Veterinarian Shea Cox has enjoyed an indirect path through her professional life, initially obtaining degrees in fine arts and nursing. She later obtained her veterinary medical degree from Michigan State University in 2001 and has been practicing emergency and critical care medicine solely since that time. In 2006, she joined the ER staff at PETS Referral Center in Berkeley and cannot imagine a more rewarding and fulfilling place to spend her working hours. In her spare time, she loves to paint, wield her green thumb, cook up a storm and sail. Her days are shared with the three loves of her life: her husband Scott and their two Doberman children that curiously occupy opposite ends of the personality spectrum.
Wellness: Health Care
February 22 2013
A broken toe nail can be a painful and potentially expensive injury for our furry friends, and it is something that I often see in the ER. A common scenario is a pet suddenly begins to limp while out playing, and upon closer inspection, an injured nail is seen. Some nails have just a minor crack with some bleeding, while other injuries put a toenail at a 90-degree angle (ouch!). Because they can be painful or have bleeding, a cracked or broken nail may be best treated by a veterinarian. With that being said, it may not necessarily require an urgent trip to the emergency room. A broken nail may be something you can care for at home, or, depending on the degree of injury, it may be reasonable to wait to see your regular veterinarian in the morning.
So, what to do if your pet is suddenly favoring a paw and/or you see bleeding? First, get a good look at the paw—including in between the toes and webbing—to see if it is a cut, foxtail or other foreign object, insect stinger, or (you guessed it) possibly a broken nail. When doing so, be sure to look closely at the nail bed, as I have seen cracks and injuries in the nail that were actually hidden underneath the fur line, where the base of the nail goes into the toe. There are 3 general “types” of nail injuries: one where the nail has been completely broken off and is bleeding, one where the nail is cracked or broken but is loosely attached, and one where the nail is cracked or broken but remains firmly attached.
Usually, the best case scenario is when the nail is fully broken off and some bleeding is noted. In these cases, bleeding is usually mild but can be worrisome if it continues. These are the easiest types of injuries to treat at home as you generally only need to apply pressure with a gauze or clean cloth to the nail to stop the bleeding. The key is to hold pressure for at least 5 to 10 minutes with no “peeking to see” if the bleeding has stopped before this time is up. It is important to keep your pet calm during this time, as excitement increases blood pressure and works against a good clot forming. If bleeding continues despite applied pressure, you can apply styptic powder (such as Kwik Stop) and resume applying pressure for another 5 minutes or so. If you do not have styptic powder at home, sometimes a little baking soda can do the trick. If the bleeding continues despite these measures, then I would go to the ER rather than wait.
If you do happen to find a nail that is very loose and dangling, then you can attempt to remove it at home. It is important to have someone help restrain your pet safely while you gently try to remove the nearly broken off nail with a quick pull motion. Caution: only attempt removal if the nail is very loose! Think “loose wiggly tooth” like when you were a kid. Also, be careful during your inspection or attempt to remove a loose nail as this can cause a sudden and unpleasant pain sensation in which some dogs may nip or bite in surprise. If bleeding is noted following the removal, you can then use some gauze and light pressure, and/or Kwik Stop, as previously discussed.
Lastly, there is the type of broken nail that would ideally be treated by a veterinarian. These are nails that are cracked, continually painful, may be bleeding, and are still firmly attached. Treatment for these stubborn injured nails is typically some form of sedation with pain medication followed by cutting off the damaged nail just above the level of the crack. Sedation is needed because you are cutting through the very thick part of the nail with a live blood vessel and nerve, which is very painful. This is usually followed by styptic powder application and a bandage that is left in place for about 24 hours. The bandage promotes a day of rest so that a solid clot forms and the minor wound does not continue to bleed if it gets bumped on something. Although these types of injuries require professional care, it is something that can wait to be seen the following day if you are unable to get an immediate appointment with your veterinarian (unless your dog seems excessively painful, then I would not wait).
