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News: Guest Posts
Advances in Veterinary Care Come at a Cost
How do you put a price on love?

In his recent story for The New York Times, William Grimes provides an interesting look at recent advances in veterinary care, especially in the treatment of cancer (including bone marrow transplants), urinary-tract disorders, and even dementia. Thanks to improved technology, drugs, surgical techniques and holistic care—there are many more options for keeping our dogs and cats healthier longer. All of which comes as a comfort to those of us with pets.

But as with human medical care, these interventions come at a price, often a high price, for animals who are only very rarely covered by insurance. Bills can easily run into the thousands of dollars, even the tens of thousands, making for a difficult cost/benefit calculation. Grimes suggests it comes down to the question: “Precisely how much do I love my dog?”

I’m not sure that’s really the question. Sometimes loving your dog might mean forgoing expensive treatment. Extending a dog’ life by a few months with painful surgery, frustrating crate-rest and a long, slow recovery—regardless of the cost—may not be the most loving gesture.

If you read the story, be sure to check out the comments. The story sparked an interesting conversation about how we value our dogs, with many personal, heartfelt stories. I’d love to hear how Bark readers have navigated these difficult questions.

Wellness: Health Care
Ten Commandments of Veterinary Office Visits
Become an advocate for your dog

How much easier it would be if vets had Dr. Dolittle’s ability to talk to the animals—when we took our pups in for a check-up, they could speak for themselves. Since that’s not the case, our dogs rely on us to act as their advocates in the exam room. In Dr. Nancy Kay’s ground-breaking book, Speaking for Spot, she provides us with the tools we need to do just that, relayed clearly and with gentle humor. We’re pleased to offer our readers a sample.

Here are 10 tried-and-true secrets to making every visit to your dog’s veterinarian exceptional for you and the entire office staff. They also directly benefit your dog’s health—and nothing is more important than that.

I: Thou shalt push thy veterinarian off her pedestal.
Much to my supervisor’s chagrin, I adamantly refuse to wear a white lab coat. I agree that it would keep my clothing clean and help me stand out as a doctor, but I shun it because I believe it hinders relaxed, open conversation with my clients. (I don’t think dogs are crazy about white coats either.) I’m referring to what is known as the “white coat intimidation factor,” a phenomenon that gives the doctor an air of authority and superiority. When she is on such a “pedestal,” two-way communication flounders. Medical advocacy requires active client participation, and a client who is intimidated does not feel comfortable voicing an opinion.

In most cases, the pedestal on which a veterinarian resides is a figment of the client’s imagination. I’m delighted that the profession is viewed favorably, but vets truly don’t deserve any extra helpings of adulation. So, before you arrive at the veterinary clinic, prepare yourself to “push” the vet off her pedestal. Remember, this is a simple mind-over-matter endeavor. And if your vet clings fast to her pedestal, consider choosing a different teammate!

II: Thou shalt be present.
A face-to-face conversation with your vet is invariably more valuable than connecting later via phone or email. Actually being there allows you to view X-rays and see how to administer medication. And don’t forget, given the choice, your dog would absolutely, positively want you to be by his side! So, do not ask your mother, your brother, your housekeeper, the kid next door or anyone else to pinch-hit for you. Unless you’ve had recent discussions with your veterinarian to arrange a procedure, if at all possible, avoid simply dropping your dog off at the veterinary hospital in the morning before you go to work or school. If this is truly necessary, consider arranging a discharge appointment, during which time you and your veterinarian can talk about your dog face-to-face.

When a dog is experiencing significant symptoms or is sick, it helps to have all the decision-makers present at the time of the office visit. If this is difficult to arrange, the person present should take notes, and even consider tape-recording the conversation with the vet. This is useful, since details inevitably get lost in translation—especially when traveling from spouse to spouse! Consider bringing the kids along (unless they will create a significant distraction), as they can be wonderfully uninhibited sources of information and keen observers of their dog’s habits.

Lastly, turn your cell phone off before entering the exam room. A client who answers a call while I am discussing her dog’s health isn’t truly “there” with me.

III: Thou shalt let the staff know if thy dog is aggressive.
All dogs are capable of unpredictable behavior. A savvy veterinary staff can usually peg an aggressive pooch within seconds of meeting him. Occasionally, one surprises us and bites—either a member of the staff or the client. Everyone feels terrible, but it’s made far worse when we learn that the client knew it could happen, but failed to warn us.

I clearly recall a nasty bite to my hand with no warning glare or growl to clue me in. As I stood by the sink washing my wound and muttering under my breath, the client had the audacity to inform me that the same thing had happened to the last veterinarian they had seen! I momentarily fantasized about biting her, but showed tremendous restraint.

