Clinical Signs: Recent Episodes
Dr. Matthew Panarella
This podcast is my take on topics in veterinary medicine relating primarily to dogs and cats for the general public. Also I will explore medical and scientific topics of interest to veterinarians and veterinary nurses. All are welcome. I will also consider topics to present by email: askdrmatt@proton.me If you are interested in science, animals and veterinary medicine then give me a try!
This episode discusses heart worm disease, caused by the internal parasite Dirofilaria immitis. The disease can affect all dogs, cats and ferrets. This is a vector born disease, transmitted by a mosquito bite. The heartworm life cycle is partially completed in the mosquito and finished in the animal that is bitten. Heartworms live in a symbiotic relationship with the bacteria Wolbachia, that live in the GI tract of the heartworm. Reservoirs in the environment include other dogs, wolves, fox and coyote. The disease can cause clinical signs such as breathing difficulty, coughing and lethargy. There are many choices of preventatives, available for dogs, cats and ferrets. There is an approved treatment for dogs, but not cats or ferrets. In general, preventative should be given monthly all year long. Treatment includes the use of doxycycline to kill the Wolbachia, which in turn will help to cause the death of the heartworms.
If you have any questions or are concerned about your pet, please contact your local veterinarian or emergency clinic.
Thank you.
In this episode I discuss both thrombosis and embolisms. A thrombosis is a blood clot, an embolism can be a blood clot, but not always. Other types of emboli include fat and air.
Clinical signs of a clotting issue may be in cats loss of use (paralysis) of the hind legs or tail. In dogs clinical signs may be dyspnea (bad breathing) where the animal may have rapid, shallow breathing rate (panting). Bleeding from the mouth, nose, anus and genitals may occur as well.
Diseases that can activate the clotting cascade in cats is hypertrophic cardiomyopathy (HCM, which is a thickening of the heart muscle and a reduction of the amount of blood that can be ejected during systole) and in dogs an endrocrine disease such as hyperadrenocorticism (Cushing's disease, which arises from either a pituitary tumor or an adrenal gland tumor).
Diagnostic testing includes clotting panels and a search for the primary etiology (what disease is causing the animals body to react in such a way as to throw clots).
Treatment is focused on analgesia (pain relief), thrombolytics (enzymes to help break the clot down), anticoagulants (such as aspirin to reduce platelet adhesion) and possibly surgery.
If you thinhk you pet experiencing a medical issue please contact your local veterinarian or veterinary emergency clinic.
In this episode I follow up from episode 21 on the corn cob incident. Here I explain the possible ramifications from an animal swallowing a corn cob or other "foreign body". The damage caused by a foreign body can lead to various clinical signs such as vomiting, diarrhea, inappetance (not eating), to straining to defecate and anorexia. If not treated, this process and the resulting clinical signs can be fatal. Sometimes even with the appropriate treatment, the outcome for an animal is not good.
Originally I wanted to discuss the difference between a thrombosis vs embolism. I then thought, I hadn't thoroughly explained the possible consequences of a GI obstruction. So talking about obstructions is a terrific lead in to a discussion on thrombosis/embolism. As I completed the GI obstruction portion of the podcast, I decided to make this a 2 part episode. The next episode will cover the thrombosis/embolism discussion.
In this episode I talk a bit about the documentary by Werner Herzog, "Grizzly Man". It was released in about 2005, so I am quite late to the party. Nevertheless, I see a troubled human being projecting his needs on to grizzly bears and the tragic outcome. I see similarities between this man and people that hoard or also "rescue" particular animals. I wonder if the rescuers are really helping the animals or mostly themselves and are they truly benefiting the animals. You must decide for yourself.
If you suspect that your pet has swallowed a foreign body, please contact your veterinarian or local emergency clinic for veterinary care.
Thank you and see you again.