Whatever the type of nail injury, dogs are very good at keeping the area clean all on their own with licking, and antibiotics are not needed. A little licking is OK, and it is what a dog would do “in the wild” to keep it clean. With that being said, some of our babies get a little obsessed, and their good intentions can actually make the area more irritated by their constant worrying at it. Because of this, you should continue to monitor the area for any signs of redness, increased swelling, cloudy discharge, or increasing discomfort. The development of these complications is rare in my experience, but if noted, then an e-collar, pain medications and possibly some antibiotics may be indicated. No matter what kind of damage has occurred to the nail, it will generally regrow normally in all but a few situations. Sometimes the nail will regrow with a slight curve or different pigment, but usually returns to its normal appearance over several months - kind of like when us humans lose a nail.
As always, it is best to seek veterinary care if you are uncertain about the severity of any injury, but hopefully this may save you an unnecessary trip to the ER if this happens to your dog during a weekend while you are out having fun!
Wellness: Health Care
Excessive levels of steroids in the body leading to disease
February 13 2013
Hyperadrenocorticism, known as Cushing's disease, is a hormone imbalance that results from excessive cortisol in the bloodstream over a long period of time. Cortisol is produced and stored in the adrenal glands, which are two little glands that “sit” on top of the kidneys and is what is released in times of stress, preparing for a “flight or fight” response. However, if this system goes awry, and a dog's body is exposed to this hormone for a majority of the time instead of just in times of stress, it can become chronically debilitating.
There are 3 main ways that a dog can get Cushing's Disease. The first way is from a tumor forming on the pituitary gland, and is known as Pituitary-dependent hyperadrenocorticism (PDH). These tumors are generally small and non-cancerous, although rarely a cancerous tumor can occur. The pituitary gland is located in the brain and is the “master gland” of the body. One of its jobs is to detect when cortisol levels are declining, and in response, secrete a stimulating substance, called ACTH, that kicks the adrenal gland into gear causing it to secrete more cortisol. When the body reaches normal levels of cortisol, the pituitary gland stops this message from being sent, and production is halted. In the case of PDH, a tumor causes the pituitary gland to go into overdrive, telling the adrenals to produce excessive amounts of cortisol, despite there already being too much in the body. This is the most common form of Cushing's and accounts for about 85% of dogs with disease.
Adrenal gland tumors are the next common cause, account for approximately 15% of dogs affected. This is a situation where a tumor is on the adrenal gland instead of the pituitary, and puts the gland into overdrive. The adrenals begin making excessive steroids all on their own, no longer “listening” to the pituitary when it tells the adrenals to shut off. These tumors are generally larger in size (usually detectable on ultrasound) and both cancerous and non-cancerous tumors are possible. Another problem that can happen with this type of tumor is that the pituitary “sees” that there is enough cortisol in the body, and subsequently stops producing ACTH. As a result, the other adrenal gland (the one without the tumor) becomes shrunken due to nonuse.
The last major cause is what is known as Iatrogenic Cushing's and is the result of the long-term use of steroids, or medications containing steroids. This is not from any inherent disease in the pet's system, but from the effects of the hormones given over the long term. Over time, the pituitary gland perceives that the body is getting enough steroids (thinking it is being produced from the adrenal glands-not knowing it is coming from medications) and quits sending its signal to produce more. In turn, the adrenal glands stop doing their job and also begin to shrink, temporarily loosing their ability to release cortisone on their own should their body require it to do so. This inability to produce steroids naturally in the body can last for several months following the stopping of medication. This is why your veterinarian will instruct tapering doses of steroids instead of an abrupt stop: this gives these important glands time to recover and begin working on their own again.
There are a multitude of clinical signs that can be seen, and as always, can mimic many other disease processes. Signs are generally gradual, and because of this, they are often attributed to “normal aging” and disregarded. The most common signs that are easily observed in pets by their owners are increased drinking and urination, increased appetite (a good reminder that eating well is not always a sign of normal health), a “pot-bellied” appearance, thin skin and sparse hair coat, blackheads and/or darkening of the skin, and loss of muscle mass or muscle weakness. Aside from these symptoms described, advanced or untreated Cushing's disease can also put a dog at risk for the development of bladder stones, diabetes and blood clots to the lungs.
