Dr. Au joins us from her position as Assistant Professor of Small Animal Surgery (Orthopedics) and Director of the Veterinary Rehabilitation Service at The Ohio State University Veterinary Medical Center. A nationally and internationally recognized lecturer on orthopedic surgery, minimally invasive surgery (arthroscopy) as well as minimally invasive fracture repair and physical rehabilitation, Dr. Au and her team look to make CVRC a regional surgical and rehabilitation center of excellence.

Appointments are available beginning May 20th. Welcome Dr. Au!!!

Dr. Sayer has been honored with multiple awards for service and teaching during her internship and residency. Her background includes research focused on the effect of the drug pimobendan on the renin angiotensin system.

A graduate of the University of Maryland, Dr. Sayer received her DVM from Virginia Maryland Regional College of Veterinary Medicine in 2002. Her internship was completed at Animal Medical Center in New York City and in 2006 she finished her residency at North Carolina State University.

The following are 5 ways in which your pet would benefit from rehabilitation and physical therapy:

* Pain Control- Modalities such as massage techniques, laser therapy, and use of hot/cold packs all aid in controlling your pets discomfort.  Depending on the condition or injury these modalities may be used in conjunction with other pain medications.  Physical Therapy (PT) is also great for pets that are unable to tolerate some traditional pain medications.

*Conditioning- The use of physical therapy has really taken off with the agility, working, and sporting dogs.  The use of PT and the knowledge of a certified rehab practitioner aids in not only keeping these athletes strong in the off-season but also helps in preventing injuries during heavy training.

*Weight Loss- Physical therapy, along with diet modification, will aid in faster weight loss for your pet.  We know that obesity can take 2 years off an animal’s life; therefore it is important to start working on shedding the pounds when recommended by your veterinarian.  Weight loss will also be important for those pets with arthritis as the extra weight places more strain on the diseased joints.   Aquatic therapy is a great modality for these pets as it takes the weight off the joints allowing the animal to work a little harder.

*Strengthening- Many orthopedic and neurological conditions may cause your pet to lose muscle mass due to either muscle disuse or loss of nerves to a muscle group.  By using exercise equipment such as physioballs, electrical stimulation, and land treadmills your pet will get stronger by building back the muscle mass lost by the injury.

*Balance and Coordination- Challenging an animal’s stability with use of exercise equipment such as bosu balls, cavaletti rails, cones, and balance boards will make them more stable in their everyday life.   These exercises will prepare them for maneuvering obstacles, slippery surfaces, or stairs.

Article by: Artise Stewart, CVM, CCRP
Charleston Veterinary Referral Center

About Charleston Veterinary Referral Center:
Charleston Veterinary Referral Center (CVRC) is a specialty referral, emergency & critical care veterinary hospital which opened in March, 2011. The Center offers a cohesive team of veterinary professionals and staff that are dedicated to practicing the highest caliber of medicine and surgery available. CVRC believes that great care and service are intertwined. With a commitment to respect the integrity of the referral relationship with primary care veterinarians, doctors and staff at CVRC work tirelessly toward the goal of great communication. Our facility is open 24 hours a day, 7 days a week and can be reached at (843) 614-VETS (8387). For more information, please visit us online at http://www.CharlestonVRC.com or find us on Facebook at Facebook.com/CharlestonVRC.

Michelle is known for her extraordinary way with clients, doctors and patients. With Bachelor’s degrees from both Cornell and Mercy College, Michelle has developed expertise in the areas of theriogenology, cardiology, internal medicine and ophthalmology. She will be presented with a plaque at the South Carolina State Meeting in Greenville on October 20th.

As we enjoy the summer months with our families, it is important to be aware of how to avoid some common pet related emergencies. Dr. Kristin Welch is a board certified Critical Care Specialist, and the Director of Emergency and Critical Care at Charleston Veterinary Referral Center in West Ashley. This is the first in a series of articles by Dr. Welch to educate our readers and keep our pet family members safer this summer.

As we approach summer, the very activities we enjoy can potentially become hazardous to our pets. Whether your dog enjoys spending the afternoon on the boat, chasing the waves at the beach, or swimming, there are a number of precautions that you should take to ensure that your dog remains healthy. Ensuring that you provide plenty of fresh water for your dog is vitally important. In the absence of fresh water and with ready access to salt water, many dogs will drink from the ocean in spite of the taste.

Ocean water has 3.5% dissolved salts, 90% of which is sodium chloride (NaCl). Sodium toxicity occurs with ingestion of 0.5 to 1 gram of NaCl per kilogram of body weight, so for a Labrador Retriever, as little as two to three cups of salt water could be toxic; less than one gallon of salt water would be fatal. Once ingested, the salt is rapidly absorbed resulting in clinical signs within 30 to 60 minutes.
Salt is a direct mucosal and gastric irritant. Early clinical signs of salt water intoxication are vomiting and diarrhea. As the sodium concentration in the bloodstream increases, water is drawn out of cells resulting in effective “dehydration” of the brain. There is a rapid progression to neurologic abnormalities including uncoordinated walking, abnormal mentation, seizures and coma. Rapid emergency intervention is necessary in all cases when salt water intoxication is suspected as many animals with severe salt intoxication don’t survive.

