Intown Animal Hospital

Cystotomy. Easily my favorite surgery - because it’s so immediately gratifying to know that your patient wakes up in better health. A cystotomy is bladder surge...ry to retrieve and remove bladder stones (uroliths). Bladder stones start as tiny crystals which aggregate over time, layer upon layer, to build a myriad of different shapes and colors and sizes based on their mineral composition. Today’s stones from a Husky remind me of smooth river stones, ones that I might pick up from a creek bed. This was rather impressive collection today - well over 50, with 3 measuring up to 2.5cm in diameter. Several have already been packed up to send off for stone analysis, to determine the composition which will help me make plans to reduce the likelihood of future occurrence. Many factors can contribute to stone formation, depending on the pet - urinary tract infection, diet, genetics and breed, liver disease - each as unique as the animal itself. No gross pictures - I promise, just some examples of diagnostic imaging, that help me confirm their presence. Art in Nature. #vetmed See more

As we look with eager anticipation to a future with some return to normalcy, I wanted to share an article I wrote about steps to take to optimize your pets' transitions as you return to the workplace or school. Preparation now will lead to a better adjustment for all! Home Alone Abby Huggins Mowinski, DVM...Continue reading

I’m a big fan of the Road ID collar tags for pets. I was reminded of them by a friend/client a few weeks ago. Jingle-free and snag free and same high quality you expect from their human products that so many of us endurance athletes wear. Good deal on shipping today! https://www.roadid.com/prod/dogid-the-rock-solid-collar-id #RoadID #veterinarian #petsafety

An article I wrote on Feeding Your Kitten. Meow!

Veterinary Medicine in the time of COVID. Sending love and support to all of my veterinary colleagues - receptionists, vet techs and nurses, kennel staff, and f...ellow vets - the past several months have been challenging, to say the least. I grow weary of the word unprecedented, but these have truly been unprecedented times for our profession. And I want to help pet owners understand what is happening in our hospitals so that they can better manage their expectations. We are slammed - across the nation - we are working well above our max capacity. To adapt to the pandemic, veterinary hospitals have made radical changes in the way we do business to best protect you, our clients, and our staff. Most of us have adopted curb-side service to mitigate cross-contamination and exposure risk and we have limited the number of our personnel on each day for those same reasons. What this translates to, at least at our hospital, is only one doctor on a day (as opposed to two) with a reduced support staff. But our daily patient numbers haven’t changed - in fact, they have increased thanks to the overwhelming (and wonderful) increase in newly adopted and purchased pets. Subsequently, one doctor is seeing double the volume of appointments, plus surgeries, plus drop offs and work-ins. My front staff is doing their best to handle a never-ending influx of phone calls and emails, all while trying to check people in and out in the parking lot, carry medications and prescription foods out to the cars, and serving as pinch hitters to lend a hand in the back. My techs have each had to grow an extra set of arms as they do the work of an army, both inside the hospital and outside in the 95 degree Georgia heat. Please know that we are doing our very best to take care of all of you and to provide the compassionate and personal service we want each of you to experience. But there are only so many hours in the day and, ultimately, there is a finite capacity. We are not being mean or uncaring when we tell you we are full, we simply literally don’t have an extra second of time. Lunches aren’t being eaten, medical notes aren’t being written until 8PM - and many of us head home late to families and children that need us too. I am a lucky one - my co-workers are an incredibly talented, positive, and motivated team, and the vast majority of our clientele has been kind and understanding. As the pandemic continues to linger and as we head into the fall with virtual learning for students across the nation, please remember to have patience and grace with all those you encounter, from veterinary professionals to teachers to grocers to delivery individuals and to yourselves. We are all under new stresses and adaptations - but we are all in it together. #wegotthis #bekindalways #veterinarian See more

Veterinary Classroom: Entropion. Entropion is the term for inappropriate inward rolling of the eyelid (most commonly the lower eyelid). When this occurs, the ey...elashes and surrounding haired skin contact the cornea, resulting in irritation and discomfort. This can manifest as excessive tearing and discharge or, worst case scenario, corneal ulceration. Entropion is most commonly genetic (and has a higher propensity in certain breeds), but can also occur secondary to trauma or other causes. In the immature animal, we tend to treat by tacking the eyelid to achieve eversion to a normal anatomic position (this case is a great example). Many of these guys will outgrow the condition when they reach maturity. In the adult animal, we often need to perform a surgical resection of the extraneous skin. It’s a fun procedure, but hopefully - for this little dude - the tacking will be sufficient. The video is the day of the tacking procedure. The picture is 3 weeks post-op with great results thus far. See more

I was searching for a tutorial on the administration of at-home subcutaneous fluids for one of my patent with kidney disease, since we are unable to provide in-person demonstrations during COVID. This is a truly outstanding resource! https://youtu.be/9M9TPhIaszk

Day 38 of quarantine... Update: After over 2.5 M views, Figaro the Cat thinks he is famous and has demanded treats and his own FB page.

