Author Archives: loriscarlettdvm

About loriscarlettdvm

Lori Scarlett, DVM is a practicing small animal veterinarian in Madison, WI. She graduated from Michigan State University College of Veterinary Medicine in 1995. She opened Four Lakes Veterinary Clinic in 2013, after working in Durham, NC for 12 years and McFarland, WI for 7 years. Dr. Scarlett enjoys getting to know her clients and patients, and helping to keep them healthy and active for many years.

Viral Papillomas or “What is this weird thing on my dog’s lip?”

viral papillomaViral papillomas are small (generally) round skin tumors that some people call warts.  These “viral warts” tend to look a bit like a cauliflower and are most commonly seen in and around the mouth on younger dogs (less than 2 years of age).

The virus is spread through direct contact with papillomas on an infected dog or the virus in the dog’s environment.  The virus can survive up to 2 months in a cold (40F) environment, but only 6 hours in a hot (98F) one.

Papilloma virus tends to infect dogs with an immature immune system, which are usually young dogs and puppies.

In many cases, treatment is unnecessary; the papillomas will go away on their own in one to five months.  Squeezing or squishing the papilloma is thought to stimulate the immune system, but can be uncomfortable to the dog.  But sometimes a dog will have so many papillomas in the mouth that eating becomes difficult.   Papillomas in the mouth can become infected, causing pain, swelling and bad breath.  If the papilloma isn’t going away on its own or is spreading, surgical removal of at least one of them appears to stimulate the dog’s immune system, and all of them will regress afterwards.  A small percentage of dogs respond to azithromycin, an antibiotic.

Four Lakes Veterinary Clinic saw quite a few dogs in the spring of 2015 with viral papillomas.  All of the affected dogs went to doggie daycare.  This fall we are starting to see them appear again.

titus wartIn the spring,  two Shar-Peis from the same family were affected.  Titus, the older dog, was affected first, and had one large papilloma on his mouth.  It grew in size and Titus would sometimes lick or scratch at it, but eventually  it was torn off by the other puppy in the household and regressed on its own.

Two months later, the owners noticed a papilloma in  the younger dog, Nova’s, mouth.   Because Nova developed a lot of papillomas in a short period of time, she was prescribed the antibiotic, azithromycin.  There was no change after two weeks.  We did another round, this time adding in cimetidine, a medication normally prescribed for stomach ulcers, but anecdotally noted to help with papillomas.  Again, there was no improvement and Nova was developing more and larger papillomas in her mouth, on her tongue, on her lips, and near her eye.nova wart mouth

nova wart photo

Because of the owners concern for anesthesia in SharPeis, she was hoping for a non-surgical treatment, but it just wasn’t to be.  Nova was sedated (not at Four Lakes–it was Memorial Day weekend and the owner was visiting her hometown) and many of the papillomas were surgically removed.

Based on advice from other SharPei owners, Nova was fed the papillomas diced up in her food.  Within 10 days, all of Nova’s remaining papillomas were gone and no new ones had cropped up.nova today

I saw other dogs with papillomas that started to become more numerous and not respond to time or azithromycin.  From my experience with Nova, I now recommend surgical removal much sooner than before.  I think it is reasonable to wait several weeks and see if the papilloma goes away on its own, but if there are more forming, I recommend sedation and removal quickly.  I leave it up to owners if they want to feed the papillomas to their dogs, but the growths seem to disappear without that step.

Is your dog killing your grass?

This is the time of year I get calls about the effectiveness of various products that are supposed to help prevent those brown lawn spots caused by dog urine.  Do they work?  Is it worth the money?  Is there anything else that can be done to stop the problem?

First, it is important to understand why those brown spots form where a dog urinates.  It isn’t due to the pH of the dog’s urine, but rather the amount of nitrogen in the urine.  Nitrogen is a break-down product of the protein in the diet and it is passed out of the body in both the urine and feces.   Nitrogen is also the main component in fertilizer.  So some nitrogen on the grass is a good thing, but if there is there is too much, then it will burn the grass, leaving that brown spot on your lawn.  But as the nitrogen diffuses into the soil, the concentration decreases and the grass becomes fertilized.  So you have a brown spot surrounded by fast growing, very green grass.lawn burn

It has been found that the volume and, especially, the concentration of the urine (and therefore the concentration of nitrogen) are the important factors in lawn burn.  Female dogs (or male dogs that squat, rather than lift their leg) are more likely to cause lawn burn.  Male dogs that lift their leg urinate smaller amounts and, generally, on a vertical surface, so the volume and amount of nitrogen deposited is much less (and often in areas where you wouldn’t notice killed grass). The pH of the urine (how acidic or basic it is) had no effect.

