Wellness: Health Care
My career as a physical therapist shifted dramatically 11 years ago after I adopted a dog named Teddy. Teddy came to me with a limp, so naturally, I wanted to help him. The first step was to find out what could be done. Several veterinarians later, the conclusion remained the same: rest and nonsteroidal anti-inflammatories (NSAIDs). As a licensed physical therapist, I knew there had to be something more; after all, bed rest and medication for the treatment of human conditions had fallen by the wayside decades ago.
After Teddy landed in a vet ER with a horrifying reaction to a prescribed NSAID, I was determined to help him myself. I began by going online to explore the comparative anatomy and biomechanics of canines and humans. During this search, I discovered a whole new avenue I could take to not only help Teddy, but also, to help his species: a canine rehabilitation certification program available for licensed physical therapists and veterinarians.
I enrolled in the program offered by the Canine Rehabilitation Institute (CRI), which is partnered with Colorado State University’s College of Veterinary Medicine. During my course of studies, I gained an appreciation for the differences and similarities in canine and human anatomy. The CRI program confirmed that all the methodology and expertise I had gained in physical therapy school and human clinical practice could transfer nicely to serving our four-legged friends. While there are certainly important differences between the two species, in general, the years of training I undertook to obtain my advanced PT degree proved to be a huge asset to the profession and practice of my animal rehabilitation career.
The goal of animal rehabilitation (aka rehab) is the same as the goal for humans: improve quality of life through restoration of function, increased mobility and reduction of pain. The best way to determine if your dog is a good candidate for rehab is to ask your primary veterinarian. If the vet is unfamiliar with the services these specialized professionals offer, do some research and become better acquainted with your options. Though the specialty practice of animal rehabilitation has been around for nearly two decades in some areas of the world, it is still in its infancy in the United States. Fortunately, the field is rapidly growing.
Rehab can help any dog with a musculoskeletal or neuromuscular problem, from young puppies to seniors. Some of my canine patients participate in agility, flyball, dock diving, rally, and search and rescue. Others are companions who prefer to hang out and get plenty of nap time. Because conservative methods have proven to be successful a high percentage of the time, the rehab therapist makes every effort to help the patient avoid surgery. When surgery cannot be avoided, post-operative rehab has also been shown to be beneficial for a faster reduction of pain and a quicker return to a more fully functional lifestyle.
PT CAN HELP
• Soft tissue sprains and strains
• Post-operative orthopedic recovery from cruciate ligament repairs such tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA)
• Congenital and degenerative joint disease (dysplasia and osteoarthritis)
• Neurological rehabilitation following spinal decompression surgery (hemilaminectomy)
• Other forms of non-operative neurologic insult, such as fibrocartilaginous embolism (FCE) or spinal cord contusion
Before trying physical therapy with your dog, clear it with your primary veterinarian to ensure that it’s appropriate. There are underlying medical conditions that can rule out PT as an option, so a referral/medical clearance is essential for your dog’s safety.
Your dog’s first visit with a certified canine physical therapist or a rehabilitation veterinarian will involve a fullbody musculoskeletal and neuromuscular evaluation. This specialized, comprehensive, hands-on examination gives the practitioner information needed to develop an individualized treatment plan for your dog’s specific problem(s).
Once the problems have been accurately identified, the practitioner goes to work to address them. A range of approaches is used: skilled manual therapy techniques (joint and soft tissue mobilization), therapeutic strengthening exercises, range of motion/flexibility exercises, and proprioceptive and balance exercises. Additionally, physical agent modalities—“techniques that produce a response in soft tissue through the use of light, water, temperature, sound, or electricity,” according to the California Board of Physical Therapy—may successfully address pain and accelerate healing.
While physical therapy methodology and techniques transfer nicely from the human to the canine patient, canine PT has some important specifics that are beyond the entry-level competencies of human physical therapy programs in the U.S. Similarly, not all veterinary schools include physical rehabilitation as part of their core curriculum. So, finding the right practitioner with the right education is important. Physical rehabilitation rendered by a certified canine physical therapist assistant (PTA) or registered veterinary technician (RVT) is also an option, but these practitioners must be supervised by a qualified PT or DVM with additional training in canine rehabilitation.
State regulatory bodies across the country are currently looking at establishing better laws and regulations to govern this particular specialty. These are needed to allow both non-vet rehabilitation professionals—certified and licensed canine physical therapists—to practice and to determine competency standards for veterinarians.