If your pup has previously growled or attempted to bite in a clinic setting, it is vital that you divulge this information. Trust me, withholding such important information is the quickest, most effective way to alienate yourself from an entire staff, and you will not be welcomed back. The flip side of this coin is that veterinarians have nothing but respect for the client who brings along a muzzle that’s just the right fit.

A dog acts out of character in a hospital setting for a number of reasons. Pain, fear, a bad experience or the need to protect their human can all provoke aggression. Fortunately, there are many humane ways to work effectively with an aggressive dog: chemical sedation or muzzling is a reasonable option. Sometimes, simply separating a dog from his human subdues this aggressive tendency. Restraining with brute force (a.k.a. “brutacaine”) is never warranted.

IV: Thou shalt provide information.
The “history” of your dog’s health, past and present, is exceedingly important, more so than many people realize. This often provides more clues for a correct diagnosis than the actual physical examination. Your vet will want to know if you’ve seen any changes in behavior, appetite, thirst or energy. Report any vomiting, diarrhea, coughing, sneezing, decrease in stamina, or change in bladder or bowel habits. Do some sleuthing on the home front.

Medication and Diet
Bring your dog’s current medication to every visit, so drugs and dosages can be confirmed. Your veterinarian will want the name and strength of the drug, not just a description of the tablet. (Many medications come in the form of small, round, blue pills!) All too frequently, we come across a prescription that has been dispensed, or is being administered, incorrectly.

And, know the brand name of the food your pup eats. The color of the bag and name of the store where it was purchased simply won’t give your veterinarian adequate information.

Prior Medical Conditions
First-time visitors to a vet clinic should have in hand their dog’s vaccination history as well as any medical records, laboratory test results and X-rays that pertain to prior problems. If your dog’s recent symptoms or medical history are somewhat complex, it helps to see a concise written summary of events. For example, when your dog has had a seizure disorder for the past nine months, providing a journal of the dates and duration of the seizures might be extremely helpful. By the same token, it is possible to provide too much information. I once received an inch-thick log of many months’ worth of a patient’s bowel movements—including weights and lengths (I couldn’t possibly make this stuff up).

V: Thou shalt confess everything.
If your dog has trained you to feed him nothing but table food; if you have been sharing your own prescription medication with your pooch; if he fell out of the back of a pickup truck because he was not properly tethered; even if he has just eaten a plate of marijuana-laden brownies—you must force yourself to rise above any embarrassment or awkwardness and be truthful with your veterinarian.

I once had to confess to a large-animal vet that I’d fed rhododendron trimmings to my goats. Rhododendrons are toxic to goats, causing terrible abdominal distress—something every veterinarian learns in school, but I’d somehow managed to forget. Ingestion requires immediate and specific therapy, so my confession facilitated my goats’ complete recovery, thank goodness. I still feel a wee bit embarrassed when I cross paths with the vet who saved them. Ah, the things that keep us humble!

VI: Thou shalt pause for confusion.
It is just about impossible to do a reasonable advocacy job if you don’t understand what your vet says. As the saying goes, “What we don’t understand, we can make mean anything.”

Most veterinarians, myself included, lapse into “medical speak” because we are so used to these terms running around in our heads. We might say to a client, “Ruffy is in renal failure and needs aggressive diuresis,” instead of, “Ruffy’s kidneys aren’t functioning properly, and we can help him by giving him intravenous fluids.” We need you to stop us in our tracks when we confuse you. If you are a “visual learner,” ask your vet to draw a picture or show you what she is talking about on your dog’s X-rays, lab report or ultrasound images. Remember, always “pause for confusion”—when you don’t understand, stop and get clarification.

VII: Thou shalt share thy concerns.
Most veterinarians do what they do because they appreciate how much dogs mean to their humans. Who better, then, to empathize with you? To help you, your vet needs you to tell her your particular worries and concerns:

• Are you feeling scared or angry? (Anger is a normal stage of the grief process—many people experience it in response to a dog’s illness.)

• Are financial limitations creating a roadblock?

• Are you convinced your dog has a terminal disease?

• Are you terrified by the thought of anesthetizing your dog because a beloved pet once died unexpectedly while under anesthesia?

• Are you receiving pressure from family or a co-worker to put your dog to sleep, but you don’t think it’s time yet?

Your vet will be better able to understand your reasoning if she knows how you are feeling, and you will receive a much-needed dose of empathy.

