Authors Posts by Michelle Gerhard Jasny V.M.D.

Michelle Gerhard Jasny V.M.D.

Michelle Gerhard Jasny V.M.D.
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Michelle Gerhard Jasny, V.M.D. has been practicing veterinary medicine on the Vineyard since 1982 and writing the Visiting Vet column for more than 25 years. She lives and works in West Tisbury.

The three kittens in the carrier peered out curiously. “We weren’t going to get purebreds again,” one of the owners said. The couple had shared their home for years with a beautiful pair of Burmese cats who were now gone. “Then we read about Tonkinese and couldn’t resist.”

Looking at that trio of exquisite faces peeking through the grate, I understood completely, but I didn’t know much about the breed. To me the word Tonkinese conjured up images, not of cats, but of the musical South Pacific. (“How far away, Philadelphia, P.A….from coconut palms and banyan trees and coral sands and Tonkinese.”) I, too, was curious, so I did a little research.

Tonkin is the name given by the French to the northernmost region of Vietnam. In the 1900s, indigenous people from this area emigrated to work on colonial plantations on the island of Vanuatu (formerly called the New Hebrides). Referred to as “Tonkinese” by westerners, James Michener wrote about them in “Tales of the South Pacific,” on which the famous musical was based. So what about Tonkinese cats? Are they from Vietnam, too?

The breed called Tonkinese was developed in North America in the 1960s by crossing Siamese and Burmese cats, so let’s start there. Siamese cats are thought to date back at least to the 1600s. Their introduction to the West began with a pair named Po and Mia given to a departing British Consul-General by the Siamese king in 1884 (Siam, of course, being modern day Thailand). The Siamese Cat Society of America was founded in 1909. Over the decades Siamese breeders altered their appearance to have a thinner body, elongated head, long, skinny legs, and unusually large ears. The Burmese breed began with a single small walnut-brown cat named Wong Mau brought from Asia by a sailor in 1930 and given to Dr. Joseph Thompson in San Francisco. The doctor bred Wong Mau to Siamese cats and, using selective breeding, developed a consistent coat color called sable. Burmese eventually became recognized as a separate breed, with four officially accepted colors — sable, champagne, platinum, and blue.

In the mid-1960s, two breeders in North America began crossing Siamese and Burmese, working to develop a specific “moderate” breed they agreed to call Tonkinese. So, no, Tonkinese don’t actually come from the Tonkin region of Vietnam, but they are descended from cats that originated in southeast Asia. Tonkinese now come in 12 officially recognized colors with varying levels of contrast between body color and “points.” Most have dramatic aqua eyes. Because they started out as hybrids, theoretically Tonkinese are less likely to have inherited medical issues than breeds like Burmese, which have narrower gene pools.

One of the three kittens had an upper respiratory infection, giving his owners a bit of a scare, but this fairly common condition is rarely serious, and Kitten One soon recovered. Then, at five months old, Kitten Two suddenly began pawing his face. We’re not talking gentle rub-the-face-with-the-paw. Two was having repeated intense episodes of frantically clawing at his mouth. His dad even shot a video for me.

“Let’s take a look,” I said calmly, trying to soothe the owner’s anxiety. Two was acting the way a dog does when a bone or stick gets lodged in the mouth. I expected to find something in Two’s mouth, remove it, and be a hero. But I couldn’t see anything unusual. “Let me check under his tongue,” I continued. Occasionally cats playing with string or thread will get it caught around the tongue causing similar behavior. Nope. Nothing under the tongue. The only thing I could see was Two was teething. His adult canines and premolars were erupting and the associated gums were a bit red.

“We read on the Internet about some kind of serious mouth problem in this breed,” the owner volunteered.

“I think he’s just teething,” I stammered, “but I’m not sure.” We decided I would give Two pain medication and keep him for observation while doing further research.

Who knew? It’s called FOPS. Feline Orofacial Pain Syndrome. First recognized in the 1990s, it is characterized by severe oral pain and self-mutilation. It is most common in Burmese cats. Signs can be intermittent or continuous and can be triggered by eating, drinking, grooming, or stress. Current information suggests that there are two different age ranges when FOPS is likely to occur. The first is around six months of age and is associated with teething.

Bingo. There’s our diagnosis for Two.

The second time it occurs is often between 10 and 12 years old. FOPS is defined as “neuropathic pain,” an exaggerated response to a normally painful stimulus. It appears to be a genetic dysfunction of the processing of information from the trigeminal nerve in the brain. Definitive diagnosis is based on clinical signs and by ruling out everything else. This could mean dental X-rays and referral for expensive tests like MRI. The more I read, the more worried I became. Often multiple drugs are needed to control symptoms, sometimes even anticonvulsants. In one study, 10 percent of cases ended up with unremitting, severe self-mutilation leading to euthanasia.

Luckily, Two responded to the first pain medication we tried. He was still pawing, but much less. One article reported that antibiotics can be helpful in cases with underlying dental infections, so we gave an injection of long-acting antibiotic and sent him home with additional doses of pain medication. In case things got worse, we ordered a second recommended drug in kitten-sized tablets from a compounding pharmacy. But we never needed them: within a few days, Two seemed back to normal. I breathed a cautious sigh of relief.

Seventy percent of FOPS cases recur. All we can do right now is hope that Two is in the other 30 percent. Because of the suspected genetic basis, individuals with the syndrome should not be bred. Two’s owners are fine with that. They just want One, Two, and Three to live long, happy, and healthy lives.

When my daughters were little I read them the Little House On The Prairie series. We loved learning about life on the frontier. The simple pleasures. The ingenuity. The hardships. Sometimes we watched the television show based on the books.

What always struck me was what happened when someone needed a doctor. Pa would hitch up the horse and buggy, then ride as fast as he could into town to find Dr. Hiram Baker, the local physician and veterinarian. When he got to Doc’s office, Pa often found that no one was home. The doctor might be ten miles away, delivering a baby, or tending someone on their deathbed. As far as I remember, there were almost no telephones in Walnut Grove. There were certainly no pagers, no cell phones. Pa couldn’t call, text, or email. If he needed Doc badly enough, he had to physically go track him down. My children couldn’t imagine such a world.