In California, for example, these regulations have been hotly debated; efforts are being made to allow properly qualified animal physical therapists to practice on their own premises with a veterinary referral. Historically, the California Veterinary Medical Board has wanted to put qualified practitioners under the direct supervision of veterinarians, who may or may not have training in this specialty niche. A legislative task force has been created to work on more appropriate language.
Everyone who’s a consumer of veterinary medical services has a stake in this discussion. Get involved by letting your legislators know that being able to choose a qualified canine physical therapist is important to you. Those who live in California can find out more at caapt.org.
Wellness: Health Care
Treating lick granulomas with cold laser.
My first dog, Ouzel, a Lab mix, spent his last year worrying at a wart on his leg until it became a rough, raised, red patch—an acral lick granuloma. I tried bitter sprays, socks, steroid creams and an Elizabethan collar. I could not get him to stop. I was frustrated, he was obsessed. He died before I finished vet school and had learned about other treatment options.
The causes of this type of inflammation are many: referred pain from arthritis or disc issues, anxiety or boredom, food/flea/environmental allergies, wounds or lumps, cancer. Whatever causes it, once the licking starts, it’s hard to halt. The wound gets thicker, wider, deeper, becomes ulcerated and infected. The hair does not come back, and the skin darkens.
Lick granulomas occur most often in older, male, large-breed dogs, and treatment depends on what caused them in the first place. Deep infections often require six to eight weeks of oral antibiotics. Topical and oral steroids can help break the inflammatory cycle, and antianxiety medications can be tried. On the non-drug front, some dogs are calmed by the snug swaddle of an antianxiety vest; relaxing treats with L-theanine, an amino acid that raises dopamine— and perhaps serotonin—levels; Bach’s Rescue Remedy; a pheromone collar or diffuser; and consistent, ample exercise.
Holistic modalities are also important. Chiropractic can help disc-disease-related nerve pain, and an acupuncture approach I call “surrounding the dragon” encircles the wound with needles to reduce pain and inflammation. Finally, dog owners can elect surgery and CO2 laser, which uses highly concentrated light energy, to remove the sore.
Lick granulomas are recalcitrant and complicated, and a combination therapy may be more successful. Control rather than cure is common.
Vet medicine now has a newer tool to manage these granulomas, a Class IV laser, also called low level, or cold, laser therapy. Laser strength is described by class, and the stronger the wattage of the beam, the shorter the individual treatment. Lasers can be found in printers, CD and DVD players, bar-code scanners and light shows, but these are too weak to use medically. Toys like pointers, which some cats and dogs like to chase, are under 5 milliwatts and fall in the Class I-IIIa category. (Offtopic but important warnings here: never point any laser into the eye or at a reflective surface, like metal or glass. And laser-play can cause frustration in certain dogs, leading to obsessive-compulsive disorders.) Class II-III are used by dermatologists for skin treatments. Class IV’s light penetrates skin down into muscle, tendon, ligaments and bone.
A Class IV laser reduces inflammation, swelling, muscle spasms, stiffness and pain, and we use it at our clinic to address wound care, post-op incisions, otitis, pancreatitis, arthritis, limb edema and soft-tissue injuries. The light, which is slightly warming, also stimulates acupuncture points, which is good for patients who cannot tolerate needles. Animals tend to find the treatment relaxing.
How does light lead to recovery? On a cellular level, the laser enhances biological effects by increasing oxygen turnover in the tissues. Imagine a blood vessel as a moving sidewalk; as red blood cells cruise along under a spotlight (the laser), the beam heats the tissues and speeds up blood flow, which encourages oxygen uptake. With increased oxygen, more ATP (adenosine triphosphate) energy is made, which prompts healing. Present in every cell of the body, ATP is the body’s basic currency, energy used or stored in this nucleotide. When a group of atoms are cleaved off the side of ATP, energy is released to perform cellular activities.
Research conducted worldwide shows the widespread advantages of medical-grade lasers. Human studies found benefits for patients with fibromyalgia, tennis elbow, chronic neck pain, osteoarthritis, rheumatoid arthritis, traumatic neuropathic pain and compromised limb circulation. Wound healing and skin studies include positive effects for diabetic-ulcer healing, blood vessel growth, increased skin cell migration (fibroblasts), hair growth in canine non-inflammatory alopecia and survival of surgical skin flaps for wound coverage.
Laser treatment strength and duration are determined by the size of the area that needs to be addressed and whether the injury is acute or chronic, the wound is dermal or musculoskeletal, the fur is dark or light. After the veterinary team elects a treatment type, the machine calculates an appropriate and safe dose. Precautions are common sense: the light needs to be kept moving so that it doesn’t overheat skin, and it’s never used near a fetus or a tumor.
