    • Adult dog
    • Puppy
    • Small animals (rabbits, etc.)
  • Quarantine (healthy animals)
    • Variable
    • Can be unoccupied isolation, holding space or foster
  • Isolation (sick animals)
    • Adult cat URI
    • Kitten URI
    • Adult cat diarrhea
    • Kitten diarrhea
    • Feline ringworm (adult and kitten)
    • Adult dog URI
    • Puppy URI
    • Adult dog diarrhea
    • Puppy diarrhea

I hope this overview has been helpful. Look at your particular shelter and make sure that you have basic holding and isolation spaces. Still overwhelmed? Consultation with an expert in shelter medicine may help!

Stuck between a rock and a hard place: Legal dilemmas in shelters

Let’s face it: shelter medicine is evolving. As sheltering systems improve and the bar is raised for animal welfare organizations, what was once acceptable for sheltering 10 or 20 years ago is no longer in vogue. While shelters are not as heavily policed as some other industries, shelters can easily find themselves in a complex legal situation. While shelters may be more likely to be the victims of bad social media campaigns than a government audit, the implications of the latter being much more serious.

Shelters are governed not only by federal law, but by state and local ordinances. It is important to know that many organizations are involved, from the Drug Enforcement Agency (DEA) to the state pharmacy boards. As inter-state transport and shelter cooperation increase, it is especially important to know the differences in state regulations. To look up local and federal laws, try Michigan State’s wonderful website: www.animallaw.info

Perhaps the most important laws to follow are those relating to the DEA and controlled drugs. The DEA enforces federal law regarding controlled substances in an attempt to reduce human abuse. Shelters can hold limited DEA licenses or use a veterinarian’s personal DEA license. Neglected log books, security or reporting errors can have serious consequences. If you haven’t recently reviewed the regulations, head on over to  www.dea.gov for more information.

Less serious, but equally important legal issues can arrive from the community and social dilemmas. Have you ever had someone surrender or request euthanasia of a pet which was not theirs? Make sure that your surrender forms encompass transfer of ownership and family issues with a statement such as “I am the sole and exclusive owner of (animal’s name). I am signing for myself, my spouse, heirs, etc.” The same is true of adoptions for dangerous or ill animals, foster care and rescue groups.

Remember, there is no way to completely stop a lawsuit from occurring, but you can mitigate the risk of prosecution with a good defensive paper trail. Organizations should consider getting professional legal services to ensure that their “fine print” is up to date. Contracts can be a good first step, but don’t forget to engage in the conversation. Many lawsuits are due to poor communication, rather than true malpractice or negligence.

Get the facts: Foster vs. nursery

Kitten nurseries are a hot topic in shelter medicine right now. As more and more shelter jump on the bandwagon it is important that we examine the pros and cons of creating your own kitten nursery and determine what is best for your shelter.  Kittens season lasts from mid spring to early fall and many shelters find themselves overrun with kitten at this time. Traditionally, kittens are either euthanized or sent to foster care until they are old enough for surgery and adoption. Kittens are generally not housed in the shelter due to risk of developing illness and due to physical limitations such as sheer volume of kittens and their high requirements for basic care. Foster care has long provided free labor for cleaning, medicating, feeding and socializing kittens. Foster homes should only have one litter of kittens at a time, which means that they function as quarantine units. Sick and healthy litters are thus kept separate, which is important for reducing spread of infectious disease. Foster care also provides a home environment, to get kittens used to things such as vacuums, stairs and children. Some foster parents end up adopting kittens, or find homes for their foster kittens, which helps expedite the flow of kittens through the shelter system.

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While foster care has been a staple for kitten rearing in many shelters, it does have drawbacks. Fostering hundreds of kittens means that you need a dedicated base of individuals who are available to take kittens. Some foster parents only take small numbers of kittens per year, or get burnt out due to emotional fatigue. Foster parents also have differing skill levels. Often shelters have a lack of caregivers who are comfortable–and available–to take bottle feeders or extremely sick kittens. Managing hundreds of foster caregivers is also a huge responsibility–foster coordination takes a lot of time and often requires several individuals to arrange check-ups, make calls and provide care to all the kittens in the system. For some shelters this is simply too much work, or their foster system is not yet developed enough to handle the current numbers of kittens coming through the door.

