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News: Shea Cox
Prescriptions for Pet Meds
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;
• Requires veterinarians to write a prescription regardless of whether or not the hospital will dispense the medication;
• Verify a veterinary prescription electronically or by other means;
• Prohibits a veterinarian from requiring payment for providing a copy of or verifying a prescription;
• Requires a client to sign a waiver or liability disclaimer should the veterinary prescription be inaccurately filled by an off-site pharmacy;
• Supply a client with a notice waiving or disclaiming a veterinarian’s liability for the accuracy of the veterinary prescriptions filled off-site.

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?”

Wellness: Health Care
Holistic Approach to Cancer in Dogs
Healing maladies holistically.
Follow Your Nose.

In my office, an aging golden retriever named jasper sits by my fax machine and waits for his latest ultrasound report. But I already know the results from a gentle wag of his tail and his rejuvenated appetite: the cancer is in remission. Unlike an oncologist, I don’t treat cancer. I focus instead on healing the patient’s failing immune system; Jasper’s gave rise to two large liver tumors. I worried that Jasper would succumb to one of his bleed-outs, or pass away after a severe reaction to a pain patch. But in each instance, a force rallied inside him, a spirit that science cannot yet quantify, and he beat the odds.

People generally assume that there is just one acceptable way to treat cancer — with conventional medicine, chemotherapy, radiation and surgery. Many oncologists today advocate not using any holistic medicine while a pet is under their care. They believe that herbal supplements and antioxidants are not well characterized and can have unforeseen and negative interactions with chemotherapy drugs. They also typically state that special diets are not necessary. While their approach may successfully treat some types of cancer, the risks can often outweigh the benefits, especially in older, compromised animals.

Contrary to their opinions, I believe that dietary therapy is critical in the treatment of cancer. For years, I used the energetics of food to treat many forms of disease. If a disease caused heat or inflammation, I’d prescribe organic, homemade, finely ground diets including cold-water fish, pork and green leafy vegetables to cool the inflammation. I might also prescribe raw diets, which are cooling to the body. On the other hand, if a patient had a cold imbalance, his ears cool to the touch, I might prescribe cooked lamb or chicken, and warming vegetables like steamed rutabagas, turnips, parsnips and a tiny piece of fresh ginger. For either constitution, the introduction of live-plant antioxidants, vitamins and minerals would be beneficial, especially since these ingredients are often unavailable in commercial diets. If herbs and homemade diets could help Jasper, I thought, why not try them?

To my surprise and relief, Jasper survived the week on this regimen. Now, according to [his person], Wendy, he was having a few good days, time seemingly stolen back from his cancer, giving us a remote hope that we had suspended a downward spiral. I saw him for his second appointment on a sunny Monday afternoon. As he entered my office, rather than dragging his back toes, he walked in fairly normally, lifted his head occasionally and proceeded to sniff all four corners of the room. Rather than the deep brick red it had been the week before, his tongue color was now lavender pink, suggesting that his overall circulation and body temperature had improved.

Even with these signs of improvement, though, Jasper was still extremely underweight and very weak. His eyes remained dull, and the nominal amount of weight he had gained was a result of accumulating abdominal fluid produced by his leaking tumors.

Attempting to remove the fluid presented multiple problems and would only give him short-term relief. Again, we were left with few possible medical treatments, which reminded me of climbing a steep slope above the tree line and grabbing small twigs only to have them rip out of the ground; so few medical options, so few big trees left to hold on to.

“I hope he improves a little more this week,” Wendy said, her eyes puffy and tired. “We enrolled him in a nosework class when we learned he had cancer.”

She read my puzzled look. “After the diagnosis, we enrolled Jasper in a training program for nosework. We hoped it might help him stay mentally and physically stimulated.” The idea was to encourage and develop a dog’s natural scenting abilities and innate desire to hunt a target odor. In the process, the dogs have fun, building confidence and focus while burning mental and physical energy. It was not normally the place you’d find a dog with such a serious health condition.

But Jasper had spent his life as a natural seeker. The Millers often took Jasper with them on kayak trips. When they paddled to shore, the dog would bound from his bucket seat onto the beach. Immediately, he’d begin to dig, pawing so aggressively at the sand that it flew out behind him. After an hour, he would proudly lie in the middle of a 20-foot-long trench, happily gnawing on a stick to celebrate his masterpiece of excavation.

All of my medical training told me that Jasper should be inside a bubble, isolated from infectious disease and confined to the house to prevent the rupture of his tumors. Sick dogs, I had learned, should be quietly resting at home. But then, rules were meant to be broken. I remember reading Temple Grandin’s book Animals Make Us Human. She highlighted the importance of seeking: looking forward to an activity or object. When an animal’s attention is in a playful, seeking mode, he or she cannot simultaneously feel fear. Seeking is a necessary emotion that is often [missing] in many animals’ lives, especially after a grave diagnosis. Jasper’s nosework class would provide him with a new form of seeking, and instead of obsessing over his tumors, the Millers could let his new focus alleviate their own fear as well. I imagined Jasper barking and wagging his tail when he picked up the scent of birch oil in a little metal box hidden in the backyard. Jasper’s seeking behavior would be just as important to his overall health as any herbal therapy. When I was young, I unknowingly implemented this idea of seeking with my own dog, Julietta. Just after we adopted her from a litter of sick puppies at the shelter, she broke with bloody diarrhea. As we waited for the veterinarian, I held her in my lap, upside down in a blue blanket as though she were a doll.

