health care
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.

Wellness: Health Care
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.

    Dog's Life: Lifestyle
    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?

    Dog's Life: Lifestyle
    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?


    Dog's Life: Lifestyle
    Sago Palm Alert
    Plant and its seeds are toxic to pets

    One of the highlights of my weekend was the successful treatment of an adorable puppy named Leeloo. After being hospitalized for nearly 72 hours, she thankfully fell into the percentage of dogs who survive the ingestion of this highly toxic plant: the sago palm.

    Sago palms are not really palms at all; they just look like one. The sago palm is a cycad and contains the toxin cycasin and even very young plants are toxic enough to cause death in pets. Contrary to popular belief, all parts of both male and female plants are toxic, with the seeds being the most lethal component.

    The reddish-orange seeds are round to oblong in shape and can be a little bigger than a golf ball in mature plants. Many dogs seem to enjoy chewing on these bitter seeds, which leads to nothing but trouble. I’ve even heard talk of people throwing the seeds like a ball for their dog, completely unaware of the deadly dangers!

    Like Leeloo’s family, many people are unaware that the plant is deadly. And even if they have heard of the toxic effects, they don’t realize that the plant they are purchasing is actually a sago palm! Why is this? The plants are becoming increasingly popular in all areas of the country, and are often sold as unmarked potted plants in stores such as Target and Home Depot. They are simply labeled as a “palm tree,” without any warning label, and people are not aware that they are bringing home a potentially lethal plant. Over the past five years, the ASPCA Animal Poison Control Center has seen an increase in sago palm toxicities by 200 percent, and according to their data, 50 to 75 percent of cases result in the death of the pet. This number includes pets that are euthanized due to the cost of care; on a slightly brighter note, 68 percent of those pets that are treated early are reported to survive.


    Dogs who have ingested any part of the plant soon begin vomiting, and this can be accompanied by diarrhea, depression, and lack of appetite. Liver failure generally occurs within 24-36 hours following ingestion, and in most cases, intensive treatment is necessary. If it has been 4-6 hours since ingestion, your veterinarian will attempt to induce vomiting, as well as give charcoal to help absorb the toxin. Intravenous fluids for 72 hours, medications to help support liver function, and possibly the transfusion of blood products are needed. Frequent monitoring of liver values will help to determine if your pet will survive the exposure.

    Leeloo was a lucky survivor and we were able to keep her from going into liver failure with early and intensive treatment.  Sadly, there was a case a couple of months ago that involved one of our police dogs, and he did not survive. The officer had a sago palm in his yard for 5 years, unknowing of the danger, and his canine partner decided to chew on a seed after leaving it alone all that time. So please, if you share your home or yard with a sago palm, now is the time to dig it up and dump it in the garbage. Make sure you are disposing of it in your “actual” garbage, and not your compost or yard waste bin, as these contents are often mulched and repurposed, putting the palm back into the environment where other pets can be exposed. If you believe that a pet may have eaten any part of a sago palm, please seek veterinary care immediately!


    Wellness: Health Care
    The Dangers Snail Bait Poses to Pets
    Awareness and prevention of “shake and bake” toxicity

    Spring is one of my absolute favorite times of the year. The arrival of new bulbs and blossoms breaking through the earth makes me giddy. It’s the official kick-off of another season in the garden and I look forward to the earth’s welcoming party. But spring also brings snails, followed close behind by the perennial gardening-season danger, snail bait.

    Gardeners around the country use snail bait to keep plant-munching slugs and their ilk out of gardens, and it constitutes the most common poisoning agent in my community. Unfortunately, it’s extremely toxic when ingested by pets. During the spring and summer months, I treat pets poisoned by snail bait at least once a week.

    The toxic substance found in snail bait is a compound called metaldehyde. Malicious poisoning is generally not the issue. The majority of toxicities are accidental, either due to lack of knowledge of its dangers or thinking that the compound has been properly stored or applied: Dogs are notorious for getting into things they shouldn’t or into places you think they can’t!