Enter the nursery. A kitten nursery is a physical location–often a room, trailer or building–which is used seasonally to house kittens. Nurseries are run by paid staff and volunteers, who provide 24 hour care to their patients, functioning much like an ICU in a veterinary hospital. Depending on the scope of the nursery, they may house bottle feeders, weaned kittens, and nursing moms in different rooms, or only provide housing for certain categories of kittens. Having 24 hour staff in short shifts means that instead of hundreds of foster care-givers waking up every 4 hours for bottle feeding, one person can feed the whole ward while the rest of the team sleeps. The nursery can be temperature controlled and all supplies are in one location. For obvious reasons, nursery staff need to be highly trained in kitten care in order to prevent milk aspiration, diarrhea and spread of contagious disease. This means that a supervisor needs to train staff and be accessible for any questions volunteers may have. Good hygiene and biosecurity is essential in nurseries in order to prevent outbreaks of diseases like panleukopenia, coccidia or ringworm. Nurseries also allow for great PR, and are a cause which many people may donate towards–perhaps those same people who didn’t donate to support the foster program or your shelter in general. That being said, nurseries can be costly to run due to increased labor time, utilities, and supplies, which are normally supplemented by the foster care-giver.

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Overall, kitten nurseries are a hot new service which some shelters are providing. Foster care will remain a stable of kitten rearing in summer months, but for some shelters a nursery may be a more viable option. Knowing the pros and cons of each paradigm is essential for organizations thinking about making the switch. Remember to create protocols, consult with your veterinarian, and to provide training and support for all those involved–no matter what your kitten-saving strategy may be!

Check out the North Shore Animal Rescue League’s nursery, which includes great PR material including a live cam and information about some of the animal in their care.

The magic of fenbendazole

Most shelter workers have heard of the magic dewormer known as Panacur–it is one of my favorite dewormers–and is a great drug for many reasons. Fenbendazole, the active ingredient in Panacur and Safe-Guard, it is a benzimidazole dewormer which prevents cell division. It is generally considered a safe drug, toxicity only occurring at 100x overdoses and in exotic species. Fenbendazole isn’t systemically absorbed and over 50% leaves the animal in feces. It must be given for at least 3 days to kill parasites, since it needs to halt cell division for a certain duration before it is fatal to the parasite. 

Fenbendazole is labeled for use in cows, horses, pigs and dogs; but has also been used in cats, sheep, birds, reptiles and fish. It’s labeled to kill roundworms, hookworms, whipworms, and some tapeworms, but it isn’t effective against the most common tapeworms, and therefore shouldn’t be relied on to kill tapes. Fenbendazole’s major use in shelters is for killing whipwormsGiardia, and lungworms.

Fenbendazole comes as a liquid and as granules, both of which can be kept at room temperature. A major con of fenbendazole is cost. A three day course of liquid Panacur for an adult cat will cost $1, while a single dose of pyrantel (Strongid) will cost $0.05.

Fun fact: When treating whipworms (Trichuris vulpis) you may have heard of the rule of 3’s, treat for three days, then repeat a three day course at three weeks and again at three months. This is an easy and commonly recited treatment regime, but did you know that there is actually a scientific reason NOT to treat like this? Whipworms take 3 months to mature from an egg to an adult. If you kill adults at day 1, then three weeks later there will be some immature adults which will have matured, but you’ll still have eggs and larval worms present. Wait until 3 months and then treat again, and don’t bother with the three week treatment.

PetPoint Summit 2014 Highlights

This past weekend, over a hundred animal welfare professionals flocked to Chicago for the 4th annual PetPoint Summit.  Offerings included workshops in basic and advanced functionality, Q&A’s, lectures and personal training sessions. Several product announcements occurred, including new PetPoint modules and new microchip technology. Just like a Kickstarter fund, PetHealth is still looking for funds to pay for the development of these new features. Early adopters will get access to the features as they are made available, get significant discounts on pricing, and have lower prices locked in for 3 years. Let’s take a look at some features which are now available, and which ones will be available in the near future.

Advanced Productivity

Logo-DMSFile storage: In addition to the standard three images and video which can be added to an animal, it will now be possible to attach other types of files. A new tab is now available for purchase, which will allow you to upload up to 250 files per animal. Finally we can attach vet records, lab results, scanned letters or other documents, and even .ZIP files. There is a maximum of 5MB per file, and a total of 1TB per organization. For those of you not technologically savy: 1-2 page PDFs are 200KB, high definition pictures are 2,000KB, and a large veterinary textbook is 5,000KB (5MB). Most standard files will be less than 5MB, and 99.9% of organizations will not exceed the 1TB (1000GB) data cap.