Financial Matters
It’s never easy discussing financial worries—candor suffers because the subject is often awkward and much too personal. Clients feel guilty and worry about being judged when cost needs to be a factor in medical decisions. Be aware, though, you should discuss this matter up front. Be sure to get an estimate before services are provided so as to avoid any unpleasant surprises. Ask about payment plans or prioritization of services. Most veterinarians are willing and able to provide reasonable financial options.

VIII: Thou shalt ask questions.
Asking questions is the most resourceful way to be your dog’s medical advocate. In the heat of the moment, when you have received some disconcerting news, a child is tugging at your arm and your dog has just lifted his leg rather too near the veterinarian, it is easy to forget the important questions you were meaning to ask. It pays to write them down beforehand. No doubt you will do some homework and research when you get home, and you will invariably think of more questions you should have asked. No problem. Veterinarians expect clients to call with questions after they’ve had some time to process and ponder the information they’ve received.

IX: Thou shall treat the entire staff well.
I get really peeved when I learn that a client, who has been sweet as can be with me, has been abrupt, condescending or rude to one of my staff. Everyone deserves to be treated with equal respect, and, without a doubt, the entire staff will know if this has not been the case! Likewise, a client who has been respectful and gracious will have the “red carpet” rolled out the next time she visits.

X: Thou shalt always come away with a plan.
What do I mean by this? It is this simple: Every time you talk with your veterinarian, be sure you know exactly when and how you will next communicate. Consider the following examples:

• Your six-year-old Norwegian Elkhound has just had his annual checkup, and, much to your delight, everything is completely normal. The “plan” is to bring him back in one year for his next “annual.”

• Your three-year-old Chihuahua-Jack Russell Terrier mix has just been evaluated for coughing, and prescribed an antibiotic and cough suppressant. The “plan” is to call the hospital in one week to report whether or not the cough has fully resolved. If not, chest X-rays and a blood test will be scheduled.

• Your Golden Retriever puppy has a heart murmur. Ultrasound reveals a problem with the mitral valve in his heart. Future prognosis is uncertain. The “plan” is to repeat the ultrasound in six months, or sooner if coughing or decreased stamina is observed.

• Your Terrier mutt just had surgery to remove bladder stones. At the time he is discharged from the hospital, the “plan” is to feed him a special diet to prevent stone reformation, return in two weeks for removal of the stitches, and schedule a two-month follow-up to recheck a urine sample.

Vets often fail to provide clear follow-up recommendations and well-intentioned clients often fail to comply with them. Do your best to solidify the “plan” and put it in writing. You’ll be glad you did.

 

News: Shea Cox
How to Care for a Bleeding Pet

Working in the ER, I often see dogs suffering from blood loss as a result of trauma, which can become life-threatening if not properly treated. If bleeding is severe or continuous, a dog can lose enough blood to cause shock.

Shock from blood loss is classified as hypovolemic shock, which basically means that there is not enough fluid (blood) circulating throughout the body. Without an adequate volume, organs such as the kidneys and GI tract are not being perfused (nourished), and this state can quickly turn deadly. Your veterinarian can tell if your dog is in shock by physical exam findings such as a high heart rate, a low blood pressure and weak pulses.

Did you know the loss of as little as 2 teaspoons of blood per pound of body weight can result in shock? This blog post describes ways to control bleeding in your pet during transport to your nearest veterinary hospital.

The following techniques are listed in order of preference. As a word of caution: The first rule when dealing with an injured pet is to avoid injury to yourself. Take appropriate precautions, such as the use of a muzzle, to avoid being bitten. You can create a “make-shift muzzle” by using a long piece of material such as a men’s tie, non-retractable leash or piece of cloth. All too often, I see owners having to make a trip to the emergency room for themselves as well as their pet.

The best way to learn these techniques is in a pet first aid class. April is Pet First Aid Awareness Month, a perfect opportunity to sign up for pet first aid classes, which are offered by local chapters of the American Red Cross, some shelters and humane organizations. Also, it's a good reminder to have a complete pet first aid kit (which includes a muzzle) among your dog supplies.

Direct pressure
Direct pressure on a wound is the most preferable way to stop bleeding. Gently press a pad of clean cloth, gauze or even a feminine sanitary napkin over the bleeding area: this will absorb the blood and allow a clot to form.

If blood soaks through, do not remove the pad. This will disrupt the clot; simply add additional layers of cloth and continue the direct pressure more evenly. The compress can be bound in place using loosely applied bandage material, which frees your hands for other emergency actions. If you don’t have a compress, you can apply pressure with a bare hand or finger.

