Wellness: Healthy Living
Addressing the second most common problem on the vet hit parade
Question: Recently, my dog's nighttime scratching is keeping both of us awake. Her fur seems dry and a bit dandruffy, and she also seems to be shedding more than usual. What can I do to help her?
Answer: Dogs itch for many different reasons, and sometimes, for no reason, and it’s not uncommon for the scratching to seem worse at night, when the house is quiet. Every dog’s gotta scratch some time, and that’s completely normal. But when a dog is incessantly licking, scratching, biting and chewing to the point of wounding herself, then scratching becomes a symptom of an underlying pathology.
The medical term for scratching related to excessive itching is pruritus. This is the second most common reason people take their dogs to the vet (gastrointestinal problems such as diarrhea top the list). The causes of pruritus can be quite complex, but there are two main reasons why dogs itch. The first has to do with the condition of the skin itself: Is it infected? Is it too oily? Is it too dry? Of these three, dry skin is a frequent occurrence. The second major cause of pruritus is allergies.
Is It Dry Skin?
Dry skin can be influenced not only by environmental factors, but also by diet. Commercial pet foods process out the good oils that contribute to healthy skin and a lustrous haircoat. Dry pet foods have an even more dehydrating effect on skin and hair and also stimulate increased thirst, which only partially compensates for the drying nature of these diets.
If you must feed dry foods, then by all means add digestive enzymes to your dog’s meals. In fact, digestive enzymes are good to use with any type of food. Enzymes improve the release of nutrients, and beneficial probiotic bacteria also assist in the digestive process. (Probiotics also help with allergies, as noted below.) A healthy digestive system absorbs fluids more readily from the food your dog eats, thus improving hydration and increasing the moisture levels of the skin and haircoat.
Whatever the cause, allergies are difficult to address. In the worst cases, afflicted dogs require strong (and potentially toxic) pharmaceuticals just to get some relief. Though allergies are rarely cured, early identification and intervention can keep them under control, and in some cases, can substantially diminish them.
Clinical research has shown that one important way to reduce the likelihood that dogs will develop allergies is to give them high-potency cultures of beneficial probiotic bacteria such as Lactobacillus acidophilus and Lactobacillus bifidus when they are very young. Probiotics are relatively inexpensive, absolutely safe to use, and can save both dog and the owner tons of grief—and visits to the vet—later in life.
Regardless of age, many dogs’ allergies are controlled by improving the quality of their diet, giving them high potency acidophilus cultures and high doses of fish oils; adding freshly milled flax seed; and, in some cases, giving them antihistamines. (It can take up to three months for this regimen to take effect; see sidebar for details and dosages.)
Determining which condition your dog is dealing with requires a vet’s evaluation, but implementing some of the suggestions provided in the sidebar can certainly help your pup be more comfortable in her own skin—literally.
Wellness: Health Care
A Vet’s Perspective
Every day in veterinary emergency rooms across the country, shocked, distraught and overwhelmed dog owners face tough decisions. In addition to medical complexities and ambiguities, they deal with guilt, fear, grief and, sadly, money. But for Kathy Noons and her seven-year-old Boston Terrier, Tessie, it was all about hope.
Although Ms. Noons had asked her dog-walker to keep Tessie leashed, the woman often let her run loose with other dogs, and Tessie clearly loved it. But then came the phone call: The dogwalker had lost Tessie. It was January. The little dog was found the next morning, miles away, lying in a cemetery.
When Tessie arrived at the Angell Animal Medical Center ER, she had a temperature of 86.7°F (normal is around 101°F), the bones of her pelvis were shattered and, as a result of spinal trauma, she was paralyzed and incontinent.
Barely responsive, Tessie was so cold that warming her up had to be done slowly over the course of several hours to avoid further shocking her system. Blood and urine were drawn and tested, she was X-rayed and an ultrasound was performed. Throughout it all, she received intravenous fluids and medications for pain.
Eventually, Ms. Noons was presented with a long list of negatives that, when added up, suggested that euthanasia would be the kindest course of action. As she retold it, “That’s when I said, ‘C’mon, throw me a bone (no pun intended),’ [and] one doctor told me what I needed to hear. She said there’s always a chance.”