    Snail bait is formulated in chewable pellets that are flavored with molasses, apple and bran to attract the snails. Unfortunately, our dogs find this a tasty treat as well. Snail bait is also available in liquid and powder formulations, which can get onto paws and be licked off with normal grooming. Additionally, many of these products also contain insecticides, which make the exposure potentially even more toxic.

    Snail bait is highly toxic and even small amounts are enough to cause poisoning: less than a teaspoon per 10 pounds of body weight can cause life-threatening clinical signs in your pet.

    What are the symptoms of snail bait poisoning?
    Signs of poisoning begin quickly after the bait is ingested. Generally, the first clinical signs observed are anxious behavior with mild twitching. This progresses to uncontrollable and severe twitching, followed by seizures and possibly death if not treated promptly.  

    Severe twitching equates to constant muscle contractions, and this can raise the body temperature so high that permanent brain damage can result. This clinical course has lead to the colloquial emergency room term of “shake and bake syndrome.” Click the link to watch a short video that demonstrates what mild clinical signs of snail bait toxicity look like.

    Making the diagnosis
    Generally, the appearance of the twitching patient is characteristic, and a diagnosis can be made even if there is no known history of snail bait exposure. A radiograph may be recommended to try to evaluate stomach contents. If this is a known exposure, remember to grab the package containing the snail bait so that your veterinarian can evaluate the active ingredients.

    What is the treatment?
    There is no direct antidote for snail bait toxicity and treatment is aimed at controlling the clinical signs. Treatment includes possible induction of vomiting, supportive care with IV fluids, medications to control the twitching or seizures, “stomach pumping” and enemas to help rid the body of the toxin, and charcoal to help absorb any substance that remains in the body.

    At home, your yard should be hosed down with water to dissolve any remaining bait and your dog should be restricted from the area for a two-week period.

    Will my dog return to normal following toxicity?
    Chance of recovery is largely determined by how much poison was ingested, how quickly therapy was initiated and the general health of your pet. While this is a serious type of poisoning, most pets fully recover if treated promptly and properly. If your dog is not successfully treated, death can occur within 4 to 12 hours.

    I love my dog, but I also love my beautiful garden—what are alternative ways to keep snails at bay?
    For the above reasons, I do not use toxins for snail control in my yard; I try a more natural route and accept that some of my greenery will have “snail art” throughout the leaves. But I also realize that this approach is not for everyone, so, what are the options?

    Wrapping self-adhesive copper barrier tape (available in many garden supply stores) around the rim of plant pots or containers deters slugs and snails with a tiny positive electric charge that is given off by the tape.

    One of my favorite alternatives is to purchase predatory snails known as Decollate snails. These snails do not pose a health hazard to pets, birds or other mammals and they have been used in gardens and landscapes throughout the temperate regions of the United States for nearly 150 years. This famous predator snail comes out of the leaf mulch or soil at night and eats the eggs of slugs and snails as well as feeding on the young snails. The Decollate Snail can live for two years and lays a small amount of eggs on a regular basis so there should always be many new protectors in your garden.

    You can also purchase various commercial snail traps. There are also many “home-made” snail traps options as well. For more information, watch this video  demonstration of how to control slugs organically, helping to protect your garden without fear of harming your pets.

    As always, prevention is better than cure and hopefully this article has raised your awareness of the dangers of snail bait. If an accident does happen, it is critical to seek veterinary attention immediately. If you suspect snail bait ingestion, please go directly to your veterinarian immediately as every minute counts!

    Wellness: Health Care
    Three-Legged Dogs Do Adapt
    Second Opinion
    Three Legged Dog

    About a year ago, I walked into a busy waiting room, called a patient’s name and was rewarded with the kind of life lesson usually delivered by dogs. A woman in her early twenties (I’ll call her Lauren), with cropped, bleach-blond hair and a healthy tan, struggled to hang onto her frisky retriever’s leash. From a distance, I thought I saw one of her arms in a sling, hence her difficulty, and rushed right in with, “Can I give you a hand?” The question got away from me and found its mark before I realized my grievous mistake — Lauren had no right hand. Lauren was an amputee.