Laser treatments for lick granulomas focus on small areas. In fact, the less the light is diluted, the more successful the treatments tend to be. For example, if your dog has arthritis in his knees, back and wrists, it’s best to work on them one at a time.
Laser protocols for lick granulomas recommend starting treatments at two to three times a week for a few weeks, tapering to once a week, then to every two weeks as the wound shrinks over a month or so. The treatments have a cumulative effect, so it’s important to commit to the schedule.
With the addition of the Class IV laser, we now have a pocketful of treatment options for lick granulomas. Canine friends who spend their days and nights licking a limb might finally find the respite they need, which could improve our own sleep as well.
Is the Mars acquisition of VCA cause for concern?
An explosive, must-read article in Bloomberg Business Week looks at what happens when big business monopolizes the pet health business and how this corporatization might not be in the best interests for our dogs.
Ever wonder why many veterinarians do not heed the 2003 American Animal Hospital Association’s recommendation for core vaccines to be administered every three years? Instead a number of vets still prescribe annual vaccinations—with boosters for distemper, parvovirus and adenovirus. According to the Bloomberg article the immunologist, Ronald Schultz, from the University of Wisconsin School of Veterinary Medicine, was one of those researchers who recommended this three-year protocol in the 1970s. He recalls that the AAHA Canine Vaccination Task Force, facing a revolt from vets about the decrease in their future vaccine incomes, struck a compromise at three years instead of the once-in-a-lifetime approach that he and others recommended. But yet you can find that annual vaccines are still being recommended by the 1,000 Banfield Vet Clinics in this country. Another surprising fact is that pet vaccines seem to be the only vaccines where one size, seemingly, fits all—the doses are the same regardless of weight or size of the animal, so the same 1 milliliter is given to a Chihuahua or an Irish Wolfhound—very little research has ever justified that approach. Bloomberg points to an example from Banfield's software program "Pet Ware," used to instruct the veterinarians in diagnosing and prescription advice:
“the book shows a checklist of therapies for a dog with atopic dermatitis, or itchy skin. Doctors are encouraged to recommend a biopsy, analgesics, topical medications, antibiotics, a therapeutic dietary supplement, an allergy diet, and a flea control package. They’re required to recommend antihistamines, shampoos, serum allergy testing, lab work, a skin diagnostic package, and anti-inflammatories. It’s a treatment course that might run $900 for symptoms that, in a best-case scenario, indicate something as prosaic as fleas. The manual reminds doctors: You cannot change items that were initially marked Required. They must remain required.
No wonder the pet health industry is booming and going through a period of rapid consolidations, Banfield, located in many PetSmart stores, was purchased in 2007 by Mars, the candymaker and pet food giant (the largest in the world with over $17 billion in sales from brands like Pedigree, Cesar, Eukanuba, Iams, Natura brands, Royal Canin, Sheba, Nutro). Then in 2015 the Mars Petcare portfolio of vet clinics grew when they acquired BluePearl Veterinary Services, with an additional 55 locations.
Mars, seemingly, facing a slowdown in consumer purchases of prepared/package foods and sugary products, is acquiring even more veterinarian companies and it was announced that their newest acquistion that they are paying $7.7 billion is VCA, Inc., the veterinary and doggie day-care business based in Los Angeles. VCA owns 750 hospitals and employs 3000 vets and 23,000 people, and had a 2015 revenue of $2.1 billion. The Los Angeles Times noted that “VCA has used acquisitions to combine hospitals, diagnostic labs and veterinarians into its network. In 2014, the company even acquired a dog day-care chain called Camp Bow Wow.”
And similar to Banfield’s approach, the Times notes that “VCA has been criticized at times by some customers for requiring tests that can be costly, but VCA maintains that it’s against its policy to sell unnecessary tests or treatments.” But 41 percent of VCA’s operating profits comes from their company’s Antech Diagnostics that also does bloodwork and other tests for more than half of the country’s hospitals, including their own of course. As Bloomberg reported, Tom Fuller, VCA’s chief financial officer, puts it this way when he speaks to investors: “Diagnostics is what grows the industry.” And the company’s business strategy has been “to leverage our existing customer base by increasing the number and intensity of the services received during each visit” (as found in their annual financial reports by Bloomberg reporting.)