It took a few days for Tessie to stabilize, and that’s when I got involved. Ms. Noons later told me her biggest fear was that I would refuse to operate … that I would tell her it was futile. To be honest, it crossed my mind. Despite surgery, the risk of permanent nerve damage, incontinence and an inability to stand, let alone walk, was significant. But sometimes, if you put everything back in place, screw it all together and take a leap of faith, tissue heals. Tessie’s injuries were really bad, but not hopeless.
Though the odds were slim at best, I believed surgery offered her at least the possibility of a cure. An uncertain prognosis can be like a bad trip to Vegas, a gamble in which the only way out is through — risky, all or nothing. But that’s the hand we were dealt, and it was the one we played.
My involvement in Tessie’s recovery, while important, was brief and, to be honest, secondary. I reconstructed her broken pelvis with plates and screws, but the critical-care doctors and attentive technicians gave her the chance Ms. Noons sought. Yes, it takes a team to heal a “humpty-dumpty” dog, but in the jigsaw puzzle of putting Tessie back together, I only did one or two of the corners. Tessie’s primary-care team did all the tricky, thankless stuff.
Once Tessie was released from the hospital, Ms. Noons was committed to giving her the best possible chance to recover. Diapers, pain meds, hydrotherapy, acupuncture: Whatever Tessie needed, Ms. Noons provided. Ultimately, this level of commitment, this steadfast conviction, paid off. Three months after surgery, Tessie was running around, chasing other dogs and fully continent. Why this dog made it and a dozen others with the exact same injuries would not, I can’t say. Maybe a dog who can survive being hit by a car and a cold January night in Boston has an extra helping of luck.
“She was always a source of pride,” says Ms. Noons. “People would stop me and want to play with her. When they saw her in a diaper, barely able to walk, I could tell they were thinking, Is it fair what you’ve done to your dog?”
“How’s it feel today,” I say, “when you meet these naysayers in the street?” “It’s nice to be smug; I’m not going to say it isn’t. I’m proud of her, being fresh, going after bigger dogs. My princess is back.”
Ms. Noons marvels at what we did for Tessie and, though I appreciate (and am humbled by) her gratitude, it’s far more than I deserve. Perhaps the hands-on nature of surgery, the physicality of mending broken bones, the instant gratification of postoperative X-rays, makes it look as though the doctor with the scalpel created the cure. Truth is, I’m as amazed as she is, and under no illusion; in this magic act, I was nothing more than a willing assistant.
Wellness: Health Care
Part 3 in 4 part guide
Welcome back for part three in our four-part DIY physical exam! This week we are going to move down to the chest area, known as the thorax.
NECK, CHEST AND BREATHING:
The skin is one of the body’s major organs and it is an important indicator of overall health. The first things to do are to simply look at, smell, and feel your dog’s skin and haircoat.
SKIN TURGOR TEST:
The skin turgor test is one of the most helpful ways to determine whether your pet is well hydrated; although this test can be affected by several factors other than hydration status, such as weight loss, age and general skin condition, it can help you to make a rough determination of the hydration status. To perform this test, pull up the skin over the neck or back into “a tent” and release it quickly: it should return quickly to its resting position. If the skin returns slowly to position, or if remains slightly tented, then this is a good indication that your pet is dehydrated.
That sums up the thorax region of our pets, including one of the other major organs—the skin. Keep practicing your physical exam skills—it’s definitely a win/win for your dog! Not only does your pet get a good “once over” from you, he or she gets even more hands-on attention in the process. See you next week as we move to the last parts of the body which will include the abdomen and musculoskeletal system.
Check out DIY Physical Exam: Part 2 of this series if you missed it. Go on the next final part, DIY Physical Exam: Part 4.
Wellness: Health Care
I consider myself to be an optimist, a “glass-half-full” veterinarian. So why was I so worried about Zeus, a four-year-old Great Dane mix?
“He’s been lame for a couple of months,” said Jeff.
“And he’s very active,” added Jeff ’s girlfriend, Adrian. “We run six miles, five times a week, and go to the dog park for an hour or so every evening.”
Zeus had been referred to me for a torn cruciate ligament in his left knee — a perfectly reasonable diagnosis. But what I was seeing didn’t align with it. For starters, he held his withered leg totally off the ground, and when I palpated his knee, it felt stable. His X-rays confirmed the presence of arthritis, but it was mild, not enough to account for his apparent discomfort.