“Well, when I was your age, there were no home computers,” I said while driving them to school. “No wi-fi. No Google. If you wanted to find something out, you had to go to the library, search your subject in a card catalog, find the book in the stacks, look in the index, and see if that book could answer your question.”

They looked aghast. “I love Google,” one sighed. I agreed. It is very cool to have so much information right at our fingertips. Unfortunately, it means we also have a lot of misinformation at our fingertips.

When clients bring me tomes downloaded from “Dr. Google,” I have to wade through all their research, separating the wheat from the chafe. I don’t want to ignore an owner’s efforts. Perhaps there is some new treatment I am not aware of that might be useful. It’s nigh impossible for one lowly veterinarian to keep current with all the advances in medicine these days. But most of the time, I find they are bringing me information about some 21st-century equivalent of snake oil or magic beans.

Then there’s Facebook. I resisted mightily for a long time, but eventually joined in order to find an old friend. Then several old friends found me. That was nice. Then clients started to friend me. Okay. I like my clients. Then people I didn’t know started sending Friend Requests. “Do I know you?” I wanted to ask, but that seemed so rude. Then people started messaging me veterinary questions. All the time.

“It’s bad enough I can’t go to Cronig’s without having to talk about fleas,” I thought grumpily. “Can’t I even waste time on FB reading about everyone else’s perfect lives (children, vacations) without having to play James Herriot!” I longed to move to Walnut Grove where Pa would never hitch up the buggy after dark or on a weekend just to bother Doc about fleas or diarrhea. But in the midst of my Bah Humbugging, I happened to see that one of the animal-focused Facebook folks had shared a link about veterinarians and burnout along with a lovely comment encouraging people to appreciate their veterinarians.

Burnout. Also called compassion fatigue. It is a kind of physical, emotional, and/or mental collapse brought on by overwork, stress, and isolation. Medicine has come a long way since Doc Baker’s day, which is all well and good, but for physicians (and veterinarians) it means a huge amount of ever-burgeoning information to be mastered. This has led to a statistically proven increase in burnout among doctors, often manifested by substance abuse, depression, even suicide.

Doctors on the front lines of health care are at highest risk because they usually work the longest hours for the lowest pay. Primary care docs have a higher rate of burnout than specialists such as dermatologists or pathologists. (Though when you see how busy dermatologists are here on the Vineyard, there’s no doubt they have their share of overwork and stress.). General practice veterinarians are in a similar situation to primary care physicians, facing long hours, hugely diverse demands, and lower pay than their specialist colleagues.

People who are caregivers for the chronically or terminally ill also suffer from the depression associated with burnout. Faced day in, day out with a situation in which a patient doesn’t get better, it is not unusual to succumb to feelings of helplessness and hopelessness.

For veterinarians, because our patients typically have much shorter life spans than human beings, we see an awful lot of death. Probably more than your average primary care physician.

We also play a particularly poignant and personal role, guiding people through decisions about euthanasia, then personally performing the actions that lead to an animal’s passing. Add the loss of control of one’s time that comes with doing emergency work, and technology that now enables us to be available 24/7, and you end up with an emotionally exhausting life. Especially when you consider that most of us went into this business because really, we actually do love animals. Some of us even like the people that own the animals.

And hard as it is for you to lose your beloved pet, it’s hard for your veterinarian too. Hard for us to feel like we couldn’t fix the problem. Hard for us to say good-bye to animals we may have known since they were puppies and kittens. Hard to see you grieve. You, our clients, who often over the years have become our friends.

People in all walks of life suffer from burnout, from depression, from hidden struggles. It’s a good time of year to remember to open our hearts to each other. In the words of Laura Ingalls Wilder, “Christmas Eve was the time when everybody was unselfish. On that one night, Santa Claus was everywhere, because everybody, all together, stopped being selfish and wanted other people to be happy. And in the morning you saw what that had done. ‘If everybody wanted everybody else to be happy, all the time, then would it be Christmas all the time?’ Laura asked, and Ma said, ‘Yes, Laura.'”

Landon has never been a dog who hides his feelings. Adopted from an off-Island shelter six years ago, no one knew for sure how old this sweet beagle was nor much about his medical history, but when anything hurt, Landon let us know loud and clear with a classic hound dog howl. He suffered periodic neck and back pain, yelping in anticipation if his mom went to lift him. As he got older, he developed a heart murmur, a cough, a benign growth inside his eye called an iridociliary cyst, and a case of separation anxiety. He made himself sick eating chicken bones from the trash and chocolate chips off the counter, but his mom adored him, nursing him tenderly through one thing after another.

As his veterinarian, it was often hard to know when something was really wrong, since Landon would scream any time I touched him. Did his leg hurt, or was he just anxious? What about that tooth? It looked fine, but he shrieked whenever I tried to examine his mouth. I was just thankful his owner knew I was not, in fact, torturing her beloved pet when he carried on this way in the exam room. But when he arrived on emergency late one night there was no doubt Landon’s distress was real. Earlier that evening he had been restless and breathing hard. She had called me, but knowing Landon’s propensity for drama, I hadn’t been overly concerned. “Let’s see if he settles down overnight,” I said, suggesting a little Benadryl to calm him, but several hours later his owner decided he truly needed urgent care.

She was right. Landon walked in my door, his breathing rapid and labored, his stomach heaving in and out as he tried to move air. He held his neck stretched forward in his efforts to breathe and had been coughing badly at home. Putting my stethoscope to his chest, I immediately heard loud crackles. “Sounds like fluid in his lungs,” I said. “And that heart murmur is much louder.”

Landon looked like a classic case of acute congestive heart failure (CHF), a cardiac illness that is usually characterized in dogs by sudden onset of fluid in the lungs. The underlying heart problem may vary. Elderly small dogs often have heart valve disease. Certain large breeds such as Doberman pinschers are prone to a genetic condition affecting the heart muscle called cardiomyopathy. Regardless of the initiating cause, the result is often pulmonary edema — fluid in the lungs. Symptoms may include coughing, rapid, labored respiration, and an elevated heart rate. Landon fit the picture and we made a presumptive diagnosis of CHF.