Elevation
If a severely bleeding wound is on the foot or leg, and there is no evidence of a broken bone, gently elevate the leg so that the wound is above the level of the heart. Direct pressure of the wound must be continued in addition to elevation.

Elevation uses the force of gravity to help reduce blood pressure in the injured area, slowing the bleeding. Elevation is most effective in larger animals with longer limbs because of the greater distance from the wound to the heart.

Applying pressure on the supplying artery
If external bleeding continues after you have used direct pressure and elevation, you can use your finger or thumb to place pressure over the main artery to the wound. For example, if you have severe bleeding on a rear leg, you would apply pressure to the femoral artery, which is located in the groin (on the inside of the thigh). If you have severe bleeding of a front leg, you would apply pressure to the brachial artery, which is in the inside part of the upper front leg.

Tourniquet
Use of a tourniquet is potentially dangerous and should only be used for life-threatening hemorrhage in a limb. If you see blood spurting or pumping from a wound, which, luckily, is a rare occurrence, consider the use of a tourniquet.

Use a 2-inch wide piece of cloth or leash, and wrap it around the limb twice and tie it into a knot. Then tie a short stick or similar object into the knot as well. Twist the stick to tighten the tourniquet until the bleeding stops. Secure the stick in place with another piece of cloth and write down the time it was applied. Every 20 minutes loosen the tourniquet for 15 to 20 seconds. This is potentially dangerous and can result in the need to amputate the limb.  Remember, a tourniquet should only be used as a last-resort, life-saving measure.

Internal bleeding
Internal bleeding is another form of potentially life-threatening blood loss, where blood pools in the abdominal or chest cavity, but does not result in visible blood in the stool or bleeding from the rectum. A few causes of internal bleeding include rat bait poisoning, ruptured masses on the spleen, trauma and sometimes in the case of immune-mediated disease.

Internal bleeding can often be more dangerous because it occurs inside the body, and being less obvious, delays evaluation by your veterinarian. There are, however, some external signs of internal bleeding, which can include any of the following:

  • Your pet’s gums appear pale to white.
  • Your pet feels cool on the legs, ears or tail.
  • Your pet is coughing up blood or having difficulty breathing.
  • Your pet is unusually subdued; progressive weakness and sudden collapse may be observed.
  • Your pet has a painful belly when it is touched.

If your pet is bleeding externally, or you suspect any internal bleeding, immediately transport your pet to your veterinarian or to your closest emergency hospital for treatment.  I hope you never have to use the information in the blog, but I feel it is important for everyone with a pet to know.

News: Shea Cox
The Trouble with Puddles
Giardia, not muddy paws

Diarrhea. Boy, do I see lots of this, and when I say “lots,” I mean lots. In fact, on some shifts, it feels like that’s all I see. One of the common causes of diarrhea in dogs worldwide is giardia, a ubiquitous single-celled protozoan parasite. Giardiasis is transmitted by a fecal-oral route, meaning that the parasite is swallowed in food and water (think: puddles, lakes and streams) contaminated with feces. Note: Your pet does not have to eat feces to get the parasite!

Infection can be present without symptoms, but when signs are present, the most common one we see is large volumes of watery feces, oftentimes with blood and mucus. Weight loss, decreased appetite and vomiting can occur as well.

How is the diagnosis made?
Diagnosis is often made by evaluating fecal material under a microscope. However, this little parasite can be difficult to find. So, in addition, we use a nifty “snap test,” adding some stool to a solution that gives us a positive or negative result (like a pregnancy test for poop). This test is very sensitive to the presence of giardia.

How does one treat this parasite?
Generally, easily and inexpensively, provided your dog doesn’t get so ill that he or she needs IV fluids or hospitalization. The little puppy pictured is named Rascal, and he was hospitalized due to an infection with giardia. His diarrhea came on fast and furious, and because teeny puppies don’t have much “wiggle room” when it comes to bodily reserve, it caused a critical drop in his blood sugar. He required more intensive hospitalization, and made a full recovery.

Giardiasis is generally treated with an inexpensive antibiotic called Metronidazole (Flagyl) that is readily available. In small puppies, such as Rascal, or dogs sensitive to this antibiotic, a dewormer known as Panacur can be used instead for five to ten days.

How do I prevent it?
This best way to help prevent infection is to keep your dog from drinking from puddles, lakes, streams or other sources of stagnant water. I know, this can be difficult.

Dog park puddles carry a higher risk than, say, fresh rainwater pooled in a birdbath or fountain. Remember, giardia is transmitted by a fecal-oral route, and what better place to have concentrated levels of feces than a dog park, especially when some pet parents are not diligent about removing their doggy’s waste. Think of it this way: If a dog infected with giardia defecates on the grass, and the rain creates a puddle of water in grass, your dog is essentially drinking a giardia martini.

