Wellness: Health Care
A vet’s perspective
Skin lumps can be tricky. we stick them with a needle, suck up some cells, smear the sample on a slide and take a peek down a microscope, but sometimes we still can’t make a diagnosis. This leaves us with the option of surgery on a lump of unknown provenance and the dilemma of how wide an excision to make. If the culprit is benign, the surgery need not be radical. But what if the lump is malignant? Should the surgeon be aggressive, just in case? How on earth do we strike the perfect balance?
From time to time, I am presented with precisely this kind of case. Hannah, a Shar-Pei, was seven years old when her owner noticed an innocuous but slightly pigmented and raised skin mass on her left forelimb. The referring veterinarian had performed a local excision and in doing so, achieved his foremost objective: a diagnosis — in this instance, the troubling discovery of melanoma.
“The margins were dirty,” said Hannah’s owner, Barbara. “Do you think you can get what was left behind, given the location?”
On the extremities of the body, particularly the face and limbs, loose skin is at a premium compared to the chest and abdomen. When doing surgery, a veterinarian’s natural tendency is to take less to ensure that the hole left behind will close. On occasion, some owners will question whether the original surgeon was at fault. Barbara was not one of those owners.
“Sure,” I said, pinching an inch around the scar. “It’s always difficult to decide how aggressive you should be when the lump is a mystery. But now that we know it’s a melanoma, Hannah can also reap the rewards of a treatment not even available in human medicine.”
Barbara looked confused.
I was talking about the first fully licensed anti-cancer vaccine to be approved by the USDA: the canine melanoma vaccine, Oncept™.
“You mean Hannah could have been vaccinated against melanoma?”
“Not quite,” I said.
“The vaccine is therapeutic, not preventive.”
I went on to tell Barbara that melanoma cells express large quantities of a protein called tyrosinase. The vaccine incorporates DNA that expresses a gene for the human version of tyrosinase. When the dog’s immune system recognizes this human protein as a foreign substance, it mounts a response. Fortunately, the human version is similar enough to its canine counterpart that the stimulated immune system attacks the melanoma tumor cells.
“Why not vaccinate all dogs?” asked Barbara.
“Malignant melanoma is quite common, affecting about one in every 20 dogs with cancer, but it’s still not common enough to justify widespread vaccination.”
“So when do we get started?”
“We don’t, or at least I don’t — I’m not allowed. For now, only board-certified oncologists can administer the vaccine: four doses, inside of the thigh, every two weeks, and then a booster every six months. I’ll have you meet with one of our oncologists and she’ll give Hannah her first treatment once she recovers from the surgery.” And this was what we did for Hannah after the pathologist confirmed that my surgical margins were clean.
While the vaccine is primarily aimed at oral melanoma, especially where the tumor is locally invasive or has spread to local lymph nodes, many oncologists are keen to reap its benefits for melanomas in other locations. One of the appealing features of the treatment is its lack of side effects. Some dogs may develop a low-grade fever, but that’s about it. The biggest deterrent may be the price; in our hospital, an initial course of vaccinations will set you back around $2,000.
It is important to bear in mind that the vaccine is not a cure. For dogs with early-stage melanoma, like Hannah, survival times greater than three years can be expected. For dogs with more aggressive types, a median survival of one year might be more realistic (but much improved from the previous expectation of only two to three months with other therapies). Oncologists have also seen periods of remission in dogs with visible spread of the cancer to the lungs.
One of the lessons I learned from my experience with Hannah is that the vaccine appears to be more effective the earlier it is given; sometimes the disease will progress while you are waiting for the immune system to kick in. In removing a bleeding but benign skin lump on a 16-year-old Jack Russell named Charlotte, I snipped off a small lip mass in the spirit of “while you’re at it.” As so often happens, the seemingly incidental lip mass turned out to be the more serious concern when the pathology report came back: malignant melanoma.
“Charlotte’s way too old for chemotherapy or radiation therapy,” said her owner, Ann. I didn’t even try to argue, but I did mention the vaccine.
Guess who booked the first available appointment with oncology!
*Bergman, P. J., et al. 2006. Development of a xenogeneic DNA vaccine program for canine malignant melanoma at the Animal Medical Center. Vaccine 24(21): 4582–85.
Wellness: Health Care
What not to do at the vet’s office.
Most dog guardians love their vets and, for the most part, the feeling is mutual. After all, we’re working together for a common goal: good health and happiness for our best friends. Most vets accentuate the positive. Dr. Susan Wagner, a veterinary neurologist and author of “Through a Dog’s Ear,” praises the thoughtful generosity of her human clients. “The good ones will even take out checkbooks and pay for a person in need,” she says. “They more than make up for the bad ones.”
Every now and then, however, people make their vets’ lives more difficult. We asked vets to share some of their “pet” peeves, which are rarely about the pet and mostly about, well, us.