If you notice any of these signs in your pet, a veterinary exam is in order. Your veterinarian can begin the process of testing for the disease, ensuring your pet is appropriately treated. If your veterinarian has reason to suspect Cushing's (based on history, physical exam and initial blood work), it will then be necessary to perform confirming blood tests and ideally, an ultrasound. This is not an easy diagnosis to make, and it requires several specific tests to positively identify not only the presence of Cushing's, but whether the problem is in the pet's pituitary or adrenal glands, as there is a different treatment for each form of disease.
The expected course of disease depends on which type of Cushing's is present, as well as response to treatment. PDH generally carries a good prognosis, and survival time for a dog treated with appropriate therapy is 2 years, with at least 10% of dogs surviving 4 years (this is better than it sounds, as dogs are generally diagnosed at an older age, usually 10-12 years old). Dogs with non-cancerous adrenal gland tumors usually have a good to excellent prognosis; those with cancerous tumors that have not spread can have a fair to good prognosis, making early detection important.
Other tips and sidenotes:
Wellness: Healthy Living
Hospice care eases the way
February 7 2013
“They have been our loyal companions throughout their lives, and in hospice, they need to know that we will dance to the end of the song with them.”
When our dogs are young and healthy, it seems as though we have all the time in the world with them. But, as it always does, time catches up with us, and eventually, the “end of the song” begins to play. For many of us, our companion animals are so integral to our lives that their decline and death affect us similarly to the loss of human family members.
However, the heart-wrenching words “Nothing else can be done” do not mean that euthanasia is the only option. As they move into the closing stages of their lives, pets (we’ll focus on dogs here, but the concept is the same for other companion animals) can benefit from animal hospice, and so can their people.
Like the program for humans, animal hospice exists to provide support and care during the last phase of an incurable disease or at the natural end of life; its primary goal is to manage pain. As such, hospice care is geared toward maintaining comfort and ensuring the highest quality of life possible during a time that may be measured in months, weeks or days. It focuses on creating a safe, loving and intimate endof- life experience in a familiar setting. This approach also gives us time to plan, grieve and say good-bye to our dogs. And—perhaps most importantly —it is a way to allow our best friends to spend their final days at home rather than in a hospital setting. This interval can be invaluable, as it helps us come to grips with our dog’s condition, and to say good-bye in our own way.
Though it can be extremely rewarding, hospice care does require preparation and effort. The first step is to connect with a veterinarian who is comfortable with the concept (not all are).
He or she will guide you in how to best provide for your dog’s needs, and in setting up a care plan to carry out at home: administering medications, supplying nutritional support, recognizing pain, implementing proper nursing care and tuning into your dog’s general emotional and physical state. If you are unsure about taking on these kinds of responsibilities, you may be able to employ a vet technician to assist you as needed.
As mentioned, one of the most important aspects of hospice care is pain management. Because it is easier to prevent pain than to relieve it, a multimodal approach—in which a variety of methods, including various classes of pain medications, natural supplements, acupuncture and massage therapy, to name a few, are employed—usually results in the best control. Part of this protocol involves monitoring your dog’s behavior and physical state, since agitation and vocalization may be signs of pain. In providing hospice care, you are the eyes and ears of the veterinary team, recording changes in your dog’s weight, temperature, eating habits, mobility and other characteristics and reporting them to the vet so that interventions or adjustments to the care plan can be made in a timely manner.
When it comes to end-of-life matters, we are faced with the difficult decision of allowing for a natural death or intervening with humane euthanasia; for some, a natural death is preferable to euthanasia as long as no suffering is involved. The decision if and when to euthanize is as individual and personal as you and your dog, and it’s important to keep in mind that no one knows your dog better than you do. You have spent your dog’s lifetime learning to communicate by reading body language and developing a unique bond. Attend to what your dog may be trying to tell you and, above all, trust your heart.
Identifying the point at which your dog’s quality of life has irrevocably ebbed requires personal courage and sacrifice, and many people fear they will not be able to recognize when the time is right. Seek guidance in the decision- making process from family members and friends, as well as from your veterinarian, all of whom share a bond with your dog. You will need the support of those who truly understand.