I looked around the waiting room and noticed other people staring off into space: a slumping old man, a young woman in plaid jeans and a wool scarf, a couple holding a baby carrier on one side and a Beagle on the other. Their pets were quietly protesting from within carriers or crouching fearfully under chairs. Julietta and I looked at one another. She was weak, and her eyes gazed up at me for a clue to her destiny. Three black eyebrow whiskers followed my every move. Owing to my mother’s amazing ability to work despite almost any disturbance, she sat next to us reading and correcting students’ final exams, making big swirls with her red pen.

Thinking back to that veterinary clinic, I can still remember the exam room, the perky technicians and the doctor’s white lab coat and grim face as he reported Julietta’s poor prognosis. Parvovirus had struck her small, malformed, Basset-like body, and her only beautiful feature, the darkened liner around her brown eyes, now drooped as she hung her head on the steel exam table. “The smell,” the veterinarian said, “is unmistakable.” His eyes shifted to the clock when a cat howled in a back room.

My mother was speechless at the diagnosis, not because she loved the puppy even an eighth as much as I did, but because we were facing the death of an immediate family member for the first time, and were completely unprepared for it. The veterinarian suggested putting Julietta to sleep, no doubt because he correctly assumed that we could not afford hospitalization, and even if we could, her future looked bleak.

It was then that my 12-week-old puppy looked up at me pleadingly, giving a last tiny wag of her tail. My mother looked up from her pile of ungraded exams and silently nodded her tacit semi-approval. Even she noticed the puppy’s hint of hope. Right or wrong, this decision would be left to me, even though I may have been too young to make it. “Doctor,” I said with a small voice and a lump in my throat, “I’d like to try to save her at home.”

The veterinarian looked at my mother’s face for a more sensible decision, but when none came, he said, “Okay, young lady, you’ve got to work hard at this, and even then, she might not make it.”

Although 30 years later, Julietta’s veterinarian might have been sued for giving so many pills to a nine-yearold, back then, he thought nothing of handing me the plastic prescription bottles and showing me how to pinch the puppy’s skin to check for dehydration. With no fanfare, I tucked Julietta back under her towel, and carried her out to our dented blue car while my mother paid the bill. I didn’t know it then, but she had cashed in some family heirlooms and old coins to pay for this unforeseen expense.

Before and after school, I treated the small puppy. Sometimes I felt the hopelessness in it, while other times my determination took over. Every day I’d race home to find her waiting for me. I’d clean up the bloody diarrhea on the newspaper-lined kitchen floor that we walled off especially for her. Then I’d give her canned food and water through a large syringe as her pale tongue lapped it up. Afterward, I’d gently pry open her mouth to slide a huge blue pill as far down her throat as possible. After a few days of no improvement and minimal appetite, she hung her head as though the force of gravity weighed heavier on her than on anyone else. I asked my mother to let Julietta sleep with me, imagining that if I could hold her cold body close to me, I’d be able to warm her up. Naturally, with the putrid nature of Julietta’s stools, Mom resisted my request for a while, but I explained that there was a medical point to it.

Even with medication and round-the-clock nursing care, Julietta was still unwilling to eat on her own. I decided to try a new technique to stimulate her appetite, hiding small pieces of chicken in various places throughout my room. At first, she appeared uninterested, but gradually, her nose began twitching with the allure of appetizing scents lurking under the covers, behind the bed and in an old pair of dress shoes. Each day, I added larger pieces to our new seeking game. And over the next few days, Julietta’s appetite slowly returned. Within a month, she had rounded a corner, gradually returning to her normal, playful self.

I thought of Julietta’s remarkable recovery from parvovirus as I sat contemplating Jasper’s precarious health. “Wendy, maybe you’re onto something with this nosework,” I said. “But, if possible, try to keep Jasper from jumping around too much.” I worried that, among other concerns, any heavy exertion could cause the tumors to bleed. Wendy promised that all his initial training would be done on flat terrain. I continued, “Just in case, let’s add another Chinese patent herb, yunnan paiyao, to his herbal regime. It aids in blood clotting and might help keep his tumors from bleeding.”

As I inserted acupuncture needles into important liver-strengthening points, Wendy shared her trick of combining all Jasper’s powdered herbs and vitamins in a turkey baster and then briskly rubbing him down with a towel to get him excited about taking the gruel. “If I use the towel to fluff up and down his back, he gets so excited and happy, he barely realizes he’s taking any medicine at all!”

