Without question dental problems are the most common issue we deal with in our patients on a daily basis. Pet owners need to understand that it can be very difficult to know if their dog or cat is suffering from oral pain. Certainly, if you can detect a foul odor from the mouth, see blood or your pet shows a reduced interest in his food a dental issue may be the culprit.

This is where we come in.

Many times a pet’s appetite may not be affected very much by bad teeth. Our pets are usually well adjusted and they try to get through their day as best they can. They don’t understand why their mouth hurts. They just deal with it; maybe by eating a little more slowly, chewing less and swallowing the food whole or they manipulate the food around inside their mouths in order to avoid the sore spots. It can be difficult to know.

Lots of things can affect your pet’s appetite, but in general, if your dog or cat acts hungry but doesn’t eat as enthusiastically as you are used to seeing, think about dental issues.

This year we upgraded our equipment so we can now take dental X-rays just like your dentist. In fact, the equipment we use is the same as my personal dentist’s. Unlike you and me, however, we can’t place the films between your dog’s teeth and snap a film. They need to be under anesthesia. They don’t sit still and won’t hold that disgusting cardboard thingamajig that makes us gag between their teeth while we say “hold it”.

And the good news is we can now see lesions we could not see before. Seemingly normal looking teeth and gums can have significant damage below the surface. Broken teeth and root abscesses are more common than you think. When we perform a dental cleaning now we recommend a full set of oral X-rays. It doesn’t add that much to the cost and it frequently allows us to fix a problem right then and avoid futu
re problems and added expense. Your dog and cat will be much happier too.

Afterwards, we can recommend a number of ways for you to keep your dog’s teeth clean and avoid future dental expenses. The new “OraVet” chews made by Merial (the Heartguard and NexGuard people) are terrific. They look like a traditional “greenie” but contain delmopinol which is a human dental, plaque preventing product found in pastes and mouthwashes. It really works and most dogs love them. They taste like peanut butter. Check them out at our front desk.

And believe it or not, marrow bones are also wonderful plaque preventing tools for dogs who accept them.

We recommend alternating OraVet and marrow bones 2-3 times each per week to keep plaque at bay.

Even brushing your dog’s teeth helps…if he or she will let you. You don’t need any special pastes. Just using a soft, moist tooth brush will do. Brush the outside and crowns of the teeth. Don’t worry about the inner part. Plaque doesn’t form there very well.
Now, as for kitty cats….well….that’s entirely different. They don’t like having their teeth brushed. Try it if you like. Let me know how you do. There are also a number of chew toys on the market that claim to keep cat’s teeth clean but I’m suspicious. Sometimes these gadgets get swallowed and cause all sorts of digestive problems, so I say avoid them. T/D, a dental diet for cats can be very helpful. The key is that your cat must chew them….crunch, crunch, crunch.  They’re very crusty in the middle; like a crouton, and they can scrape off plaque and keep it from building up. There is a doggy version of the diet too. We have them at our front desk.

In the end, clean teeth and fresh breath are well worth the effort. When I see an elderly dog or cat with all their teeth still there, most of the time they are very healthy pets.

Things Change

I’ve been practicing veterinary medicine for over 38 years. I’m only 61. You can’t start as young as I did anymore.

Back in the 70’s there was a shortage of veterinarians in the United States. It was the beginning of a new era. People wanted more and better care for their house pets. The James Herriot books didn’t hurt either.

Up until that time most veterinarians were engaged in farm practice and only treated dogs and cats on the side. Veterinarians who practiced strictly “small animal practice” were rare. Only in large, metropolitan areas were there practices devoted just to small animals. I grew up in Grand Rapids, Michigan. I recall there being only 2, strictly small animal practices in the city of 200,000. My dad took our dogs to see a vet out in the country. I don’t remember his name. He did farm calls and saw dogs and cats in his kitchen at night. I remember taking our dog to him. No appointments; we just drove to his house, rang the bell. He was having dinner in front of the tv. He stopped eating, we went in the kitchen and put our dog up on the table for the exam. The vaccines he gave were in the refrigerator, next to the milk and leftovers. That was my earliest exposure to a veterinarian.

Most veterinarians were male back then too. “Large animal” practice was for men (not my opinion) and fixing cows and horses was physically demanding.  Because of the increased demand for small animal practitioners, veterinary schools, of which there were less than 20 in the country, expanded their class sizes, admitted younger students and a lot of women, and doubled their faculties so they could add a small animal curriculum.