It may also be advisable to treat other animals in the same household while treating the infected, symptomatic pet. There is a vaccine available for giardia in dogs, but most veterinarians don’t recommend it unless your dog is at really high risk or is one of those pets who gets giardiasis frequently.

Don’t forget: People can get giardia too. Younger children are at a higher risk as hands often find their way to mouths during outside playtime (grass can be contaminated with giardia cysts as well). And those adorable doggy kisses we love so much? Let’s just say that it is easier to accidentally ingest one of those little cysts than you might think.

There are also environmental control measures that can be taken to prevent reinfection. People should be vigilant in clearing fecal material from the environment. If your pet has been diagnosed with giardia, it is often recommended that you wash as many areas of your environment as possible, followed by disinfection with a solution of bleach diluted in water (another measure that is easier said than done).

As with anything medical, there is no one clinical sign that equals a definitive disease, and diarrhea happens to be of the most common clinical signs of any disease process. Because of this, if your pet has diarrhea that persists beyond 24 hours, or is very sudden and severe, a veterinary exam is in order.

And, on that note, I’ll leave you with this closing mantra: No drinka da puddle, no snout in da bay. Pick up poop in da yard, quickly throw it away!

News: Guest Posts
Free Eye Exams for Service Dogs
Plus, five simple eye-care tips for all pups

One of my favorite types of dog stories to read or write are those that feature working dogs. From guide and assistance dogs to search-and-rescue and arson-detection dogs, I am always inspired by their ability and willingness to do what we ask and in the process transform our lives. So I was thrilled to hear about the 5th Annual ACVO/Merial National Service Dog Eye Exam Event.

Channeling the spirit of service, more than 200 board-certified veterinary ophthalmologists throughout the U.S., as well as Canada and Puerto Rico, provide free eye exams to thousands of service dogs. Last year, a record 4,000 service animals received exams.

During the complete ocular exam, the veterinary specialists look for problems including redness, squinting, cloudy corneas, retinal disease, early cataracts and other serious abnormalities. Early detection and treatment are vital. Just think about how critical good vision is to these dogs with jobs and all of those who depend on them.

To qualify, dogs must be active “working animals” that were certified by a formal training program or organization or currently enrolled in a formal training program. Additional registration details can be found at www.ACVOeyeexam.org.

Owners/agents for the dog(s) must first register the animal online from April 1–30, 2012. Once registered online, the owner/agent will receive a registration number and can then contact a participating veterinary ophthalmologist directly to schedule an appointment, during the month of May. Appointment dates and times are filled on a first-come, first-served basis.

Eye care basics
Meanwhile, good eye care is important for all dogs, and the American College of Veterinary Ophthalmologists has provided these five simple steps for protecting all our dogs’ precious vision.

  • Clean ocular discharge with a warm, wet washcloth.
  • Do not use eye medications prescribed for a previous eye problem for a new eye problem.
  • When buying a pure bred dog ask if the parents have had their eyes certified by an ophthalmologist.
  • If you suspect vision loss or eye discharge persists for more than a day, see your veterinarian.
  • Don’t let your dog hang his or her head out of the window when you are driving.
  • News: Guest Posts
    A Cautionary Tale About Breed Standards
    Jane Brackman, PhD

    In the beginning was the word and the word was dog and the people made more dogs and used more words to differentiate those dogs until they had more than 400 different kind of dogs and more than enough words to explain the differences.  —Doctor Barkman

    Breed standards are one of the tools breeders use to suspend change in purebred dogs. But breeds evolve anyway, even when standards remain unchanged. How is that so?

    Exaggerated traits come and go with fashion. If the standard says the skull should be “very short from the point of the nose” to the eye (Bulldog), or “egg-shaped” (Bull Terrier), fashion will dictate the length and shape of the head. A note of caution though—breeds are not mix-and-match combinations of thousands of small parts where you pick and choose what you want. They’re more like combinations of genes, pre-packaged in bundles and shuffled around. A whole lot of genetic stuff, good and bad, goes along for the ride when a breeder pulls out a trait.

    This is what a Bulldog looked like in 1900...

    ...and today.

    A Bull Terrier in 1900...

    ...and today.

    If the standard says, "The ears are extremely long," in a hundred years the ears will be really, really long.

    This is a Bassett Hound in 1900...

    ...and today

    Some breed haven't changed much in a century.

    This is the German Pointer in 1900...

    ...and today.