E-signature: Closely related to the ability to store files, is the ability to store e-signatures. Signatures can be obtained through touch screen devices (tablets, smartphones) or standard credit card signature pads. E-signatures can be used for adopters, consent forms and payments, allowing receipts and contracts to be e-mailed rather than printed. This can be particularly useful for saving medical or veterinary staff signatures, which can be printed out on vaccine or medical records.

Mobile Animal Inventory: PetPoint is finally going mobile! This new features will not be a traditional app one which can download onto your device from the Apple or Google Play stores. Instead, PetPoint will be available as a mobile web app. A mobile web app is a website, which is accessed through a browser like a normal site, but when the device which accesses the site is below a certain size or resolution, the website will automatically switch to the mobile web app view. This is similar to a mobile responsive website, which resizes and changes appearance to look better on a small screen. A mobile web app is designed to look like a native app (the kind you download), but to exist within a web browser. Through this app we can expect new features including taking pictures and videos with your phone that are automatically added to an animal’s file, to-do lists for daily rounds, and increased ease of real time updates.

Advanced visual calendar: The scheduling module is getting a facelift, including a basic visual calendar for ease of reading. Scheduling is also getting new features such as find next appointment, automated reminders, and a public consumer portal for self-scheduling of appointments. The scheduling module enhancement will be useful for those wanting to organize fosters, spay/neuter, vaccine, and other appointments or clinics.

Pricing: The Advanced productivity suite will be $2,000 – $3,000/year, but can be purchased as individual features. File storage alone will be $1,000/year, file storage and electronic signature $1,500/year. An additional TB of data storage will be $400/year.

My verdict:  Features I am most interested in are the file storage and mobile web app. Adding vet records, test results, x-rays, and other documents to the digital record has been sorely needed. The price is high, but provides adequate storage for most purposes. The mobile web app makes me excited, I love the idea of using PetPoint while on rounds. However, the app is a LONG way off, and PetPoint’s web design and UI have not impressed in the past.

Clinic Services Suite

CaptureMore and more shelters are also creating or are affiliated with clinics that provide low-cost veterinary services to the public. Shelters are also often involved with outreach, vaccine or spay neuter clinics. Worse of all, some shelters have to use two software products: one for the shelter and one for the “private practice” side of the organization. PetPoint’s new Clinic Services Suite will allow for standard features such as annual client vaccine reminders, integration in the scheduling module, invoices, multiple or recurring debit/credit card payments.

Other enhancements we can expect in the future include body system (SOAP) checklists, standardization of procedures (allowing tasks, medication, exam, and food to all auto-populate), reactivate canceled treatments, and skip treatments. Exciting news is that records transfer will now transfer ALL exams and treatments between organizations, rather than only basic information.

Some features will be Clinic Services Suite exclusive, while others will trickle down to Enterprise, Professional and Lite versions. This module requires a $2,500 deposit, and will be $5,500 – $6,500/year when complete. There is 25% discount for those wanting to sign up now, but many features are not yet available. Some feature overlap with Advanced productivity means that you’ll get a significant discount if purchasing both modules.

My Verdict: With a very large price tag on top of your Enterprise or Advanced Productivity modules, I think this module will be a hard sale for PetPoint. I personally don’t use public clinic features, but understand the need in certain organizations. Other new features tied in with the development Clinic Services Suite, such as the standardization of procedures, reactivation of canceled treatments, and complete records transfer will be of more use to the general PetPoint user. Again, this module is a long way off, so early adopters may not be getting much bang for their buck… yet.

Allflex T-chip

image004On Monday Allflex unveiled their new microchip product, the T Chip, a microchip with functions as a built in thermometer. The microchip can be read as a regular chip, but will also provide a temperature reading at scanning. Certain compatible scanners require a software upgrade (available online) in order to read the temperature. The temperature you take will be lower than a rectal temperature, as the chip is on the periphery, rather than in the core of the animal. This superficial temperature reading is subject to high variability due to environmental factors (e.g. dog walking outside in the fun). Temperatures also have high individual variability, and taking multiple readings is essential in order to interpret the results, which can downloaded off the scanner into an Excel spreadsheet.