With the needles in place, I sat back and watched him relax into his acupuncture treatment. I asked myself what else I could do to strengthen his immune system. The answer to my question was an herb first introduced to me one summer in the Cascade Mountains by my herbal teacher, Madsu, a thin, gray-haired man reminiscent of an elf. With a wildcrafter’s permit — a guarantee that no plant would be over-harvested — Madsu had silently walked through the forest carrying a heavy burlap sack slung over his left shoulder. As I followed him, I had to look up occasionally to be sure I had not veered off his path, sucked accidentally into a patch of salal.

We climbed over huge logs covered with green sheets of elk moss and usnea lichen. Dirt built up and caked onto our knees as we knelt in front of some rattlesnake plantain, investigating its vibrant white center vein. The air was damp and cold. Droplets fell when I exhaled, and each breath made me feel more alive.

Madsu stopped abruptly to admire and bless his favorite plant, ocean spray, a large bush also known as ironwood because bows and arrows were made from its sturdy pith. I watched him place sacred red willow bark beside its base. To him, the bush represented the survival of his people, and indeed, it was a shrub worthy of notice. With a collection of small, energetic white flowers extending proudly into the sky, it resembled the spray of the sea crashing against a rocky shoreline. Each of its leaves was decorated with fine ridges in circular fan-like patterns, the leaf margin as wavy as water, reminding me of the thrill of a storm at sea.

Pieces of cedar crumbled into our hair as we ducked under a large rotten stump to find turkey-tail mushrooms, a shelved cluster of woody fantails, brown- and orange-tinted with a white underbelly. When one hikes with a mushroom expert and herbalist, every rotten log becomes a subject worthy of special treatment, full of hidden clues. Unlike plants, mushrooms are only present for a few days, sometimes only a few hours, so you have to leave your worries, your lists and your disagreements with others behind and focus on that bounty of mushrooms. Known as an immune modulator, turkey tail is one of many medicinal mushrooms that help the immune system recognize and kill cancer cells.

Madsu sought wild herbs by day and made medicine by night. We spent hours gathering reishi and turkey tail, chiseling at the mushrooms and then slinging the wood-like fungus into our burlap sacks. Our other sacks contained sheets of f luffy, light green usnea rolled on long sticks like cotton candy, and chunks of precious red root, an herb whose potency increases as its environment becomes more hostile. When we returned to our camp on a hillside outside Twisp, the moon gave us just enough light to layer some of our herbs onto thin racks and place them into a large dryer. Then we began crushing the mushrooms, tincturing them immediately and then pouring the liquid into large amber bottles to retain their medicinal potency.

Madsu learned how to gather medicine and process it from his mother, who traced her native roots to a Spokane woman named Teshwintichina. From her, he also learned how to make cakes from camas, bitterroot and black tree lichen. [The] camas bulb needed to be baked long enough to release the sweet inulin; an hour too early and it would still be bitter; an hour too late and it would turn to mush. The black lichen was packed into cakes when it was still a warm, sticky substance that could be molded easily. His family would cook the camas on warm summer nights when song and fire could pass the hours. They could smell when their camas had cooked long enough to convert the inulin. They could smell when [the] medicine was ready.

To me, many of Madsu’s herbal and food preparation practices seemed witch-like, entrenched in fire-born ritual. But I later discovered that some of the plants’ active ingredients, so important for immune modulation, disappeared quickly without immediate preparation. They were also more bioactive in the beginning of the autumn when the leaves of the alder tree start to turn gold. The ability to know when to harvest one plant based on the life cycle of another made sense when one lived in community with the plants, truly understanding their annual rhythms.

Jasper understood annual rhythms, too. In the summer, he hunted for moles in the fields. As fall approached, he sniffed out and ate blackberries. As Christmas approached, he dutifully protected the house, bravely fending off evil deliverytruck drivers.

Back at the clinic, I left Wendy and Jasper in the exam room while I reached up in my herbal pharmacy for a bottle of turkey tail and reishi made by Madsu that September night five years prior. I thought of how the field we’d chosen to make medicines smelled of sweet tarragon after a moist evening, and how Madsu blessed the medicine, completely present with his full attention on healing. The stars had beamed over our makeshift laboratory on a deeply nourishing night, and the nearly full moon floated overhead as we worked on counters of cut logs, swirling jars of herbal menstruum.

“Let’s start him on this mushroom blend,” I suggested, handing Wendy an amber bottle, just as herbalists have done for generations. As they got up to leave at the end of the appointment, I saw the tip of Jasper’s dry, cracked nose sniff at a liver treat I had cradled in my palm. At that point, I could see a trace of his inner life force, not through a brightness in his eyes, but through a twitch of his nose.

News: Shea Cox
Safety Tips for Dogs on the 4th of July

One of the busiest times of the year for our emergency service is the Fourth of July holiday. While many people celebrate Independence Day with fireworks and BBQ’s, many others spend it waiting in the ER while their pet is treated for an array of holiday-induced emergencies, including serious laceration injuries from pets jumping through glass windows or doors, high rise fall injuries due to jumping from balconies, hit by car trauma as pets attempt to flee from noises, dietary indiscretions from our pets stealing post-picnic scraps, and cases of severe anxiety due to overwhelming stimulation.  In addition to the trauma that we see, we also receive many phone calls from distressed owners trying to locate their lost pet, following it running away from home in a panicked state.