“I’m giving him a diuretic to draw the fluid out of his lungs, and other medications to support his heart,” I said, then explained how to monitor his sleeping respiratory rate (SRR) at home, i.e., the number of breaths per minute when he was fast asleep. “We’ll repeat doses of the diuretic until his SRR is less than 40. Tomorrow we’ll take radiographs. Maybe consult a cardiologist.”

The next day Landon’s SRR was down to 36 and he was feeling fine, but I still wanted X-rays of his heart and lungs. The films surprised me. There was a little fluid in his lungs, but his heart looked pretty normal. His liver and spleen, however, were enlarged.

“Let’s run a few blood tests,” I suggested, beginning to question my late-night diagnosis. A chemistry profile revealed a few abnormalities including elevated liver enzymes. Moving on to a complete blood count (CBC), my in-house machine kept refusing to register a white blood cell count, lights flashing and error messages telling me to make and examine blood smears under the microscope. That’s what we did, and in no time flat realized that something was desperately wrong. There were way too many of the white blood cells called lymphocytes. Way way too many. A sample sent to the pathology lab the next day confirmed our fears. At more than 10 times normal, Landon’s lymphocyte count was consistent with a diagnosis of lymphoid leukemia.

Lymphoid leukemia is cancer of the bone marrow resulting in a huge proliferation of one specific type of white blood cell, the lymphocyte. It is classified as acute or chronic.

Chronic lymphoid leukemia (CLL) often has an insidious onset with virtually no clinical signs initially. It progresses slowly, leading to weight loss and lethargy. Treatment can be delayed until the dog is feeling poorly. Survival times with chemotherapy range one to three years.

Acute lymphoid leukemia (ALL) has a more dire prognosis with less than half responding to chemotherapy and an average survival time of two to four months. It is more common in younger animals, around four to five years old, but older dogs may be affected. Signs may include lethargy, weight loss, poor appetite, nose bleeds, bruising, increased respiratory rate, labored breathing, lameness, and/or enlarged liver and spleen. Sometimes a pathologist can differentiate ALL from CLL on the CBC, but in Landon’s case we would need additional tests — flow cytometry, ultrasound, possibly liver, spleen, and/or bone marrow aspirates.

Landon’s mom was faced with tough choices. The prognosis for ALL was very poor, no matter what we did. CLL might be treatable, but the medications are extremely expensive. While we were still considering the options, Landon suddenly developed another problem, one more consistent with ALL. He went blind in one eye, the eyeball bulging and red. Despite having been surprisingly stoic so far, he now was obviously in pain and his owner was increasingly concerned about his quality of life.

We started oral corticosteroids in hopes of making him feel better, maybe even getting temporary remission, also eyedrops to lower intraocular pressure, and analgesics for pain. Once again, Landon rallied.

We know his time is short, but we’re taking it one day at a time. Landon is not a dog who hides his feelings, and we trust he will tell us when it’s time to say good-bye.

Each night of Hanukkah begins with lighting of menorahs. From left: Max Marcus, Jack Crawford, Ali Marcus, Molly Crawford, and Sydney Marcus. — Photo by Sally Cohn

The story of Hanukkah tells the tale of the first documented armed struggle for religious freedom in human history. It begins in the second century B.C.E. when Judea was conquered by the Greco-Persian tyrant Antiochus. Although many urban Jews embraced Hellenistic culture with its emphasis on science, poetry, and athleticism, to rural religious Jews Greek culture smacked of pantheism and idolatry, with its marble statues of gods and deification of the human form. To force them to assimilate, Antiochus outlawed essential Jewish practices. Jews were forbidden to keep their dietary laws, study Torah, or observe the Sabbath. The Temple in Jerusalem was desecrated and the Jews driven out.

A family named Maccabee took refuge in the mountains from where they fought a guerilla war in the face of staggering military odds. The Maccabees became folk heroes, and after three grueling years, recaptured the Temple, and the country. The legend goes that when they reentered the Temple to rekindle the sacred Eternal Light, they found only enough oil for one day. A messenger was sent on the long journey for more holy oil. Miraculously, one tiny cruse of oil burned eight days until he returned. The Hebrew word Hanukkah means “dedication” and refers to the reconsecration of the Temple.

Long considered a “minor” festival, Hanukkah has been celebrated for more than two thousand years. In contemporary times, after the Holocaust decimated the European Jewish population, many Jews found inspiration in the story of the Maccabees. Hanukkah took on even greater emotional significance when the state of Israel was established. In the Diaspora, where Jews live increasingly assimilated lives, the proximity of Hanukkah to Christmas also served to increase the holiday’s prominence. Both observances involve festive lights and gift-giving, but the similarity ends there. This year, due to differences between the solar-based Georgian calendar and the lunar-based Hebrew calendar, Hanukkah will coincide with turkey and football, not Santa Claus and eggnog. Hanukkah actually has far more in common with Thanksgiving, as both commemorate struggles for religious freedom.

The lighting of the candles

Each night of Hanukkah begins with lighting of menorahs, also called chanukiahs. These special candelabras have eight branches, one for each day, and a ninth branch for the shamash, a “servant” candle for lighting the others. Hanukkah candles may not be used for mundane purposes. They are not to be used to light a room, read a book, or accompany dinner. Their sole purpose is to enjoy their beauty and reflect on the miracles of God. Except in times of severest persecution, Hanukkah menorahs are customarily displayed in a window.

After candle-lighting, Jews traditionally eat foods fried in oil, in remembrance of the miracle of the long-burning oil in the Temple. Potato pancakes, called latkes, served with applesauce and sour cream, exemplify the Ashkenazi tradition from Eastern Europe, but there are many other Hanukkah foods. Ljuba Davis of Vineyard Haven keeps alive her family’s Sephardic heritage that reaches back to the expulsion of the Jews from Spain in the 15th century. She makes burmuelos, deep-fried dough drenched in warm honey, and keftes, fried patties made from leeks, onions, eggs, and pine nuts.

West Tisbury resident Geraldine Brooks and her family plan to serve latkes at Thanksgiving dinner. They have a family custom of betting whose candle in the menorah will last the longest. Asked about Hanukkah customs in her native Australia, she says “like all holidays [there], it’s topsy-turvy. It’s early summer, and there’s no snow for the light to flicker on, but we do all the same things.”