Initial emergency evaluation includes physical and neurologic examination and blood work to evaluate levels of sodium and chloride. An IV catheter is immediately placed and a urinary catheter may be placed as well to monitor kidney function and urine output. Based on mathematical calculations, specific IV fluids are used to lower the sodium and chloride concentrations slowly and precisely. Seizures are treated with intravenous antiepileptic medications. Since oral and gastrointestinal ulceration occurs, intravenous and oral antiulcer therapy is administered. Electrocardiogram (ECG) and blood pressure are often monitored as well. Frequent repeat blood work is used to assess the effectiveness of fluid therapy in lowering the sodium and chloride.

All dogs with saltwater intoxication are hospitalized for continuous IV fluid administration and serial monitoring of blood values. The duration of hospitalization is case dependent but five to seven days of hospitalization would not be uncommon. Neurologic signs resolve over a period of days as the sodium concentration slowly returns to normal.

With deliberate lowering of the sodium and chloride concentrations, intensive monitoring of blood values and frequent patient reassessment, survival is possible. Complications in treatment may occur, especially if the sodium is lowered too rapidly; the risk is minimized with treatment by experienced veterinarians in a 24 hour emergency and critical care hospital.

Prevention of salt water intoxication is simple. Always carry fresh water for your dog; for a day at the beach bring one gallon of water (an empty milk jug works well) and a portable bowl. Make your dog take breaks from running and playing to lay down in the shade and have a drink. Be sure to keep your dog cool and well hydrated while outside to avoid another common summertime complication; heatstroke.

Beware of snakes as warmer weather arrives in the Lowcountry. Our outdoor pets are vulnerable these days, and it’s not just hunting dogs that are in danger.

Dr. Kristin Welch, who helped with this article, is the head of Emergency and Critical Care at Charleston Veterinary Referral Center and the only board-certified critical-care specialist in South Carolina. She reminds us that of more than 120 species of snakes identified in the United States, 20 of them are venomous. Those that are poisonous in South Carolina include three species of rattlesnakes as well as cottonmouth water moccasins, copperheads and coral snakes.

Snakebites are most commonly reported in April through September around here. Pine straw, brush and downed timber provide outstanding camouflage, and are the snakes’ preferred environment. Most bites in pets are to the face, neck and limbs as they sniff around. Typically, a cat or dog startles the snake, which makes a defensive strike. Luckily, 20-30 percent of snakebites are “dry,” meaning that the victim has not been poisoned.

 When considering what makes a snake bite in one dog result in severe systemic illness, while another develops only a wound, one must consider “snake factors” and “victim factors.” The snake’s species, size and age, and whether the bite is offensive or defensive in nature influence the severity of situation. Rattlesnake and cottonmouth venoms are the most toxic. Rattlesnake venom is responsible for the majority of the illness and death. Larger and more mature snakes manufacture more venom and thus are a bigger risk.

 Moreover, an offensive bite is much more dangerous. Imagine a snake stalking a mouse for prey before lunging and striking. This premeditated strike and venom delivery is made to kill. Contrast this with a dog running through the woods that accidentally steps near a copperhead. A surprise defensive bite injects a smaller volume of venom or may inject none at all.

The size of the victim, location of the bite and whether it is a dog or cat determine the severity of the result. Cats tend to be more resistant to snake venom than dogs, and perhaps due to their size and hunting behavior, tend to suffer snakebites to the torso. In contrast, dogs are most commonly bitten in their face, tongue, eyes and neck. Bites in these areas are more serious since the venom is often delivered directly into the victim’s bloodstream.

Interestingly, immediately after a snake bite there is no difference in the appearance of the bite wound whether or not venom has been delivered. If a dog has a thick coat, fang marks may not even be seen. Or, there may be one to six punctures seen and the first sign of a problem is pain at the site. Bruising and swelling at the site might occur within minutes to hours. The dog or cat may become weak, dizzy and nauseous, have muscle tremors or an elevated respiratory rate.

It is crucial to obtain immediate veterinary care. Within minutes, a bite to the tongue can result in swelling of the upper airway and respiratory distress. It is very important to remain calm and avoid exciting your injured friend. Keeping the dog or cat as calm as possible while en route to your veterinarian will minimize the spread of venom through the body.