Follow these tips to help prevent injury and loss during this holiday:

  • Make sure your pets are secured indoors and as far away from the sounds as possible as the loud noise of fireworks can startle. Keep your pet in a safe room where they are comfortable once the festivities begin. If your dog is crate trained, put him/her in its crate with a blanket to help offer a feeling of security. You can also help to block the outside sights and sounds by lowering the blinds and turning on the television or radio. And remember, it is a mistake to assume that a fenced pet won’t look for a way to escape the yard during times of extreme stress!
  • Be sure that your animal can be identified in case they do escape! If you don’t already have a name tag for your dog, instant ones can be made “on demand” at many local pet supply stores. Engraved tags start at $5.99. Microchipping your pet is one other way to help missing animals find their way back home. Sadly, many animals that have been microchipped are not registered in the system and we are unable to reunite families; please ensure that your pets microchip truly has been registered, and just as important, that your address and phone numbers are current!  If you are in question as to whether your pets microchip is active, see your veterinarian for a scan prior to the holiday!
  • If you live out of earshot of city fireworks displays, don’t forget that small neighborhood displays or children can be just as distressing to your pets; if you or your neighbors plan to celebrate, it is still important to keep a sharp eye on your well-secured pet; if you plan to go to a friends home for the festivities, it is safer to keep your dog home than to bring him or her, even if the party is dog-friendly. If you have to leave for the day, keep your pets inside of the house rather than outdoors to help remove the temptation to leap over the fence to try and find you.
  • Pets often try to relieve anxiety by chewing and it is important to make sure confined pets do not have access to anything that they could destroy. Indoor crating could be a good option for some dogs, but not for periods longer than four hours, and you still need to keep a watchful eye on them while contained. We have seen injuries as mild as broken toe nails from trying to “dig out” from their kennels, to more extreme cases of mouth trauma and fractured teeth. This is not a good option to try if your pet has never been crated before as this will only add to their distress.
  • You can also distract your four-pawed friend with a toy and praise him or her for non-fearful behavior, like tail-wagging.
  • Some pets respond well to sedatives, such as Acepromazine. It is always a good idea to plan ahead and anticipate that this will be a time of stress; make an appointment with your veterinarian to have your pet examined and a sedative dispensed, or, if your pet has had a physical exam in the past year by your veterinarian, they will often dispense this medication for you if your pet is otherwise healthy. There are also herbal over-the-counter remedies such as Feliway and NaturVet Calming Aid, which can offer homeopathic relaxing effects to your pets. Thundershirts can also be very helpful for some pets at reducing anxiety caused by noise.
  • Do not feed your dog scraps from the grill and properly put away those garbage bags filled with the remains of your Fourth of July picnic—the lure of leftover BBQ chicken, corn cobs and the like is often too great for any pup to resist, and these types of dietary indiscretions can lead to pancreatitis, gastroenteritis, and intestinal foreign bodies requiring surgical removal. Remember that some foods can be toxic to dogs such as chocolate, onions, grapes, and avocados. Alcoholic beverages also have the potential to poison our pets.
  • Avoid spraying your dog with insect repellant and only use sunscreen that is intended for animal use as human products can be dangerous to your pets. Ingestion of sunscreen products can result in drooling, vomiting, diarrhea, excessive thirst and lethargy. The misuse of insect repellent that contains DEET can lead to neurological problems. Always keep matches and lighter fluid out of your pets’ reach; certain types of matches contain chlorates that can damage blood cells and result in difficulty breathing or kidney disease in severe cases. Lighter fluid can be irritating to the skin and if ingested, can produce irritation of the stomach and intestines as well as causing aspiration pneumonia if it is inhaled or vomited.  Citronella candles, insect coils and oil-based insect repellents can also cause stomach irritation and possibly central nervous system depression.

It is hoped that these tips will help ensure a happy holiday celebration for your entire 2 and 4-legged family… one without any trips to the animal ER!

News: Shea Cox
Foxtails Can Pose Serious Risks to Dogs
Foxtails

As an ER vet, I officially mark the start of the summer season when I see several patient charts over the course of a 10 hour shift with the presenting complaint: sudden sneezing. By the third one I think, “Another one? What the foxtail!”

Annual grasses releasing foxtails grow quickly throughout the rainy season. As temperatures rise, the foxtail-shaped tip of each grass blade dries out and the individual awns take a ride on any passing object. This plant is engineered by nature to spread its seed, and the foxtail is actually designed to burrow further into an object with each movement, making it a major problem for small animals.

There is no escape. The pesky seeds from these dried grasses get stuck everywhere, and I mean everywhere, our furry friends included. Many pet owners have heard the warnings about foxtails and know to avoid them as much as possible. What many don't know, however, is that foxtail migration can cause severe—and potentially deadly—consequences.