Not surprisingly, no-shows, lateness and general rudeness are high on the list. Dr. Nancy Kay, author of “Speaking for Spot,” explains, “Arriving late for appointments is a biggie, especially for new clients who need to fill out paperwork. Our receptionists always advise arriving a bit early but, invariably, some clients arrive late and then wonder why we can’t fit everything we need to do into the office visit that day.”
“We probably average about one missed appointment a day,” says Dr. Arthur Wolfheiler, an Ohio vet. Sometimes clients walk in without an appointment or even bring along an extra pet. Adding insult to injury, they may also try to wiggle out of paying for the additional exam. Dr. Bruce Coston, author of “Ask the Animals,” has had the same experience. “This trashes our schedule and makes other people wait unnecessarily,” he observes.
A failure to communicate (à la “Cool Hand Luke”) ranks as the biggest peeve inside the exam room. Perhaps from embarrassment, clients may neglect to mention that their dogs are aggressive or particularly nervous in vets’ offices, and some — amazingly — laugh when the dog bites. “Getting bitten or scratched hurts! It’s not funny. That’s why we place muzzles on your fractious pets,” says Dr. Coston.
Dr. Nick Trout, author of “Ever by My Side,” agrees. “No one likes to hear, ‘Oh, I forgot to mention, he tends to bite’ when you are checking to see if you just lost a finger.” The vets suggest that you speak up before the dog bites, and if your dog does bite or scratch, don’t laugh. An apology is in order.
To facilitate communication, remember that you should be doing the talking, not your dog. “Probably one of my biggest peeves,” says Dr. Trout, “is when I’m trying to have a discussion with an owner and their dog refuses to stop barking. The owner seems quite happy to talk over the barking as though only I can hear it.”
All conversation should be directed, of course, to the vet and not to your cell phone. Here’s how Dr. Wolfheiler handles cell-phone rudeness: “When people take a call while I’m examining their dog,” he says, “I start questioning the dog: ‘How’ve you been feeling? Got any complaints?’ I hope the people take the hint.”
Communication problems also arise when a friend or neighbor unfamiliar with the dog’s history brings the pet in for an exam. Dr. Kay lists “Thou shalt be present” as one of her 10 commandments of veterinary visits. “Given the choice,” she writes, “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.”
"And husbands,” Dr. Wolfheiler adds —“98 percent of the time it’s the wife who brings the dog in. The husband often doesn’t have a clue.”
These vexing problems demonstrate the challenge of getting an accurate medical history. Dr. Trout comments, “Obviously, our inability to communicate directly with the patient means we rely on the owner for chronology and detail so we can be methodical and thorough in our examination.” He describes listening in frustration as married couples argue over their dogs’ symptoms and habits.
Finally, we humans sometimes just don’t answer a simple question. “For example,” Dr. Kay explains, “I might ask whether the person has had to fill the water bowl more or less than usual. This should evoke a ‘yes’ or ‘no’ response, followed by an explanation. Instead, I might get a response like, ‘Oh, he’s always loved water,’ or ‘I only give him bottled water.’”
Acquiring information needed to diagnose our dogs’ problems and assess their needs is often the vet’s greatest hurdle. To illustrate, Dr. Wagner relates the following story. A colleague was questioning a client on the phone, trying to discover a cause for his dog’s anemia. Explaining that sometimes a swallowed metal object is the culprit, the vet asked, “Has your dog swallowed anything unusual?” No response. “Maybe a coin?” No dice. Feeling desperate, the vet asked, “Could we take an X-ray?” The guy on the other end suddenly said, “Hold on,” and shouted, “Hey, Ma! When’d he eat the doorknob?”
Dr. Wagner offers this wry piece of advice: if your dog has swallowed a doorknob, you might want to mention it to your vet.
Dog's Life: Lifestyle
New prosthetics give dogs a normal life
Dogs are amazing creatures who are able to live in the moment and adapt to anything that comes their way. I've met dogs missing one or two legs who barely seem to notice that they are different from the other pups. We definitely have a lot to learn from the canine mindset!
Recently a Red Heeler named Naki'o became the first dog to be fitted with a complete set of bionic legs. The prosthetics are built to mimic muscle and bone to allow dogs to run, jump, and swim. The prosthetics were designed and fitted by Martin Kaufmann, founder of Orthopets.
Just after they were born, Naki'o and his siblings were abandoned after their family's home was foreclosed. Weakened by malnourishment and the harsh Nebraskan winter, Naki'o got his paws stuck in freezing water and developed severe frostbite at the tender age of five weeks old.
Soon after, the puppies were rescued, but not before Naki'o lost his paws, leaving all four of his legs with rounded stumps. Amazingly, Naki'o adjusted by crawling around on his belly.