    A standard is a handy tool for dog show judges who need to evaluate dogs in competition, but it doesn’t suspend change. It’s really just a lexical snapshot of a breed on its way to being something else. Breeds evolve. It’s the breeder’s job to make sure they evolve in a healthy way.

    To learn more, read the entire article about how standards influence purebred dogs in unintended ways.

    News: Shea Cox
    Investigating Halitosis
    Bad breath may not be a sign of dental disease

    Halitosis is the fancy word for bad breath, and that odor is nearly always a sign of a bigger problem. Just this week, I noted a slightly foul odor coming from my own little girl, Dharma. On closer inspection, I noted that the very top of her canine tooth is beginning to turn brown. Overall, the tooth and gumline appear pretty much normal, but I am suspicious of a tooth root infection lurking below.

    As in Dharma’s case, the cause of halitosis is most often attributed to dental disease, but there are many other sources of odor that should be considered and put on your mental checklist. These can include:

    Metabolic causes:

    • Diabetes.
    • Uremia: This develops with kidney failure, when the body cannot clear urea and nitrogen waste products from the blood.

    Respiratory causes:

    • Inflammation of the sinuses or nasal passages.
    • Cancer/tumors.
    • Foreign objects up the nose, such as a piece of stick, food or even a lodged foxtail.

    Dermatologic causes:

    • Infection of the skin folds around the lips, known as lip-fold pyoderma.

    Dietary causes:

    • Eating offensive smelling food.
    • Eating other odorous substances, such as feces.

    Diseases of the mouth, in addition infection of gums and teeth, your “basic” dental disease:

    • Ulceration of the tissues of the mouth, which can happen with kidney disease or other trauma.
    • Inflammation of the throat or tonsils.
    • Cancer/tumors.
    • Foreign objects.

    Trauma causes:

    • Electric-cord injuries, such as biting a live wire.
    • Fractures.
    • Exposure to caustic agents, such as Tide detergent (Hard to believe a dog would eat that, but I’ve seen it).

    Infectious causes:

    • Bacterial, fungal, viral.

    Miscellaneous causes:

    • Autoimmune causes: A condition where the body can attack itself because it “sees” its own tissues as foreign.
    • Diseases caused by masses in the mouth containing a type of white blood cell known as an eosinophil or eosinophilic granuloma complex.

    Halitosis is a diagnosis that is easily made: Just smelling your dog’s breath at home is the first step. If there is a disagreeable odor, halitosis is present, and there’s a problem. As the list above illustrates, a full spectrum of potential sources of “yuck mouth” exist, and interestingly, as varied as these potential causes can be, sometimes the first clinical sign observed in many of them is odor.

    If the diagnosis is not obvious from a peek in the mouth (such as a bad tooth), further steps will be needed check for other disease. Once the reason of the bad breath is discovered, therapy can then be directed at correcting the cause.

    The major take-away message is that halitosis is not a disease in of itself, but a sign of disease. While bad breath generally indicates an unhealthy mouth, there are many other potential causes to consider, and evaluation of this symptom by your veterinarian is recommended.

    Wellness: Health Care
    Melamine: Toxicity in Dog Food
    Recall Follow-up
    Marion Nestle

    For the last year or so, we have been working on a book about pet food, What Pets Eat, to be published by Harcourt late in 2009. One of the pleasures of a long-term project like this is the time to follow digressions wherever they lead. Last year’s (2007) massive pet food recall was so much of a diversion that it resulted in a spin-off publication—Pet Food Politics:Chihuahua in the Coal Mine —scheduled for release this September by University of California Press.

    The recall made us especially curious about the role of melamine, the substance responsible for kidney failure in pets eating food that supposedly contained wheat gluten. Just a glance at the chemical structure of melamine shows that it is high in nitrogen, a nutrient usually obtained from protein. This made us suspect that melamine must have been added deliberately to boost the apparent amount of protein in wheat gluten, because methods that measure the amount of protein in animal feed count nitrogen, not protein itself. Our suspicions were confirmed. The toxic “wheat gluten” turned out to be wheat flour laced with melamine.

    But why would melamine harm cats and dogs? A quick search for studies of melamine toxicity turned up several performed on rats and mice, but just one on dogs (which dated from 1945).These studies gave the impression that melamine was not very toxic except at extremely high doses. Furthermore, the kidneys of animals who had eaten the contaminated food contained odd crystals that did not look like crystals of melamine.These turned out to be formed from complexes of melamine and one of its by-products, cyanuric acid. Even so, researchers and federal officials were puzzled. They had not heard of associations of melamine or cyanuric acid with kidney failure.