In this episode I discuss my dogs misadventure with a piece of corn on the cob and how I remedied the situation. I only had access to over the counter 3% hydrogen peroxide, which I administered to my dog. This successfully caused her to regurgitate her dinner along with many chunks of chewed up corn cob. Thankfully there were no long term consequences.
This is cookout/barbecue season, always dispose of any bones/corn cobs appropriately so your pets do not have access to them.
Some possible clinical signs of a foreign body/gastro-intestinal obstruction can include, loss of appetite, drooling/nausea, abdominal pain, diarrhea, lack of feces, hunched appearance and lethargy. If your pet has any of these signs please contact your veterinarian immediately.
Remember if your dog/cat has swallowed anything it should not have please contact your local veterinarian or emergency hospital immediately.
This podcast does not provide instruction on how to use hydrogen peroxide, if you choose to use it you use it at your own risk. Aspiration/aspiration pneumonia are potential complications of administering any product by mouth or as a result of regurgitation and/or vomitting.
Thank you and see you again.
In this episode I discuss fleas, particularly the cat flea (Ctenocephalides felis), which is the most likely culprit in an infestation of both cats and dogs. The flea life cycle can be completed from egg to adult in as little as 3 weeks or as long as a year. The completion of the life cycle depends on 3 things, these are food, warmth and moisture. If any one of these criteria are missing then the eggs can go dormant and wait for the proper criteria to start the cycle again even one year later.
Fleas can carry several diseases, these include tapeworm eggs (Diplydium sp.), and bacteria (Rickettsia typhi or R. felis). The Rickettsia can cause fever, a rash and GI problems such as diarrhea. Fleas, specifically rat fleas can carry Yersinia pestis, the plague. In the western US cats that are outdoors can carry these fleas and transmit the plague bacteria to humans. This is a zoonotic disease and was the cause of the Black Death epidemic in Europe. All of the diseases I just described are treatable with dewormers or antibiotics.
There are many different flea treatments and preventatives available, both from your veterinarian and over the counter. Your veterinarian is the best resource when tackling a flea infestation so please talk with them if you have questions or your pets have fleas.
Thank you.
In this episode I discuss fentanyl, a synthetic opioid used in veterinary medicine. There is an overdose epidemic in the USA concerning fentanyl and many media stories about this. Recently I came across a story about a person overdosing and possibly giving their dog fentanyl. Thankfully the dog survived. I have a link to this story and several other links about fentanyl.
Opioids are potent analgesics used therapeutically by veterinarians to relieve acute, severe pain in animals. This is different than the adulterated drugs used by people illegally and causing overdoses. The reversal agent naloxone (known as Narcan) is readily available to resuscitate unconscious people as well as animals.
Thank you and see you again.
In this episode I discuss the book titled "How Doctors Think" by Jerome Groopman MD. I have found this book to be beneficial by helping me think more clearly, critically and to always perform a full physical exam on my patients. Although the book was written for physicians and their patients, I think it is just as valuable for veterinarians and our clients. How we think as doctors is critical to providing the best care possible and will help clients/patients to communicate more clearly.
Thank you and see you soon.
In this episode I recount the recent history of an issue with my dog involving one of her toes. So far her outcome has been great. My dog's story segues in to a discussion about squamous cell carcinoma cancer in dogs and cats.
Squamous cell carcinoma is cancer of the epithelial cells, which are found in the skin, the linings of the body and the hair follicles. Diagnosis is by histology and treatment involves surgery to excise the mass. There are adjunct therapies such as radiation and chemotherapy.
I have 3 links for this episode and I discuss a recent publication by a Canadian team that looked at over 250,000 biopsy specimens and determined that 1500 or 0.5% of these specimens were subungual squamous cell carcinomas.
I can be contacted at: askdrmatt@proton.me.
Thank you and see you again.
Welcome. This episode covers the pulse oximeter from how it functions, to what the readings mean and some troubleshooting tips. Without understanding ventilation, hypoxemia and hypoxia the data acquired by the pulse ox will not be useful to you. I recommend that you listen to episode 15 on this topic.