Nicole Cabot of West Tisbury agrees. Like many Islanders, her family also observes with latkes, dreidels, and small gifts. Although some parents feel compelled to match the effusive gift-giving associated with the commercialized aspects of Christmas, traditionally Hanukkah presents are small. They might include gelt, or coins, for playing dreidel, a gambling game played with a four-sided top inscribed with four Hebrew letters: nun, gimel, hey, and shin that stand for the Hebrew phrase “A great miracle happened there.” In Israel, dreidels have one letter changed so the phrase becomes “A great miracle happened here.”

On the other side of the world, Dominique Ariel Hendelman, formerly of Edgartown, is observing both Thanksgiving and Hanukkah in Israel. “We are doing a potluck meal that is going to merge the two holidays together,” Dominique reports from Talpiot in eastern Jerusalem, where she is studying Hebrew. “We’ll have a turkey obviously and one of the girls even had cranberries sent from The States because they’re very hard to find here in Israel.” Jelly donuts, called sufganyot, are a traditional Israeli Hanukkah treat. Dominique has a recipe for sweet potato sufganyot to really blend the two celebrations. A freelance writer for the Jerusalem Post, Dominique touches on some deeper political concerns. “We’ll play dreidel and eat stuffing, and try to reconcile the fact that Thanksgiving is not such a nice holiday to celebrate in the first place. Hopefully there will not be any small pox blankets. To me, Thanksgiving is really about over-eating good food and being with family and friends. Hanukkah has a lot of those same elements.”

An act of justice

Acknowledging that humanity still faces many challenges, Judaism teaches that people have a responsibility to participate in tikkun olam — which means “healing the world.” Thus, giving tzedakah is an important part of all Jewish observances including Hanukkah. Loosely translated as “charity,” the word actually is derived from a root meaning righteousness, justice, or fairness. In Judaism, giving charity is not seen as being magnanimous. It is simply an act of justice. Rabbi Caryn Broitman’s family has a tradition of each person choosing a charity to which to donate during Hanukkah and many families encourage their children to place donations in a Tzedakah Box at home or at synagogue. A community Hanukkah celebration is planned at the Martha’s Vineyard Hebrew Center on Wednesday, December 4, at 5 pm. Congregants are asked to bring their menorahs from home. In past years there have been more than 30 menorahs, all lit together. Since this year’s party falls on the eighth night, that could mean 270 candles. All are invited to come and enjoy their light, and reflect on miracles.

“My daughter has a new cat named Gaia” a client called me the other day with a cautionary tale. “I had loaded the wood stove with newspaper and kindling, then left the door open and turned away to get matches…”

I could see where this was headed. Cats love to explore, to curl up in strange, out-of-the-way places. These are natural instincts with adaptive value. There may be delicious mice under the porch, or tasty birds in the rafters. In the wild, sleeping tucked away in a hiding place keeps slumbering animals safe from predators and retains body heat in cold weather. But sometimes these natural instincts lead kitties astray. Like our caller’s cat.

“I was about to light the fire when I heard rustling inside the stove,” he continued. Sure enough, Gaia had climbed inside the stove and nestled down in the papers. Luckily, the owner realized it before he set anything on fire.

That family’s cats like heating equipment, I thought. Fifteen years ago their cat Ringtail went missing. They searched in vain. The children scoured the neighborhood on bicycles, but he was nowhere to be found. Three weeks after his disappearance, a neighbor called from Philadelphia. An electrician doing repairs in their vacant Vineyard house had heard faint mewing in the walls. Were they missing a cat? Ringtail’s dad immediately went to the house in question and called for the cat. Ringtail meowed. Calling back and forth like a game of Marco Polo, the owner discovered that somehow Ringtail had gotten into the house, then the basement where he crawled into a heating duct. He had traveled deep into the walls, the ducts becoming narrower and narrower, until he found himself lodged in a six-inch-wide pipe, unable to turn around or back out.

Ringtail had dropped from nine pounds down to four. He was skin and bones, weak, dehydrated, hypothermic, and soaked in urine. But he was alert and seemed to know he had been rescued. We started intravenous fluids and warmed him up. Soon he was eating baby food and using his litter box. By the second day, he was able to stand up. By the fourth day he was able to wobble around a bit. After six days hospitalized in my clinic, he had gained two pounds and was ready to go home. He eventually regained all his weight plus some and lived to be almost 18.

I remember another curious cat mishap, involving one of those old gas stoves with the broiler on the bottom near the floor, and a client cooking pork chops. The chef opened the broiler compartment to peek in and see if dinner was ready. Then, turning around to do something else in the kitchen, he realized he hadn’t closed the stove. Without looking, he pushed the broiler door shut with his foot. Seconds later, there was a wild banging inside the stove. He quickly jerked the door open, and his cat came flying out. When the cat arrived at my office soon after, she had a series of parallel grill marks across her back and side, like steak coming off the barbecue. Luckily, her thick fur had protected her well. It was mostly hair that had been burnt, though she had several linear areas of first and second degree burns to the skin, which we treated with topical medication and oral antibiotics. I don’t remember the patient’s name, but we referred to her thereafter as Broiler Kitty.

It’s understandable that cats would be attracted to warm wood stoves, yummy pork chops, and the excitement of exploring duct work, but what about my friend AnneMarie’s curious kitten story. Here’s what she wrote when I asked for details. “When I was living in a big farmhouse in Vermont, I couldn’t find my little black ball of fur (only eight weeks old) one night. After searching everywhere I could think of, and not finding him, I went to bed, figuring he was all curled up somewhere snug. In the morning I asked my roommate to help me pull the refrigerator out from the wall because we had not thought to look behind it. At the same time we saw he was not there, we heard a meow. I looked at her and said, ‘It sounds like he’s in the fridge!’ Sure enough when we opened the door and pulled out the crisper drawer, there he was! I thought he would be in shock and hypothermic, but he came walking out, started purring and wanted to eat. We figured he was in there for about 15 hours! (I remembered the night before I had made a salad and when done just pushed the drawer in and closed the door.) Needless to say, I do think the cold affected his brain cells because even though he was lovable he was not a particularly smart cat!” In honor of his escapade, she named him Crispy Critter, and he also went on to live a long life.