Pushing tests unto clients is “good” for business, if not always for their clients’ pets,
"according to Wendy Beers, a veterinarian who resigned in 2014 from a VCA hospital in Albany, Calif. 'Every month they would print out things to say how many packages you sold, how many procedures you did,' she says. 'And if they came out and said, ‘This month we want everyone to do 20 heartworm tests,’ and you only did eight, well, next month you have to do better. I don’t feel when they’re lecturing us that their chief interest is to make sure animals get the best care.'”
According to Ken Shea, an analyst at Bloomberg Intelligence, who says that with Mars’ expanding presence in animal hospitals, the company will have an opportunity to use the facilities to sell even more of its pet foods. Is this troubling news for pet parents? A recent class action suit brought on behalf of consumers by a San Francisco law firm thickens the plot further when you consider that this suit contends that pet food manufacturers (including Mars) and retailers (such as PetSmart) are using "prescriptions" to justify overcharging consumers for food that contains no restricted ingredients. Neither the FDA nor any other government agency mandates such prescriptions.
Bloomberg clearly makes the case why all these things, like over vaccinations, unnecessary testing, false prescriptions for pet food matters is that veterinary medicine is largely unregulated. And one of the reasons why businesses like Mars find the pet industry a good investment strategy is that
“...pet owners pay cash: Vets don’t deal with insurers haggling for better prices or questioning whether that vaccine or ultrasound or blood panel is really necessary. (A small percentage of pet owners carry insurance, but they pay vets upfront, like anyone else, and then take on their insurers for reimbursement.) What’s more, when veterinarians make fatal mistakes, they face no real financial consequences. The law hasn’t changed to reflect the attitudes of the average pet owner; courts still treat pets as property. Damages paid to owners whose pets have been killed or injured are so low that a typical medical malpractice insurance policy for a veterinarian costs less than $20 a month. Damages are so low, in fact, that few pet owners can find a lawyer willing to take even the most egregious case of veterinary malpractice.”
So, yes, it should matter, and as always, it is good to understand what you are up against, what to expect if you use any of these services, to double check before you agree to over vaccinations, or receive a “prescription” for pet food, you are after all the only advocate your dog has and the better informed you are, the better decisions you will make. Nancy Kay, DVM, author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life, added that she “feels truly disheartened for my profession” about this expansion of Mars’ vet monopoly. Be sure to read the Bloomberg story and get the word out.
Wellness: Health Care
Let’s just get it out there: for a dog, coughing is never “normal.”
As a small-animal veterinarian, I hear this all the time. Clients tell me that their dog has been coughing for a while/off and on/when he’s excited/after pulling on the leash/after going to the groomer and so forth, but that they think he’s “okay.” However, a healthy dog should not cough, and a history of coughing always raises a red flag with me.
Coughing is caused by an irritation or inflammation of one or more of the respiratory organs. A problem anywhere in that system—the larynx, in the back of the throat; the windpipe; the airways (bronchi); or lungs—can cause your dog to cough. Heart disease, which is closely tied to the lungs and airways, also causes coughing.
Sometimes, the cause is benign, like a small bout of tracheobronchitis (an paralysis or a cancerous tumor that is pushing on respiratory structures can all cause a dog to cough.
When coughing is due to a problem in the laryngeal area, it can be a real pain in the neck, both literally and figuratively, and new research is showing that more coughing dogs have laryngeal problems than previously thought.
The anatomy of a dog’s throat is much the same as that of a human’s. The larynx (the area between the nose and the trachea), trachea (windpipe), epiglottis (a f lap of cartilage at the root of the tongue that is depressed during swallowing to cover the opening of the windpipe) and esophagus are the same in both. As well as housing the voice box, the larynx serves to protect the lower airways—trachea, bronchi and lungs —from foreign material and germs. The larynx is lined with secretory membranes, and comprises muscles, cartilage and ligaments.
Also like humans, dogs can develop laryngitis, an inflammation and swelling of the larynx secondary to infection, irritation by dust or smoke, inhaled foreign bodies (grass, bones), or trauma due to excessive barking or pulling against a collar. Older dogs can also develop laryngeal paralysis, a condition in which the muscles that move the arytenoid cartilages (a pair of pyramidshaped pieces of cartilage that open and close during breathing) stop working.
Dogs with laryngeal disorders typically exhibit what are called “upper airway signs” such as changes in their bark; loud breathing that sounds like “roaring”; and a dry, hacking cough that can be exacerbated by pressure on the larynx. Other upper airway signs that clue veterinarians into a laryngeal problem infectious inflammation of the airways more commonly referred to as kennel cough) that resolves easily with medication. Sometimes, the cause is more sinister; collapsing airways, pneumonia, a piece of grass or bone stuck in the back of the throat, parasites, the previously mentioned heart disease, laryngeal include difficulty swallowing, bad breath and an extended neck. A dog with laryngitis looks like he has a sore throat. When veterinarians see these signs, we suspect laryngeal disease and point our efforts in that direction. If we don’t see them, we look for other causes of coughing farther down the respiratory tract.