Intown Animal Hospital’s resident feline, Princess, misses welcoming all of our human clients into the hospital. But we believe it is in the best interest of ou...r community to continue our social distancing protocol until we feel a more structured return to normal engagement is established and deemed safe by the scientific community. We will continue our pets only in the hospital to minimize contact for both you and our staff. Thank you, as always, for the privilege of caring for your four-legged family members! @intownanimal @morningsidevillageatl #veterinarymedicine #pethealth #socialdistancing #staysafe See more

Calendar Girls! Little did we know we were seeing Ms. Aprils!! These two beautiful pug sisters came in and looked just like the calendar on our hospital wall. Too cute! @intownanimal @morningsidevillageatl #puppiesofinstagram #puglife #pugpuppy #calendargirls #veterinarian

I’ve had a number of excellent questions about pets and COVID-19 since the news about the tigers at the Bronx Zoo. I had intended to write my own explanation, ...but the following article does an excellent job of explaining the details. The important take-aways for pet owners are: (1) practice the same policies of social distancing with your pets as you do with yourself - minimize your pets’ interactions with other people and pets (2) if you are sick/test positive for coronavirus, please limit your interactions with your pets (3) if you are sick and your pet has subsequently been exposed, please keep your pet at home to limit its exposure to others Be smart, stay safe. FACTS: Coronaviruses in the Domestic Animal Kingdom: What the zoonotic origin of SARS-CoV-2 implies for pets and livestock April 3, 2020 (published) By Natalie SlivinskiView VINner Profile The coronaviruses that cause the potent respiratory diseases SARS, MERS and COVID-19 have an important feature in common: They are zoonotic, meaning they first came from animals. What does that mean for people and their pets? Since February, four household pets have tested positive for SARS-CoV-2, the coronavirus sweeping the globe: two dogs in Hong Kong, a Pomeranian and a German shepherd; a cat in Belgium; and, most recently, a cat in Hong Kong. All the animals' owners had COVID-19. Although they apparently picked up viral particles shed by their human companions, none of the Hong Kong pets showed signs of illness consistent with COVID-19. The Belgian cat, however, did become sick, showing signs about a week after its owner became ill. The occurrences raise questions about whether pets could become part of the COVID-19 transmission chain. Veterinarians and other health experts say there is no cause for owners to abandon their animals for fear of catching the disease if anything, it's the pets who should be kicking us out. There is no evidence that pets can transmit the virus back to people. "I think it's far more likely that they'll get it from the person that's shedding large amounts of virus, rather than the other way around," said Dr. Melissa Kennedy, a virologist at the University of Tennessee College of Veterinary Medicine. Medical experts say the real threat lies in human-to-human transmission. While some pet species may be able to pick up infections, that doesn't mean they play a role in spreading the virus. Still, research is ongoing, and owners should include their pets when practicing COVID-19 precautions. In his blog Worms & Germs, Dr. J. Scott Weese, a pathobiologist and internal medicine specialist at the University of Guelph's Ontario Veterinary College, advises: "If you're sick, stay away from animals just like you would other people. If you have COVID-19 and have been around your pets, keep your pets inside and away from other people. While the risk of transmission to or from a pet is low, we don't want an exposed pet tracking this virus out of the household (just like we don't want an infected person doing that)." Meet the coronavirus family Coronaviruses are diverse. They have adapted to occupy a slew of animal species, including birds, cats, dogs, pigs, mice, horses, whales, monkeys, ferrets, camels and cows. There are hundreds of known coronaviruses, which fall into four genetically different genera, or subgroups: alpha and beta, which mainly infect mammals; and gamma and delta, which mainly infect birds. Often, they don't make their host sick, and most cannot transmit from one species to another. But occasionally, when a virus evolves a mutation that benefits its ability to thrive, it can jump species, or "spill over." If the mutated virus can replicate to high enough levels, it can cause an outbreak among humans or other animals. Seven known coronaviruses infect people. Four of these are endemic that is, regularly found in a particular region and usually cause what we call a common cold. Three of the seven coronaviruses that afflict humans have evolved within the past two decades and can make some people severely ill. These are SARS-CoV, MERS-CoV and, most recently, SARS-CoV-2. All three are thought to have come from bats, whose specially adapted immune systems enable them to carry coronaviruses without becoming sick. The coronavirus that caused severe acute respiratory syndrome in 2002 may have passed directly from bats, but is thought to have been transmitted to humans largely through intermediate animals likely masked palm civets and raccoon dogs, both common in Chinese live-animal markets. The coronavirus that causes Middle East respiratory syndrome exists comfortably in dromedary camels without causing them obvious signs of illness. To this day, camels occasionally pass the virus to the humans who handle them. Experts suspect that SARS-CoV-2, the cause of COVID-19, also may have made the journey from bats to humans through an unknown intermediate animal, perhaps the pangolin. What makes the SARS and MERS viruses special? How can they transmit to humans when other members of their family cannot? The answer lies in the name. The coronavirus is named for the crown, or corona, of spikes on