In animals the pulse ox is typically placed on a non-pigmented portion of skin such as the lip or tongue. Other locations include a skin fold, a toe or the tail. Placement is limited by the width of the clip you use, it is best to have the 2 clips of the unit be parallel for best functioning.
Always check your equipment prior to use and keep it clean!
I am linking again to the article on pulse oximetery in exotic animals as it has a good version of the oxygen-hemoglobin dissociation cure that visually represents what happens when the SpO2 is below 95%.
Remember the pulse ox is a proxy measurement of the amount of oxygen in the arterial circulation that can be transported to the cells. The gold standard measurement to measure oxygen in the blood is a blood gas analysis.
SpO2%=pulse oximeter reading of the percentage of hemoglobin saturated with oxygen
PaO2 mm Hg=the partial pressure of oxygen in the arteries
SpO2% 98-100 = PaO2 mm Hg 100 (animal breathing room air or under anesthesia with 100% oxygen)
SpO2% 95 = PaO2 80 (hypoxemia, low oxygen in blood)
SpO2% 90 = PaO2 60 (hypoxia, low oxygen to cells)
SpO2% 75 = PaO2 40 (death)
Thank you.
In this episode I covered 2 miscellaneous topics, with the bulk of the podcast reserved for discussing ventilation, hypoxemia and hypoxia. This information provides the necessary understanding for the next episode which will cover the use of a pulse oximeter.
Introduction 00:00-00:20
Pulmonary atelectasis, ramblings 00:20-04:19
Dog hair 04:20-05:21
Gonad sparing surgery 05:22-12:30
Ventilation, hypoxemia and hypoxia 12:30-1:12:20
Closing thoughts 1:12:20-1:14:48
Some abbreviations:
O2-oxygen; CO2-carbon dioxide
ATM-atomosphere, barometric pressure; mmHg-mm mercury (measures barometric pressure)
P-partial pressure (partial pressure of oxygen)
PaO2-partial pressure of oxygen in the arteries, PaCO2-partial pressure of carbon dioxide in the arteries)
PAO2-partial pressure of oxygen in the alveoli
SpO2-% oxygen saturation of hemoglobin (measured with pulse oximeter)
Hb-hemoglobin, carrys oxygen molecule in the RBC (red blood cell)
FiO2-fraction inspired oxygen (air FiO2- 0.21, 100% oxygen FiO2-1.0)
FRC-functional residual capacity (air remaining in the airway that is basically unused by the body, dilutes the air coming in and going out of the body during respiration/ventilation)
HCO3-bicarbonate
Partial Pressure Gradients :
Oxygen diffusion from outside the body to the blood
PAO2 (alveolar) 104 mmHg > PaO2 (arterial) 100 > PO2 (intracellular, ultimate use of oxygen for cellular metabolism) 23 > PvO2 (venous) 40
Carbon Dioxide diffusion from the blood to out of the body
PCO2 (intracellular, results from cellular metabolism) 46 mmHg> Pv CO2 (venous) 45 > PA (alveolar) CO2 40 mmHg
Thank you for listening.
I can be reached at:
askdrmatt@proton.me
In this the 14th episode, I discuss 3 topics. The first are the S1 and S2 heart sounds, S1 is the "lub" sound and the S2 is the "dup" sound. S1 sounds refer to the closing of the AV valves ( located between the atria and ventricle, these are the mitral valve on the left side and the tricuspid valve on the right) and the S2 refers to the closure of the semilunar valves, the aortic on the left side and the pulmonic on the right side.
Next I discuss stethoscopes and some of their functionality. I have a link to the Littman website which demonstrates the components, how to use a stethoscope and its care.
Finally I discuss a link to normal and abnormal heart sounds recorded by Dr. Stephen Ettinger from the 1970's that has been posted online. These recording are a fantastic resource to anyone interested in veterinary cardiology. Dr. Ettinger is a pioneer in veterinary cardiology.