    Really? Our Internet search turned up a brief and not particularly informative abstract of a 1960s study on melamine toxicity in sheep.We thought we needed to look at the entire paper, and found it and others in old bound journals in the Cornell library. These decades-old studies demonstrated that melamine is quite toxic, and causes kidney-related symptoms in animals at doses nearly identical to those reported in contaminated pet food. The studies were designed to test the idea that, because melamine nitrogen is far less expensive than protein nitrogen, melamine might have two useful purposes: (1) as an honest feed additive for ruminant animals, whose microorganisms can convert nonprotein nitrogen to amino acids, and (2) as a dishonest adulterant that makes feed test as though it contains more protein than it really does.

    By following other leads,we also found references to relevant studies from the early 1980s in Italian journals that we had to request through interlibrary loan. These showed that melamine was so frequently used for fraudulent purposes in the 1980s that Italian scientists developed a test for it. They used the test to show that melaminna had been used to adulterate more than half the samples of fish meal they examined.

    Most of the early information about melamine toxicity came from attempts to use it as a drug or nutrient. In the 1940s, investigators explored its potential as a canine diuretic. To follow what comes next, pay attention to the size of the melamine dose in milligrams per kilogram (mg/kg) of body weight, and recall that a kilogram is 2.2 pounds. The 1945 study showed that at a dose of about 120 mg/kg, dogs excreted crystals in their urine but otherwise did fine. In the 1960s, investigators used cyanuric acid (which is 32 percent nitrogen) to feed ruminant animals, and observed no problems even at high doses.Wouldn’t melamine (66.6 percent nitrogen) work even better?

    A South African scientist fed daily doses of about 250 mg/kg to sheep, but most animals refused food and lost weight, and some of them died. Another South African investigator gave melamine doses to a single sheep, starting with 2,600 mg/kg. At such high doses, the sheep died within a few days from kidney damage, and the investigators could see crystals of melamine hanging from the animal’s prepuce. Lower doses of melamine caused sheep to stop eating, especially if their water intake was restricted. These studies suggested that a dose of about 250 mg/kg kills some— but not all—sheep over time.So, by 1968, melamine was known to induce kidney damage when fed to sheep over prolonged periods. Ten years later, American investigators tested melamine in cattle and found that a dose of about 100 mg/kg caused four out of six steers to refuse feed.

    We think these studies are highly relevant to the pet food situation. The FDA reported that melamine could have accounted for 10 percent of the weight of the false wheat gluten, and the false wheat gluten could have accounted for as much as 10 percent of the weight of the pet food. If so, 100 grams—about 3 ounces—of pet food could have contained as much as a gram (1,000 milligrams) of melamine, and an average cat or small dog could have eaten an amount close to the 250 mg/kg level that proved toxic to sheep in the 1960s.

    Recently, investigators from Georgia and the University of California, Davis, have shown that much smaller amounts of melamine can form crystals if cyanuric acid is also present. In cats, doses as low as 32 mg/kg each of melamine and cyanuric acid caused crystallization and kidney blockage.

    We were surprised that neither the university or FDA veterinarians involved in the melamine investigations knew about this earlier work, but we think we can guess why. Papers in international journals are not readily accessible on the Internet, and the old animal feed literature is not likely to be studied these days.We had to discover the papers the old-fashioned way, by going to the library in person, sifting through reference lists, following up leads that sometimes required interlibrary loans and pursuing the reference trail back to its origins.We had the interest and time to pursue these questions. For the veterinarians and FDA officials caught up in the heat of the recall, a trip to the library might have seemed like a luxury they could ill afford.

    We can’t say whether earlier suspicion of melamine would have hastened the recall or improved veterinary care of the sick dogs and cats.But we can say that the old experiments on animal feeding are well worth reading, that it’s best to read entire papers and not just their abstracts, and that libraries still have much to offer that the Internet cannot.

    This article is based on Nestle M., Nesheim M.C. Additional information on melamine in pet food [letter]. JAMVA 231(2007):1647.

    News: Shea Cox
    Can Your Dog Give the Gift of Life?
    The importance of canine blood donors

    Not long ago an adorable Dachshund-mix puppy named Sunny was brought into my ER because he was having trouble breathing and was coughing up blood. A quick blood test determined that he had eaten rat poison. A blood transfusion was required to save his life. He made a full recovery.

    The need for blood or plasma transfusions is a frequent occurrence in our referral hospital, and can be crucial in many situations including trauma, immune diseases, blood-loss during surgery or, as in the case of Sunny, for eating rat bait.