The various products marketed to help eliminate lawn burn when fed to your pet (or put in their water), don’t work.  They are designed to alter the urine pH, which isn’t the problem at all.  And altering the pH of the urine can predispose your pet to developing crystals in the urine, which can eventually form into bladder stones.

So what can you do?

The first thing to try is to dilute the urine.  Have your dog drink more water each day. Feed at least some of the daily calories as canned food or add water to the dry food.  Make the water bowl more interestidrinking dogng by adding some ice cubes.  Have multiple water bowls throughout the house.  Have one water bowl with flavored water–a little chicken broth or beef broth added to the water can make it more enticing.

You can also feed your dog a food lower in protein, which will decrease the nitrogen in the urine.  Most dogs (except for very energetic, working breeds) don’t need nearly as much protein as is found in most dog foods.  (This also explains why so many dogs are overweight.  But that is a topic for another blog!)  It can be very difficult to read pet food labels as the %  protein doesn’t really tell you much by itself.  But it is a place to start.  A diet with high quality proteins are also more digestible, so less protein (and therefore nitrogen) is dumped into the urine.  Premium pet foods tend to have more digestible proteins than foods from the grocery store.

As far as the lawn, diluting the urine immediately after your dog squats can help.  Carry a water bottle with you and dump the water on the spot right away.  Train your dog to eliminate in a designated area, ideally one landscaped with pea gravel or mulch.  It has been found that fescue and perennial rye grass are the most resistant to lawn burn, while Kentucky bluegrass and Bermuda grass is the most sensitive.  So if you are reseeding your lawn, choose fescue!  I’m guessing dandelions and crab grass are pretty resistant, too…

One final note: if your dog has been causing lawn burn and suddenly isn’t, and you haven’t changed anything, you should have a urine sample checked and some blood taken.  Your pet may suddenly be drinking more, diluting the urine, which can indicate underlying diseases.

Here’s to a great, green-lawn summer!

Grapes & Raisins Can be Poisonous to Your Dog!

Grapes for Dogs–Good, Bad, or What??

We all know that chocolate is bad for dogs, but not everyone knows that grapes and raisins can be just as toxic, if not more so.  The first reports of grapes causing problems in dogs appear to have started in 2003.  There were 140 reports of kidney failure due to grape ingestion reported to the Animal Poison Control Center that year.   How can a piece of fruit possibly be harmful?  Is every dog at risk if they eat even one grape or raisin? 

can-dogs-eat-grapes-noThe facts are that for SOME dogs, eating grapes or raisins can cause kidney failure to develop within a few hours.  Not every dog is susceptible, but we currently have no way of knowing which dogs will have problems and which can eat grapes to their heart’s content.  The lowest recorded amounts of the fruit that caused acute kidney failure are 0.7 oz/kg of grapes and 0.11 oz/kg of raisins.  That works out to 3 oz of grapes for every 10 pounds of body weight or 1/2 oz of raisins for every 10 pounds of body weight.  Depending on the size of the grape, one ounce is approximately 4-6 grapes and one ounce of raisins is approximately 2 raisins.

The current thinking is that there are some, as of now unknown, risk factors in grapes that are toxic to some dogs.  Maybe some dogs are genetically predisposed to reacting to something in grapes.  The toxicity does not appear to be due to a fungus/yeast on the grape, pesticides on the grape, or heavy metals.  So organic grapes are just as likely to cause problems.

Clinical signs of kidney failure usually begin several hours after the dog eats the grapes.  Initially there may be vomiting and lethargy, then either increased drinking and urination or no urine production at all.  Without quick treatment (which can include hospitalization and intensive intravenous fluid therapy), a dog can die.  If the dog doesn’t develop kidney failure, they can have gastrointestinal signs (vomiting, diarrhea) for weeks after ingestion.