its surface, which the virus uses to attach to the outside of host cells and insert its RNA. These spike proteins have binding sites that stick to a specific cell receptor protein on the host cell's surface. Many viruses recognize only receptors that are specific to one animal species. Others are generalists. A recent study in the Journal of Virology found that the spikes of both SARS-CoV and SARS-CoV-2 bind to a host cell receptor called angiotensin-converting enzyme 2, or ACE2. ACE2 is found in many different animals, and if the spike protein can form a strong enough bond with an animal's ACE2, the virus can successfully infect that animal's cells. According to the study authors, the SARS virus evolved mutations in its spike protein to better stick to human ACE2 during the 2002 epidemic. The researchers found that SARS-CoV-2 spikes also appear to bind well to ACE2 and not just in humans but also in other primates, bats, pigs, ferrets and cats. Other studies have suggested that it also recognizes ACE2 in pangolins, civets, raccoon dogs, camels and, possibly, domestic dogs. The veterinary and research communities remain vigilant. But although domestic animals such as cats and dogs may be infected, viral transmission in household pets is considered unlikely. Based on current evidence, Kennedy believes that dogs are not "epidemiologically important" for COVID-19. That's because there's more to a successful infection than sticking to host cells. And while humans provide a very comfortable environment for SARS-CoV-2, Kennedy said, dogs apparently do not. 'Infected' versus 'infectious' The dogs that tested positive in Hong Kong were found to have viral RNA in the mouth and nose. When the Hong Kong Agriculture, Fisheries and Conservation Department performed serological tests to measure antibodies against COVID-19 in the blood of the Pomeranian, the final result came back positive, indicating a bona fide infection. However, the dog never showed any clinical signs. In fact, you can be infected with a virus without feeling sick. When you feel ill, it's the result of the virus replicating to high enough levels to do two things: first, to destroy large numbers of healthy cells; and second, to trigger inflammation that can cause unpleasant symptoms such as fever and coughing. But if the virus can't replicate efficiently, it can't muster enough copies of itself to pose much of a challenge to the body's immune system, which mounts a coordinated attack and clears out the invader before its host notices symptoms. It seems likely, Kennedy said, that dogs are not a hospitable host for SARS-CoV-2. "The host specificity of a virus is determined, basically, by two factors," she explained: "One, that the cells the virus is infecting have a receptor that it can attach to. And then, once the virus is inside the cell, that cell has to be able to provide everything that the virus needs in order to replicate." While dogs' cells might have a fitting ACE2 receptor, Kennedy suspects that SARS-CoV-2 isn't happy enough in the canine cellular environment to replicate to high levels. There must also be a large enough dose of virus to breach the frontline defenses of every new host. Without the ability to replicate efficiently, the virus has nowhere to go. Vaccinating against coronavirus Existing vaccines for coronaviruses are thought to boost the animal's immunity, at least partly, to the viral spike proteins. Spikes are genetically and structurally different among coronavirus genera. Therefore, antibodies produced in response to a vaccine for one genus of coronavirus won't recognize spikes from a different genus of coronavirus. It's not only the spikes that differ. Bovine coronavirus is a beta coronavirus, for which there is a vaccine. BCoV and the SARS viruses are in the same genus. But SARS-CoV, the virus that causes SARS, and SARS-CoV-2, the virus that causes COVID-19, belong to yet another genetically different subgenus a subgroup within a subgroup. BCoV is a group 2a beta coronavirus, while SARS viruses are group 2b beta coronaviruses. The subgenera are genetically different enough that they stimulate the production of completely different antibodies that don't cross-react. Even existing coronavirus vaccines are not especially effective, and in some cases have caused adverse reactions. Some have been reported to cause their target coronaviruses which are unusually genetically adaptable to mutate into a new pathogenic strain. This is why experts recommend practical measures as a first-line defense against coronavirus transmission. That means adequate surveillance, rapid diagnostic testing and swift quarantines, if necessary. In humans, there's no doubt: Our bodies are like a five-star hotel for SARS-CoV-2. We can transmit the disease even without symptoms, perhaps because our cells are quite permissive to the virus. This effect is amplified in cities, where the high density of people means that a large population is being exposed to particularly high levels of virus. As for dogs, Kennedy believes they are likely a dead end for SARS-CoV-2 meaning they can catch the virus but they cannot give it back. While human cells are permissive for some reason, canine cells may not be. "From what we know thus far, the dog is not providing everything that virus needs in order to replicate to significant enough levels to make it important in the spread of the virus," she said. "There may not be enough permissive cells. But that's under investigation now." The cells of cats and ferrets, however, appear to be more receptive to coronaviruses. Scientists at Harbin Veterinary Research Institute in China, in a study not yet peer reviewed, found that "SARS-CoV-2 replicates poorly in dogs, pigs, chickens and ducks, but efficiently in ferrets and cats. We found that the virus transmits in cats via respiratory droplets." The finding on cats and ferrets is consistent with the SARS virus from 2002. For that reason, Weese, who is a zoonotic disease expert at Ontario Veterinary College, anticipated some