After months (or more) of caring for a dog in declining health, it can often be difficult to decide when the end has come, which is why it is helpful to determine ahead of time at what point you feel your dog’s quality of life is no longer acceptable. This may be when he or she ceases to find joy in eating, no longer enjoys interaction and connection, can no longer stand or walk, or when pain begins to be difficult to control. It is often helpful to consider good days versus bad days; more bad days than good is another indicator that the time is near. By establishing these criteria in advance, you are better prepared to make the appropriate decision, since emotion can cloud your thinking during the difficult final days of your dog’s life.
Hospice can be a wonderful, caring option. Regardless of how you choose to navigate this stage, it is good to know that it exists. Whether we opt for a natural death or a peaceful euthanasia, hospice care not only allows our dogs to live out the remainder of their lives as fully as possible, it also allows them to embark upon their final journey with dignity while surrounded by love in the comfort of their familiar home environment. Hospice care is truly a gift, both to our dogs and to ourselves.
Wellness: Health Care
Emergency help only a phone call away
February 2 2013
ASPCA Poison Control Center, 888-426-4435: 10 digits every dog owner should know!
A number of calls we receive in the ER are inquires about whether or not a substance is toxic to their pets. These inquires can include questions about specific pet or people medications, vitamins and supplements, both common and unusual household items, as well as various food stuffs.
With literally thousands of medications and oddities that our pets can get into, it becomes nearly impossible to know what is toxic, at what dose toxicity becomes a concern, and the treatment for each of these substances. Because of this, when we receive a call, we frequently refer pet parents to the Animal Poison Control Center for further information regarding the “dietary indiscretion.” This amazing service provided by the ASPCA is truly invaluable when there are questions or concerns about the potential for toxicity of any given substance. The center is staffed 24/7 by veterinary toxicologists who have at their disposal an expansive data base that includes every imaginable substance ever to have been known to meet a dogs mouth.
There is a nominal fee of $65 for this service, but a call might actually save you a trip to the ER or to your veterinarian, as well as give priceless peace of mind. When you call from home, you will actually be able to find out whether or not your pet needs medical attention, if you can induce vomiting at home (this becomes especially important for those people who live far away from veterinary care), or if you can potentially give some other home treatment. At the completion of the call, owners are given a case number that can be referenced again later should your pets condition change or clinical signs develop. If your pet does happen to need medical attention, once you arrive at the hospital for treatment, your veterinarian can call the center, also referencing this number, and can continue your pets care based on the toxicologist's recommendations.
This is truly priceless information, especially considering all the misinformation you can come across during a consult with Dr. Google. In fact, I have had to treat pets whose condition actually worsened because of an inappropriate treatment given at home. A situation that comes to mind was a good-intentioned owner who induced vomiting at home, based on what she read, after her dog ate Tide laundry detergent. Detergents can be very caustic (making vomiting a big no-no) and her dog subsequently suffered from erosive ulcers along the entire length of its esophagus as a result. Her pup required the placement of a feeding tube to bypass the esophagus, allowing it to heal.
I would also like to add that part of our responsibility as veterinarians is to call back the toxicologist and report the response to treatment. This follow-up information continues to help others in the future as each toxic exposure, treatment and response to treatment gets added and stored in the ever-growing data base.
I cannot say enough good things about this invaluable pet resource. Every pet owner should have the ASPCA Poison Control number (888-426-4435) on their speed dial or refrigerator—this number may save your pets life as well as help other pets in the process.
Wellness: Health Care
January 21 2013
What would you give to be able to spend another month, another week, or just another precious day with your best friend? Anyone who has ever loved and lost a pet has probably had such a wish.
Pets are no longer just pets; they fill the role of family, child, companion and guardian. As such, their dying process can carry a burden equal to the loss of our two-legged loved ones, and it is during this time that both pets and their people can benefit from animal hospice. Hospice allows our pet’s final journey to be experienced with dignity while surrounded by love in the familiarity of their home. It allows our pets to live out the remainder of their lives as fully as possible until the time of death, whether a “natural death” or compassionate euthanasia is elected.
As with human hospice, animal hospice exists to provide support and care for pets in the last phases of incurable disease or at the natural end of their lives. It helps facilitate the availability of resources to educate, support comfort care, manage pain and allow for a good quality of life, whether that is days, weeks or months. Hospice care also grants pet parents time to plan, grieve and say good-bye to their companions while providing a way for them to bring their pets home for their final days instead of being in the confines of a hospital setting or an unfamiliar exam room.