Generally, coughing dogs are not extensively evaluated for problems with their larynx. However, a study conducted by Lynelle Johnson, DVM, PhD, at the University of California, Davis, School of Veterinary Medicine and recently published in the Journal of the American Veterinary Medical Association* showed the importance of checking all chronically coughing dogs for signs of laryngeal issues. What’s interesting about the UC Davis study is that it found that a majority of coughing dogs who didn’t exhibit classical upper airway signs associated with the larynx had a laryngeal disease that may have gone undiagnosed. This study showed that they should be, and that we should be aware of the possibility of a hidden condition.
To investigate the prevalence of laryngeal abnormalities in this class of coughing dogs, Dr. Johnson enrolled 138 dogs in the study, which lasted for 13 years. Dogs were assigned to one of three groups, based on the duration of their cough: acute (less than two weeks), subacute (two weeks to two months) and chronic (more than two months). As part of the study, the dogs were sedated and their throat and airways were examined via endoscope (a medical device with a light attached), a procedure also known as “scoping.”
Interestingly, Dr. Johnson found that 19 percent of the dogs examined because of cough alone (no upper-airway signs) also had some form of laryngeal dysfunction, ranging from laryngitis to swelling to laryngeal paralysis. Dogs with an acute cough were not observed to have laryngeal inflammation, but it was noted in more than half of the dogs who had been coughing longer than two weeks.
Results also indicated that dogs with a cough of more than two weeks’ duration commonly have laryngeal swelling regardless of the underlying problem. This makes sense, as chronic coughing irritates the throat. Laryngeal paralysis or partial paralysis was also fairly common, seen in 19 percent of the dogs with a cough of more than two weeks’ duration. Remember, these dogs had none of the classic signs of laryngeal paralysis (such as excessive panting and loud breathing); the problem was only diagnosed when their throats were scoped.
Once their laryngeal problems were correctly diagnosed, the dogs received focused testing and treatment.
In dogs with laryngitis, treatment includes antibiotics if appropriate, as well as anti-inflammatories and pain medication. (Laryngitis hurts!) When the inflammation is caused by allergies, the allergies are addressed. A dog with a swollen larynx also benefits from humidified air; a warm, clean environment; and soft food. Dogs with a weak or paralyzed larynx can be treated surgically, or may require hormone therapy; there is anecdotal evidence that laryngeal paralysis may be related to hypothyroidism. Those whose dogs have laryngeal paralysis need to be advised on how to prevent overheating and aspiration pneumonia as well as informed of the links between paralysis and systemic neuromuscular diseases and megaesophagus.
The finding that dogs can have laryngeal disease even when they don’t have the classic signs has significant implications. If we as veterinarians aren’t scoping these coughing dogs, we might be missing something. The bottom line: if your dog has been coughing for more than two weeks, or if the cough doesn’t resolve with medication, talk to your vet about further medical evaluation.*Johnson, L.R. 2016. Laryngeal structure and function in dogs with cough. JAVMA 249(2):195–201.
Wellness: Health Care
A new device as a way to avoid osteotomy for cranial cruciate ligament (CCL) injuries.
THE CANINE KNEE—known as the stifle—is a large, complex and vulnerable joint. Damage to one of its four main ligaments, most commonly the cranial cruciate ligament (CCL), results in pain and lameness and is the reason many dogs wind up in their vet’s exam room. The CCL connects the thigh bone with the lower leg bone and helps stabilize the knee. When it’s torn or ruptured, surgery may be required, particularly for large or very active dogs. In the U.S., the most common surgical repair techniques are the tibial tuberosity advancement (TTA) and the tibial plateau leveling osteotomy (TPLO), both of which require implanted hardware as well as cutting the bone(s) around the stifle joint, a procedure called an osteotomy.
However, an innovative technique utilizing a newly designed device—the Simitri Stable in Stride™—makes it possible to skip the bone-cutting. A Simitri stifle repair involves putting a small plate on the bones on each end of the knee (the femur and the tibia) and connecting them with an interlocking hinge.
Developed by Neil Embleton and Veronica Barkowski, Canadian veterinarians with extensive experience in orthopedic surgery, as a way to avoid osteotomy and preserve maximum joint motion, the device provides immediate joint support with minimal change to its form or biomechanics. It also offers a potentially quicker and less painful recovery.