weeks ago that cats and ferrets might become infected by the virus that causes COVID-19. "With the original SARS virus, cats ... were able to grow enough virus to pass it on to another cat," he said. Weese was therefore unsurprised by the news about the Belgian cat, which had both a positive test result and clinical signs. According to an article in The Brussels Times, the cat had diarrhea, vomiting and difficulty breathing. Researchers found virus in the cat's feces, the newspaper reported. The cat in Hong Kong, which has not shown any signs of the disease, also had virus in its rectal samples, as well as in its mouth and nose, according to the government statement. Ferrets, too, have been found to have ACE2 receptors and are permissive to a number of viruses that infect humans, including some types of bird flu and seasonal flu, according to Kennedy. Early studies have shown that SARS-CoV-2 replicates well in ferret cells. However, Weese believes their transmission risks are low, at least from an epidemiological standpoint. "If you put a cat and a ferret in front of me and ask me which one I want to get in close contact with, I'd pick the cat, because ferrets are high risk at that one-on-one level," he said. "But for me, cats are still a bigger concern because there are a lot more cats than ferrets." While the susceptibility of ferrets may be worrisome for ferret owners, it could be a boon for COVID-19 research. According to the New York Times, scientists at the University of Pittsburgh recently found that a ferret in their lab developed a high fever after being exposed to SARS-CoV-2. The strong immune response suggests ferrets likely are vulnerable to illness, which makes them a promising animal model for developing a COVID-19 vaccine. Assessing risk Despite the ferret finding, experts believe the likelihood of catching COVID-19 from a pet ferret or cat is low. Even if transmission to individual owners is theoretically possible, both Weese and Kennedy believe the risk does not translate to large-scale spread. "An infected cat isn't a big concern in the household, since the person who exposed the cat in the first place is the main risk," Weese wrote last week in his blog. "The virus is being transmitted very effectively person to person, so animals likely play little role, if any, in the grand scheme of things." Other than the Belgian cat, there are no other reports of domestic animals, including livestock, getting sick with COVID-19. That could change, of course; more animals from households with COVID-19 cases need to be tested to form a clearer picture. Furthermore, coronaviruses constantly mutate. They are RNA viruses, which, unlike DNA viruses, have no proofreading enzymes that fix mistakes in the course of replicating. Coronaviruses also have unusually large genomes. That leads to a large number of mutations, and such genetic "mistakes" are what drive their evolution. "Those mistakes are purely random," Kennedy explained, "but if they give that virus selective advantage over its comrades, then that mutation will be maintained in the virus population." If SARS-CoV-2 were to mutate such that the virus became more able to infect and spread, domestic animals could become reservoirs. That would have major implications for a world full of pet and livestock owners. It's also theoretically possible the virus could find a way to spill over from cats or ferrets back into humans. But there's no evidence to date that this is happening. A call for common sense Weese is working on testing more animals from COVID-19-positive households. "We're trying to do active surveillance of animals that are in contact with infected people," he said. If many more positive tests emerge in pets, public-health experts will review the transmission risks. But routinely testing large populations of domestic animals would be impractical and probably not very informative, Weese said: "Testing is useful to use from a research standpoint, but testing your average animal isn't something we want to get done." His focus is on practical protective measures. For pig farmers, for example, simply exercising caution may effectively prevent transmission. "If you've got COVID and you've got pigs but you don't go near the barn, then we don't have to worry about it," Weese said. "And with farmers, it's actually probably easier [than with pet owners], because a pig farmer realizes that if someone reports a pig being positive, pork prices are going to plummet." For pet owners, it's about managing animals the same way we manage people, Weese said. This means staying separated from pets if you're sick, as painful as it may be to deny yourself snuggle therapy. It also means including pets in social distancing. If you are under local stay-at-home orders and keeping a distance from others, keep your pet distant from others, too. Even if pets can't get COVID-19, viral particles can get on their mouth, nose, fur or skin and be picked up by the next person who touches them. Think of pets as another surface that can be contaminated, like a countertop or door handle. The overall message, Weese said, is simple: "Just use common sense." The best defense against transmission by household pets is to keep exposed animals in the home but sometimes this is impossible; for instance, if someone who lives alone needs to be hospitalized. In a blog post Thursday, Weese discusses options for such situations. The best scenario, he writes, is for someone who has recovered from COVID-19 to come into the household to continue caring for the pet. If no one is available, not even a benevolent low-risk neighbor, owners may be able to temporarily house their pet with a shelter or clinic that has the facilities and capacity. Weese's own hospital is positioned to house animals from COVID-19 households. Space is limited, and the option is intended as a last resort. "We're set up to handle those animals," he said, "but our focus is to keep animals in the household or find alternative approaches rather than see them in clinics."