While foxtails are often caught in the fur and can be quickly removed, they can also migrate internally if left unfound through several common routes such as the nose, ears, and eyes. They can even penetrate through the skin or through a pet’s genital openings. If these problematic hitch-hiking seeds find their way inside of a pet’s body, they can cause many serious problems. Once internalized, foxtails can wreak havoc on the body, causing internal abscesses and even infections of the bones around the spinal cord. I have also seen cases of foxtails getting lodged in the abdominal organs or lungs.

While foxtails aren't always easy to spot, their presence can be noticeable through various telltale symptoms, depending on their location in the body. Be mindful of the following symptoms during foxtail season:

  • Nose: violently sneezing and pawing at the nose, and sometimes a bloody nose.
  • Eyes: rubbing the eye, squinting and pain, excessive tearing or discharge, or an eye “glued shut.”
  • Ears: head tilt or violent shaking of the head from side to side, pain, discharge, or odor.
  • Mouth/Throat: gagging, loud coughing, difficulty swallowing (you will notice your pet having “exaggerated swallowing” movements, like when you have a sore throat), and possibly increased odor.
  • Paws: continuous licking of the paw or pad, or the appearance of a swollen “bubble” between the toes, or a small “hole” in the skin which is indicative of a draining tract, which is the path the foxtail is taking under the skin (pictured)
  • Under skin: formation of sores or abscesses.

If any of these symptoms are noted, you should see your veterinarian immediately for a check-up. If a foxtail is found relatively superficially in the skin or nose, it can be removed rather simply. If a foxtail has moved into the lungs or deeply into the nose or genitals, an endoscope can be used for its location and removal (pictured).

An endoscopy involves the use of a high-tech instrument with a specialized video camera and small grabbing tools that can be passed through the mouth, nose, or rectum and is a lot less invasive than traditional surgical methods. However, if the foxtail has entered the belly or lungs, surgery is sometimes the only treatment possible.

While it's best to avoid areas where foxtails grow, if your pet has been exposed to the grass, make sure to brush her coat well, feel all over the body with your hands, and perform a thorough inspection of the ears, nose, between the toes and paw pads, and underneath the collar after each romp. It’s important to learn about the dangers of this plant, take extra precautions, and remove foxtails immediately. Be overly cautions during foxtail season- dogs and their people deserve to enjoy a drama-free summer outdoors.

 

Wellness: Health Care
Pain Relief for Dogs
Treating chronic pain in dogs.
Chocolate Lab

I see it all the time. it might be a yellow Lab cursed with crunchy, stiff elbows; a Rottweiler with knees that refuse to bend; or a German Shepherd who circles forever before daring to lie down. Degenerative arthritis in our canine companions is a common, debilitating and frustrating problem, especially for older dogs. Though some dog owners opt for surgical solutions like joint replacement, others think twice about the merits of major surgery, particularly in the later stages of a dog’s life. Thus the questions: Are there alternative ways to effectively manage my dog’s pain? Can I restore quality of life and, given these tough economic times, not break the bank? My colleague at Boston’s Angell Animal Medical Center, Lisa Moses, VMD, DACVIM, CVMA, heads up the center’s specialty Pain Medicine Service, and I turned to her for insights, which she generously provided.

“We almost always use a multimodal approach, combining different techniques and/or types of drugs to target the different ways in which pain is produced. It’s not about adding more and more, it’s about treatments complementing and enhancing one another.”

Like me, the first thing Dr. Moses focuses on is weight. Studies have shown that an 11 to 18 percent reduction in body weight significantly decreases the severity of hind-limb lameness. It’s not easy, but weight loss has huge potential to reduce arthritis-associated pain. When recommending supplements, Dr. Moses is a fan of the omega-3 (n-3) fatty acids. “You need to make sure you get the right dose for your dog. Check with your vet, use a dog-specific preparation and choose a supplement that separates the fatty acid from vitamin D,” she cautions. Then there are glucosamine and chondroitin sulphate.

In broad terms, these compounds are thought to target some of the destructive enzymes that cause arthritic pain. Dr. Moses uses an injectable supplement, Adequan (polysulfated glycosaminoglycan), but remains cautious about all the unregulated products for oral administration, regardless of how much anecdotal success they claim. “Sometimes we are so desperate to help our best friends that we’re willing to believe anything will work. We’re the ones susceptible to the placebo effect, not our dogs,” she says.

Non-steroidal anti-inf lammatory drugs (NSAIDs) are the mainstays of pain management, especially for canine arthritis. According to Dr. Moses, “Regardless of what you read on the Internet, NSAIDs such as Rimadyl, Metacam and Deramaxx remain the best class of drugs. We know the risks, we know how to monitor our patients and we know how to minimize side effects.”

Both Dr. Moses and I strive to use the smallest effective dose to restore function. As she notes, “Clearly, in older dogs, use of NSAIDs depends on kidney and liver function, but [all things being equal] I often use them in conjunction with other drugs.”

Amitriptyline, amantadine and gabapentin may also enhance pain relief in combination with other analgesics. Every dog’s pain is individual and needs to be addressed as such.