Partnering with a U.S.-based veterinary implant manufacturer, New Generation Devices (NGD), Embleton and Barkowski developed and tested the Simitri in medium and large dogs. Although the procedure is too new to have good data on its long-term outlook, initial clinical trial results have been promising. (It’s worth noting that there’s also a shortage of evidence-based info on long-term TTA and TPLO results; most of the literature reflects information from their initial development.)
The current sizes of the Simitri Stable in Stride implants are most suitable for dogs 40 to 90 pounds (20 to 40 kg); per correspondence with Dr. Embleton, he is now trialing a device for dogs 15 to 35 pounds (7 to 15 kg), and a version for dogs more than 90 pounds (40 kg) is currently in development.
Interested in exploring this option for your dog? Dr. Embleton suggests that you ask your vet about it, or contact NGD to see if a vet in your area already has experience with the Simitri.
Dog's Life: Humane
WHEN A DOG OR CAT is surrendered to a shelter or dies of a disease that could have been prevented, some want to blame the owners. If they couldn’t care for the animal, they should never have gotten it in the first place, right?
But people’s lives can change in an instant; jobs end, children get sick, families lose their homes. A national survey conducted in January 2016 found that six out of 10 Americans couldn’t cover an unexpected $500 car repair or $1,000 medical bill.
That doesn’t leave much slack for the family dog. Paw Fund, a San Francisco Bay Area nonprofit founded five years ago by animal advocate and longtime activist Jill Posener, has very deliberately disconnected from the blame game. Preventable diseases, uncontrolled breeding and overflowing shelters are crises not just for pets and owners, but also, for our communities as a whole. That’s why Paw Fund provides the pets of homeless and low-income residents of Alameda and Contra Costa counties with free vaccinations; free or low-cost spay and neuter; basic wellness care, such as dewormers and flea preventives; and sometimes even nail clipping. The goal is what Posener, Paw Fund’s executive director, calls “harm reduction.”
“The truth is that relatively small interventions can keep dogs and cats healthy, in their existing homes and out of the shelters,” Posener says.
It started in 2011, when an outbreak of canine parvovirus raced through the camps of homeless youths in People’s Park in Berkeley. Parvo is easy to prevent, but making sure their pets get a series of vaccinations can be challenging for street kids. Posener sprang into action. She recruited a vet tech, loaded vaccines into her car and took the lifesaving shots right to the animals who needed them, week after week, until the epidemic abated. And with that, Paw Fund and its harm-reduction approach was born. People trust Paw Fund to be there for them without judging them, and Paw Fund trusts its clients to truly need its services. “We don’t ask for proof of income,” says Posener. “People feel bad enough when they can’t provide for their pets. We don’t need to rub it in by making them prove they have no money.”
The Paw Fund model seems to work, and it’s catching on. It’s not unusual to find 80 people and up to 150 pets at its monthly open-air clinics in Berkeley, patiently waiting as long as two hours in the sun, rain or Bay Area fog. Since its founding, Paw Fund has provided care to more than 5,000 at-risk dogs and cats, coordinated more than 1,500 free or low-cost spays and neuters, and given more than 10,000 free vaccinations at its monthly clinics and pop-up clinics in trailer parks and inner-city neighborhoods across the East Bay. It also mentored two startup organizations with similar goals in Brentwood and Oakland that are now self-sustaining.
Traditional rescue per se isn’t Paw Fund’s primary mission, but sometimes, people beg to surrender a basket of puppies or kittens. When that happens, Paw Fund often persuades the owners to spay or neuter the parents, and picks up the tab.
Many people want to have their pets sterilized but literally can’t make it to the vet appointment. They may be afraid to take time off from work, or don’t have a driver’s license, or live under a freeway overpass. Paw Fund volunteers will pick up a dog or cat at the crack of dawn and deliver the animal back after the procedure. That kind of block-by-block, pet-by-pet outreach led the City of Berkeley to award Paw Fund the contract to run its free spay/neuter program in 2016 and then to extend the contract into 2017.
Paw Fund, a 501(c)(3) based in Emeryville, Calif., is staffed largely by volunteers; vets, vet techs and even a tax preparer work pro bono. In 2017, plans include hiring a part-time medical director to oversee clinics and to make home visits and treatment possible, including humane euthanasia at home. Because, no matter how rich or poor their people are, every pet deserves to live as healthy a life as possible and then to go peacefully when the time comes.