“Something doesn’t add up,” I said, trying not to sound like a pessimist. “I’m worried that I may be missing a bigger problem.”
Jeff seemed wary and Adrian looked alarmed, though she later confessed that she had suspected as much.
“I’d like to anesthetize Zeus and feel the knee when he’s totally relaxed, then take another X-ray. If everything jibes, we’ll go straight to surgery and fix the problem.”
However, my examination while Zeus was anesthetized failed to expose joint laxity, and I began to worry that the changes I saw on the X-ray weren’t the result of arthritis but rather, a tumor in the joint.
“I’d like to take a biopsy,” I told Jeff. If he was losing patience, he kept it to himself. When the results came back normal, I had to make another difficult phone call — difficult because I still didn’t have an answer.
“I don’t want this to be something bad,” I said, “but I’d also hate to put Zeus through a surgery that doesn’t address the real problem.”
“What do we do now?” Jeff’s flat tone revealed his waning confidence.
“Let’s put a scope, a camera, inside the knee. If the ligament’s damaged, I’ll see it and repair the knee. If not, I’ll keep hunting for what’s wrong.”
I tried to put myself in Jeff and Adrian’s position; they must’ve felt as though they were dealing with a cagey Dr. Doom. They wanted me to fix their dog, not speculate on the ways in which Zeus’ problem has failed to match up with my textbooks. Would they seek another opinion? After all the money they’d spent, poor Zeus was still not better.
Fortunately, I got my chance to look inside the joint, discovered that the ligament was partially but significantly torn, and verified the need for corrective surgery. Even so, when Zeus returned for his six-week recheck, I braced for the worst: a dog still struggling to get around on three legs.
Sometimes, it’s good to be wrong. Zeus was bouncy, fresh, eager to play and using the leg very well for this stage of his recovery. Now that we were out of the woods, I felt as though I could speak frankly with Adrian about my concerns, and encourage her to come clean about her own perspective on the process I’d put them through.
“It was frustrating,” she said. “Jeff and I definitely got into a lot of … disputes. We thought about not doing surgery, about going somewhere else. In the end, I realized you were just being thorough.”
I made sure Adrian knew how grateful I was that she had kept the faith. Though I’m a surgeon, I’m not married to the adage, “cut to cure.” Despite my initial negativity, I had done my best to be honest, voice my fears, take time to listen, be rational about my approach and, most of all, make sure they understood that my hesitation was rooted in what mattered most: doing right by Zeus.
“When did you know he had turned the corner?” I asked.
“The first week was tough,” said Adrian. “I was still worried. But Zeus loves two things in life. He loves to chase his tail, and the day I saw him spinning around on his back legs trying to catch it, I cried because I knew my boy was back.”
“What’s the second thing?”
“His orange ball. For the first time in months, he found it and brought it to me because he wanted to play fetch. No doubt about it, he’s on the road to recovery.”
I smiled and kept a reprimand about premature ball-chasing to myself.
Wellness: Health Care
Part 2 in 4 part guide
Hello again, Bark readers! Welcome back for the second installment of the DIY physical exam. We are going to start at the head today, continuing to move down the dog body over the next couple of weeks.
Chronic ear problems are common in pets, and are often a result of allergies to inhaled pollen (like hay fever in people) that are then complicated by secondary infections with bacteria or yeast. Ear infections can be painful and head shaking can lead to an accumulation of blood in the floppy part of the ear, known as an aural hematoma.
That completes the head! Please feel free to ask any questions and see you next week as we discuss and learn about the chest area, known as the thorax. Check out DIY Physical Exam: Part 1 of this series if you missed it. Next, DIY Physical Exam: Part 3.
Wellness: Healthy Living
A year ago, one of patty Glynn’s three dogs, a five-year-old Chinese Crested named Merry, became ill and very nearly died. It turned out that she had inflammatory bowel disease and required transfusions, among other care. Blood work, emergency vet-hospital treatment and after-care expenses brought the total close to $5,000; luckily for Merry, Glynn and her husband, Stew Tolnay, were able to handle the bills.
However, that experience convinced Glynn that it was time to buy pet insurance for all three of their dogs. When she checked into it, she discovered that approximately 10 companies now offer pet insurance in the United States.