Not every story ends so happily. Don’t leave the clothes dryer door ajar, tempting your pet with that cozy laundry. More than one cat has been badly tumbled, and some killed from being closed inside. In winter, cats who spend time outside are attracted to the warmth and shelter provided by cars and trucks. Some climb inside wheel wells, tucking themselves atop a tire, or crawl under the hood of a recently driven car, where it is nice and toasty. If you turn the car on without warning, a dozing cat inside can be severely injured. Veterinarians call these “Fan Belt Cats,” and the resultant trauma is often life-threatening. So bang on the hood of your vehicle before you get in. Close the dryer door. Check the wood stove. I don’t know how many kittens would actually climb into the vegetable crisper, but at least one did. Never underestimate a feline’s sense of adventure. Don’t let curiosity kill the cat.

One of the fun parts of writing my column is naming the animals. For hypothetical cases, I might choose something silly. Sweetie Pie, the diabetic cat. Polly Dipsia, the dog who drinks excessive water. When reporting about actual pets, I use pseudonyms to protect the privacy of the owners. Dogs don’t seem to care much. Cats like to read about themselves in the paper, but they know my pseudonym choice is irrelevant as it is never their true “deep and inscrutable singular name.”

Sometimes I go obvious. Tom, the cat, becomes Dick or Harry. The dog Grover becomes Elmo. Sometimes I take a more circuitous route. Leopold becomes Kinshasa. (Know your African history?) Charlotte becomes Currer. (Check out pen names of the Bronte sisters.)

When I write about patients, it is often in the midst of caring for them. Researching the latest helps me keep current medically while simultaneously gathering information for the column. The upshot, however, is that I often don’t know how things are going to turn out when we go to press. A gentleman recently left me a message inquiring about the outcome of one story. “What happened to Thunderbolt? Please call back.”

I was happy to reply, but being a pseudonym, I had no idea who Thunderbolt was or what problem he had. I racked my brain. I checked my old articles about thunderstorms. I thought about dogs named Zeus or Thor. I searched my data base for various terms. I finally gave up. I couldn’t remember. Here at the office we have computerized reminders for follow-up calls. I plug in data when a pet goes home, and later my staff calls owners and gets updates. You don’t have that option, so today here are progress reports about some cases you may have read about in these pages.

Isaac, the overweight golden retriever who went acutely blind soon after starting weight loss medication was diagnosed by MRI with immune-mediated meningitis of unknown cause. The neurologist does not think it was related to the diet medication, though we opted not to use it again with him. He has been on corticosteroids for a year. His vision returned quickly, though when we first tried to lower his cortisone dose he relapsed slightly until we bumped it back up. He’s doing great now, though still plump, and we are very, very slowly weaning down his medication.

Tunny, the border collie cross with autoimmune hemolytic anemia received multiple blood transfusions and other treatment at the specialists but then had to come home a little before the doctors would have liked. He’s doing well on a variety of long-term immunosuppressants as well as medications to protect his gastrointestinal tract from side effects and anticoagulants to lower the risk of blood clots. I was a little concerned about how long it has been taking for

his blood counts to normalize. In my 30 years of practice, all the AIHA cases I have seen either got completely better or passed away by this point, but I check in with the specialists regularly and they reassure me everything is on track.

Don Quixote, the big lab with neck pain who was collapsing and virtually unable to walk, had an MRI that revealed a large lesion in his spine. At first we thought it might be cancer, but it turned out to be a ruptured disc that was removed surgically. Don is dancing around now almost as though nothing ever happened.

Sylvester, the diabetic Maine coon cat, had less definitive results. The special diet did not get his blood sugar under control. Before starting insulin, we decided to send him to the neurologist, who noticed abnormalities in his front legs as well as his hind. She is concerned he may have a primary problem with his muscles or nerves, unrelated to his diabetes, but recommended regulating his blood sugar with insulin first. If he doesn’t improve, the next steps may be MRI, muscle biopsies, or other specialized tests to evaluate his neuromuscular function.

Piglet was the cat with the recurrent urinary tract blockage who needed the penile amputation surgery called a perineal urethrostomy. Surgery went well, after which, on the advice of some specialists, I stopped his antibiotics. Big mistake. Piglet’s kidney failure worsened dramatically soon thereafter. We obtained a urine sample, and cultured a nasty bacteria that turned out to be susceptible to only a very limited number of antibiotics. I prescribed one available at the local human pharmacy. His owners gave it to him faithfully, as well as daily subcutaneous fluids at home. The renal failure turned out to be completely the result of bacterial pyelonephritis, i.e., a kidney infection, which resolved with a month of treatment. He has gained two pounds, his kidney function is normal, and he’s peeing beautifully. It’s funny the things that make me happy.

Maya, the rottie who I was afraid might have the uterine infection called pyometra that is life-threatening without emergency surgery, happily survived to bark another day with just oral antibiotics. But her problem is likely to recur with each heat so her owner is thinking about having her spayed despite her senior age.

Blanche, the cat with feline infectious anemia, and Coal, the kitten with anaplasmosis, both recovered completely with antibiotics, though sadly Coal passed away from other causes. Zev was the cockapoo with the cardiac problem called AV block. The cardiologists suggested a pacemaker, but Zev was not a young dog, so his owner decided to just enjoy whatever time he had left. We had hoped he might live for many months, but he passed away peacefully in his sleep soon after his diagnosis.

I’ve scanned back through years of articles to glean these follow-ups. Still haven’t found Thunderbolt. And now I’ve misplaced the message slip with the caller’s name and number. Perhaps it will come to me, suddenly, like a bolt of lightening. Or maybe you will call and remind me. Please. I promise to report how things turned out.

You know you’re getting old when women your own age, or even younger, start showing up with Little Dogs. We’re talking dogs that fit in your pocketbook — Yorkshire terriers, teacup poodles, Chihuahuas.

As a teenager, my family had a diminutive cocker spaniel I adored, but by college I youthfully dismissed any canine under 50pounds as Not A Real Dog. I longed for a statuesque Irish wolfhound, but settled for an Irish setter husky cross (who, sadly, ended up having the worst traits of both breeds). As an adult I adopted Heidi, a Labrador with diabetes and cataracts, then Sadie, a Samoyed with glaucoma. Both were blind, but both were big. Then when my kids came along, we got Flower, a mixed breed pup who grew large enough to be a passable substitute for the often requested pony. My younger daughter inherited my penchant for large dogs, yearning for a great dane or Swiss mountain dog, both of which I tell her she can have when she has her own house, hopefully bigger than the one we live in now. But the older I get, the more I understand about owning Little Dogs.