To learn more visit pawfund.org
Wellness: Health Care
Fatty turkey trimmings can set the stage for pancreatitis
Next week is Thanksgiving, and for many families this means the tradition of spending the day preparing and enjoying a delicious turkey dinner with all of the trimmings. Us humans are not the only ones who look forward to this meal, and I see many dogs in the ER after they have decided to help themselves to a serving or two. While our pets may find this to be an initially satisfying (albeit naughty) indulgence, it can set them up for the development of pancreatitis, a potentially life-threatening disease.
What is the job of the pancreas?
The pancreas is an organ that sits cozily just under the stomach and along the first part of the small intestine. The pancreas is all about secretion and it has two main jobs. The first is the secretion of digestive enzymes to help break down food, and the second is the secretion of insulin and glucagon (to regulate sugar metabolism). The digestive enzymes are the part of the story that concerns us in pancreatitis.
Just what is pancreatitis?
Put simply, pancreatitis is inflammation of the pancreas that disrupts its normal integrity. Digestive enzymes that are normally safely stored are released prematurely, beginning to digest the body itself, and the result can be a metabolic catastrophe. As the tissue becomes further inflamed, the damage begins to involve its next-door neighbor, the liver. Toxins released from this progressive party of tissue destruction can circulate more broadly, causing a body-wide inflammatory response. If the pancreas is severely affected, its ability to produce insulin can be affected and diabetes can result.
The good news is that most commonly the inflammation is confined to the area of the liver and pancreas, and most pets make a full recovery with support.
What causes pancreatitis?
In most cases, we never find out what causes it but we do know some events that trigger it. These can include:
Miniature Schnauzers are predisposed to pancreatitis as they commonly have altered fat metabolisms.
Signs of Pancreatitis
The classical signs are appetite loss, vomiting, diarrhea, painful belly, depressed attitude and fever.
Making the Diagnosis
Until recently, a reliable blood test has been lacking. A new newer generation option called the SPEC cPL (specific canine pancreatic lipase) test has come to be the lab test of choice. For dogs only, the SPEC cPL can be run overnight by a reference lab and is able to detect 83 percent of pancreatitis cases and exclude other possible diseases in 98 percent of cases.
This test should not be confused with the “in-hospital” pancreatic test, which resembles a “pregnancy test” and gives you an answer of “abnormal” or “normal.” I am personally not a huge fan of this test because other disease processes (such as liver or gastrointestinal disease) can cause an “abnormal” result.
Ultrasound detects 68 percent of cases and provides the opportunity to look at other organs. Since pancreatitis can be accompanied by a tumor near the pancreas, ultrasound is an important tool for catching such complicating factors. I discuss and recommend this diagnostic for all patients I suspect have pancreatitis.
The passage of food through the intestine is a strong stimulus to the pancreas, which is what we want to avoid. Essentially, we want the pancreas to “rest.” This generally means no food or water for 2 to 3 days (in our very ill patients) using IV fluid support to prevent dehydration. Fluid support generally requires electrolyte supplementation and a critical patient will need 24-hour care with blood-test monitoring several times a day. A plasma transfusion represents a specific type of fluid therapy and may be of great help in severe cases.
Pancreatitis can be a very painful condition and pain management is of utmost importance in recovery and is a cornerstone of treatment. Untreated pain affects the immune system and has been shown to increase death rate. Medications to control nausea are also used. Antibiotics are used because even though pancreatitis is not a bacterial disease, bacterial invasion from the diseased intestine is a common occurrence.
Once the patient has started to eat again, a low-fat diet is important to minimize pancreatic stimulation. Since there is potential for the pancreas to always have a smoldering bit of inflammation, long-term use of a low-fat diet is likely to be recommended.
Pancreatitis can be a very severe disease to experience and treat and I hope this helps raise awareness of a potential source of calamity. Please remember to keep your countertops pet-safe: Take all garbage outside promptly and be extra vigilant of the fact that even the most well behaved pets can be tempted with all of the food festivities.
Here’s to a SAFE, happy and wonderful Thanksgiving!
Dog's Life: Home & Garden
86 toxic plants to keep away from your dog
While plants and flowers are a great way to decorate, not every plant is safe in a home with pets. Below is a list of 199 common poisonous plants, 86 of which are toxic to dogs, so you can be sure you’re picking the safest choice. The majority are safe to grown in your home, but should be avoided if you’re concerned of accidental ingestion from a curious and/or hungry pup. Look through the list of plant names and make sure no one in your home is at risk.
Infographic by proflowers.com
Wellness: Health Care
Does yours exclude normal dog behavior?