There have been anecdotal reports of problems in cat that ate grapes, but not many cases have been reported.  Are cats less sensitive or is there just less exposure to grapes or raisins?  There is a lot that is unknown about this toxicity in animals.  No one knows if grape juice is a concern, but grape pomace in foods does not appear to be a problem. Grape pomace is the dried and extracted grape skin and seed, rather than the whole grape. There’s no risk feeding it to dogs as the seed and skin are considered safe. Studies indicate that the toxic element is in the flesh of the grape. The flesh is not included in grape pomace.  Grapeseed oil is also not currently thought to cause any problems in dogs.

Because we don’t know which dogs will have a problem, if your dog has eaten any amount of grapes or raisins, the best thing to do is make him or her vomit.   Vomiting can be induced in dogs with 3% hydrogen peroxide.  For a dog 15 pounds and under, give 2 teaspoons of 3% hydrogen peroxide, then wait 15-20 min for your dog to vomit.  If no vomiting has occurred, give another 1 teaspoon.  For dogs 15-30 pounds, give 1 tablespoon 3% hydrogen peroxide.  Can give another 1/2 – 1Tablespoon if no vomiting has occurred in 15 min.  For dogs over 30 pounds, start with 1-2 Tablespoons.  Do not give more than 3 Tablespoons total.  Do NOT give hydrogen peroxide to cats.  If your cat has eaten raisins or grapes, the best thing is to take him/her to a local veterinary emergency hospital and have them induce vomiting.

bunch-grapesNow, grape COSTUMES are just fine and, in fact, are good for starting conversations about the toxicity of grapes and raisins with people who may be unaware of the problem!



Sissy’s Heartworm Saga

SAMSUNG CAMERA PICTURESSissy is a 2 1/2 year old Blue Tick Hound.  She had been kept outside in a dog house since adopted as a pup.  Since she wasn’t getting the attention she deserved, the original owners gave her up to another family.

Sissy was brought to Four Lakes Veterinary Clinic for an exam and to be spayed.  She was a sweet girl and was getting along very well with her new owner’s other dog.

Sissy’s ovariohysterectomy (spay surgery) went well, with no complications.  She was examined, vaccinated, and blood was sent off to check for heartworms and exposure to tick-borne diseases (like Lyme).

Heartworm-mapHeartworms aren’t terribly common in Wisconsin, especially when compared to warm, southern states.  So we were surprised when her test came back positive.  In addition, a stool sample showed she was infected with 3 other types of intestinal worms: roundworms, hookworms, and whipworms.  Poor Sissy!

She was treated for the intestinal worms with a deworming medication and started on heartworm preventative and an antibiotic prior to starting heartworm treatment in 1-2 months time.  Heartworms are often infected with a bacteria called Wolbachia that can make the body react more strongly to the heartworms.  The antibiotic kills the Wolbachia in the adult worms,  so the lungs have less of an inflammatory response to the heartworms being killed by the Immiticide.

whipworm-adultsInitially Sissy was prescribed Heartgard to start killing the microfilaria (“baby” heartworms), but because that medication doesn’t control whipworms, we decided to give her Sentinel Spectrum instead.  Whipworm eggs, passed in the feces, are very hardy and can stay in the soil a long time, even through harsh winters and hot summers.  Once there are whipworm eggs in the environment, a dog is always at risk of contracting them again.  So giving a monthly preventative that controls them is very worthwhile.

The owner gave the first dose of Sentinel Spectrum and over the next several days Sissy started vomiting and not eating.  It turned out the vomiting was really coughing, so chest x-rays and bloodwork were performed to try and determine what was going on.


Her bloodwork was normal, but we did find microfilaria in her blood.

Thsissylate x-ray showed a lot of inflammation in the lungs, likely heartworm pneumonitis.The most likely scenario was that the high dose of milbemycin in the Sentinel Spectrum killed off a large number of microfilariae quickly. They then got filtered out in the lungs, caused severe inflammation, which then led to the forceful coughing and lethargy.

Sissy was immediately started on steroids, which decreased the inflammation and stopped the coughing, making her feel much better within 24 hours.  Until her heartworm treatment is done and she no longer has microfilaria in her blood, she will take Heartgard monthly.