Animals intentionally bred for extreme physical characteristics, like being extra big or extra small, are at greater risk for medical problems. Giant breed dogs have notoriously short life spans, as well as a predisposition for problems like bloat. Pug-faced dogs are known for respiratory difficulties from their smooshed-in snouts. Little Dogs…well, they have their own list.

Take Amigo, the Chihuahua, who came in recently for an introductory examination. At six months old, he weighed less than four pounds. “I can’t let him outside unattended,” his mom said. “A big hawk buzzed him the other day. It just came out of nowhere.” I nodded.

Another Chihuahua owner I know was walking her wee one on a Vineyard beach when a red-tailed hawk swooped down, grabbed her pup by the head, lifting it several feet into the air. Whether it was the weight of the dog, or the effect of an hysterical woman screaming and waving her arms frenetically, the big bird lost its grip and the Chihuahua tumbled to the ground. Miraculously, except for several puncture wounds from the talons, the pup was uninjured. Yup. Better not let Amigo run around outside taunting the local raptors.

Examining young dogs always includes checking for congenital defects, i.e., abnormalities they were born with. Amigo looked fine. Eyes, ok. Teeth, no overbite or underbite. I opened his mouth to look for cleft palate. Nope. I ran my hands over the top of his domed head, gently feeling where the various skull bones join across the crown. Except Amigo’s skull bones didn’t all join in the middle. Instead there was a central area about the size of a nickel that was soft and squooshy.

It’s called a fontanel — a membrane-covered opening between the bones of a young skull. If you’ve raised a baby, you know those “soft spots” on an infant’s head that allow it to squeeze through the birth canal. In people, fontanels close gradually between the age of three months up to two years. In dogs, the fontanel on top of the head should close by 12 weeks of age. But in Chihuahuas, as well as several other toy breeds, the fontanel often doesn’t close. Ever.

Chihuahua fanciers call it a “molera,” saying that it is normal for the breed, and it is not considered a defect by the American Kennel Club Breed Standards. In fact, for many years, the presence of a molera was considered proof of the purity of a dog’s Chihuahua blood line. Here’s where breeders and veterinarians may be at odds. Many veterinarians consider any fontanel that does not close by 12 weeks to be an inherited defect and advise that the dog in question not be used for breeding.

There is also some controversy as to the health implications of persistent fontanels. (A brief aside about grammar. Many people call this condition an “open fontanel.” Technically speaking, that is redundant: by definition, a fontanel is open.) Some veterinarians believe that persistent fontanels are associated with greater risk of hydrocephalus — increased accumulation of cerebral spinal fluid inside the ventricles of the brain. This puts pressure on the brain and can lead to seizures, blindness, pressing of the head into corners, and extreme difficulty in house training. Hydrocephalic dogs may also exhibit the “setting sun sign” in which the eyes point downward and sometimes to the outside. They can be treated temporarily with medications to reduce the pressure, but eventually a shunt should be placed surgically to drain the excess fluid. In their “Molera Statement,” the Chihuahua Club of America cites several studies and veterinarians stating that there is “adequate medical evidence” that a molera does not predispose a Chihuahua to hydrocephalus. But I think the jury is still out on this one.

Amigo was well past the 12-week mark for closure of the fontanel, but some Chihuahua sites claim moleras may continue to get smaller until a dog is up to three years old. I do not know if this is true. I do know that since Amigo appeared neurologically normal there was nothing else we needed to do. If he ever showed signs of hydrocephalus, an ultrasound of the brain could be done via the fontanel, but he has a perfectly good chance of leading a perfectly normal life and never having any problems. I advised his owner to take extra care with his head and to never press the soft spot. If she wanted, there were even places she could purchase a tiny helmet for him. I wondered if Amigo would tolerate such headgear. Then I thought how cute he would look and imagined myself toting around a four-pound dog wearing a mini-bike helmet. That could be as cool as having an Irish wolfhound.

The older I get, the more I understand the charm of Little Dogs.

— Photo courtesy of pugeyes.com

Every year at his physical exam, I gaze into Bingo’s big brown eyes. Being a pug, those eyes — well — they bug out a bit, but that’s part of his charm. Adopted from the shelter at the age of two, he’s eight now and handsome as ever. This year, however, I noticed a change. “Let me get the big light,” I said, rolling the lamp around the table and shining the beam at Bingo’s face, giving me a better look at his corneas.

The cornea is the outer transparent surface of the eyeball — at least it’s supposed to be transparent, but in Bingo’s case it looked as though someone had splashed a blotch of brown paint on each eye at the inner corner closest to the nose. Bingo has pigmentary keratitis, a condition that can occur in response to a variety of different stimuli that irritate the eye, leading to the appearance of these brown opacities in the corneas. It is most common in brachycephalic dogs. That’s a fancy word that literally means “short-headed” and refers to breeds such as bulldogs, Pekinese, Shih tzus, Lhasa Apsos — and pugs. A recent study showed that as many as 82 percent of all pugs are affected with some degree of pigmentary keratitis.

So what are the different stimuli that may be irritating all these eyes? And why are our smoosh-faced friends so frequently affected? Here’s why I love ophthalmology — all the great words: buphthalmos, exophthalmus, lagophthalmos, distichiasis, trichiasis, keratoconjunctivitis sicca, entropion, to list a few. Let’s start with simple anatomy. Pugs tend to have unusually large eyeballs. That’s buphthalmos. Because of how their faces are pushed in, they also have shallow eye sockets, resulting in bulging eyeballs. That’s exophthalmos. Large, bulging eyeballs may mean that when they close their eyelids, the lids may not completely cover the globes. That’s lagophthalmus. Taken all together, what do you get? Chronically exposed corneas, irritation, and pigmentary keratitis.

“Does he sleep with his eyes open? I asked. “Or do his eyes not close all the way when he shuts them?” His owner responded that Bingo slept with eyes closed and she thought the lids covered the globes fully.