Pet insurance, like most forms of insurance, definitely qualifies as a “Buyer Beware” purchase. Jamie Richardson found that out the hard way when her seven-year old dog Muddy tore a ligament in his leg and her insurance company Petsecure refused to cover his veterinary care. One reason for denying the claim was that Muddy was running when he hurt himself. Specifically, he was happily running through the woods, which can also be described as “being a dog”.
Unfortunately for Richardson, “being a dog” is essentially excluded in her accident policy. The fine print states that any injury sustained while the dog is “jumping, running, slipping, tripping or playing” is not covered. Additionally, any accident that the guardian does not witness is not covered. In Muddy’s case, even if he had torn his ligament in full view of Richardson while he was, say, eating his dinner, none of the $4,200 in veterinary costs would have been reimbursed by the insurance company due to a “pre-existing condition” clause that relates to arthritis or degenerative joint issues.
Though X-rays at the time of surgery showed no signs of arthritis, the fact that the presence of bone spurs had been noted in Muddy’s medical records allows the insurance company to deny the claim. That’s true even though the surgeon said that the accident was not caused by arthritis and the veterinarian pointed out that those bones spurs are normal for seven-year old dogs, and minor to boot. Two vets saying no pre-existing conditions are present does not prevent the insurance company from denying the claim based on the “pre-existing condition” clause.
Richardson has cancelled her policy, since it did her no good at all. She borrowed money to pay her bills, and is now saving a little each month just in case Muddy has another accident or an illness that requires expensive veterinary care. She continues to let him be a dog, though, and he still runs through the woods near her home in Yukon.
Wellness: Health Care
Learn how to do at-home physical exams
To identify a problem or an abnormal situation, you must first be able to recognize what’s normal for your dog. Performing this exam in the comfort of your home when your dog’s in good shape is the best way to do this. Consult your veterinarian if you’re concerned about any exam finding; early recognition can save your dog’s life.
Before you start the exam, take a good look at your dog when she’s just hanging out; observe her posture and general demeanor. Getting a good picture of your dog’s “normal” in a relaxed environment will help you pick up any subtle changes that may occur.
1. Take her temperature. Using a digital rectal thermometer (the ear type is less reliable, and mercury thermometers can break), lubricate the end with petroleum jelly and gently insert it into the rectum, about 1 inch for small dogs and about 2 inches for larger ones. If it does not slide in easily, do not force it. A normal temperature is between 100º and 102.5º F.
2. Check her heart rate by taking her pulse at the femoral artery, which you’ll find on the inside of her thigh; feel for the roll of the artery and a pulsing sensation. Count the number of pulses in 15 seconds and multiply by four. A dog’s pulse rate is highly variable, but generally, normal is 80 to 120 beats per minute. Relaxed, large-breed or athletic dogs tend to have slower rates, while the rate for puppies and small dogs tends to be higher.
3. Start at her head. Nose: smooth, soft and clean, like supple leather (noses aren’t necessarily always cool or moist). Eyes: bright, moist and clear, with pupils equal in size; the whites should be white, with only a few visible blood vessels. Ears: clean and dry, almost odor-free; you should be able to gently massage them without complaint. Mouth: teeth clean and white, gums uniformly pink and moist to the touch.
4. Watch her chest as she breathes. The chest wall should move in and out easily and rhythmically in an effortless way; each breath should look the same as the last. (Unless she’s panting, you should not be able to hear your dog breathe.) A normal resting respiration rate is 15 to 30 breaths per minute; a sleeping or relaxed dog would be near the low end, while an active and engaged dog would be higher. As with heart rates, smaller dogs tend to have a faster resting breathing rate than larger dogs.
5. Examine her skin. One of the body’s major organs and an important indicator of overall health, the skin of a healthy dog is soft and unbroken, with minimal odor and—except for wirehaired breeds—the hair coat is shiny and smooth.
6. Check her hydration with the skin turgor test. Pull the skin over her neck or back into a “tent” and release; it should return quickly to its original position. If it returns slowly, or remains slightly tented, your dog may be dehydrated.
7. Finish up with the torso. Starting just behind the ribs, gently press your hands into your dog’s belly; if she’s just eaten, you may feel an enlargement in the left part of the belly just under the ribs (where the stomach lives), which can be normal. Proceed toward the rear of her body, passing your hands gently over the entire area. Lumps, bumps or masses; signs of discomfort; or distention of the belly warrant further investigation by your vet.
For a more detailed discussion of the in-home exam thebark.com/exam and see Dr. Shea Cox on bridgevs.com
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