By asking friends and doing her own research, she eventually decided which was best for her situation. Of course, Merry’s earlier condition was considered preexisting and excluded from coverage. Still, the insurance allows Glynn and Tolnay to rest easier, knowing that if their pets develop a serious medical problem in the future, some of the costs will be covered.
By the Numbers
But what about the unexpected, like Merry’s illness, or the puppy who swallows a sock? Plus, specialty veterinary care is now available — ophthalmologists, oncologists, neurologists — which means that the costs of care are steadily increasing. Even the average cost of a typical corrective surgical procedure, for dogs in this case, are enough to give one pause: gastric torsion (bloat), $1,955; foreign-body ingestion (small intestine), $1,629; pin in broken limb, $1,000; cataract (senior dog), $1,244.
You’d think that, faced with these numbers, everyone who has pets would also have pet insurance. Yet less than 1 percent do. Should you buy pet insurance to cover your pet, and your bank account? Unfortunately, like many things in life, there’s no clear yes-or-no answer.
Some are fortunate in that they have the resources, or the willingness, to go into debt for their pet’s care if necessary; they are, in effect, opting for self-insurance. Others, perhaps without extra resources or who just want to sleep better at night, like Glynn, prefer paying a monthly insurance premium of anywhere between $20 and $60 (depending on the age of the animal and the coverage) in the hope that it will cover expensive vet bills down the road.
Like all insurance, pet insurance is, at its most basic, a gamble. We pay the premiums hoping we’ll never need to use the coverage. If we do, our gamble has, unfortunately, paid off.
Before You Buy
Before you sign on the dotted line and write that first check, do your due diligence.
Read the policy very, very carefully.
Understand co-pays, deductibles and caps.
Know the policy’s exclusions.
Following are some of the terms included in policy exclusions that you should understand thoroughly before you purchase.
(Note that some conditions fall into two categories. For example, cleft palate can be congenital or developmental. Deafness can be considered a hereditary congenital condition.)
According to Karp, in all policies, unless an additional rider is purchased, “congenital conditions are deemed preexisting and not covered. Some policies bar hereditary and developmental conditions as well, unless additional coverage is purchased.” Karp notes that a policy he recently reviewed was one of the few to define a “chronic condition” to mean “not curable.”
“Thus, even if the condition went into remission for a year, if the initial onset preceded the effective date of the policy, it will be deemed an incurable and preexisting condition,” he says.
Make sure your current vet qualifies under the terms of the plan you choose.
“Another concern,” says Karp, “is that [few] policies cover experimental, investigative or non-generally accepted procedures, as determined by the veterinary medical community.” That is the sort of language lawyers love. Does it mean the AVMA? The HSVMA? Or some other more vague, local medical community?
Have a headache yet? Believe me, this is just the tip of the insurance-lingo iceberg. It’s complicated, confusing and a little terrifying, because the financial investment you make when you purchase insurance is significant and you want to be sure it pays what you hope and need it to pay. Each company’s policy includes numerous terms, conditions and exclusions, as well as dispute- resolution provisions. You need to understand them all.
Rolling the Dice
Here’s an illustration that makes this issue very real.
In 2002, Dana Mongillo, dog trainer and owner of Fuzzy Buddy’s Dog Daycare in Seattle, Wash., purchased pet insurance with a cancer rider for Mango, her healthy young Boxer. It initially cost her $20 a month. Over the next few years, Mango remained healthy and no claims were made on the policy. Then, the premium increased to about $50 a month. “Paying $600 a year for nothing is a little indulgent,” says Mongillo, “and I remained on the verge of canceling the policy for months. But then a vet visit for a slight limp ended up with the worst diagnosis possible: Mango had cancer.” The diagnosis came in 2008. Mango received treatment and care for two years before he finally succumbed in 2010, at age eleven. “While I helped Mango through the final weeks of his life, the insurance was suddenly very wonderful,” says Mongillo. “Every time I got a quote for treatment options, I knew the final amount I would pay would be less. That made it easier for me to consent to treatments that might help Mango, or at least help us find out the extent of the problem. In the last six weeks, he had a whirlwind of vet appointments, two sets of X-rays, an MRI and weekly acupuncture. Insurance removed the huge burden of the financial, leaving me able to focus on what was best for Mango and not what was best for my wallet.”