Sissy took the prednisone, for about 2 weeks.  The amount given was decreased every 4 days.  Near the end of the medication, she developed diarrhea.  We first just treated it like “normal” diarrhea–withholding food for 24 hours then feeding a bland diet.  This didn’t help, so we examined a sample of the diarrhea and were suspicious of a Giardia infection.  She was prescribed metronidazole, which can kill Giardia and is also helpful for other causes of diarrhea.  It didn’t help Sissy at all.  She started defecating fresh blood and not much stool at all.

When I examined her, she had lost weight, her gums were quite pale, and she had fresh blood on the rectal exam.  A complete blood count (CBC) was done and it showed she was anemic and had virtually no platelets, which aid in clotting blood.  Because of all her clinical signs (anemia, low platelets, weight loss, coughing, lethargy, and because she lived outdoors, I started wondering if she might have a fungal infection of Histoplasmosis.  Histoplasmosis isn’t common in Wisconsin, but she did live in other states, where the risk is higher.  The best test for histoplasmosis is through urine, so the owner’s brought in a urine sample the next day.  It took a couple days for the lab to get results, so I also started her back on high doses of steroids, in case her very low platelets were due to destruction by her immune system.

Thankfully, her histoplasmosis test was negative.  Fungal infections can be very difficult to treat.  But the high doses of steroids I started her on were causing her to be extremely ravenous.  She broke out of two very sturdy cages and destroyed the house, eating brillo pads and anything that was in her path.  The owner was ready to relinquish her to the shelter because of the behavior!  It was touch and go for Sissy for that first week.

The high doses of steroids suppressed her immune system, allowing her platelets to rebound.  The blood and diarrhea stopped and she was much more energetic.  As her platelets stayed in the normal range, we started decreasing the steroid dose, which helped with her behavior.  At least she stopped breaking out of kennels!

Now that her platelets are holding steady and in the normal range, she is almost ready for her heartworm treatment!  The plan is to take another chest x-ray to make sure her lungs are all normal, taper the steroid dose a little more, and give the first Immiticide injection.

To be continued…

Piper’s Premolar Problems

Piper is an 11 year old Cocker-Bichon mix belonging to a veterinarian who specializes in chiropractics and acupuncture.  Over Christmas, Piper received a bully stick and enjoyed chewing on it.  One day, however, Piper’s human brothers noticed that she had bad breath.  On closer inspection, her owner noticed a fractured upper fourth premolar (also known as a Carnassial tooth).

Piper was brought to Four Lakes Veterinary Clinic so we could see if the fracture was bad (had an exposed pulp cavity, which could lead to a tooth root abscess) and needed extraction or if it was just loss of enamel.  Sadly, it was definitely a slab fracture–a chunk of the tooth was fractured off and there was exposure of the root canal.  Piper was scheduled to have the tooth extracted.

Once Piper was anesthetized, Allison used a probe to look for other diseased teeth–if the probe goes under the gumline more than about 3 mm, there is bone loss and the tooth may need to be extracted.  The probe found some pockets under the gumline, but none over 2 mm in depth.  Dental x-rays were then taken to assess the health of the roots and look for problems under the gum line.

Since the probing didn’t show any obvious areas of disease, we were a little surprised when we saw the x-rays of Piper’s lower first and second premolars on the left side.

piperbadrootsThe x-ray of the same teeth on the right side showed a little dark area under the first premolar (the small, one root tooth), but since the left side showed lucency around 2 roots, the owner opted for extraction.  All of Piper’s teeth showed some “horizontal” bone loss, which is common in older dogs, especially small breed dogs.  Once there is sufficient bone loss and the bifurcation of the root is exposed, then the tooth needs extracting.

Now poor Piper had 3 teeth that needed to be extracted.  Local lidocaine nerve blocks were given to help with post-op pain.

SAMSUNG CAMERA PICTURESI extracted the lower two premolars first.  The gum over the outside of the tooth is cut and elevated off the bone, then a bur is used to remove some of the bone.  There is a dental tool called an elevator that is inserted alongside the tooth to help break down the ligament holding the tooth in the socket. Once the tooth is loosened, it can be removed.  Then the gum is sutured closed over the holes.

Next I tackled the fractured Carnassial tooth.



First a flap of gum was made over the outside surface, then bone was removed.  The tooth was then sectioned, leaving 2 roots in the front and one in the back, to make elevating and extraction a little easier.


I thought I had extracted all 3 roots, so we took an x-ray to verify.  Much to my consternation, there was a root remaining!