It’s not all about drugs, however. Acupuncture, another useful modality, has no side effects, though, as Dr. Moses says, it’s important for owners to understand that the response to acupuncture is not as immediate as the response to drugs: “It’s a cumulative change in the way pain is signaling.” Typically, Dr. Moses (who is also certified in veterinary medical acupuncture) treats dogs weekly for up to two months. “Very few cases show no improvement on acupuncture, though some owners feel the improvement is insufficient.”

Physical therapy is another option. Dr. Moses advocates aquatherapy, provided by a trained physical therapist in a controlled environment and heated water, with the dog wearing a floatation device. I agree; letting your arthritic Labrador dive into the local pond on the weekend doesn’t have the same effect. The goal of aquatherapy is to carefully build muscle strength and boost a dog’s quality of life, not pound away on sore joints while chasing ducks or tripping over rocks.

Then there’s transcutaneous electrical nerve stimulation and laser therapy. When I asked her if she was sold on these, she replied that the jury’s still out. “I think these treatments hold promise, but as far as I know, there’s no peer-reviewed evidence that proves they’re effective.”

The proverbial bottom line? It takes time to make changes in the nervous system. The owner has to have faith and not keep jumping from one option to another. Dr. Moses generally uses a treatment plan for four to eight weeks before trying something else. “Think about it — the way your dog shows discomfort often waxes and wanes. If you change the treatment plan too frequently, it’s hard to know whether it’s working or not.”

And how do you know a treatment’s working? Look for markers of normalcy, says Dr. Moses. “It might be your dog’s ability to once again get up on your bed. It might be a male dog once more cocking his leg to pee. My favorite comes from an owner who said he knew his Miniature Poodle was responding to treatment when the dog tried to hump his wife’s leg!”

Wellness: Health Care
Learning Curve
Second Opinion
Australian Shepherd named Cyrus

As an englishman, I’m used to fielding questions about my homeland, but earlier this year, my jaw dropped when a patient asked me, “Who’s Kate Middleton?” It amazed me that anyone could be unaware of the future king of England’s bride. I couldn’t help thinking, How did you manage to avoid this story? Where have you been hiding? Little did I know that my next patient, a three-year-old Australian Shepherd named Cyrus, would show me how easy it is to be uninformed.

“He’s been lame in his front right for about five months,” his owner, Jaime, told me. “It gets worse with exercise.” The symptoms seemed consistent with a shoulder injury. It may be a sweeping generalization, but problems involving toes, wrists and elbows — hinge joints — tend to reveal themselves with pain, swelling or an abnormal range of motion. Ball-and-socket joints, like the shoulder, rely a little more heavily on muscles, tendons and ligaments for stability, which makes the shoulder vulnerable to repetitive sports injuries. Throw in this breed’s innate desire to exercise, and you have a recipe for low-grade, niggling lameness.

“I’d like to sedate Cyrus, get some ultrasonographic images of his shoulder joint and, if indicated, give him a steroid shot.”

Jaime agreed, and we set a date for the imaging. Later, when she dropped off Cyrus, she gave me a printout she thought I would appreciate. Hidden in Cyrus’s record, I discovered a document stating that he carried two copies of the mutant MDR1 gene, and a list of the dozens of drugs (including most sedatives) that would be seriously detrimental to his health.

Where had I been hiding? I read the information as though I were a green veterinary student struggling to assimilate important new stuff. What was the MDR1 gene? Did I miss that lecture? Surely Cyrus was not the first blue merle Aussie I had seen since graduating more than 22 years ago.

It turns out I was not completely ignorant. I recalled warnings about the mysterious sensitivity of Collies and related breeds to a variety of drugs, especially the anti-parasitic ivermectin. Not so long ago, the reason behind this sensitivity was discovered: the multi-drug resistance gene (MDR1) codes for a protein integral to pumping a variety of drugs from the brain back into the blood.* Dogs who carry two mutant MDR1 genes (mutant/mutant) lack this all-important protein, which means that many drugs can linger in the brain and cause life-threatening side effects. Even dogs with only one normal copy of the gene (mutant/normal) can be more vulnerable to drug toxicity.

The MDR1 mutat ion notably affects Collies — roughly three out of four Collies in the U.S. carry mutant MDR1 — Longhaired Whippets, Shelties, Aussies and Old English Sheepdogs. (Washington State University’s website provides a comprehensive list of drug susceptibilities and instructions for having your dog’s DNA tested via a blood sample or cheek swab; ) Naturally, I wondered why I had never witnessed adverse drug reactions in any of the listed dog breeds whom I had cared for in the past. Could I just have been lucky and only had normal/normal dogs?

When I asked my colleagues in anesthesia, they gave me the same withering look I had dispensed so easily only days earlier. Of course they knew about MDR1, and altered dosages and chose drugs accordingly. Sedatives can be used safely if the dose is reduced by 25 to 50 percent. Perhaps this was the answer. Maybe my natural proclivity for using the lowest possible dose to achieve sedation had inadvertently prevented dangerous side effects.