After Naki'o was adopted, his new family organized a fundraiser to pay for two prosthetics on his back legs. Naki'o took to his new legs so well that Orthopets decided to fit his front legs free of charge. It was the first time Orthopets set up an animal with a complete set of bionic legs.
There was an adjustment period, but just a few days later Naki'o was already running around. Now Naki'o routinely beats Christie's other dogs to the ball!
Dog's Life: Lifestyle
Exposure to dogs can be beneficial for developing immune systems
I don’t currently have kids, but one of my fears is that my future children may become allergic to my dogs. Fortunately, a new study found that having pets in the house could potentially lessen the risk of developing allergies.
The study, led by Ganesa Wegienka, MS, PhD, of the Department of Public Health Sciences at Henry Ford Hospital, set out to answer one of the most popular questions parents have—whether pets will increase their baby’s risk of developing allergies.
Researchers followed 565 children from birth through the age of 18. They found that boys who lived with a dog during the first year of their life had about half the risk of developing allergies as compared to those without a dog in the house.
Interestingly the study did not find a connection with girls and dogs, but both sexes had a smaller risk of developing a feline allergy if they lived with a cat. Researchers have determined that the first year is the most important exposure period when it comes to allergies.
What has been your experience with kids and pet allergies?
Dog's Life: Lifestyle
IRS denies request
Tank was diagnosed with cancer. When his guardian, Victor Mills, attempted to withdraw money from his retirement plan to pay for treatment, the request was denied. Withdrawals for certain types of emergencies are allowed, but the American Bulldog’s cancer was not considered a qualified “unforeseeable emergency.”
Mills says he told his plan administrator that it made no sense that he could have used the money to play for a roof, a furnace or a sidewalk but not a living creature.
He is appealing the ruling with the Internal Revenue Service, though it’s already too late for Tank. He passed away at the end of May.
News: Guest Posts
Whistleblower questioned product claims, fired
In response to a 2009 class action lawsuit against Merial, Ltd., over the effectiveness of its popular heartworm preventative, Heartgard Plus, Kari Blaho-Owens, Ph.D., claims her employer asked her to destroy a document pertaining to the lawsuit and to stop analysis of data from an internal investigation that she suspected was inaccurate.
In her own lawsuit against Merial, Blaho-Owens says she was fired in July 2010 when she refused to follow the company directives. She served as the "global head of pharmacovigilance" and in the course of her independent research, says she "discovered that Merial had been aware of serious lack of efficacy adverse events reported regarding 'Heartgard Plus' since as early as 2000." Allegedly, the U.S. FDA's Center for Veterinary Medicine was questioning whether its FDA-approved label that Heartgard Plus was 100 percent effective should be changed, which could put Merial at a competitive disadvantage.
Dog's Life: Lifestyle
What’s your dog’s risk?
Most dog guardians have some idea what to look for in terms of health issues based on the breed of their dog. Those who have Pugs and Bulldogs know that respiratory problems may crop up, while those with Dachshunds and Bassett Hounds are aware that their dogs are more likely than many other breeds to have back issues.
A recent study of almost 75,000 dogs over a period of 20 years delved deeper into serious health concerns that are breed related. Dr. Daniel Promislow and Dr. Kate Creevy investigated the causes of death in 80 breeds from 1984 to 2004 and published their study in the Journal of Veterinary Internal Medicine. Their findings include many expected results as well as some surprises.
As predicted, they found that small breeds such as the Chihuahua and Maltese have high rates of cardiovascular disease, but they learned that the Fox Terrier does, too. It was no surprise that Golden Retrievers and Boxers are at high risk for cancer, but the finding that Bouvier de Flandres die from cancer at an even higher rate was unexpected.
Understanding what the causes of death are across breeds is important for two different reasons. One, it may help explain a paradox within domestic dogs: Typically, larger mammals live longer than smaller ones, but in dogs, little dogs have longer life spans than bigger ones. Knowing the causes of death may help explain why this is so.
Two, knowing what diseases and health problems a dog is at risk for based on breed can help veterinarians screen for, diagnose and treat health problems earlier. This may result in better management and treatment of these issues, which can prolong life and improve the quality of life for dogs. For rare breeds especially, veterinarians may not see enough individuals in their practice to elucidate the patterns for risk that they notice in more common breeds, which makes studies with large numbers of dogs, such as this one, so valuable.
What health risks are you aware of based on the breed of your dog?