After scrutinizing the x-ray and the extraction site, Allison and I finally found where this root was and extracted it.  I was very glad we took a second x-ray!  I made sure the bone was all smooth, then sutured the gum closed.  Piper recovered nicely!


Why is Daisy Vomiting?

Daisy is a 2 year olSAMSUNG CAMERA PICTURESd cat that was adopted from the local humane society about a month prior to her veterinary visit.  While at the shelter, she was vomiting a few times a week, but everything checked out on her exam.  After she and her sister were adopted, their new owners changed the diet and the vomiting decreased.  But one day she started vomiting frequently–multiple times in one day.  Since the owner hadn’t brought them to a veterinarian yet, he thought this would be a good time to have them checked out.SAMSUNG CAMERA PICTURES

Daisy and her sister, Precious, are beautiful muted  tortoiseshell cats.  Daisy has the most unique whiskers–they have a grey speckled pattern to them, which matches the grey speckled patch on her tail.  But while Precious was exploring the exam room, Daisy sat on the bench and didn’t really want to move around.

During her physical exam, I palpated her stomach and intestines to feel for any pain or lumps.  Her intestines felt normal and she wasn’t showing any signs of pain. Her stomach, however, felt lumpy and irregular-shaped.  We took a couple x-rays and it appeared there was something in her stomach that didn’t look like food.  Her owner mentioned that Precious had found a hair scrunchy and put it in their food bowl, so I wondered what other things Daisy might have found around the house.  Since the object appeared to just be in her stomach, we did discuss sending her to the veterinary specialty hospital for endoscopy.  But if the object hadaisylats moved out of the stomach or isn’t easily “grabbable,” then surgery would be needed anyway.

So Daisy stayed overnight and received IV fluids to keep her well-hydrated, since she wasn’t eating.  The next morning we found she vomited once over night and was just cuddled up in the back of the cage.  I palpated her abdomen daisyjdagain and she was definitely more uncomfortable.  I couldn’t feel her stomach well and wanted to see if the foreign object had moved into her intestines.  An x-ray showed that nothing had moved, which was good.  It is easier to open up just one area, rather than having to make incisions into several areas of the intestines.


SAMSUNG CAMERA PICTURESDaisy was anesthetized and her fur was clipped (just as it was starting to regrow from her spay surgery last month!).





SAMSUNG CAMERA PICTURESAfter prepping her skin and placing a sterile surgical drape over her abdomen, a fairly long incision was made to allow her stomach to be manipulated.  ASAMSUNG CAMERA PICTURESn incision was made into her stomach and I reached in with hemostats and started pulling out the foreign object.



It wasn’t just one object, however!  It turned out to be 12 hair rubber bands along with a rope necklace cord!SAMSUNG CAMERA PICTURES SAMSUNG CAMERA PICTURES




After removing all of that, I sutured the stomach closed, then checked all of her intestines to make sure nothing had moved past the stomach.  Linear foreign objects like rubber bands, yarn, thread, and necklace cord can cause severe problems in the intestines and I didn’t want to miss anything.  But everything was confined to the stomach.  The total surgery time (from making the incision to suturing the skin) was 25 minutes.


Daisy recovered very smoothly and by later in the afternoon she seemed so much happier than that morning!  She liked having her cheeks scratched and seemed hungry.  She went home the same day and she and her sister shared a dinner of canned food.  She has not vomited at all since being home!  Now the hard part–keeping rubber bands and hair products away from her!


Cat Dental Care

SAMSUNG CAMERA PICTURES Cat’s teeth are generally a subject we don’t think about much.  As long as the cat’s teeth aren’t imbedded in your arm, most people are content to assume all is well.  It isn’t often that your cat gives you a toothy smile so you can take a look at her teeth.  Sometimes you can smell bad breath on a cat to help clue you in that there might be a problem, but often there are no obvious signs that your cat has mouth pain from diseased teeth.  Cat’s teeth are mainly designed for puncturing and slashing small rodents and they don’t do much chewing.  So even with a painful tooth, they can usually get dry kibble down their throat.

But cats do develop dental problems, often at just a few years of age.  When you take your cat in for his yearly wellness exam, your veterinarian should be examining all the teeth for problems.  By age 2 or 3 years, cats can have noticeable tartar on their teeth.  This will appear as a brownish yellow color, most often on the upper premolars.