As for Cyrus, despite his genetic anomaly, his procedures went well; the suspected tendon injury was confirmed and he responded nicely to the steroid injection. There were no problems with his sedation, unless you count the professional embarrassment I felt for not knowing about his DNA. The good news was that this dog reminded me that I cannot possibly know everything, that I must be receptive to learning and that I am grateful for others who know so much more than I.

More importantly, it’s going to be a while before I think any question is too dumb to ask.

News: Shea Cox
Bone Marrow Mishaps
When a good chew turns bad to the bone
Dog with bone stuck around lower jaw

An uncanny reason for a visit to the ER is when a playful pup manages to get one of those circular marrow bones caught around its lower jaw and canine teeth. I still remember my first patient that found himself in this very predicament; perplexed, I thought, “How is this even possible?” While it looks like a trick that only David Copperfield should be able to pull off, it can actually happen with surprising ease.

When it comes to marrow mishaps, I have seen the entire breadth of bone bad luck. While some are easily removed with lubrication and gentle manipulation alone, others need to be removed with a cast cutting saw (or other manly tool, depending on the thickness of the bone) while the pet is sedated.  I have also seen dogs that have suffered from fractured canine teeth as well as extensive injury to their lower jaw and tongue. Tissue injury occurs when the circulation of blood is cut off to the skin and/or tongue while it is trapped within the bone. The marrow bone literally turns into a tourniquet with the continued and inevitable swelling of the tissues. Major or minor, any of these situations can be painful, distressing, and potentially very costly, depending on the extent of trauma and demeanor of your pet. 

Your dog absolutely loves these bones and you love to give them, so what’s a pet parent to do?  Here are a few tips to help prevent any misadventures:

  • Size really does matter. Make sure the size of the marrow bone is suitable for the size of your pet. Have your butcher “custom make” your marrow bones, trimming them into longer pieces, such as 8 inches for larger dogs. Skinnier bones can more easily work themselves around the jaw, and should be avoided.
  • Try a knuckle bone instead. These can offer a similar chewing experience, and because there’s no hole, there is no risk of it slipping around the jaw. However, as with any type of bone, these too, can come with risks. Be sure to take them away while they are still large, which is as soon as the gristle and soft parts of the “knuckle knobs” are gone. This will help to prevent accidental swallowing and choking once it is whittled down to a smaller size.
  • Sensitive stomach? Marrow bones may not be the chew of choice for those pets that get diarrhea or an upset stomach easily.  Marrow is very high in fat, and I have seen them cause these signs, as well as pancreatitis, in pets that are not used to the richness of the marrow fat.
  • Lastly, never leave your dog unattended while he or she is fancying the flavor—it is amazing how fast these accidents happen! And remember, extra aggressive chewers need extra close supervision.
  • As gratifying as these treats can be, one can still find a bone to pick with them because the serious complications happen just as often as the “simple ones.” The marrow of the story: know the risks and let your pet enjoy them only under direct supervision.

    News: JoAnna Lou
    First CPR Guidelines for Pets
    Researchers identify the ideal rate for chest compressions

    Demand for pet first aid and CPR classes has increased as animal lovers look for ways to be prepared in an emergency. Until recently there was no standard for the canine and feline version of the procedure, despite the fact that laboratory animals were instrumental in developing CPR guidelines for people.

    Researchers from the University of Pennsylvania and Cornell University set out to change that by looking at decades of peer-reviewed data to determine the proper rate for chest compressions. Earlier this month they published the first set of evidence-based guidelines for resuscitating dogs and cats with stopped hearts.  

    The researchers found the ideal rate of chest compressions is 100 to 120 per minute, the same rhythm used for humans. Doctors and medical students have found it helpful to think of the Bee Gees disco hit, Stayin' Alive, to help keep the ideal beat when performing CPR.

    Fortunately sudden cardiac arrest is not as common in dogs as it is in people. It's thought that the condition in pets is closer to what occurs in young athletes with structural abnormalities of the heart muscle or a defect in the electrical circuitry. Pets can also suffer cardiac arrest due to difficulty breathing or a severe illness that also affects the heart.

    Now that there's a CPR standard in place, I hope that veterinarians will be more proactive about getting this information out to pet parents. I would also like to see pet first aid certification becoming a requirement for those who work in animal-related fields like pet stores or doggy daycares.

    Have you taken a pet first aid class?

    News: Shea Cox
    Keeping Dogs Safe in the Summertime

    This morning, as I watched my partially bald dog Dharma bask in the sun’s rays, I was reminded of the risks that the sun and heat can pose to our pups. It has prompted me to discuss a few sun tips to help keep our dogs safe- while still having fun- this summer season.