If it is safe to do so, identify the snake. A photo or description of the size, coloring and markings will aid in determining if it is a rattlesnake, cottonmouth, copperhead or coral snake. There are also a number of nonpoisonous snakes that have similar markings to their poisonous counterparts. In the majority of snake bites, the species is unable to be definitively identified, therefore is it critical that all snake bites are treated as if from a poisonous snake.

Your veterinarian will immediately assess your pet’s overall health status, paying special attention to the heart, lungs, neurological system and bite wound. Baseline blood work will be obtained to evaluate for problems with clotting, electrolyte imbalances and organ damage. A blood pressure and electrocardiogram may be completed to evaluate for effects on the cardiovascular system. The bite-wound location will be measured periodically throughout hospitalization to assess for worsening or response to treatment. More than likely, your pet will be hospitalized for 12-48 hours for intravenous fluids, pain medications and possibly anti-venom therapy. Anti-venom provides antibodies that bind and inactivate venom components thereby halting tissue and organ damage.

All snake bites should be considered an emergency. Immediate veterinary care can be lifesaving.

It is summertime fun for you and your pet but do you know the top four pet emergencies to beware of this time of year? The region’s only Board Certified Critical Care Veterinary Specialist, Dr. Kristin Welch of Charleston Veterinary Referral Center (CVRC) wants you to know them to be better prepared to keep pets safe this summer. Dr. Welch is the Director of Emergency and Critical Care at CVRC, and recently treated a young, beautiful German shepherd named Seelow. Seelow experienced two out of these four which required surgery to remove a kidney and part of his intestine. He also had treatment for a severe snake bite just weeks ago.

Here are the top four summer pet emergencies in our areas:

Car accidents— Dr. Welch says holiday weekends and weekends with nice weather where people spend time outdoors are the times when we see most hit by cars. CVRC’s emergency room receives 3-5 cases a week on average. Seelow, the German shepherd had gotten out when the mail came and returned an hour later, bleeding, with major trauma from being hit by a vehicle. Seelow was in the hospital a week recovering and now has just one kidney. He was lucky that his owners reacted fast and brought him into the facility.

Snake Bites— Right now is peak time for snake bites, with CVRC’s emergency team seeing 5-10 cases or more per week (from May-September). All snakebites are an emergency. The venomous snakes of South Carolina and Georgia include three species of Rattlesnakes, the Cottonmouth, the Copperhead and Coral Snake. They hide in pine straw, brush, and timber before striking at dogs or cats. Most snake bites in pets are to the face, neck and limbs in animals that are sniffing in the brush.

Cats tend to be more resistant to snake venom than dogs and perhaps due to their size and hunting behavior, tend to suffer snake bites to their torso. In contrast, dogs are most commonly bitten in their face, tongue, eyes and neck. What should you look for? Punctures of the skin and pain at a specific site, and possibly bruising and swelling, pet weakness, dizziness, nausea, muscle tremors or rapid breathing.

Obtaining immediate veterinary care is crucial for blood tests, blood pressure tests and an electrocardiogram. More than likely, your pet will be hospitalized for 12-48 hours for intravenous fluids, pain medications and possibly anti-venom therapy. Seelow, the dog was bitten most likely by a Copperhead or Rattlesnake on the front paw. Luckily, his snake bite was only moderate severity, but the fact he has experienced two of the four summer emergencies shows just how common these are.

Heat Stroke—CVRC sees 4-10 cases a week of heatstroke, and that number spikes when the humidity spikes. Dogs and cats have little choice when it comes to keeping cool in summer heat. Recognizing the signs of heatstroke will allow for prompt treatment; and time is of the essence when treating this condition. Symptoms include: elevated body temperature, excessive panting, dark or bright red tongue/gums, sticky or dry tongue/gums, staggering or stupor and seizures. If you suspect heat stroke in your pet, seek veterinary attention immediately.

To prevent heat stroke, follow these steps:

• Find some shade. Get your pet out of the heat.
• Use cool water, not ice water, to cool your pet. (Very cold water will cause constriction of the blood vessels and impede cooling.)
• Cool wet cloths on feet and around head.
• Do not aid body cooling below 103 F degrees – some animals can actually get Hypothermia (too cold).
• Offer ice cubes for the animal to lick on until you can reach your veterinarian, but do not force ice or water to your pet.

Saltwater poisoning— Whether your dog enjoys spending the afternoon on the boat, chasing the waves on our beautiful beaches or enjoys swimming, there are a number of precautions that you should take to ensure that your dog remains healthy. Ensuring that you provide plenty of fresh water for your dog is vitally important. In the absence of fresh water and with ready access to salt water, many dogs will drink from the ocean in spite of the taste.

Ocean water has 3.5% dissolved salts, 90% of which is the sodium chloride (NaCl). Sodium toxicity is based on body weight but levels can be reached rather easily. For example, for a Labrador Retriever, as little as 2-3 cups of salt water could be toxic; less than 1 gallon of salt water would be fatal. After drinking, symptoms can start showing up within as little as 30 minutes. You should watch for vomiting and diarrhea, as well as uncoordinated walking, abnormal mental activity, seizures and coma.