Gingivitis, or redness and inflammation of the gumline, follows.  Gingivitis eventually gives way to gum recession and bone loss, which leads to loose and lost teeth.

There is another common tooth disease in cats that occurs even without tartar buildup.  This is a resorptive lesion and is sort of like a cavity into the side of the tooth.  First there is just some enamel loss, TR_diagram_all_stagesbut then the hole opens into the root canal.  At this point the lesion is very painful as the nerve is involved.  It may look like the gum is growing up the side of the tooth or just like a very red area.  If touched with a fingernail or probe, the cat’s lower jaw will often “chatter,” even under anesthesia, because of the pain.  The lesion continues through to the other side of the tooth and eventually the crown of the tooth breaks off.  The root, under the gum line, eventually is resorbed into the bone.

Studies have shown over 50% of adult cats develop tooth resorption.  One of the most common teeth affected is the first upper and lower premolars. cat denition chartIt is worthwhile to look at your cat’s teeth on a regular basis to look for these resorptive lesions.  Because they are painful, it can make you cat less active and a little more cranky–signs that are often attributed to “growing older.”

This is a premolar tooth with a resorptive lesion: resorptive lesion web

You can see the inflamed area at the bottom of the tooth.

Another commonly affected tooth is the canine: canine tooth resorptive lesion

Sometimes the area over the lesion isn’t bright red, but just looks like gum growing onto the tooth.

If you see a resorptive lesion, your cat needs to have that tooth extracted, rather than waiting for it to break off on its own.  Would you want to have mouth pain for months?

Not all resorptive lesions can be detected visually, which is why dental radiographs are so important.  Dental x-rays show us what is going on under the gum line.  They are also very helpful in determining how best to treat a tooth with a resorptive lesion.  Sometimes the root has already started to be resorbed by the bone; these teeth just need a “crown amputation” rather than having the roots extracted.  This is a much easier procedure for both the cat and the veterinarian.

Here is a picture of a tooth with a resorptive lesion where the root is already indistinct: resorbing half tooth

Without an x-ray, I would have tried to extract a non-existent root, causing more pain and trauma to the kitty than he needed (or deserved!)

It is still unclear as to why resorptive lesions occur.  Some might be due to inflammation against the bacteria in the mouth, so brushing your cat’s teeth could be helpful.  Hopefully further research will give us better ways to prevent these painful lesions, but until we know more, brushing offers the best protection.

Here is a good video to get you started:

Good luck and good breath!

Exploratory Surgeries

I’m sure you know the feeling of anticipation and excitement just before you open a present on your birthday.  That is a similar feeling that veterinarians and veterinary technicians feel when they are doing an exploratory surgery on a dog or cat.  Radiographs are analyzed, wagers are made, and eyes crowd the surgery door window in hopes of seeing what the surgeon removes from the gastrointestinal tract.  There is also a feeling of worry and dread (at least by the vet) about what damage that foreign body has wrought on the GI tract.

Recently the staff at Four Lakes had two dogs present within a week with suspected foreign bodies.

SAMSUNG CAMERA PICTURESChief was a 2 year old Labrador Retriever.   He had been vomiting and not feeling well all weekend.  He was dehydrated, so we started him on IV fluids and then took an abdominal x-ray.  We were excited to find:

ChiefrocklatA heart-shaped something!  And lots of gas in his intestines.  No wonder Chief didn’t feel very good!  With the very obvious foreign object, he was taken right into surgery.  Because he had been vomiting and not feeling well for 4-5 days and had a high white blood cell count,  I was very worried about what his intestines would look like, if there was a perforation, and if part of the intestine was going to need to be removed.

Because “exploratory” means just that, the incision made is a long one.  Every organ is examined and the entire length of intestines (estimated to be about five to six times the length of the animal’s body) are “run” through the fingers to feel for any abnormalities. SAMSUNG CAMERA PICTURES In Chief’s case, when I first started to “run the bowels” a firm area was felt.  When that part of the intestine was opened, a wad of black fur and food was found.  I removed it, but that was not the bright white object seen on the x-ray.  I kept going and suddenly found very “angry” intestines–a dark red, inflamed area surrounding a large, hard mass.