Evaluation and Diagnosis of the Squinty Eye....the latest installment of Veterinary Classroom for my future scientists, as well as anyone interested in learning more about the canine eye! https://youtu.be/XUO8Jgmhz3Q

Allergy season is upon us in the Southeast, and many dogs manifest their allergic symptoms in their ears, in addition to their skin. We made this User’s Guide to your Dog’s Ears to help explain otitis and ear anatomy for all pet lovers, young to old! https://youtu.be/cRmT97EgTVc

New puppy at home and nervous about trimming her nails? Don’t fear the clippers - you can DO this! Sweet Frankie helps us demonstrate nail trim tips. For wiggli...er pups, distractions with tiny treats can help keep their focus elsewhere, their bodies still, and provide positive reinforcement! Don’t forget to layer on the praise! See more

Chapter 3 of Young Scientist Academy: Visit the Veterinary Hospital - PUPPY EXAM! During this time of social distancing, it is still important for young animal...s to receive their exams and vaccination boosters in a timely fashion. Join me as we walk through a puppy exam on this adorable dude! https://youtu.be/cNSb3IgeXTQ See more

Stay healthy Intown!!

Future scientists academy! I know so many kiddos are interested in veterinary medicine and science. I made this video today for our local elementary school-aged kids, but thought it might be fun to share more broadly! Yay Nature!

Cranial cruciate ligament (CCL) rupture is a common veterinary orthopedic injury, particularly in medium to large breed dogs. The CCL is analogous to the ACL in... humans - cranial vs anterior is simply the different nomenclature for a quadruped vs biped. The cranial and caudal cruciate ligaments are the stabilizing ligaments of the knee (stifle). The knee is the joint between the femur (thigh bone) and the tibia (shin bone). Derived from the word cross, the ligaments create an x. If one of ligaments ruptures (tears), the knee joint is destabilized. To test for that instability, veterinarians check for a cranial drawer sign or a tibial thrust. In the video below, my patient is under sedation and his toes are facing the top of the screen and his head is to the left. See more

In this time of great uncertainty, it is easy to feel overwhelmed...and that feeling can rapidly turn into anxiety and fear. Decisions are being made swiftly th...at will impact your routine and your projected plans. Decisions that you had no say in but must abide by...school closures, work closures, event cancellations. When there are so many things happening that are outside of your control, remember to FOCUS on what you CAN control. You can control your attitude, your love for your friends and your family, your compassion and helpfulness to your neighbors...and to strangers. You can continue to take care of yourself - to exercise, to eat well, to get good sleep. All of these things you have power over. Put your energies there. My veterinary nurses, front office, and I had a good discussion about Covid-19 as we wrapped up our last surgery today. We talked about the disease itself, its impact on our local and global community, the economic implications, and our roles as individuals. I encourage you to stay informed and make decisions that protect not only your own health but those around you. And if you have questions, ask them. Fear of the unknown can only be defeated by knowledge. Disease transmission and epidemiology are not everyone’s specialties. Feel free to reach out to me - I am happy to do my best to explain the science of this to you. Wishing you health and fortitude in these tumultuous times.