What else could lead to his corneal irritation? Looking closely, I could see that a small bit of Bingo’s lower eyelids curled inward, rubbing ever so slightly on the corneas. This is called entropion. Bingo also had very pronounced nasal folds — those adorable rolls of furry skin on his face. Bingo’s nasal folds were prominent enough that when he moved in certain ways, the fur on the folds touched his corneas. This is called trichiasis, when normally occurring hair touches the eye. Both his entropion and trichiasis could be contributing to his keratitis.

There were two more similar conditions I needed to rule out — distichiasis in which aberrant hairs grow out of little glands that line the eyelid, and ectopic cilia, abnormal eyelashes growing from the inside of the lids. Using a magnifying headset and then an ophthalmoscope, I scrutinized the margins of Bingo’s lids but could not see any evidence of these.

Now it was time to check for keratoconjunctivitis sicca. Commonly known as KCS or “dry eye,” in this condition the dog does not produce adequate tears to lubricate the eye. Constant dryness results in irritation and inflamation. We measure tear production by tucking a small strip of special calibrated paper in the corner of the eye for exactly one minute. Bingo was not thrilled with this procedure, but we were able to determine that he appeared to be making a normal amount of tears.

Some dogs, however, make sufficient quantity of tears yet still have poor “tear film quality.” In other words, they have an inherent deficiency in the viscosity of the tears, so the fluid breaks up too fast, not keeping the eye properly protected. I put a drop of fluorescein stain in each of Bingo’s eyes. This non-irritating, water-soluble dye, starts out as orange, then turns day-glo green. It is used primarily to check for corneal ulcerations but can also be used to evaluate tear film quality. With normal tear film, a drop of dye placed on the eye should take 20 seconds to evaporate, if the dog is not allowed to blink. With tear film deficiency, dry spots may appear almost immediately. Bingo was not keen on our attempts to prevent him from blinking, and I did not have much experience with this test, making it hard to assess his tear film quality. But since many ophthalmologists automatically assume that all pugs with pigmentary keratitis probably have some degree of deficiency, I did the same. There were no corneal ulcers and his intra-ocular pressure was fine.

“Optimal treatment is to correct any underlying causes,” I advised, and I offered referral to a veterinary ophthalmologist who could evaluate Bingo more thoroughly and make sure I hadn’t missed anything. Then the entropion and trichiasis could be surgically corrected. If warranted, there is also an eyelid surgery that can be done to improve coverage of the cornea. In the past, surgeons sometimes removed the pigment by shaving off the corneal surface, but this is no longer recommended as the pigment recurred in most cases.

Bingo’s owners opted to try medical treatment, as some dogs improve without surgery. I prescribed two ophthalmic ointments. The first, cyclosporine, promotes increased tear production and better film quality and also has pigment-reducing properties. The second was a combination antibiotic and anti-inflammatory steroid. Although pigmentary keratitis is not painful, it definitely affects an animal’s vision, even causing complete blindness in severe cases.

Bingo’s owners have recently noticed him being less active and having trouble going down stairs. We ruled out Lyme disease and put him on arthritis medication, but I suspect the main reason for his inactivity is that he has trouble seeing where he is going. We hope medical treatment will stop the progression of the disease or even reverse it. If not, then it’s time to see the ophthalmologist.

This has been one of those weeks when I really wish my patients could talk. I’ll tell you a secret. Some days, after innumerable appointments with extremely chatty human beings, I appreciate the nonverbal reticence of the animals.

Don’t get me wrong. A master gabber myself, I love conversing with folks about everything from parenting to politics. But today, I wish it were Sylvester who was talking. During 30 years of practice I’ve gotten pretty good at “listening” to cats and dogs. The wince of a sore back. The hunched demeanor of belly pain. The happy bounce of the limping dog saying he’s just sore from playing hard. All those little cues they give me. But this week, with my friend Sylvester, not so much.

Sylvester is a big guy — almost 20 pounds of taciturn Maine coon cat. At home he has often expressed himself with what we delicately call Feline Inappropriate Elimination (FIE.) Like when we put him on a reducing diet and he immediately began urinating and defecating on the rugs. Message received. We changed from the low-calorie approach to a low-carb diet instead, and he stopped misbehaving. Temporarily.

The behavior would recur sporadically, especially when his owners had to leave him in the care of pet sitters. Over the years, we discussed various things that can cause FIE — medical conditions like feline idiopathic cystitis and inflammatory bowel disease versus behavioral issues like litter box aversion or territory marking. As Sly got older he also began pulling out the hair on his tummy and acting nervous and grumpy. We discussed allergies, anxiety-related overgrooming, hairballs. His owners coped with Sly’s foibles and I depended on their astute interpretations of his actions.

But this week, when Sylvester started seeming unhappy, even his owner was unsure what he was trying to tell us. “He’s limping on his left hind leg,” she said. “His coat seems different. See these big matts? He never used to have them, and he’s vomiting hairballs. He’s urinating and defecating outside the box again…and today he was crying pitifully at the top of the stairs and was very slow to come down. When he did come down, he didn’t finish his breakfast, which is very unusual.” Sly stared at me, inscrutable, and didn’t say a word.

Examining the big cat, I searched hard for explanations for his symptoms. Was his lower back a little tender? Was that left knee puffy? Why was he crying and not eating well? He had lost a little weight. Was there some kind of metabolic disease going on? We put him on the floor to observe the limp, but Sly would only take a step or two, then sit down. All attempts to nudge him into motion were met with regal disdain.

“Let’s run blood work to get some more information,” I suggested. “But it may just be back pain, or arthritis, or an injured knee,” I concluded lamely, sending them home with a prescription for TLC while awaiting lab results.

All the tests were normal except a moderately elevated blood glucose, technically called hyperglycemia. If his glucose had been much higher, I would have immediately thought “Diabetes,” but his was in a gray zone.

“We can’t conclude too much from this blood sugar,” I told his owner. “He hadn’t been fasted before we drew the sample, and normal cats can get hyperglycemia just from stress.”

Definitive diagnosis of feline diabetes requires three things — a persistently elevated fasting blood glucose, glucose in the urine, and clinical signs consistent with the disease such as excessive drinking and urination, or excessive appetite combined with weight loss. We scheduled to fast Sylvester overnight, recheck his blood glucose, do an additional test called a fructosamine level which would provide a ballpark idea of where his blood sugar had been over the last few weeks, and, finally, take radiographs of his hind end to look for other explanations for his reluctance to move.