These are just a few reasons why I feel hospice care is so incredibly important and why it has always resonated with my heart. Prior to my veterinary career, I worked as a registered nurse, and it was during this time that I was first exposed to the concept of hospice care. Over the past several years, I have found myself drawn back to these roots, and have since started a pet hospice service within the referral hospital where I practice emergency medicine.
To highlight what a difference hospice care can make to a pet and a family, I would like to share the story of my first hospice patient, Sunny, who was one of the most loving and happy girls I have ever met. She quickly earned the nickname “Kissy Girl,” as I couldn’t be within a tongue’s length of her lest I be the receiver of her spirited attempts to lavish an endless stream of wet and cold-nosed kisses on me.
Our paths first crossed during a typical Sunday in the ER. As I was getting ready to see my next patient, who was having trouble urinating, I thought: diagnosis, UTI. But during the physical exam, my heart sank as I realized that the source of her straining to urinate was not an infection, but rather, a tumor that was compressing her urethra. An ultrasound revealed that it was inoperable, and chest X-rays confirmed that the cancer had already spread to her lungs. Looking at that sweet and happy face, you would never guess that all that badness was living inside her.
Bad turned to worse when I found out that Sunny’s dad, Jeff, was in another state attending his own father’s funeral. Besides the devastating news of her cancer, the most difficult thing for Jeff to endure was the fact that he would not have a chance to say goodbye, nor be by her side when she passed away. He was torn: in his heart he wanted to be with her once more, while in his mind, he did not want to delay the inevitable and risk her being in discomfort. This broke my heart, and I shared his sense of helplessness.
My hospice service wasn’t set to officially begin until the following month, but I could not let Sunny pass without her dad having had the chance to see her just one more time. I offered a hospice situation for her, and helped her by placing a catheter so she could urinate despite the tumor. Jeff took a red-eye flight home that very night and reunited with her the following morning. She erupted in sheer joy the moment she saw her dad, and Jeff easily learned how to manage her urinary bag.
Hospice care allowed Sunny to have another amazing week at home—one that included heaps of love, trips to the park and her favorite beaches, and a doggy party where filet and ice cream were served. It also allowed Jeff time to return home, spend more quality days with her and begin the process of saying good-bye to his best friend.
At the end of the week, I spent an incredible afternoon with Sunny’s family, celebrating and toasting her life, as well as getting more of those famous kisses. I helped her cross the Rainbow Bridge from her favorite sunshine-filled spot in the back yard, surrounded by those who loved her. You see, Sunny was not just “any dog”: she was also the rock who helped Jeff through the death of his first wife due to cancer.
As I reflect on my life’s path, it seems strangely paradoxical: I spent the first eleven years of my veterinary career doing everything possible to save lives in an ER setting, and now I am working just as fervently to end them as beautifully and as peacefully as I possibly can.
I am often asked, “Aren’t you always sad? Isn’t this just so difficult to do?” The short answer to this multi-layered question is “yes,” and in fact, I still cry during every euthanasia. Although it can be a heart-wrenching journey to take with another, it is through these experiences that my life becomes more blessed and made richer. For what people often don’t realize is that my tears well from being in the midst of great love, from experiencing the tremendous bond between family and pet, and from being able to give another the precious gift of good-bye.
Wellness: Health Care
A bacterial disease that's spreading
January 18 2013
Leptospirosis is a bacterial disease of great importance as it can affect both humans and animals, and can readily be spread from one species to another (i.e., from our dogs to us). For many years the occurrence in pets was rare, however, in the past few years, the disease has become diagnosed more frequently-I myself have treated four dogs suspected of having Leptospirosis just this past year. The disease is caused by a bacteria that is spread through the urine of infected animals into the soil and water where it can survive for up to 180 days, given the right conditions. Then, as other animals come in contact with this contaminated area, the bacteria can then be taken up through their skin and mucus membranes (gums, nose, eyes) or through drinking the contaminated water (another reason to stay clear of puddles!).