Getting your pet to an emergency veterinarian is necessary in all cases when salt water intoxication is suspected as many animals with severe salt intoxication don’t survive. But it’s simple to prevent this tragedy. Always carry fresh water for your dog; for a day at the beach bring 1 gallon of water (an empty milk jug works well) and a portable bowl. Make your dog take breaks from running and playing to lay down in the shade and have a drink to stay hydrated.

Read Dr. Bostrom’s Welcome Postcard

Dr. Rissetto and Skylar

The Nafpliotis family dog, Skylar, was brought into Charleston Veterinary Referral Center (CVRC) back in February. Diagnosed with Lymphoma, Skylar went through weekly and bi-weekly chemo treatments, where she would come in and sit and have her belly rubbed while she got her injection or took an oral pill. Skylar, like MOST canine and feline chemotherapy patients, never experienced any ill effects from her treatment and grew to love her visits to CVRC. After celebrating her last chemo treatment this month (pictured right), Skylar is doing extremely well and in a complete remission! Skylar, who once hated going to the vet, amazed everyone at how at ease she was when she went back to her regular vet for a checkup – her owner is convinced she grew to love the vet because of her experience at CVRC.

Kerry Rissetto, DVM, MS, DACVIM (Oncology) of The Cancer Center at CVRC, who treated Skylar, says while Lymphoma is rarely curable, it is very treatable if caught early. In addition to enlarged lymph nodes, pet owners should be on the lookout for any of the following symptoms:

• Lumps, bumps or swelling
• Decreased appetite
• Excess drinking and urination
• Vomiting and diarrhea
• Weight loss
• Anxiety and discomfort
• Any major changes in appetite, activity or behavior

If you notice any of these signs, your dog should be examined by a veterinarian immediately. Most lumps and bumps can be sampled non-invasively with an answer ready within 30 minutes. While the most common forms of cancer among pets are Lymphoma and skin tumors, cancer can occur in any organ system in the body, so the sooner it is caught, the better the prognosis. If found early enough, the majority of tumors can be kept in remission for a very long time, and in some cases, even cured.

About Charleston Veterinary Referral Center:

Charleston Veterinary Referral Center (CVRC) is a specialty referral, emergency & critical care veterinary hospital which opened in March, 2011. The Center offers a cohesive team of veterinary professionals and staff that are dedicated to practicing the highest caliber of medicine and surgery available. CVRC believes that great care and service are intertwined. With a commitment to respect the integrity of the referral relationship with primary care veterinarians, doctors and staff at CVRC work tirelessly toward the goal of great communication. Our facility is open 24 hours a day, 7 days a week and can be reached at (843) 614-VETS (8387). For more information, please visit us online at http://www.CharlestonVRC.com or find us on Facebook at Facebook.com/CharlestonVRC.

Our ocean water has 3.5% dissolved salts, 90% of which is sodium chloride. That means for a typical Labrador Retriever, swallowing as little as 2-3 cups of saltwater could be toxic; less than 1 gallon of saltwater would be fatal. Once ingested, the salt is rapidly absorbed, resulting in symptoms within 30-60 minutes.

Salt is an irritant and early symptoms that should be a tipoff to saltwater intoxication are vomiting and diarrhea.  As the salt concentration in the bloodstream increases, water is drawn out of cells, resulting in effective “dehydration” of the brain. There is a rapid progression to uncoordinated walking, abnormal mentation, seizures and coma. Rapid emergency intervention is necessary in all cases when saltwater intoxication is suspected, as many animals with severe salt intoxication don’t survive.

Once at the veterinarian, you should expect he/she will want to do an exam and blood work and for many pets, an IV catheter and fluids will be needed. Dogs that start having seizures will need immediate medications. All dogs with saltwater intoxication are hospitalized for continuous IV fluid and regular monitoring of blood values for sodium chloride levels. The duration of hospitalization is case dependent but 5-7 days of hospitalization would not be uncommon. As the salt levels drop, the symptoms wane as well.

Prevention of saltwater intoxication is simple. Always carry fresh water for your dog; for a day at the beach, bring 1 gallon of water (an empty milk jug works well) and a portable bowl. Make your dog take breaks from running and playing to lay down in the shade and have a drink to stay hydrated.

Dr. Kristin Welch, Head of Emergency and Critical Care at CVRC, is South Carolinas only board certified Critical Care specialist.  CVRC is a specialty referral and 24-hour emergency and critical care veterinary hospital, which opened in March 2011. More information may be found at www.CharlestonVRC.com or on Facebook at Facebook.com/CharlestonVRC or (843) 614-VETS (8387).