When Sly arrived for the second visit, I put him on the exam room floor again. This time he shuffled around a bit, enough that I could clearly see his “plantigrade” stance. That means his hocks were dropped down abnormally until they almost touched the floor as he walked. This “dropped hock” gait can occur if a cat has ruptured tendons in the hind leg, but it can also indicate something else — diabetic peripheral neuropathy. That’s right. Sylvester’s funny walk might be a sign of diabetes.

We don’t know exactly why, but the hyperglycemia that occurs with diabetes will sometimes lead to functional, structural, and/or biochemical abnormalities of the peripheral nerves, especially the hind legs. Symptoms in cats include difficulty jumping, difficulty getting in and out of the litter pan, inappropriate elimination, change in attitude or behavior, irritability, pain on palpation of joints or limbs, and a plantigrade stance. Sound familiar? Diabetic people may also get peripheral neuropathy. In humans, symptoms may include extreme sensitivity to touch, tingling, burning or sharp jabbing pain, or numbness in the extremities, especially the feet.

So was Sly diabetic, or had he just hurt himself? If only Sylvester could tell me “I landed wrong jumping off the bed and hurt my leg,” or “I’m thirsty all the time and my feet are tingly and numb.”

His fasted blood sugar and fructosamine level both came back elevated Urinalysis confirmed the presence of sugar in his pee. Putting it all together, we concluded Sly was indeed diabetic, with peripheral neuropathy.

Because his blood glucose is not too high, we are first going to see if a prescription diet can control his disease. If not, he will need insulin injections. For the neuropathy, there is no specific cure. If we get their blood sugar well-regulated, a certain percentage of diabetic cats will regain normal hind leg function. Others do not, but they seem to adjust to getting around with the altered gait and do not appear to be in pain. Perhaps they’re just stoic. Sylvester isn’t saying.

Rabbi Caryn Broitman holds the lulav and etrog in the sukkah at the MV Hebrew Center. — Photo by Lila Jasny

Rosh Hashanah, observed this year on September 4, is a Jewish holiday somewhat familiar to non-Jews. Despite the fact that the name means “head of the year,” and that it is considered to represent the birthday of the world, it has little in common with secular “New Year” celebrations.

Rosh Hashanah marks the beginning of a ten-day period of prayer, self-examination, and repentance called the Days of Awe, culminating with Yom Kippur, the Day of Atonement. This year even Islanders who are not Jewish were significantly affected by Rosh Hashanah, as it ended up falling on what would traditionally have been the first day of public school.

Jewish holidays jump around the Gregorian calendar because the Hebrew calendar is based on cycles of the moon, not the sun. A moon month is 29.5 days. A lunar year is 354 days, 12 days shy of a solar year. In order for holidays to continue to occur in the appropriate seasons, every two to three years a 13th month is added to the Jewish calendar, based on an esoteric formula in which there are seven “leap years” out of every 19. Although it sounds confusing, it has worked well for thousands of years.

At synagogue there are melodies and prayers unique to these “High Holidays,” and the blowing of one of the world’s oldest wind instruments — the shofar — made from a ram’s horn. According to the great Jewish philosopher Maimonides, the shofar sound is a call to repentance. An ancient and haunting sound, it transports the listener back to where one can imagine standing in the desert at Mount Sinai as described in the Book of Exodus. Rosh Hashanah customs include baking challah in special round loaves, symbolizing the circular nature of the year and the seasons, and eating apples dipped in honey for a “sweet” new year.

On Rosh Hashanah afternoon, many Jews on the Vineyard join Rabbi Caryn Broitman at Owen Park to observe the ritual of “tashlich,” throwing bits of bread into a natural body of water as a symbolic casting off of sins.

Yom Kippur is a serious day, but not a sad one. Observant Jews fast and spend most of the day in synagogue. Many wear all white clothes, representing purity and innocence, as well as a reminder of human mortality, and the need for humility and repentance. The Hebrew word for repentance is “teshuvah,” which more accurately translates as “return.” It is a time when Jews try to actively turn away from past mistakes, make amends to God and to people they have harmed, and return to a life of mercy and justice.

Five days later comes the week-long harvest celebration of Sukkot. The Hebrew word sukkah means “hut” or “booth” and harkens back to the frail structures in which the Israelites lived during their forty years in the desert after leaving Egypt, and also the seasonal booths in which farmers later lived in their fields during harvest time. A sukkah must be temporary, have three sides, and a roof through which the stars are visible. It may be decorated with seasonal fruits and vegetables, flowers, posters, rugs, and artwork. Families and friends gather to share meals or even sleep there.

In the sukkah, an ancient ritual using four species of plants based on a passage from Leviticus is observed. The “lulav” is composed of branches of willow, palm, and myrtle. The fourth element is the “etrog,” a fragrant, brilliant yellow citron. With a special blessing, the lulav is shaken in all directions — north, south, east, west, up, and down. One lovely interpretation of the meaning of this ritual relates each plant to parts of the human being. The willow is the mouth, saying prayers. The etrog is the heart filled with wisdom and understanding. The palm is the spine of upright character, and the myrtle the eyes by which we learn and become enlightened. Sukkot at the Martha’s Vineyard Hebrew Center is also the time when the religious school children deliver all the food collected during Rosh Hashanah and Yom Kippur for the Island Food Pantry. This year they delivered a record 128 bags of groceries.

The fall holidays close with Simchas Torah, translated as Rejoicing of the Torah, observed this year on Friday, September 27. The central text of Judaism is the Torah — the Five Books of Moses — handwritten in Hebrew on one continuous parchment scroll which is read bit by bit from start to finish each year. When the end of the scroll is reached, there is a huge celebration, not unlike a wedding, with music and dancing with the Torah. The entire scroll is unrolled around the room. The final verses describing the death of Moses are read, then the first verses of Genesis, and the scroll is rolled back to the beginning so the cycle can begin anew. For Jews, it is a joyous conclusion to a month of reflection, repentance, and return.

Michelle Gerhard Jasny is a well-known veterinarian whose office is in West Tisbury. Her column Visiting Vet appears regularly in The Times.