There are several environmental factors conducive to letting this bacteria flourish and increase risk of exposure. Warm, moist environments favor this bacteria, and they especially love stagnant water. With that being said, Leptospira do need water or damp soils to survive, and they will rapidly die on dry surfaces. The density of animal population, such as kennels and urban settings, also increases urine contamination and thus exposure. Also, areas that are heavy populated with rodents or wildlife also increases risk; they serve as “innocent hosts” meaning they are not affected by disease, but they continue to spread it to the environment through urination.
The clinical signs of disease can be vague and mimic many other disease processes. Signs can include fever, lethargy, loss of appetite, muscle stiffness or soreness, or vomiting and diarrhea to name a few. If the liver is involved, a yellowish discoloration of the gums or whites of the eyes can also be observed. Because Leptospirosis can look like any other disease, confirming the infection is generally not an “ah ha!” diagnosis when your pet walks into the exam room. This is something I tend to diagnosis by a “second round of tests” when the initial blood work and urinalysis look suspicious for disease. What can raise a suspicion of a Leptospira infection is an elevation in both kidney and liver values and sometimes the white blood cell count. If this is observed, your veterinarian will then recommend a special blood and urine test be sent to an outside laboratory. These results can take several days, and so antibiotic treatment is often started prophylactically pending the confirming results.
Most infections are subclinical, which means no signs of disease will ever develop and your pet will never experience illness. However, if your pet does develop sudden signs of disease, and those signs appear severe, we generally give a guarded prognosis (50/50 chance of survival). If your pet becomes ill, the extent of care needed depends on the severity of disease, but in my personal experience, the treatment generally requires a hospital stay with extensive supportive therapy. Without treatment, Leptospirosis can lead to kidney failure, liver failure, and even death. Blood or plasma transfusions are sometimes needed if the body losses its ability to clot due to liver compromise. Yes: this can be one bad bug.
So, how can you keep you and your pets safe? In addition to good sanitation practices and limiting your pets access to areas with standing water, there is a vaccine available. Vaccines contain what are known as “serovars,” which are “components” of the bacteria used to stimulate protection from disease. However, there is a catch. There are at least nine serovars, or strains, that can cause disease, yet the vaccine contains only a fraction of these, offering incomplete protection. Often people think their dog is safe from disease because it has been vaccinated, but sadly, this is not the case. Additionally, immunity may only last 6-8 months, and some veterinarians recommended that you should vaccinate high-risk dogs (such as dogs who hunt, show dogs, dogs with access to lakes and ponds, and endemic areas) every 4-6 months. Vaccines do not come without risk, and the use of this vaccine with regards to risk vs. benefit is definitely a conversation to have with your veterinarian. Your veterinarian can assess your dog's risk of exposure, discuss the most common “local” serovars found in your specific area and can recommend a vaccine protocol that makes sense for your pet.
Wellness: Health Care
Old Dog Senility
January 6 2013
Cognitive Dysfunction Syndrome, also referred to as “old dog senility” or “sundowner syndrome” is a common syndrome that is categorized as a slow, degenerative and progressive disorder in our aging pets. This process leads to changes in awareness, a decreased responsiveness to normal surroundings, and potentially increased signs of anxiety that usually worsen in the night hours.
There are many signs observed with cognitive changes and they can be lumped into some general symptoms as follows:
The above changes generally begin very gradually, so much so, that many pet parents fail to recognize the early stages of the disease and often attribute their pets subtle alterations in behavior to “simply getting older.” A recent study at the University of California School of Veterinary Medicine demonstrated just how common these observations are: out of 69 dogs participating, 32% of the 11-year old dogs were affected by this syndrome and 100% of the dogs 16 years of age older were affected (source: Veterinary Information Network).
The exact reason for this change in our geriatric pets is unknown, but it is thought that the body’s normal degenerative and age-related changes contribute to the dysfunction. These changes include central nervous system deterioration, oxidative stress, accumulation of free radicals, and cell death. Signs are unfortunately progressive and treatment is aimed at prevention and/or slowing the progression of disease for which lifelong therapy is required once diagnosed.