    Not my best opening gambit, but, thankfully, Lauren laughed and took me up on my offer. By the end of our consultation, I was completely in awe of her refreshing attitude toward the change in her body’s appearance. She had lost most of her right arm (and she was righthanded) in a car accident, and I loved the fact that she had absolutely no inhibitions about wearing a spaghetti strap top, laughing off her physical limitations and refusing to be defined by them. Her confidence and manner said it all.

    It was the first time I had ever witnessed, in a human, a sentiment I have perceived in so many three-legged dogs over the past twenty years. Amputation conjures mental images of civil war, genocide, unsightly stumps and puckered scars from which we avert our eyes, swallow hard and try to act as though we are perfectly comfortable with raw disfiguration. We forget that such talents as sleight-of-hand magic are for people, not other mammals. Sure, reservations and psychological projections are perfectly logical, but our dogs are focused on far weightier matters such as the absence of pain and the ability to ambulate. They remind us that, for them at least, Pride is not a deadly sin.

    My job requires me to convey precisely this reassuring message to anxious owners battling two relentless and alltoo- common demons — fear and denial. So when Zoe, a seven-year-old brindle Boxer, and her owner, Ellyn, walked into my examination room, I knew I had my work cut out.

    “I’ve been to two other vets,” said Ellyn. “They both think it’s a badly torn ligament in her knee and she needs surgery.”

    In my experience, Boxers are always fun, their bouncy and exuberant demeanor a challenge during my hunt for clues as to the cause of a lameness. Perhaps this was why Zoe struck me as all wrong. She carried her right hind leg completely off the ground, her wet eyes conveying a “don’t want to play” attitude.

    No one wants to hear, “It’s not a torn ligament, it’s a tumor,” but a brief palpation followed by a set of damning x-rays brought us to a predictable moment in which I would attempt to justify an amputation.

    Ellyn looked lost, trying to stay with me, clawing her way back after being felled by my diagnosis and shocking therapeutic option.

    “Zoe actually has three really positive factors in her favor,” I told her. “First, the tumor is in the knee joint, destructive but slow to spread to other areas of her body. With an amputation, there is a good chance Zoe might enjoy a normal lifespan. Second, this is a back leg and not a front leg. Since dogs carry about 60 percent of their weight up front and 40 percent in the back, losing a back leg is usually a little easier than losing a front. Finally, and most importantly, Zoe is already a three-legged dog. She doesn’t put weight on her right hind leg. Zoe has completely adapted to life on three legs. Believe me, she’ll be grateful to be rid of a useless appendage weighing her down, causing her pain.”

    It took a while, but Ellyn finally agreed to the surgery. On the day of Zoe’s discharge from the hospital, I watched their reunion from afar. Ellyn was visibly nervous, afraid for the transformation in her dog’s appearance, but what impressed me most was this woman’s determination to connect with the dog she loved. When Zoe trotted out, Ellyn never hesitated; she was all about reassurance in her eye-to-eye contact, sneaking a sideways glance at the incision as she fussed and hugged and convinced her Boxer that nothing between them had really changed.

    A month or so later, I checked in with Ellyn by phone.

    “What have you noticed since the surgery?” I asked. “I mean, when you take Zoe for a walk, does anyone say anything?”

    “Sometimes,” she answered. “I passed two women the other day, and the first loved her up and never said a word about her missing leg and it was great, but then another one got all upset and worried about how Zoe could possibly cope, and I found myself getting really angry at her.”

    Hmm, I thought. Perspective can be a funny thing.

    “And what about your other Boxer? How’s he acting around Zoe?” “Absolutely no different,” said Ellyn. “It’s as though it never happened.”

    I smiled, hesitated and said, “I like that,” thinking, once again, it takes another dog to see all that matters, proving a point that what counts hasn’t changed one little bit.