Here’s the tally for Mango’s insurance and vet expenses: Total premiums paid (2/2002–3/2010): $3,098. Total vet bills paid (3/2008–4/2010): $4,802. Total amount not covered (3/2008– 4/2010): $2,705.
For Mongillo, it was worth every penny, and she would do it again. She recognizes that in her case the insurance gamble paid off and Mango received the level of care she wanted him to have. Had he not developed cancer, she would have paid for insurance that she never used, but insists she would have been happy to “lose” that particular bet.
The second is CareCredit. This is a line of credit specifically for use at participating veterinary clinics. Stacy Steele, DVM, of Ocean Shores, Wash. (profiled in “World Vets” in the Sept/Oct 2011 issue) recommends this to her clients, almost none of whom have pet insurance. Like a credit card, this line of credit can be used for routine care and/or extraordinary care. There are no up-front costs and you select the monthly payment option you can handle. Depending on the amount put on the card, you can take from six to 60 months to pay off the balance (check the annual percentage rate before you sign up).
The bottom line: choose the option that will allow you to sleep well, knowing that if your beloved companion requires expensive diagnostics, treatment and care, you have the resources available to pay for them. If you choose pet insurance, read every word of the policy very carefully and understand what the terms mean before you purchase. Then, go have fun with your pup!
Wellness: Health Care
Part 1 in a 4 Part Guide
To identify an illness or abnormal situation, you must first be able to recognize what is normal for your dog. You know your dog better than anyone else and you will have to decide when an abnormal situation warrants professional help. Sometimes the condition is so serious it leaves no doubt. Frequently, however, the changes are subtle, or happen over a longer period of time, making noticing a problem more difficult.
Over the course of the following weeks, I will provide you with information on how to perform an at-home physical exam, helping to determine and establish what is normal for your pet. It is recommended that you occasionally perform this exam- while there is nothing wrong- so that you can begin to get used to what is normal. This practice will help allow for the early detection of changes in your dog’s health.
I will start with the basics this week: A good look, temperature, and how to obtain a heart rate. Next week will continue with a systems approach beginning with the head area, followed by the chest, and lastly, the abdomen. At the completion of these 4 blogs, you should have a complete home guide on how to perform a screening exam. Ready?!
First, before you start your hands-on exam, stand back and just simply look at your dog for a few minutes. The posture, breathing, activity level, and general appearance can really tell you a great deal. Get a good picture of your dog’s “normal” in its relaxed home environment—this mental snapshot will help you notice any subtle change.
Taking your dog’s temperature is an easy and important procedure. Use a digital rectal thermometer (the ear type is less reliable and mercury thermometers can break!). Lubricate the end with petroleum jelly and gently insert the thermometer 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. And do not risk taking your pet’s temperature if you feel there is a risk of being bitten.
PULSE AND HEART RATE:
Learn to locate the pulse on your dog before a crisis. The best place on a dog is the femoral artery in the groin area (see picture).
Here’s how: place your fingers around the front of the hind leg and move upward until the back of your hand meets the abdominal wall. Move your fingertips back and forth on the inside of the thigh until you feel the “roll” of the artery and the pulsing sensation as the blood rushes through it. Count the number of pulses in 15 seconds and multiply by 4. This will give you the pulse rate in beats per minute. Pulse rate is a highly variable finding and can be affected by recent exercise, excitement or stress. Do not use the heart rate at the sole evidence that your pet is sick or healthy.
The heart rates that are listed are for healthy dogs at rest in their home, not for animals that are evaluated in a veterinary clinic where higher heart rates might be detected due to excitement, stress of a visit to the clinic, or disease.
Practice these essential skills and I’ll see you next week for all things head related, including the ears, eyes, nose, and mouth! See DIY Physical Exam: Part 2.
Wellness: Health Care
The top 5 tick myths dispelled
Disease-carrying ticks can pose serious health risks to both dogs and people, no matter what state you live in. The U.S. Centers for Disease Control (CDC) reports that ticks in every state can carry disease, and the number of tick-borne diseases is on the rise. Here in Northern California, they seem to be everywhere, and it is not uncommon for me to find an “incidental tick or two” during my physical exam. This usually leads to a tick-related conversation where I sometimes have to dispel a tick myth or two.