Treatment is the utilization of a multi-modal approach to managing signs, meaning, a combination of synergistic therapies that are based on the severity of the clinical signs. Selegiline is a prescription medication that is used to help control more severe symptoms, and it is thought to improve transmission of brain chemicals (dopamine) as well as have protective effects on the brain’s nerve cells.
There has also been the development of commercial and prescription “senior diets” that have demonstrated improvements in cognitive function, such as Hill’s b/d ("brain diet"). Natural supplements have shown promise in managing signs and slowing the course of disease by reducing the neurological damage caused by free radicals.They include antioxidants (vitamins C and E, selenium, flavonoids), gingko bilboa, Omega-3 fatty acids, and medium chain triglycerides to name a few. Pheromone therapy and melatonin may ease anxiety and promote a feeling of well being for dogs that experience increased anxiety at night. And finally, environmental enrichment such as brisk brushing sessions, massage therapy, interactive toys, and stimulating walks is thought to be an important cornerstone in slowing the progression by stimulating brain activity. Maintaining a stimulating environment, and engaging in as much activity as is practical for your pet’s age and health, may help prevent or delay the onset of cognitive decline as your pet moves into its golden years.
I will end with one of my favorite veterinary mantras, which is: “Old age is not a disease” (for which I am personally more thankful for each day), and with proper care, our senior “babies” can go on experiencing a good quality of life as cognitive changes develop.
Wellness: Health Care
October 31 2012
A rare form of human meningitis has already claimed the life 5 people and caused illness in over 40 others. The culprit: an injectable back pain medication made by a Massachusetts compounding pharmacy that was contaminated with a fungal organism. This news has created an understandable ripple effect that leaves us to question: how does this affect our pets who take compounded medications to manage their disease?
As veterinarians, we often recommend the use of compounded medications for several reasons: to convert pills into chicken-flavored chewables or liquids, to create gels that absorb into the skin (for pets who refuse oral medications), to place multiple medications into a single capsule simplifying administration, or to scale down a large dose tablet for a tiny dog.
Since compounding pharmacies are not FDA regulated, and offer no guarantee of potency, stability, safety or efficacy, how can we be sure about the quality of the drug being given? This is a vital question when compounded options are needed, and are often the difference between therapeutic success and failure.
The best way to ensure safety is to have your veterinarian prescribe only through credentialed pharmacies, or those that are in the process of accreditation, by the Pharmacy Compounding Accreditation Board (PCAB). This board was established in 2004 as a voluntary program to ensure adherence to quality and ethical standards. If a pharmacy meets the incredibly rigorous standards set forth by the PCAB, then both veterinarian and owner can be assured that the medications are of the highest quality possible. The board has accredited 50 pharmacies in 40 states thus far, and just as many pharmacies are awaiting accreditation. You can find a list of these accredited pharmacies online here.
Another word of caution: do not bargain shop when it comes to compounded medications and follow your veterinarian’s recommendations. A recent case of compounding error was reported in a canine patient who was being treated at North Carolina State College of Veterinary Medicine. This dog was being treated with a medicated solution for treatment of Myasthenia Gravis. He was doing excellent on the treatment following discharge, but returned several months later, weak and unable to stand. The owner had taken her written prescription from the vet to a different compounding pharmacy than the one recommended to her. The well-intentioned pharmacist offered to compound the medication into a more “dog-friendly” flavor. Unfortunately, the pharmacist included methylcellulose in the formulation, which completely bound the active ingredient, making it unavailable for absorption into the body, causing a serious decline in condition. Thankfully, this mistake was realized before the pup was euthanized.
Because the compounding industry is growing faster than regulations, it is imperative to be diligent: listen to your veterinarian, do your research, ask questions, and if you are concerned about any safety issues, try to make standard formulations work for your pet.
Wellness: Health Care
October 23 2012
Allergy sufferers who still want to share their home with a canine companion have been known to drop big bucks on breeds that are being touted as “hypoallergenic dogs.” These are dogs who are reported to have lower household allergen levels compared to other pooches. But before you throw out your bottle of Visine and handkerchief, a new study suggests that this just may be fur fiction.