I can be reached at askdrmatt@proton.me
Thank you and I look forward to the next episode!
Have you ever wondered why in a movie or TV show that a character holding a syringe will "flick" the syringe with a finger? Well, I have the answer. It is just being dramatic. In real life, a veterinarian/veterinary nurses will do this to remove air bubbles trapped in the syringe, although we do it as we draw the drug out of the vial. This step is critical to minimize the possibility of a vascular air embolism (VAE).
VAE is a potentially life threatening, iatrogenic(doctor caused) complication of injecting small air bubbles when making an intravenous injection. These small bubbles can damage the blood vessels and also act an an air lock in the heart.
In this, the 13th. episode of the Clinical Signs Podcast, I discuss what a VAE is, how much air could be lethal to dogs, cats and people, and how we address this issue before making an injection. As added bonuses I discuss the metric system and free radicals.
As always I can be reached by email at: askdrmatt@proton.me
Thank you and see you soon, Dr. Matt.
In episode 12 I have 3 topics of discussion. First is a deeper dive on my goals for the podcast, providing you with information. The second part of my goal is education. This is your responsibility to use the information I provide and put it to good use for the betterment of you, your pest and the world.
My second topic concerns dog behavior and collar/leash training. I recommend behavioral training for all dogs. Most dogs (if their anatomy and medical condition allows) will benefit, if they are not well trained to a leash to a gentle leader harness that fits over the muzzle and behind the head. It is more effective feedback to the dog than a choker collar, slip type collar or a chest harness. I use a gentle leader on my own dog.
The third and majority topic of the podcast I discuss issues regarding vomiting and diarrhea (V/D) in dogs and cats. I cover various causes, some diagnostic testing and treatments available. The causes of V/D are numerous, from mild and self limiting to sever and potentially fatal. If you are ever concerned about your pet with V/D please call your veterinarian or local emergency clinic. They can recommend a course of action for you to follow.
00:00-00:15 Introduction
00:15-02:05 My goal; information and education
02:05-05:50 Dog behavior, gentle leader
0550-52:50 Vomiting and Diarrhea (V/D)
As always I can be reached for comments or questions at: askdrmatt@proton.me
Good news, there are no links from this week's episode.
Thank you for your time and I hope you enjoy!
Episode 11 covers the rabies virus and it's effect on both animals and people. Rabies is a fatal, zoonotic disease of animals and humans. Most people are exposed by bats or cats, especially stray cats. Animals that are infected with the rabies virus will express bizzare behavioral signs, sometimes being aggressive and biting/attacking people and other animals or animals will be more quiet, may stagger about and can vocalize. Do not interact with wild animals, especially animals behaving abnormally.
If your pet appears to be behaving bizarrely then please call your veterinarian.
Also critically important is to keep your pet up to date on the rabies vaccine.
I can be contacted at askdrmatt@proton.me
Thank you.
In this, the tenth episode of the Clinical Signs podcast I cover the pro's and con's of gonadectomy on our dogs and cats. There are potential acute, short term consequences from the anesthesia and the surgical procedure itself. I am focused here on the long term benefits and consequences of removing the ovaries or testes. Long term benefits (The Good) include an increased lifespan, a large decrease (almost 100%) in mammary cancer in females spayed before their first estrus cycle, a decrease in males wanting to roam after neutering and a hysterectomy is the surgical cure for a pyometra (a pyometra is a pus filled uterus). Typically to cure a pyometra the ovaries as well as the uterus will be removed. The Bad/Ugly of gonadectomy constitute an increase in a variety of cancers in dogs and an increased incidence of chronic kidney disease in cats. The are more studies on dogs than cats in this area, although I have 2 papers in the links for cats and several on dogs.
I can be contacted at askdrmatt@proton.me
Thank you and Happy New Year!