I was 19 years old when I was admitted to veterinary school. I wasn’t the youngest student in my class either. I was allowed to apply half way through my sophomore year of college, but only to Michigan State University where I had started as a freshman. In my class of 115, 45 of us were 2nd yr. “babies”. Almost half my class was female.

I began veterinary school in June of 1974, 3 months before I turned 20. No time off for summer. We went to school year around with only a 6 week break that was taken in the 3^rd year. I earned my bachelor’s degree sometime in 1975. I got it in the mail. I didn’t know I’d earned it. No graduation ceremony.

I graduated from veterinary school in June of 1977. We had 4 years of veterinary education crammed into 3. I was 22 years old. Needless to say, there were no spring breaks for my class. For that matter, not a lot of sunlight either. There were no computers, no internet. Everything was from books and lectures. Read, read, read, examine, memorize, study, test, study some more….maybe sleep some.

Thinking back, it was one of the best times of my life. My classmates and I were on our own little ship sailing in a big college ocean. We rarely interacted with the rest of the campus. Our classes were in buildings segregated from the rest of the university. In the clinic, we were required to wear “whites” at all times; white slacks, shirts and coats. Men wore ties. My roommate and I would sometimes wear bowties just to be different. We said we sold ice cream on the side. Some of the women wore ties too; just to change things up. Though I rarely see or speak to them anymore, they were some of the best friends I ever had. If I cross paths with an old classmate now, even if it hasn’t been since graduation, we hug each other like long lost relatives. Here is a picture of me and some of my 1977 classmates. Find me?

It’s been my pleasure to mentor a few youngsters who have gone on to become veterinarians. One of our interns, Kelly D. will be joining the Texas A&M class of 2020 this fall. We’re very proud of her. Her experience getting to this point is very different from mine. There is double the number of veterinary schools now. The profession is more than half female, which is great. I am the father of two daughters and I’ve always been proud of how the vet
erinary profession has welcomed women.

Today, the amount of time it takes and the cost of a veterinary education are dauntingly higher. One thing I’ve emphasized to future colleagues is to be careful and smart about the amount of debt you incur achieving your goal. It’s so different from my day.

Yes, a ton of things have changed since I started, but the one thing that hasn’t is the sheer joy of practice. It is hard. It’s challenging, special and rewarding. This is the honest to gosh truth. I’ve never regretted my choice (well, after a bad day, maybe once or twice). But really, I cannot imagine doing anything else.

Answer to “Where’s Dr. Beebe?” Here I am almost 40 yrs. younger, 50 lbs lighter and with a head of hair. Sigh.

If your kitty lives long enough chances are he or she might get this.

Hyperthyroidism. It’s an overactive thyroid caused by an benign tumor (adenoma) on the gland. It results in too much thyroid hormone and basically, it speeds up your cat’s metabolism. They appear quite normal. They have great appetites…maybe too great. They’re alert and playful most of the time. They’re always old when they get this disease; most are at least 12 years old. But they lose weight. Their heartrates and blood pressure go up. They waste away even though they eat like crazy. Eventually heart and/or kidney failure show up. Not good.

Here’s what one often looks like:

The disease did not exist when I was a student in the 1970’s. The first case reports were not published until around 1980. Interestingly, one of the first reports was by a veterinarian from Boston I had the pleasure of speaking to several times. The late Dr. Jean Holzworth. She was a fascinating lady and you can read more about her here.

I worked in Clinton in the early 80’s and she called me out of the blue one day as I was treating a cat belonging to a friend of hers. She had a summer home on the Connecticut shoreline. I didn’t know who she was. She proceeded to…shall we say…”inform” me about what I was missing regarding her friend’s cat. Also, since she had a PhD in Latin and had taught at Mount Holyoke College before entering veterinary school she was kind enough to correct my diction during our conversation. I was young and thought I was the “cat’s meow”; I almost dismissed her as a crank. When I mentioned the call to my boss he practically fell out of his chair and said incredulously, “Jean Holzworth called YOU?!!” He proceeded to fill me in on exactly who she was…and after following her suggestions (well…orders) I ended up diagnosing my first case of hyperthyroidism.

