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?”
Wellness: Health Care
Healing maladies holistically.
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.
Dog's Life: Lifestyle
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:
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!
Wellness: Health Care
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:
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
Treating chronic pain in dogs.
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
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.
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