I was concerned about the viability of this very inflamed intestinal area.  But removing a portion of intestines and then reattaching the two ends is not a procedure to take lightly.  I removed the hard object (which turned out to be a rock) and then watched the intestines for awhile.  SAMSUNG CAMERA PICTURESThe inflamed area had a good pulse to it and I didn’t see any areas that looked black or that were oozing anything, so I opted to leave them all intact.  Hoping that by removing the obstruction, everything would slowly heal and go back to normal.

 I worried about Chief for days afterwards, but he recovered well.  He started eating soon after surgery, with no further vomiting, and finally passed stool a couple days later.  By the time his skin sutures were removed, he was all back to normal!

The next day a client brought in her new dog, Nelson.  She had adopted him from the Humane Society five days before.  He had been fine, playing with her other dog and then suddenly became lethargic, unable to get comfortable, stopped eating and started vomiting.  On physical exam he was dehydrated and not passing any stool.  We started with x-rays to see if there was a rock in Nelson, too.  His “survey” radiograph showed some odd gas patterns, so we decided to give him some barium dye and see if it passed normally through his intestines.  Barium can help show foreign objects or an obstruction, but it also helps to coat the intestines and can improve gastroenteritis signs.

nelsonbariumlat  Here you can see the barium dye in Nelson’s stomach and the gas in his intestines.

When a barium series is performed, the animal is given the dye orally (sometimes they will eat it up with some canned food) and then x-rays are taken every 30-90 minutes to watch the dye pass out of the stomach and through the intestines.  In Nelson’s case, however, the dye didn’t move at all after 2 hours and then he vomited it up.  His blood work also showed a high white blood cell count, so off to surgery we went.

I was worried about what we were going to find in Nelson, too.  Once anesthetized, he was found to have high blood pressure and an elevated heart rate. I anticipated that whatever it was would be in the stomach, since the dye didn’t pass through, but the stomach was empty.  But I quickly found a dark red, distended area in the intestines. SAMSUNG CAMERA PICTURES I made an incision in the healthy intestines right next to the area and started pulling out this hard, black rubbery substance.  It was a large chunk and I had to cut it in pieces to remove it.  But once it was out, Nelson’s blood pressure and heart rate immediately dropped to normal and the red tissue started looking healthier.  I worried about Nelson after surgery, too, but not as much as with Chief!

The black chunks turned out to be chunks from a hard rubber ball he had been playing and chewing on over the weekend. SAMSUNG CAMERA PICTURES  Luckily he had some insurance coverage from his recent adoption, so part of the surgery was covered.

Both Chief and Nelson recovered well and continue to be healthy, happy dogs.  We much prefer that, but did enjoy talking about their surgeries and the strange things dogs eat for days afterwards!

Dave’s Legacy

SAMSUNG CAMERA PICTURESBack in 2007 I had to euthanize a cat because he had severe anemia.  Because cats are so good at hiding illness (or because we fail to differentiate a lethargic cat from an older cat that sleeps a lot), I didn’t see Dave until it was too late to determine the cause and provide much treatment.  Understandably, the owner was very sad to have lost Dave and wrote me this letter afterwards.  Although it was written seven years ago, the message is timeless and important for us all to hear.  If you have a cat that hasn’t seen the vet for a while, please call and make an appointment today!

Sept. 20, 2007

Dear Dr. Scarlett,

We are miserably heartsick without Dave Kittyface Cat.  Dave had such a wonderful personality packed into such a small body-the house seems so empty without him.

Please caution cat parents about getting their babies regular check-ups.  When Dave moved in with us, I considered bringing him in for a look-over, but then I thought, “He’s not an outdoor cat, he’s not been exposed to other cats, what disease is there for him to catch?”  I wouldn’t even allow family dogs in the house to upset him.  And I did not bring him to you, and now he is gone-much sooner then he had to be.  My poor boy should have had twice as many years to live.

Why I never researched cats in general, I have no idea.  If I had, I would have seen the maladies that could have befallen him with no fault of his actions or us at all.  I did not know cats’ systems were so different, so delicate, until I started to research his illness, to see if there was anything I could do to help him survive.

SAMSUNG CAMERA PICTURESPlease tell cat parents I beg them to get their kitties regular check-ups, with blood tests as often as you suggest.  If you had found the anemia earlier, maybe you could have diagnosed Dave’s illness before it, and I, by my lack of action, killed him  I thought I watched Dave like a hawk, but failed to see he wasn’t eating for several days-poor Dave had to have lost half his weight in those few days.  Such a  little boy needed every ounce to fight for his health, and because I looked but did not see, Dave passed away.