My Verdict: A novel idea, my personal concern with this product is the utility within the shelter. While hands-off, one person monitoring is a nice thing to strive towards, most shelters don’t microchip animals upon intake. Animals coming through the door are the most likely to be or become ill, while those who are at surgery and get the microchip are less likely to need the chip. The (significantly) increased cost of $8.95 is another issue which I cannot see in the shelter setting. This premium product also has limited application once adopted, since owners and most veterinarians will not have a compatible scanner. Unfortunately, I’d be more interested in paying a premium on a GPS product than a T-chip.

For more information about products and services, please visit the PetPoint and or PetHealth Inc. websites for more information. Please click for the official suite brochure: http://petpoint.com/info/pdf_sellsheets/PP_DMS_Add_On_Suites.pdf

Diary of a bottle feeder

20140905_194356_AndroidBottle feeding is a lifesaving intervention, one which requires time, dedication and patience. There is a plethora of resources available on the subject, and I personally recommend the Maddie’s Institute webinars from 2013. You can read many fact sheets about how big the kitten should be, the volume of their stomachs, the correct ambient temperature, etc. True, there are a lot of technicalities when rearing kittens, but what I’d like to share with you today are some pearls of wisdom about the daily grind of feeding kittens.

Mix up only as much KMR as you can use in 12-24 hours... that's a lot in my case!

Mix up only as much KMR as you can use in 12-24 hours… that’s a lot in my case!

Tip 1: Scheduling. Very young kittens need to be fed every 2-3 hours, with larger ones being able to handle up to 8 hour stretches. You will get a sense for your kittens’ schedule based on how much they eat at each feeding and how active they are between feedings. If you find that they aren’t eating much in one session, then consider waiting an extra hour between feedings to see if that will increase their appetite. Make sure you can accommodate the feedings in your daily schedule. I recommend staying up late, with a last feeding at 10-11pm, and waking up once at 2-3am, then doing a morning feed at 6-7am. Do what feeds right for your schedule and remember to get some shut eye!

Tip #2: Mixing KMR. While it is best to mix up your KMR or milk replacement as fresh as possible, this is a great way to shave off time. I mix my milk once or twice a day in a large batch, then I just refill bottles as needed. I thoroughly wash and dry all my bottles once a day. When mixing up the KMR, add your powder to a large mason jar, cup or bowl. Slowly add water while mixing with a spoon to form a paste. This makes it much less lumpy than adding the powder to the water. In order to get perfect KMR I strain it in a fine mesh sieve several times to remove all lumps. Pre-fill all your bottles so that you are ready to go at 3 and 6 am (in my case that’s 4 full bottles). Invest in a small funnel to fill your bottles without any drips!

With my less preferred tapered nipple I will cut straight across to make it blunter, and then make my X cuts

With my less preferred tapered nipple I will cut straight across to make it blunter, and then make my X cuts

Tip #3: Nipples. The perfect KMR will be rejected by a kitten if your bottle’s nipple is the wrong shape, size or diameter. There are many products available on the market, and it takes some trial and error to get it just right. The best nipples are short and rounded, such as this one from PetAg or this one from Hartz. I don’t like the long, taper, triangular ones such as this one from Four Paws. That being said, the opening itself is more important than the shape of the nipple. The goal of cutting the “X” in the nipple is to make sucking easy so that you aren’t tempted to squeeze the bottle. You are better off making a hole too big, rather than too small. When turned upside down the bottle should steadily drip, and when smashed into a kitten’s face it should make a mess. The messier the nipple the more likely the kitten is to latch on, that little drip at the end is great for encouragement.

Tip #4: Cleaning, feeding, cleaning. Every kitten must be stimulated to go the bathroom before feeding, which inevitable makes a mess. There are several ways to do this. You can use a wet cloth or paper towel to stimulate them, or if you are budget like me then just use your gloved fingers. I hold the kitten over a towel, let them go, and then clean up their rears with a paper towel. If they are having diarrhea then I will use a paper towel, as I don’t want this to drip onto my towel (regular feces I can spot clean afterwards). This allows me to quickly do numerous kittens and reuse the one towel. After feeding kittens are inevitably dirty again, use a wet paper towel or rag to clean their faces and paws. This is very important because the milk will cause awful mats and crusts in their fur. Even worse their litter mates may try to suckle on the dirty kitten, which can lead to serious trauma and even death if unchecked. A clean kitten is a happy kitten–never let your kittens get dirty!