    When a lifesaving transfusion is recommended, the natural question by worried pet parents is, “Where do you get this from?” People are generally surprised when I answer, that just like for us people, there are canine blood banks.

    Canine blood banks
    Veterinary blood banks are a fairly new concept, developed during the past 10 to 20 years, and there are essentially two kinds: collection centers using volunteer dogs and centers that house and care for their own group of donor dogs who live on the grounds of the blood bank.

    Community-based donor programs rely on volunteers to bring in their pets for blood donation. There are several veterinary schools that participate in this kind of program, including University of California, Davis, School of Veterinary Medicine. Incentives to volunteers can include free annual health exams and blood work, heartworm prevention and food. Some programs even offer a return gift of blood at no cost if the donor ever needs it during his or her lifetime.

    Animal Blood Resources is an example of the second type of blood bank. It obtains donors through partnerships with rescue groups, providing a working solution for unwanted adult dogs and cats.

    These donors are given a temporary home where they can frolic and play, including getting trained for agility! Additionally, there is a force of volunteers who groom, cuddle, walk and play with them. After one year of providing their lifesaving service, every animal is adopted into a permanent home in great health and well socialized.

    Could your dog donate?
    Donor dogs must be between one- to six-years-old, weigh at least 55 pounds and be free of any medications. Prior to becoming a donor, all dogs are screened for infectious diseases and are given a full veterinary exam to ensure that only healthy dogs enter a donation program.

    Next, their blood type is determined. Dogs have six major (but up to 13 different) blood types. The preferred donor is antigen 1.1 negative. In the dog world, they are considered “universal donors” and are similar to type-O universal human donors.

    Donor dogs can “roll up their fur sleeves” every 2 to 3 months, but this varies by blood bank. Sedation is not needed—just plenty of head rubs and treats. The blood draw takes about 10 minutes.

    A single donation can be used to save up to four lives, because the blood can be separated into two components, red blood cells and plasma.

    People understand how important it is to donate blood, and the same holds true for our pets. In the case of canine donations, one dog can give the gift of life to many others. One more reason to add to my list of why dogs are my heroes.

    Interested in having your dog become a donor or adopting a retired donor? If you live in California, contact the University of California, Davis, Veterinary Medical Teaching Hospital at (530) 752-1393. Or ask your veterinarian or local shelter.

    News: Guest Posts
    Crufts Show Dogs Disqualified
    Canine controversy erupts into blame game
    Crufts 2012 best in show Lhasa Apso

    England’s most prestigious dog show, Crufts, is now also its most controversial. This past weekend,  several Best of Breed winners were disqualified after health inspections by an independent veterinary surgeon. Of 15 so-called “high profile” breeds (out of more than 200 breeds entered) required to undergo a veterinary exam, six breed winners  failed: the Basset Hound, Bulldog, Clumber Spaniel,  Mastiff, Neapolitan Mastiff and Pekinese. Thus ended their chances of going on to win Best in Show, the highest achievement at Crufts.

    Dog fanciers around the world are in an uproar, claiming that animal rights activists and Jemima Harrison’s 2008 BBC documentary, “Pedigreed Dogs Exposed,” are infringing on their right to breed and show. 

    Best in Show Daily blogger and longtime fancier Billy Wheeler wrote, in part: “Now here is the real rub. It is the vet, who may or may not have ever bred a litter in his/her life, who makes the determination as to whether the Breed winner is worthy of the award, not the judge. I’ll hold to a future post the discussion of how veterinary students are being brainwashed today, but many of you have already run across vets who are not sympathetic to our hobby.”

    Honest Dog blogger Gina Spadafori—who has long lamented the prevalence of cancer that prematurely kills her favorite breed, the Flat-Coated Retriever—says it’s about time. In response to Wheeler’s above comments, she writes, “… I have attended seminars at two separate world-class veterinary conferences where boarded veterinary surgeons and internists said that these extreme structural malformations you so prize has led to dogs whose respiratory systems are so compromised that the animals need to have corrective surgery in adolescence. That’s so they can live a normal life—or in too many cases, just live to middle age.
     

    “ … those veterinarians who ‘may or may not have ever bred a litter’ have sure as hell delivered your litters by C-section, because that’s how Bulldogs come into this world, their heads being too large to be delivered normally. If breeding for these traits isn’t animal cruelty, it’s hard to imagine what is.”

    Some criticize the Kennel Club for singling out 15 breeds for the veterinary exams, claiming it would be more fair—and effective over the long term—for all entrants to undergo the health check. Others think it’s a step in the right direction and the process will evolve as needed.
     

    Do you think the AKC should follow suit with Westminster? Why or why not?  

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