I have enclosed a small collage of Dave-you can see how precious he was, and why I can never forgive myself for not thinking, not paying attention.  All I can do is beg others to do what I did not.

Thank you for everything,




FREE Vaccines for Life program at Four Lakes Veterinary Clinic


at Four Lakes Veterinary Clinic

We believe it is very important for all pets to have regular physical exams.  Unlike us, pets often give no indication that there is anything wrong until a problem is advanced and more difficult to treat.  Annual wellness visits give us the opportunity to give your pet a thorough physical exam, look for subtle changes, talk about your pet’s lifestyle, and answer any questions you have.

To emphasize the importance of yearly check-ups, we are offering a Free Vaccines for Life Program, a simple, cost-effective plan to give your pet the regular and personalized care they deserve.  We follow the vaccination recommendations of the American Veterinary Medical Association (AVMA) and the American Association of Feline Practitioners (AAFP) and tailor our vaccination protocol based on your pet’s lifestyle.


For each pet you wish to enroll, there is a one-time initiation fee of $49, along with a paid wellness exam every year.  After enrollment, your pet will receive all their core vaccines for free for the rest of their life, as long as they are brought to Four Lakes Veterinary Clinic within 30 days of their scheduled wellness exam.

The enrollment fee is per pet, not per client, and is non-refundable and not transferable.  If your pet dies or is lost, it cannot be transferred to a new pet.  Likewise, if you rehome your pet, it is not transferable to the new owner.

What vaccines are included?

For dogs, the core vaccines include rabies, DHPP (distemper, parvo, hepatitis/adenovirus, and parainfluenza), leptospirosis, and Bordatella (kennel cough).

Lyme vaccine is not included in this program because it isn’t considered a core vaccine.  This vaccine is still very important for those dogs at risk, so it will be discounted by 50% for pets enrolled in the program.

For cats, core vaccines include rabies, FVRCP (rhinotracheitis, calicivirus, and panleukopenia) and feline leukemia.

Will my pets get vaccines every year?

It depends.  Each pet will have a full physical exam and we will discuss with you which vaccines your pet needs.  Not all vaccines are given on a yearly basis.  If a pet is in poor health or has a condition that prohibits the use of vaccines, Dr. Scarlett may delay or not give vaccines.

This program should NOT be interpreted as a way to excessively vaccinate your pet as our philosophy is to give only vaccines warranted by the pet’s age and lifestyle.

SAMSUNG CAMERA PICTURESWill my pet need a wellness exam every year, even if no vaccines are due?

Yes.  To stay enrolled in the program, your pet will need to have a yearly wellness exam performed at Four Lakes Veterinary Clinic.  Wellness visits at any other veterinary clinic do not fulfill the requirement to stay enrolled in Free Vaccines For Life.

What if we are late for our wellness visit?

In order to make this program useful to you and your pet, we must see your pet within a month of the wellness exam due date.  If you do not come in for a wellness exam within that time frame, then your policy becomes null and void.  If this happens you may either purchase vaccines and wellness exams individually from that time on or you may re-enroll in the program if it is still available.

Please do not rely solely on your courtesy reminders, as Four Lakes Veterinary Clinic can’t be held responsible for its non-arrival at your address.  To make it easier for you to keep track of when your pet is due for the yearly wellness exam or any vaccine, you can sign up for our free ePet health account on our website at  This site is very user-friendly and is a valuable tool in maintaining your pet’s health.  There is also a mobile app that allows you to easily show boarding facilities your pet’s vaccine history.  Please check it out!

What about puppies and kittens?

Puppies and kittens require vaccinations every 4 weeks until they are 16-20 weeks of age.  You are welcome to enroll your new pet in the program at their first visit.  You would then just pay a wellness exam price at each visit and get all the required vaccinations for free and the pet would remain enrolled for the rest of its life!  All vaccines in the puppy/kitten series need to be given in a timely fashion to be effective. You will need to return for the next boosters within 4 weeks to continue to be enrolled in the program.   We will also provide a 10% discount on the spay or neuter surgery if the vaccination series is completed at Four Lakes Veterinary Clinic.