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Note dirty kitten bucket and feeding platform. Supplies on right including warm water for keeping KMR toasty and for cleaning kittens.

Tip #5 High volume set ups. Create a space for yourself to maximize efficiency in kitten feeding, as you will save a lot of time if you can keep an area set up for your kittens! I use a three tiered approach, as seen in the picture, I have a station for cleaning, for feeding, and then the primary enclosure. Kittens are moved from the primary enclosure and placed in the large floor Tupperware and are pottied. This catches all their mess and holds kittens waiting to be fed. The kitten to be fed is then placed on the Tupperware lid, and is then moved back up to the main cage. The lid I keep on my left, so that once the feeding kitten is latched on, I can hold that bottle with my left hand. I can use my more dexterous hand to use a second bottle to feed an eager kitten inside the Tupperware simultaneously.

Note that all my supplies are on my right (I am right handed), and I have trash and spare everything within reach. I prefer to feed sitting on the ground so that I can utilize maximum floor space. I use a bowl of hot water to warm my KMR straight from the fridge, and by the time I am done feeding it is the perfect temperature to clean kittens with.

Using this set up I can do seven kittens in under 30 minutes, what time-saving tips have you picked up over the years? Please share below in the comments section!

Kitten Cuddling 101 by Allison Cowen

The following is a guest post by Allison Cowen, DVM class of 2016 at Cornell University.

When people ask me what I’m doing this summer I tell them I am playing with kittens, professionally. While this is by no means 100% true, it comes closer than most jobs could. Let me explain.

At some point during my second year in veterinary school I approached Drs Berliner and Scarlett with a proposition: “I want to do research at the shelter. Can you help me?” We sat down for several meetings with some of the Maddie’s(R) shelter medicine crew and the brainstorming began. The goal was to find a project that was do-able in several months, would be interesting, but most importantly would be relevant and helpful to shelters.

charlieIt was the second or third meeting when Dr. Berliner said “Wouldn’t it be nice to know how kittens grow in foster care and in shelters?” The answer was unequivocally “yes”, and so the idea was hatched, and we ran with it. I did a comprehensive literature review to see what information was out there regarding growth rates in shelter kittens and foster kittens. Nada. I looked for papers on disease occurrence and mortality in shelter kittens and foster kittens. Nada. In total, I found several papers that looked at these factors but only within environments that differ greatly from the shelter and foster environments, ie catteries, private homes, pathogen-free colonies, feral colonies, or in adult populations. But these are inherently very different situations.

The orphaned malnourished kitten with snot coming out of its ears, eyes, nose and feet that was found in a drainpipe may grow at a very different rate from the purebred Siamese kitten in the cattery being sung to sleep every night. So it would be nice to know, is the universally accepted “1-pound per month” rule for kitten growth even relevant for kittens under these disadvantaged circumstances? What is normal for a hungry worm-filled kitten, and what is worrisome? Our hope for this study is that we will establish a normal rate of growth for kittens in these two very unique situations (shelter and foster care), and be able to use this information when monitoring the health of future kittens. We are also tracking disease occurrence as well as mortality in hopes of being able to draw correlations between some of these variables.

And so my career as a kitten snuggler began.

In actuality though, there is very little snuggling that goes on, as I do not want to become fomite-number-one. My days typically go like this: wake up, tend to whichever foster kittens I have at my home (including weighing them in what I have affectionately dubbed “the kitten cup”), head off to the shelter. I get out my data recording forms (every kitten gets its own form) and the kitten cup and work my way through the shelter kittens following these important steps:

  1. GLOVE UP
  2. Check to make sure I’ve got the ID number written down on the form matches the corresponding kitten (nothing worse than invalid data!)
  3. Pick up the kitten from the cage and try really, really hard not to snuggle it (by far the hardest part of my day)
  4. Place the kitten in the kitten cup, and jot down its weight
  5. Check its face for any ocular or nasal discharge
  6. Put kitten back
  7. Repeat all those steps for any kittens in the same cage
  8. Check its cage for stool quality, and also note how much they’ve eaten
  9. Take off gloves, spray down scale, and maybe even change scrub top if the kitten forced you to snuggle

cutieI do this for every kitten in the shelter every day that looks to be less than or around 8 weeks old. For the foster kittens, these responsibilities fall on the foster providers. Fortunately, Tompkins County SPCA has a really awesome and dedicated pool of foster parents, most of whom are more than happy to help with this and have been amazing about tracking each kitten’s weight, fecal quality, eating habits, and any disease and subsequent treatments. Much my day involves corresponding with the foster care providers, making sure things are going okay, and bringing them anything they may need – new forms, a scale, etc.