Episode 9 is a grab bag of different topics. I start off discussing other podcasts that I enjoy, following up with more information about making a diagnosis, then I discuss symptomatic treatment, next is a discussion about population medicine vs. individual medicine, then I follow up with two research papers on feline parvo virus DNA recovered from animals with cardiac disease, next I cover the new serum chemistry test that assesses kidney function earlier in disease than our older test and wrap up with my closing. Below are the times for each portion of this episode:
Introduction 0-1:06
Podcasts I like 1:06-11:39
Addendum to making a diagnosis 11:39-17:16
Symptomatic treatments 17:16-22:07
Population vs individual medicine 22:07-30:44
Feline Parvo Virus detected in heart muscle 30:45-36:04
SDMA (new kidney function test) 36:04-51:02
Closing 51:02-54:03
As always I can be contacted at:
askdrmatt@proton.me
Thank you and see you soon.
This episode dives in to Feline Parvo Virus (FPV). Known by other names such as feline distemper, feline plague and feline infectious enteritis, I prefer FPV. This is a serious contagious and infectious disease of cats primarily infecting kittens and unvaccinated or partially vaccinted cats. It is ubiquitous and worldwide. Cats are less likely to survive a serious infection than dogs, by 50%. Recovered or vaccinated cats have lifelong immunity. I have posted several links below for further reading.
Please leave a review, it will help to attract other listeners.
I can be contacted at askdrmatt@proton.me
See you again for the next episode.
In this episode, I discuss the what the pulse is, how it originates, where to locate it , how to feel it and pulse quality. Of course taking an accurate pulse and feeling the difference in pulse quality is based on you practicing the technique. An easy way to do this is on yourself or if you have a cooperative dog or cat.
I have also posted the references below . All sources are textbooks. You can also do a web search, there are plenty of references on this topic.
Note, during my discussion about counting the pulse I say "digital" watch. I meant to say analog watch with a second hand. This is my preferred clock/watch to make a count of the pulse. On the other hand, a digital watch/clock may also be used.
Happy Thanksgiving, stay safe.
Thank you for listening to my podcast.
Contact me at: askdrmatt@proton.me
Research sources are listed here, these are all books:
1.Kimber-Gray-Stackpole's Anatomy and ,17 th edition, Miller M, Drakontides, AB and Leavell LC. Macmillan, pg. 414.1977.
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Large Animal Internal Medicine, 2 nd edition. Smith BS,. Mosby. pg 115, 116. 1996.
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Veterinary Physiology and Applied Anatomy. 1st edition. Tartaglia, L, Waugh A. Elsevier. pg108, 109. 2002.
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Textbook of Veterinary Internal Medicine, 5 th edition. Ettinger SJ, Feldman EC. WB Saunders. pg 174-177. 2000.
In this, the sixth episode I cover the sometimes devastating disease of dogs called Canine Parvo Virus (CPV). Also known as "parvo" this is a worldwide viral disease of young dogs. While there is no specific treatment, most dogs will recover from a parvo infection. There are vaccines available that all puppies should receive as a series from about 10-12 weeks of age to 14-16 weeks for most dogs.
There are plenty of links posted if you would like a deeper dive in to this significant disease.
If you have comments or questions you can contact me at: askdrmatt@proton.me
Remember, if you have a puppy that is not feeling well please contact your local veterinarian.
Thank you for listening.
In this episode I give my opinion on a recent magazine article concerning the development of a pill to increase longevity in people and dogs. Apparently cats are too difficult to figure out how to accomplish this which translate in to it costs too much for the expected economic return. Welcome to the world of 2022, medical science fiction .
As I come across news stories or articles like this I will comment and provide my opinion. If you have any new or magazine articles you would like me to review and comment then feel free to send me a link.
As ever this is a learning process for me. Upon review of the episode I heard my cell phone vibrate at about 11:45. The sounds of silence in the modern world.
Thank you for listening. I do not advertising and I'm not on social media. Please tell your friends about my podcast. Also you can leave a review which I am sure helps with rankings and attracting more listeners.