Fiction: “I heard that the best way to remove a tick is with a lit match, petroleum jelly, or alcohol”
Fact: None of these methods cause a tick to “back out” of the skin and can actually cause more injury. When you try to remove an embedded tick in this manner, you can actually aggravate it, causing the tick to deposit more disease-carrying saliva into the wound, and increasing the risk of infection. The best way to remove a tick is by using tweezers, grasping it as close to the dog’s skin as possible, and pulling the tick out with a steady motion. Dispose of the removed tick down the toilet or by placing it in rubbing alcohol.You should clean the skin with mild soap and water after its removal. You may see a little red circle (like a bull’s eye) or bump of redness on the skin at the insertion site following removal- this can be normal and may be visible for up to a couple of days. You should see your veterinarian if the region of redness increases in size or if it doesn’t go away within 2-3 days.
Fiction: “My dog doesn’t go hiking in the woods, so I don’t have to worry about exposure”
Fact: Ticks live on the ground no matter the locale, and this includes our urban parks and rural areas. Ticks typically crawl up blades of grass, looking to hitch a ride as our pets pass by. Ticks like to migrate upward, which is often why they’re found on the head.
Fiction: “Ticks aren’t a problem in the colder weather, so I only have to worry in the summer”
Fact: In most areas of the country, “tick season” runs from April to November, however, infection can occur any time of the year. For example, in the winter, some tick species actually move indoors, while other species make a type of “internal antifreeze” to survive during the winter months. This is often why veterinarians will recommend year-round tick prevention.
Fiction: “Lyme disease is the only illness that ticks can transmit to dogs (and their humans)”
Fact: While Lyme disease is the most widely known and common disease caused by ticks, there are other diseases including Rocky Mountain spotted fever, babesiosis (one of the newer discovered diseases, see Jane Brody’s article about it), and ehrlichiosis. These diseases can have equally devastating effects on our pets.
Fiction: “If I find a tick on my pet, or if I see the “bull’s eye” red ring on my pet’s skin, I should get a blood test because this will tell me if my pet has disease”
Fact: If your pet is ill, and you are aware of tick exposure, a tick-borne disease screen is highly recommended. However, it should be noted that lab tests run for tick-borne diseases are often negative on the first sample and require a second test in two to three weeks to confirm infection. Therefore, a negative test does not necessarily mean that your pet is free from disease. It should also be noted that many dogs with tick-borne illness do not experience any symptoms, especially in the early stages of disease.
And one last tip to throw into the mix: if you do attempt to remove a tick at home, make sure that it is actually a tick! I cannot tell you how many times I see a pet on emergency for an accidentally removed nipple! Ouch!
Wellness: Health Care
Don’t delay—see the vet today for a thorough workup
Few events are as terrifying as witnessing your pet in the throes of a full seizure. One second, he looks perfectly normal, and the next, he’s on his side, eyes glazed, muscles twitching frenetically. He may even lose control of his bladder or bowels. A result of abnormal electrical activity in the brain, this episode may last only seconds, but when it happens, time seems to move in slow motion.
For some dogs, this is a one-time experience, but in most cases, seizures recur. If so, and if the abnormal electrical activity is caused by an underlying problem within the brain, the condition is termed epilepsy.
You might think that because epilepsy is fairly common, diagnosis and treatment are straightforward. Unfortunately, that’s not the case. Patients often show no signs; diagnostic tests are frequently negative; and, at least initially, the actual seizure events can be few and far between. These factors can contribute to a decision to take a wait-and-see approach, which can lead to problems later on.
As Dr. Michael Podell, a veterinary neurologist at the Animal Emergency and Critical Care Center in Northbrook, Ill., notes, “It’s important to identify—as much as possible—the underlying cause … Sometimes it’s easy to take the conservative approach … [but] unfortunately, it can often be a more serious problem.”
Consider, for example, one of Podell’s recent cases. “I saw an eight-year-old Shepherd mixed-breed who had her first seizure almost a year ago. The second one was several weeks later. Her regular veterinarian performed blood work and radiographs, and all was OK. She did not have another [seizure] until January. Then she had two more. Then the owners brought her to see us.” Though she looked normal, with no obvious neurological problems, says Podell, “she had a meningioma in her olfactory lobe the size of a golf ball.” Fortunately, these benign tumors, the most common type of brain tumor, can be treated with good success by veterinary neurologists.