Years later when I was in my own practice up in the Litchfield hills she called me again. By this time she had retired to Lake Waramaug which was nearby. She did not remember me but, oh baby, I remembered her. Again, a friend of hers had brought a cat to me. It turned out to be a different problem, but Dr. Holzworth was spot on once again. The lady was a gem. Intimidating, but a gem nonetheless.

Today, hyperthyroidism is a regular finding. Unlike 35 years ago there is a simple blood test for the disease. We diagnose a case or two almost every month. We used to surgically remove the tumors, but it was fraught with complications and frequently failed.  Radioactive iodine, like they use for goiter in humans, is the best treatment now, but it can be expensive, so many cat owners opt to use the drug methimazole which comes as a topical ointment  applied to the inner aspect of the ear; or a liquid or tablet that is given orally on a twice daily basis.

Here’s an in depth article about the disease from Angell Memorial Veterinary Hospital in Boston; Dr. Holzworth’s career home. 

I’ve always been fascinated about why this disease wasn’t around before the late 70’s. There are several theories and none have been definitively proven. The two that I think have some merit have to do with what has changed in our households starting around 50 years ago. When hyperthyroidism was first found in cats researchers went back to their files and examined thyroid specimens that had been preserved from cats going back to the 1940’s. They could not find any evidence of thyroid tumors. Not until the 70’s did they start to show up. Why?

One theory was that starting in the 1960’s upholstery and carpeting manufacturers starting treating fabrics with fire retardant chemicals related to bromine (polybrominated biphenols, PBBs). Bromine is very similar to iodine and we knew high levels of iodine could lead to thyroid problems. Also, around this time cat food cans started to come with ring top pull tabs; can openers weren’t necessary. The inner lining of the cans were coated with a solvent containing traces of PBBs to keep them from rusting and leaking. By the time cats born in the 60’s reached 12+ years of age in the late 70’s…Bingo…thyroid tumors started showing up. I don’t know if they will figure it out but I lean towards the can theory. I had a cat, Pete, who lived to be almost 20 years old. He never got hyperthyroidism. Yeah, he lounged around on the carpets and couches his whole life but I never fed him canned food. I didn’t like the smell. For what it’s worth.

If I haven’t seen a cat in a while but I see “Nice, roly-poly kitty cat” in my notes I know two things. First, the cat is healthy, and second he’s overweight. I also write lots of other stuff in my notes; more technical things like weight, heart rate, the condition of his eyes, ears, lungs…etc. But, nice and roly-poly are a quick reminder that this kitty was fine. Now I’m not advocating for overweight cats, but it is a fact of modern pet ownership that big, happy lap cats are a common finding these days. Why? When I started in private practice back in the late 70’s (that’s 1970’s when bell bottoms and mullets prevailed….I wore the former…not the latter) strict housecats were rare. Most cats went outside. It was uncommon to see a 15 lb. cat back then, but also, 15 yr. old cats were few and far between. Cats who went outside, like kids, ran around a lot more. They also enjoyed a more…umm…. shall we say…”continental” diet consisting of little mousies and chippies that contained high amounts of fat and protein. It was harder to get chubby in those days. Unfortunately, going outside every day exposed them to greater risks, like automobiles and other, bigger creatures that often led to shortened life spans. By the 90’s cats became more house bound. All good. However, by this time the cat food industry began marketing their products in such a variety of ways that they started to push breakfast cereal off the grocery store shelves. So many choices? Flavors? Very competitive business. Consequently, like the human, convenience food industry, cat food became highly processed with large amounts of grains added as a cheap source of carbohydrates, fibre and fats. Rice, the cheapest grain, became the backbone of dry, cat food kibble. Cats became less active and soon…fatter. Nevertheless, even as they do live longer these days…it is not without needing more veterinary attention in many cases. Which gets me to my point. The cat is now a model for Type II Diabetes in humans. My doctor keeps warning me. I’m not diabetic…yet. I have borderline high blood sugar that I watch regularly. Like my cat patients, I am not as active as I once was and I eat too many highly processed, starchy, fatty foods. I’m working on it. 30-40 years ago veterinarians did not diagnose many diabetic cats (Incidently, like them, we too ran around more). We used to see 10 diabetic dogs for every diabetic cat. Now it’s reversed. In the old days, most dogs got table scraps in their food; lots of gravy and fat. Now their food is much more balanced, no leftovers and the rate of diabetes in the dog has plummeted. Cats have gone in the opposite direction. What to do. Think about it. No, don’t start letting your cat outside, nor is getting a kitty cat treadmill going to work. Think about cat food with little or no grain in it. I’m a big advocate for grain free diets for cats. The one I feed my cat, Mr. Whoopie (more on him in future blogs, this is him in a more reflective moment),
is Nature’s Variety, Instinct. There are others. I like Blue Buffalo too. Whatever you do, avoid rice. Studies have shown that while most cats fed rice based diets DO NOT become diabetic, almost all the cats that do, are on one. Get rid of the rice. More protein, less carbs. In the end, your cat will get older…and maybe stay just as heavy, but less likely to be diabetic and more likely to get “nice” and “roly-poly kitty cat” written in his record.