As someone who previously thought she was not a “research person” I can 100% tell anyone that whether or not you are a “research person” depends on what you are studying and whether or not you care. This has been an absolutely rewarding summer because I care about the project and am genuinely excited to see what our data holds. And of course a large part of what makes this project SO easy to care about is seeing the kittens day after day and knowing that these will be the beneficiaries of your research. I truly hope this information will be helpful in the future – helpful to shelter staff, to foster parents, to veterinarians, and most importantly to the kittens.

And lastly, a huge thank you to Drs Berliner and Scarlett, the Tompkins County SPCA staff, the dedicated foster parents, Maddie’s Fund, Morris Animal Foundation, and American Humane Association for making my summer wonderful.

ASPCA/Cornell/Maddie’s 2014 Recap: Foreign Bodies in Shelter Dogs

Picture1This article contains a brief synopsis of information presented at the 2014 ASPCA Cornell Maddie’s Shelter Medicine Conference. This presentation was given this past July by Tiva Hoshizaki, BVSc, the Janet L. Swanson resident in shelter medicine at Cornell University, to the shelter staff and volunteer track.

Foreign bodies can gastrointestinal obstructions, which can be life-threatning in dogs and cats. Any item has the potential to be a foreign body. Most commonly we will see dogs eating toys, balls, fabric, rocks or plastics. Foreign bodies cause vomiting, inappetence, lethargy and even diarrhea. Many dogs in shelters develop vomiting and or diarrhea, mostly due to stress, viruses or dietary indiscretion. Dogs which have persistent or severe signs should be seen by a veterinarian for work up including x-rays and or ultrasound.

Surgery to remove a foreign body can be expensive, over $1500 in many cases! If your shelter can afford to take out a foreign body, then be sure to ask the following questions before you commit:

  1. How bad is it? The sicker the dog is, the longer the foreign body has been there, and the type of foreign body will all impact the prognosis. In uncomplicated cases 95% of dogs survive and do fine. In dogs with severe illness, such as septic peritonitis only survive about 50% of the time.
  2. How adoptable is this dog after surgery? Some dogs are already beginning to deteriorate in the shelter. Are there concurrent medical or behavioral issues which may make this dog unadoptable in the future?
  3. Will your shelter be able to manage this dog in the future? Dogs who get foreign bodies are more likely to get them again in the future. That means this dog needs supervised time with toys, special toys, special bedding, and a special adopter to take them home. Will you be able to monitor and prevent a future surgery?

Picture12There are a variety of factors that inhibit ingestion of a foreign body such as the item itself, the dog, and the environment. The item itself is not always a dangerous object, although can pose life threatening consequences if not addressed in a timely fashion. Some dogs are classic offenders like the inquisitive puppy who just loves to eat rocks while out for a stroll, or the larger breed who unknowingly gnaws off and swallows a piece of your child’s Tonka truck. These dogs can make even low-risk toys into a foreign body. Conversely, some dogs go their whole lives playing with high-risk items and never require surgery. Most importantly, is the setting and environment of the shelter. Dogs are in high stress situations, with often minimal exercise and enrichment. While a certain dog may do well with toys at home in a supervised setting, a dog in a shelter setting may relieve its anxiety by shredding and eating its blanket! When making decisions about risk, remember to consider all three factors: DOG, TOY and ENVIRONMENT!

A brief word about toys and their relative risks. The highest risk toys are those which are cheap plastics and fabrics. They are easy to destroy and often have appealing squeakers which are the perfect size to become lodged. Avoid the bargain bin at pet stores, as these cheap toys aren’t worth the time and effort. Moderate risk items include rawhides, dental chews, balls, rope toys and tough fabric toys. The slightly edible toys are great fun, but can be swallowed if they are the wrong size for the dog, or if they are broken into smaller pieces. While edible bones and chews are good for dogs in a home, use them with care in the shelter! The lowest risk toys include the hard plastics and rubbers, or super tough fabrics. These toys include treat dispensing cubes, Kongs, “dental” toys, and other items designed for “tough” chewers.

Once again a reminder: Any item can become a foreign body. Any dog or cat can develop a foreign body. There are no hard and fast rules–you must judge based on that individual animal’s risk with that item and its environment!