Prominent allergen researchers have found that there is no basis to the claim “that certain dog breeds are hypoallergenic” and have found that allergen levels vary among individual dogs, not individual breeds. The American Journal of Rhinology and Allergy published a study in 2011 that revealed the amount of dog allergens found in households does not vary depending on the breed, and families with “hypoallergenic” dogs are living with the same level of allergens in their homes as people who live with a, shall we say, “common” dog.
The researchers measured the level of the most common dog allergen, Canis familiaris 1, in the homes of 173 families who lived with one dog and found that 163 of them produced measurable levels of Can f 1. The numbers of dogs of each breed were not large enough to allow for analyses by individual breed, but the researchers compared quantities of allergens found in the samples using various categories of purebred and mixed-breed hypoallergenic and non-hypoallergenic dogs. No matter how they did the comparisons- even comparing dogs suggested as being “more hypoallergenic” by the AKC against all other dogs- they found no statistically significant differences in levels of Can f 1.
The AKC does not actually recommend or endorse any specific breed, nor does it claim that hypoallergenic breeds will not affect people with allergies, but they do suggest 11 canine candidates that have “consistent and predictable coats” that may benefit allergy sufferers. Basically, these are the breeds that have more of a non-shedding coat, which in turn produces less dander, and therefore less allergens in the environment.
How then, was the legend of the hypoallergenic dog born? Good question, as no one really knows where the whole concept got its start. But perform an internet search with the terms “hypoallergenic dog” and you will see endless links touting the perfect allergy-free pooch. I was most shocked when I read about Simon Brodie of Lifestyle Pets, a controversial U.S.-based company that breeds and sells cats and dogs as “hypoallergenic” at a price of $16,000 each! And, no, that was not a typo with an extra one or two “0’s” on the end!
So, if there are no “real” hypoallergenic dogs, what can you do to reduce the sniffling and sneezing? Here are some tips:
• Make sure your pet’s essential fatty acid requirements are met. By assuring your dog or kitty has optimal levels of EFAs in the diet, you can reduce shedding and dander associated with EFA deficiency. Adding coconut oil has also proven to help reduce dander and shedding.
• Bathe your pet often. Even kitties can be bathed regularly, but take special care to use only safe, non-drying herbal animal shampoos. Whatever you do, avoid using people shampoo on your dog or cat, and skip any shampoo containing oatmeal.
• Invest in a good-quality vacuum designed for households with pets.
• Clean your home frequently and thoroughly, including any surfaces that trap pet hair and dander like couch covers, pillows and pet beds. This will also help control other allergens in your home that could be contributing to the allergic load of family members.
• Wash bedding frequently in hot water.
• If your pet rides in the car with you, consider using washable seat covers.
• Purchase a good quality air purifier for your home.
• If possible, remove carpeting, drapes and other fabric that traps animal dander. Tile or wood floors are much easier to clean of allergens.
By following these tips, you may be able to lessen the allergenic load in your environment and live more harmoniously with your canine companions.
Wellness: Health Care
Part 4 in 4 part guide
October 18 2012
Welcome back for the last installment of the DIY physical exam for your dog! We have reached “the tail end” of things so to speak, and will be finishing up our discussion with learning some “belly basics” as well as what to watch out for with the musculoskeletal system.
The exam is pretty straightforward: touch and feel the stomach, starting just behind the ribs and gently press your hands into the belly. Like all other parts of the body, you will be getting a feel for what is normal, and then continuing to monitor for any future changes. If your pet has just eaten, you may be able to feel an enlargement in the left part of the belly just under the ribs (where the stomach “lives”), which can be normal just after eating. Continue by proceeding toward the rear of the body, passing your hands gently over the entire area.
There are many conditions that can all look like “a basic lameness” in our pets. Below are a few of the more common presentations I see and their potential causes.
I hope this systems approach to an “at-home physical exam” helps you to become familiar and stay in tune with what is normal for your pet. Performing this exam in the comfort of your own home is the best way to learn what is normal and helps you to recognize any early changes in your pets behavior. Consult your veterinarian if an abnormal condition exists or you are concerned about any exam finding. Early recognition can save the life of your pet!
By no means is this list exhaustive, and this information is intended as a general reference; it is not intended to replace professional advice or an examination by a veterinarian.
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