I can be contacted by email at: askdrmatt@proton.me.
In episode 4, I cover how a veterinarian goes about making a diagnosis. There are many formal steps to this process. The steps are: 1-the chief complaint (the problem or problems briefly summed up), 2-the history of the problem(s) and the animal, 3-a physical exam, 4-a list of possible diseases is generated, called differential diagnosises, 5-diagnostic testing, 6-rule in vs rule out (possible diagnosises ruled in or out based on test results), 7-a definitive diagnosis is made (hopefully, but not always), 8-treatment (there are many possible therapeutics (i.e. drugs, physical therapy) available today, also surgery may be required. As a veterinarian gains more experience they may abbreviate some of the early steps or a diagnosis may be made directly by visualization or the physical exam. The chief complaint and the history typically can be excellent guides to the diagnosis. I discuss 3 examples of patients I treated in my career ranging from the small, a chihuahua to the huge, a great dane! The odd cases are not easily forgotten. At about minute 16 you will hear a thumping noise and some random clunking. That's my dog, Penny a female black lab who has to make sure I'm ok and once she does then proceeds to gnaw on her bone. Got to love that. Near the last couple of minutes my voice becomes a bit croaky, I will try to remedy that for the future. You can contact me with questions or suggested topics by email at: askdrmatt@proton.me Thank you and I look forward to our next get together.
Hello and welcome back to the Clinical Signs Podcast. What does the term clinical signs mean? Is it the same as a symptom??? Clinical signs is term in veterinary medicine that is used to objectively describe what can be seen, felt, heard or smelled about an issue with an animal or pet. Some examples include the pet is lethargic or "lazy", vomiting (which most people have experienced with their pet dog or cat!) and lameness. These are but a few of the many possible clinical signs a pet may present with to a veterinarian with. On the other hand we have symptoms. A symptom is the term used in human medicine to communicate how we are feeling about whatever ails us when we see the physician. Examples include a cough, or pain somewhere in your body or you have a runny nose. Again a few examples of many different possible symptoms. When bringing your pet to a veterinarian for an issue, it is helpful to spend a few minutes thinking about what you are seeing, how long you have been aware of the issue, is there any medication or other treatments that you have given the pet, does the condition get better or worse with exercise for example. Being accurate and concise helps the veterinarian have the most information to guide their thoughts and diagnostics (tests) to make the most accurate diagnosis possible. Thank you for listening and stay tuned for more interesting podcasts. Disclaimer: This podcast is for educational and informational purposes only. If you are concerned about your pet please see your local veterinarian.
In this episode I discuss the tragedy of the mauling and death of two children in Tennessee by two dogs in their home. I review some available data from PubMed with links below regarding dog bites in the US and death by mauling from dogs in the US. Dog breed matters when discussing death caused by dogs. I discuss risk and some things to consider when evaluating risk and your circumstances such as your ability to handle the breed of dog your are adopting or purchasing, vulnerable people in your home and the dogs history if known. The final consideration is change-what dynamics have changed or will change in your home that may warrant action on your part to reduce risk to you and your family. You can email me at: askdrmatt@proton.me
Hello listeners! This is the introduction of my podcast 'Clinical Signs'. I am a veterinarian with over 30 year's experience and with this platform I hope to bridge the gap beteween veterinary medicine and the public. Also I will present medical and scientific topoics of interest to veterinarians and veterinary nurses, Finally, I will give my take on newsowrthy topics relating to animals and veterinary medicine. I look forward to seeing your here, Email the show at: askdrmatt@proton.me Disclaimer, this podcast is for informational and educational purposes only. I will not provide explicit advice or a diagnosis to you regarding your animals' issues. I will address interesting topics presented in the podcast. These topics can include understanding disease, specific treatments or drugs used to treat or prevent disease and general animal health questions. If you are concerned about your pet, then please have them examined by your local veterinarian.