Picture13The prevention of foreign bodies require communication between staff, daily monitoring of animals and their items (remove broken items!), awareness, and teamwork. Here are some other suggestions which you could implement in your shelter:

  • Do daily rounds!
  • Make foreign body prevention part of volunteer orientation and staff CE
  • Ensure there is a question on your owner surrender form about foreign bodies, and a complete medical and behavior history
  • Provide adoption counseling for potential adopters with a history of FB ingestion
  • Use a shoe rack with labeled slots for each toy, so that at the end of each day, all toys are put away and accounted for
  • Include appropriate toys and treats on the animal’s cage card
  • Use homemade shelter enrichment items which are completely digestible such as kibble, broth ice blocks, or treats in paper bags or egg cartons. Avoid making fabric or plastic bottle toys!

Do you have any other ideas of how you can prevent foreign bodies in shelter dogs? Please post below with your ideas!

Kitten season is here – Presurgical pediatric examination

Examining kittens

The high time is upon us and it is time to go back to the basics! The importance of the physical examination of our pediatric patients (especially prior to surgery) cannot be overstated. It tells us not only the age, gender, and health status of our patients, but also alerts us to many potential surgical complications, and conditions that need to be addressed during surgery. Pediatric spay/neuter is routinely performed on patients that are between 7 and 16 weeks of age. However, patients of this age may also be presented for other surgeries as well, such as enucleation or limb amputation.

A physical exam should be conducted systematically, in a routine manner, in order to prevent omission of any of its parts and missing anything important. Equipment should minimally include a stethoscope, scale and recording material, and may also include a thermometer, otoscope or penlight. Ideally kittens should be housed with litter-mates (even in the perioperative period) to minimize stress, facilitate appropriate behavioral development and reduce chance for spread of infectious diseases to other kittens. Each kitten should be clearly identified; this can be with a collar, tag, or gender and adequate description.

The first part of a physical examination is the exam at a distance. Careful attention should be given to mentation, energy level, gait and breathing pattern. Is the kitten interested in its surroundings? Is it friendly or withdrawn? Valuable information can often be gained by observing kittens before handling them.

Ideally the examination room would be free from barking dogs and other loud noises. The kitten should be allowed to approach the examiner rather than being immediately retrieved from the cage upon opening. Remember that kittens are impressionable and that gentle, low-stress handling will positively affect their future behavior. Every kitten should be weighed with a baby scale or gram scale in order to accurately dose analgesic and anesthetic agents and to be sure their weight reflects their known or estimated age. As a general rule of thumb, kittens gain about a pound every 4 weeks. Therefore, an 8-week old kitten should weigh about 2 pounds, and a 12-week old kitten should weigh about 3 pounds and be cutting its first adult incisors.

One approach to an examination is from the head to the tail. For our purposes we will divide the examination into four parts: the head and neck, forequarters and thorax, abdomen and hindquarters.

Wear gloves and minimize cuddling of kittens!

Wear gloves and minimize cuddling of kittens!

For the head and neck be sure to carefully examine the eyes, nose and mouth as well as the skin around those areas. Look for accumulation of dried secretions in the eyelid margins and corners of the eyes. Note the color of the whites of the eyes (sclera) and pink insides of the eyelids (conjunctiva). Observe the clarity of the cornea (the clear part of the eye) and check for inflammation (redness or swelling) of the conjunctiva. Look for abnormalities such as elevation of the third eyelid or discrepancies in pupil size. Press gently on the nares and look for secretions. Check the ears for debris as well as the skin around the ears for scratches and hair loss. Open the mouth gently by grasping behind the upper canine teeth and pressing down on the lower incisors. Inspect for ulcers, mucus membrane color and for abnormalities of the tongue or soft palate. Examine the teeth for discoloration (indicating a dead tooth) or fractures. Check the capillary refill time. Palpate the neck, particularly the left side of the neck, for swelling or other evidence of esophageal disease.  Palpate the mandibular lymph nodes for any abnormalities.