    Wellness: Health Care
    Idiopathic or “Old Dog” Vestibular Disease
    Vestibular signs in dogs are often incorrectly referred to as a stroke

    A fairly common reason for a veterinary visit is the concern that an older dog has had a stroke, when he suddenly starts walking like a drunken sailor with his head tilted. I know of other cases, where these sorts of symptoms are assumed to be a brain tumor and the dog is euthanized—maybe unnecessarily. (The condition plays a role in the new Hallmark movie, Duke.)

    Well, I want to shed some light on a much more common and less concerning cause of these and other disturbing signs, something known as idiopathic vestibular disease, in case it is something you ever experience with your own geriatric dog.

    Idiopathic (meaning unknown cause, think: idiot) vestibular disease is a syndrome that looks really, really bad, but usually gets better all on its own with little or no treatment.

    The vestibular system
    The vestibular system is composed of portions of the brain and ear and is responsible for maintaining a sense of balance. When something goes wrong with this system, it’s like being drunk on a rocky boat. Dogs with idiopathic vestibular disease have some combination of the following signs:

    • A head tilt,
    • An unsteady gait, loss of balance, or falling over,
    • Circling in one direction,
    • Eyes rapidly moving from side to side, known as nystagmus,
    • Sudden vomiting.

    These videos show a dog with mild, but very typical, vestibular signs and another dog with more severe signs.

    Now for the caveat: These clinical signs are unfortunately not unique, or diagnostic for, idiopathic vestibular disease and other things can cause this same presentation. These can include (yes) a brain tumor, an inner ear infection, inflammatory disease or sudden bleeds into the brain—to name a few. But with that being said, when the symptoms seemingly appear out of nowhere in an older dog, I always recommend a “wait-and-see approach,” treating symptomatically and supportively, as there is a good chance of improvement.

    Wait-and-see approach
    For a dog showing the above signs, I first discuss the possible causes. Next, I recommend blood work and a blood pressure check to make sure there is no “obvious” disease. I discuss the availability of an MRI to evaluate the inner ear and brain. Although an MRI allows for the best evaluation of disease, it is often not pursued due to cost (about $1,500 here in the Bay Area).

    I examine both ear canals, and if an infection is suspected, I discuss antibiotic therapy, as inner ear disease is one of the possible causes of vestibular signs. The inner ear (pictured below) is something you cannot see during an exam because the eardrum obscures the view to the inner ear. The eardrum is like a closed door that sits in front of the middle and inner ear. However, if there is a nasty looking outer ear and an inflamed eardrum, there is a chance that inner ear disease could be present as well.

    If the dog’s clinical signs are so severe that they cannot walk, I then recommend supportive care with IV fluids and injectable anti-nausea medications. Urinary catheters are sometimes placed for hygienic reasons. If clinical signs are mild, pets can often be managed at home with over-the-counter meclizine (for the feelings of “motion sickness” they experience). We also provide instructions for general nursing care as well as how to protect from falls.

    The conversation ends with discussing a very loose rule of thumb: If there is gradual or complete improvement within 72 hours, it is likely idiopathic vestibular disease and additional diagnostic testing is not necessary. If there is no improvement or progression of signs, it is likely something much more serious, such as a tumor, and an MRI would be recommended to reach a definitive diagnosis. With idiopathic vestibular disease, marked improvement is usually evident in this time frame, with the pet returning to normal in 7 to 14 days (although in some dogs, a head tilt will still persist).

    It should also be noted that this is not a painful condition, and my recommendations stem from the fact that euthanasia is a permanent decision, so why not wait and see, giving time a chance? There is a high likelihood that improvement will be seen and the difficult decision of euthanasia can always be made at a later date if there is no improvement or if there is a change in your pet’s quality of life. I feel there is reason to hold out hope and be cautiously optimistic, as idiopathic vestibular disease is the most common form of vestibular disease in dogs. It is the direction I would take if it were my own boy experiencing this.

    Please note: There are times, however, when a physical exam points undeniably to a brain tumor, but these neurological exam findings are beyond the scope of discussion, so feel free to ask me any questions.