    Despite all that fur, it’s important to be aware of the risks of sunburn in your pet. Dogs, especially those with short hair, white fur, and pink skin, can easily sunburn, and this can be just as painful for your dog as it is to us. Limit your dog’s exposure during peak sun hours (between 10 a.m. and 3 p.m.) and apply sunblock to the ears and nose 30 minutes before going outside. Products available to protect dogs from sunburn include vests that block ultraviolet rays and pet-specific sunscreen made with ingredients repellent to dogs to keep them from licking it. If you are unsure that your sunscreen is pet-safe, double check the label to make sure it doesn’t contain zinc oxide (Desitin) or salicylates (aspirin); these can be toxic if licked off and ingested in large amounts. Stomach irritation can also occur if excessive amounts are ingested, so be careful about putting too much on in an area where they can lick it. If your dog has lupus or pemphigus (a condition that results in a crusty appearance to the nose), consult with a dermatologist before putting sunscreen on his or her nose or before letting outside.

    While out at the beach, it is imperative to always have a fresh water source available and offer it frequently. If your dog gets thirsty, he may begin to drink the only available water, which is often salt water, and this can lead to toxicity. A few gulps of salt water won’t harm your dog, but watch for vomiting and early neurological signs of salt poisoning such as dullness and depression.

    Scan the water and sand for jellyfish. Be aware of sea lice that can cause itchy red bumps on dogs. Salt can be irritating to paws and skin, too. Rinse salt water and sand from your dog’s coat after swimming. Always clean and dry ears after a swim. Water that remains in ears, especially from a dirty lake, can result in a bacterial ear infection.

    Running on the sand is strenuous exercise, and this can easily lead to heat stroke. A dog that is out of shape can also easily pull a tendon or ligament, so keep a check on your dog’s activity. Hot sand (and pavement) can blister delicate pads that are new to these hot surfaces.

    For dogs who enjoy the sport of boating, just like people, he or she should always wear a life jacket. Make sure that the life jacket fits properly and let your dog get used to having it on while swimming before going deeper into the water.

    If you have a breed that is predisposed to eye problems (such as a Pug or Shepherd), you may want to consider Doggles to help protect their precious peepers.

    And finally, never, ever leave a dog unattended in your vehicle in the summer months. Heatstroke and death can occur within minutes in warm temperatures and we have already treated several cases of this in our hospital over the past 2 weeks!!  You can read further about heatstroke (what and what NOT to do) here. 

    I hope these tips help keep your pets safe during these upcoming summer months!

    Have a doggy sun-proofing idea? Please share!

     

    Wellness: Healthy Living
    A Bumper Crop of Parasites
    Dog with Fleas

    Heartworms and hookworms and fleas, oh my!! Get ready- the forecast is that this year’s combination of unseasonably warm winter temperatures and plenty of springtime precipitation is going to produce a deluge of parasite problems for our pets including: heartworm disease, fleas, ticks, and intestinal parasites (roundworms, hookworms, whipworms, tapeworms).

    The Companion Animal Parasite Council (CAPC) predicts a substantial nationwide rise in parasites above normal levels. Hardest hit will be the southern portion of the United States (West Virginia, Virginia, North Carolina, South Carolina, Georgia, Florida, Alabama, Tennessee, Mississippi, Arkansas, Oklahoma, Texas, and Louisiana). The CAPC anticipates that 2012 will be a “banner year” for heartworm disease, and that even the slightest deviations from administering heartworm preventive as recommended could pose significant health threats for pets.

    The CAPC is also predicting a jump in parasite populations within the Northeast (Maine, Vermont, New Hampshire, Massachusetts, New York, Rhode Island, Connecticut, New Jersey, Pennsylvania, Delaware, Maryland, the District of Columbia) and the Midwest (Kansas, Missouri, Illinois, Indiana, Ohio, Michigan, Wisconsin, Iowa, Minnesota, North Dakota, South Dakota, Nebraska), particularly in areas with above-average temperatures and rainfall. During the past five to ten years, the incidence of heartworm disease has been on the rise in both the Northeast and the Midwest.

    Washington, Oregon, and Northern California are expected to experience moderate increases in companion animal parasite populations this year. The parasite forecast for Southern California, Arizona, New Mexico, Nevada, Utah, Colorado, Wyoming, Montana, and Idaho is moderate compared to other regions in the country.

    Sounds like there will be no hiding from parasites this year! In order to protect your dogs and cats from these pesky varmints I suggest the following:

    1. Talk with your veterinarian about the products best suited for protecting your dogs and cats against heartworm disease, intestinal parasites, fleas, and ticks. There are a variety of products to choose from and their effectiveness can change from year to year. Your veterinarian will be “in the know” about which preventive medications have the current best track record. Be reminded, animals with thick hair coats or those who are housed mostly indoors remain susceptible to heartworm disease.

    2. Be downright religious in adhering to a schedule for administration of your pet’s heartworm prevention medication. This year in particular, missing the mark by even a week or two could have dire consequences.

    3. Set up a schedule for routine testing for parasites. Your veterinarian can advise you on how frequently your pets should be screened for intestinal parasites and heartworm disease.

    4. Check out the CAPC website to have a look at parasite prevalence maps (updated monthly) and get information about your specific geographic area.

    5. Visit the American Heartworm Society website to catch up on the most current information pertaining to heartworm prevention for dogs and cats.

    Are you “good to go” with a parasite prevention plan for your dogs and cats? What will your strategy be?

     

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