Because there are so many potential underlying causes of seizures, the workup must be step-wise and thorough, a comprehensive attempt to parse the possible culprits: disorders originating within the brain (tumors; viral, bacterial or parasitic infections; strokes; head trauma) from those originating outside the brain. For instance, nutritional deficiencies as well as toxins like lead, insecticides, moldy foods and some human supplements can provoke brain changes that lead to seizures. Additionally, metabolic abnormalities such as liver or kidney disease can cause seizures, and some anesthetic agents and medications may also trigger them in sensitive animals.
The workup starts with a history, including information on vaccinations, diet, exposure to toxins, and the time relationship between seizures and other activities. In most cases, blood chemistry, a complete blood count and urinalysis will help systematically rule out many of the extracranial causes. If no underlying disease process is found and the animal is between one and five years of age, idiopathic (cause unknown) epilepsy may be diagnosed. If the dog is less than one year of age, he is more likely to have a congenital abnormality, and if he’s older than five to seven years of age, specific disorders of the brain are more common. In turn, these cases (as well as those with difficult-to-regulate idiopathic epilepsy) will require further workup, which may include an MRI and cerebral spinal fluid tap.
Regardless of age and the likelihood of finding idiopathic epilepsy, early treatment is important, because with each seizure, more nerve cells within the brain will begin to fire randomly. As Dr. Podell notes, “The brain’s threshold for seizure may lower on a constant basis.” In other words, each seizure makes it more likely that another one will occur. This in turn can make the seizures progressively more difficult to manage.
So, to the bottom line: In general, Dr. Podell suggests, “If a dog has had two seizure clusters [two or more seizures occurring over a short period of time, with the dog regaining consciousness in between] in a year, or two or more regular seizures within a six-month period,” he should receive appropriate diagnostic workup and treatment as soon as possible. Early diagnosis and treatment with anti-seizure medications where indicated are critical to a successful outcome.
To find out more about canine seizures and epilepsy, start with a visit to the Canine Epilepsy Network.
Wellness: Health Care
Making the cost of pet care easier to swallow
In many veterinary practices, dispensing of prescription drugs, nutritional supplements and parasite prevention makes up 17 percent to 20 percent of practice revenue. Historically, selling these products has been a relatively passive revenue source for veterinary practices. In the past, there has been little competition for products, and consumers did not routinely “shop around” for medications. However, that landscape is rapidly changing.
There is new legislation that is currently being discussed in congress that, if passed, will mandate that veterinarians provide a written prescription, even if the prescription is filled on the premise. This legislation is called the “Fairness to Pet Owners Act of 2011,” or H.R. 1406, which will allow pet owners to go to their neighborhood pharmacy for prescriptions, or to have them filled online. The legislation was modeled after the Contact Lens Consumers Act, with the intent of giving pet owners a copy of the written prescription so they can shop around.
The legislation calls for new rules regarding veterinary prescriptions that include:
• Requires veterinarians to offer written disclosures about off-site pharmacy options for prescription dispensing;
Many veterinarians and medical associations feel this idea is a tough pill to swallow and here’s why:
• The American Veterinary Association believes this law is redundant and will cause undue regulatory and administrative burdens on veterinary practices. They feel it is burdensome and unnecessary to require a written prescription be provided, as well as a written notification that the prescription may be filled elsewhere, regardless of whether or not the client is having the prescription filled by the veterinarian.
• The provision that requires the vet to verify the prescription, regardless of whether the pharmacy is accredited or licensed, which places the veterinarian in both a legal and ethical dilemma. At the same time, it puts consumers at risk.
• Clients already have the flexibility to fill a prescription at their veterinary clinic or off-site at a pharmacy of their choice. The AVMA is supportive of a client's right to choose where they have their prescription filled.
I see both sides of the fence, and overall, I feel that the concept is an excellent one; I just hope it doesn’t get lost in translation. I feel pet parents have the same right to shop around for the best prices on the medications they buy for their pets, just as they do for products they buy for themselves.
While the various lobbyists continue the battle of semantics, did you know? Yes, it is true: most states already do require by law that a written prescription be provided to you, should you just ask. Did you realize that you most likely have this option available to you? What are your thoughts with this proposed legislature after hearing “both sides?”
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