Examine the forequarters and thorax next. The prescapular lymph nodes should be very small or indiscernible. The forelimbs should be palpated joint by joint from the toes to the shoulder. Palpate the long bones for any pain or deformities. Note any additional toes and toenails. Palpate the ribs and spine. Listen carefully to the heart and lungs (ideally with a pediatric stethoscope). The lungs should be ausculted on both the right and left side and in all 4 lung quadrants (dividing into cranial and caudal as well as dorsal and ventral parts) for abnormal sounds or quiet zones. Carefully auscultate the heart on both the left and right sides of the chest. Keep in mind that inadvertent pressure placed on the chest while ausculting can cause an inducible murmur (through deforming the cardiac wall) in cats and kittens. Murmurs can be innocent or congenital. Innocent murmurs do not usually persist past 16-weeks of age. Palpate the femoral pulse while listening to the heart to be sure that it is strong and synchronous.

For the abdomen observe the skin and musculature. Look for evidence of parasites and umbilical herniation. Palpate the spine and abdomen gently for signs of discomfort, masses or other abnormalities. Finally, examine the hind limbs in the same manner as the forelimbs, from toes to hips. Check the perineum and anus for any evidence of fecal staining, inflammation or other abnormalities. Check the gender, and if male palpate for both testicles. A pre-operative temperature may or may not be useful. Kittens usually descend their testicles by 4 to 8 weeks of age. If both testicles are not descended by 16 weeks of age, cryptorchidism should be suspected.

A thorough physical exam just prior to surgery is an invaluable tool in finding common abnormalities seen in kittens including brewing or resolving upper respiratory infections, diarrhea, ear mites and other parasites as well as less common abnormalities such as heart murmurs, cryptorchidism, umbilical hernias and more. A gentle, systematic approach, in a quiet room just before surgery can not only help evaluate anesthetic safety but also save many potential complications including the need to re-anesthetize the patient in the future to correct things that were missed such as fractured deciduous teeth or umbilical hernias.

Adapted from Veterinary Pediatrics, Dogs and Cats from Birth to Six Months by Johnny D. Hoskins, 3rd edition, by Dr. Kara Breeding, Maddie’s(R) Shelter Medicine Intern at Cornell University.

Tritrichomonas foetus: What shelters need to know

Tritrichomonas foetusTritrichomonas foetus, also know as “tritrich” or T. foetus, is a relatively new parasite of cats which is gaining recognition in the shelter community. T. foetus is a flagellated protozoa, which is similar to Giardia spp. in many ways. T. foetus is most common in catteries and sanctuaries, but can also be found in shelters or privately owned animals.

Like many gastrointestinal parasites, T. foetus is spread by fecal contamination (shared litter boxes, grooming after stepping in feces, etc.).  Infected cats can have gassy, malodorous diarrhea, or no clinical signs at all. In private practice many owners may be reluctant to treat, as signs can be mild to non-existent. However, this parasite can be devastating in a shelter situation due to the chronic nature of infection. Cats which are untreated can take up to two years to clear the infection, and some remain infected for life.

T. foetus can be challenging to diagnose, for a number of reasons. Unlike most parasites, which can be found on fecal flotation, T. foetus requires specialized testing. The parasites are rare, so finding them can be difficult. Additionally, antibiotics, contamination, and poor sample handling can cause false negative results. T. foetus can be diagnosed by either fecal smear, fecal culture, or DNA testing (PCR). DNA testing is the best, but the most expensive and often requires the use of a referral laboratory. Fecal culture and smears are less likely to find the infection, and require some skill on the person doing the test. Watch the following video to see why T. foetus can sometimes be mistaken for Giardia spp. under the microscope.

While diagnosis can be hard, treatment can be even harder. The most commonly used drug is ronidazole, which is in the same drug family as metronidazole. Ronidazole  is most commonly used as an anti-protozoal and anti-bacterial agent in turkeys, pigeons and pigs. Ronidazole is not FDA approved for use in cats and poses human-health risks. While initial studies have shown that ronidazole is a promising treatment option in cats with T. foetus, some cats experience severe side effects. Signs of toxicity include lethargy, anorexia, stumbling gait, seizures, and even death. Treatment failure is common, leaving shelters with cats that have chronic, infectious diarrhea, which will be challenging to manage and to adopt out.

T. foetus is easily killed in the environment; thus the best way to control spread of infection is through sanitation and disinfection. Infected or suspect cases should be isolated from healthy cats, especially those who are sick or immuno-compromised. If you think your shelter cats may have T. foetus , then please contact your local shelter veterinarian, or the Cornell University Shelter Medicine Program for assistance with diagnostics and treatment.

For more information about Tritrichomonas foetus, please visit Dr. Jody Gookin’s website: http://www.JodyGookin.com