Dog's Life: Lifestyle
It’s true for dogs and people
Firefighters saving lives—it’s a story that never gets old, especially when the story has a twist. In this case, the individual who was brought back from the brink of death was not human. Tammy Rodriguez performed cardiopulmonary resuscitation on a Pit Bull who was in a fire that destroyed several floors in two buildings. That CPR, along with the oxygen she administered, saved the dog’s life.Hours later, the once apparently lifeless dog was happily wagging his tail and licking Rodriguez’ face at the fire station. Rodriguez has three dogs herself and would want someone to do the same for them if the need arose. The understanding that dogs are part of our families fueled her deep desire to make sure that this dog survived. Has your dog’s life been saved, either dramatically or not, by the efforts of someone in your community?
News: Guest Posts
Poisonous species are more common than you might think.
I remember the sad sinking feeling I experienced last August as I read an email from my friend Diana Gerba. Seeing her email in my inbox initially prompted excitement—oh goodie, more photos and stories about Donato, Diana’s adorable Bernese Mountain Dog. My excitement quickly morphed into utter disbelief as Diana described the death of her barely six-month-old pup caused by ingestion of a poisonous mushroom.Diana’s heart was broken. As she wrote in her email: “A special boy, Donato was a silver tipped puppy, a rarity in our breed. With his tail always wagging, he had boundless enthusiasm for life. He was a happy little chap and was my joy. He loved me and I him. We were a team ordained by the stars.” Every region of the country is different in terms of mushroom flora. Where I live in northern California, Amanita phalloides (aka Death Cap) is the most common poisonous species and grows year round particularly in soil surrounding oak trees. Ingestion of a Death Cap mushroom causes liver failure (in people and in dogs)—makes sense given the liver’s function as the “garbage disposal” of the body. Symptoms typically include vomiting, diarrhea, lethargy, loss of appetite, delayed blood clotting, and neurological abnormalities. Every year at my busy hospital, we see at least a handful of dogs with liver failure clearly caused by mushroom ingestion. In spite our very best efforts, the individuals who survive mushroom poisoning are few and far between. Affected people can receive a liver transplant; no such technology available (yet) for dogs. To learn more about poisonous mushrooms, visit the North American Mycological Association and Bay Area Mycological Society websites. If you suspect your dog has ingested a mushroom get to your veterinary clinic or the closest emergency care facility immediately (choose whichever is most quickly accessible). If possible, take along a sample of the mushroom so it can be professionally identified if need be.
Fortunately, my friend Diana has managed to put a positive spin on the loss of her beloved Donato. Not only does she have Tesoro, a new little Berner boy in her life, she has made it her personal mission to warn people about the potential hazards of mushroom toxicity in dogs. She created an educational flyer (feel free to download and post it wherever dog-loving people congregate.) Diana sent a blast email out just a few days ago after finding a Death Cap mushroom in her yard. Coincidentally, today I discovered several mushrooms on my property while beginning the task of weeding my garden. They’re gone now, but given our current weather pattern, I’m quite sure there will be more tomorrow. What can you do to prevent your dog from ingesting a poisonous mushroom? Clear any mushrooms from your dog’s immediate surroundings, and be super vigilant on your walks, particularly if you have a pup (youngsters love to put anything and everything in their mouths) or an adult dog who is a known indiscriminate eater. Learn more about which poisonous mushrooms grow in your area and what they look like. And, please remember, if you see your dog ingest a mushroom—get yourselves to a veterinary hospital as quickly as possible (even if it is after hours). Ingestion of even a nibble of a toxic mushroom is life threatening, and the sooner treatment is started the greater the likelihood of saving your best buddy. Are you aware of poisonous mushrooms in your neck of the woods? If so, please share where you live (city and state) and the name of the mushroom if you happen to know it. Best wishes for good health.
Dog's Life: Lifestyle
A doctor learns the hard way not to mix human and canine drugs
A few weeks ago Dr. Randi Hutter Epstein wrote in the New York Times about almost killing her dog Dexter. Fortunately the German Shepherd is on the path to recovery now, but not before going through a harrowing ordeal. And one that could have been easily prevented.
In December, after a romp in Central Park, Dexter came home with a limp in his arthritic leg. In an effort to save money and a trip to the veterinarian, Dr. Epstein gave Dexter a dose of prescription ibuprofen left over from her son’s root canal.
After a day and a half of the medication, Dexter stopped eating and couldn’t control his bladder. Dr. Epstein soon found out that ibuprofen can be lethal to dogs (and many other animals, like cats). Poor Dexter ended up in at the veterinarian’s office for seven days. Over a month later, he’s still on antibiotics and needs to be walked every three hours.
It’s important to know that people medicine should not be given to your pet unless directed by a veterinarian. Even if you are a people doctor! Dr. Epstein learned the hard way that although some human medicines are prescribed to dogs, you can’t assume that for all drugs.
I know many people will jump to criticize Dr. Epstein, but despite what an embarrassing and dangerous mistake it was (even her 14-year old son made fun of her), I’m glad that she decided to share her story. Hopefully the millions of readers who read the New York Times will learn from her potentially deadly situation.
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