I’ve seen many dogs and cats with abnormally high levels of calcium. Keep reading, I’m not trying to be Dr. Smartypants. Trust me. It’s not good to have a pet with high calcium levels. Currently, Dr. Dinwoodie and I are managing two dogs with dangerously high levels; both for different reasons.

When I was senior veterinary student I was assigned a case referred to the Michigan State Veterinary Clinic suffering from lymph node cancer, lymphosarcoma (it’s a bit like Hodgkin’s Disease in people). In addition, this dog had very high levels of calcium and that’s the reason she was so sick. It had only been recently determined that lymphosarcoma could result in elevated calcium levels. It was called Pseudohyperparathyroidism (OK….that’s a Smartypants term).

My managing resident thought this was a good case for me to present at grand rounds, so he assigned me the task of not only presenting the details of this patient, but also reviewing the normal physiology of calcium metabolism; the mechanisms of absorption, storage and mobilization of calcium in the dog and what causes it to get out of whack. It was a daunting task in the era before Google, the internet and no power point. It took days. I prepared my slides and notes and delivered a 30 minute presentation and answered questions before a group of 50 senior faculty members and students. I got an “A”.

Soon after graduation, at my first job in Norwalk, I encountered another dog with lymph node enlargement and high calcium. I thought, “I got this.” However, biopsies did not show the lymph nodes to be lymphosarcoma, but a different type of tumor, adenocarcinoma. How could this be?

The pathologist who read the biopsy referred me to a pathology resident who was studying this phenomenon, Dr. Don Meuten. He suggested I examine this dog’s anal sac area and lo and behold, there was a pea sized mass that turned out to be the cause of the hypercalcemia. This was a new thing. It had never been described in the American Veterinary literature. Dr. Meuten was preparing a paper describing this new disease process for a major publication and asked if he could include my patient in his report. The owner, while saddened by the diagnosis, agreed to allow Dr. Meuten access to her dog’s records. Sadly, after 9 months we finally put her pet down, but this dog was included in the first detailed article about this disease in the United States.

Interestingly, over the next year I diagnosed 2 more dogs with anal sac tumors and hypercalcemia. Since 1979, I’ve only seen one more. It’s weird; three in 2 years, then only one over the next 35.

Dr. Meuten, who now teaches at the North Carolina State College of Veterinary Medicine, helped me write a practitioner’s case report for publication. It is my only contribution to the veterinary knowledge base. I am forever grateful.

Calcium is in my blood.

BEEBE. M.A.: Pseudohyperparathyroidism associated with adenocarcinoma in three dogs. Mod Vet Pract 61:582-585, 1980

Our first blog

This is new. We’re going to try blogging and see what happens. A friend of my mine that blogs regularly told me it’s like keeping a diary. Just write about things that interest you and come to mind.

I don’t know how often we’ll post, but hopefully every week or two. So our blog will sometimes be about our practice…or maybe a particular patient or medical issue we encountered. It may be about us…or maybe you. Sometimes it will be about something else. Maybe baseball or the movies or about something else that we find interesting. But I can absolutely assure you it won’t be about politics. No drama.

Maybe Dr. Dinwoodie can be convinced to participate. But for the time being it will be mostly me…Dr. Beebe.

So if you read something you like and want to comment, you’re welcome to. If there’s a topic you think might be interesting feel free to offer suggestions. The only promise I’ll make is that I hope it’s interesting…or maybe funny sometimes.