Wellness: Health Care
Would this breakthrough procedure improve a young Lab’s severe dysplasia?
Montilius (Monty) Tiberius is our two-year-old yellow Labrador best friend and faithful companion. On March 12, 2015, he became just the 15th dog in the world to undergo a groundbreaking procedure that, we hoped, would reduce his severe bilateral hip dysplasia and give him a chance at a normal life.
How difficult was the procedure? “On a scale of one to 10, the operation was a 12,” said veterinary orthopedic surgeon Dr. Loïc Déjardin of Michigan State University Veterinary Medical Center in East Lansing, who performed it. Dr. Déjardin is regarded as one of three surgeons worldwide able to execute this delicate operation.
The surgery on Monty’s right hip took nearly four hours. “There were some difficult areas through the surgery, finding just the right depth and shaving some bone away so Monty can access total mobility. Now, we wait and see,” Dr. Déjardin told us afterward. Monty would be closely monitored at six-week intervals for six months post-op.
Taking it slowly was key to Monty’s healing process. As Dr. Déjardin pointed out, “It’s up to you to make sure Monty heals properly, and having him take it easy is important.” My wife Ann and I took his advice seriously. For the next 10 weeks, Monty went outside on a leash to “get busy” as often as necessary; otherwise, he stayed in and rested. During the first four weeks in particular, we handled Monty oh-so-carefully, and our other dogs were kept away so they wouldn’t jump on or play with him.
A New System
Dr. Déjardin had given Monty a Centerline BFX Prosthesis. This trademarked prosthetic biologic fixation “hip system,” created by BioMedtrix Company of Boonton Township, N.J., uses an implant that is approximately eight inches long and made of steel (picture a skinny, steel ice cream cone with a scoop on top).
Unlike standard canine hip replacement implants, which are inserted down the central axis of the femur itself, the Centerline-BFX is hammered into the center of the femur neck; its base protrudes from the bone, allowing it to be secured at the top, attached without being cemented into the pelvis. It’s described as a lever (femur) and fulcrum. In order for Monty to regain complete range of motion, the prosthesis had to be inserted in exactly in the right spot, which required shaving off bone in the pelvic region.
This prosthesis and the procedure required to insert it are so new that they have not yet been fully documented in medical journals. Veterinarians with patients who are candidates for such a procedure would certainly review and study Monty’s case. Particularly if the operation was completely successful, which wasn’t a given.
What made Monty’s individual case special was the fact that he had severe dysplasia in both hips. The femoral head (the “ball” of the ball-and-socket joint) and pelvis area were seriously deteriorated, and he was almost completely lacking a hip socket (the acetabulum).
Before the surgery, when Monty walked, his left back leg dangled and flapped; when he ran, it was as if both hind legs vibrated. On his right side, his leg moved in an awkward semi-circle, like a leaf dangling from a branch. The right hip had the severest degree of lameness and, we were told, made Monty an excellent candidate for the procedure.
The regular prosthesis used for canine hip replacement wouldn’t work for Monty. Rather, in time, it would render him totally lame. During our initial September 2014 consultation with Dr. Déjardin, he explained Monty’s rare condition. He also made it clear that there was no guarantee of complete success. The specialized prosthetic implant would need to be precisely angled into the bone and secured around muscles that had already formed, which was risky. Additionally, the depth of the implant couldn’t be known until the actual surgery, another risk factor.
Before the surgery, Proto-Med Company in Colorado made 3D models of Monty’s hip (pelvis) and femur from CT scans. Dr. Déjardin practiced on the models, rehearsing the surgery to reduce the margin of error.
In weeks five to eight after his surgery, Monty was walking very short distances, which we were told was appropriate in order for him to begin strengthening the muscles in his right leg. But during week nine, something seemed to be amiss. One morning, he was fine when he went outside to get busy, but in the afternoon, when it was time for his short walk up and down the driveway, I noticed that he was seriously limping on his right hind leg. When Ann came home from work, I told her about it. She asked me if he’d done anything unusual, and I made what I thought was a joke: I said he ran around the neighborhood and seemed fantastic, which nearly put me outside in our decorated antique doghouse. In reality, I took this development very seriously, and myriad “what-ifs” raced through my mind.
I immediately made an appointment with Monty’s veterinarian, Dr. Thomas Frankmann, at the Animal Clinic of Chardon, who took X-rays. “It’s not good,” were Dr. Frankmann’s first words after he looked at them. “The Centerline implant has completely moved out of the pre-made socket [acetabulum] and is rubbing against bone. This, I suspect, is causing the limp and some discomfort.”
Dr. Frankmann said that he’d never had seen anything like it. “It’s not supposed to do that—these implants are secure. It’s bewildering.”
Dr. Frankmann called Dr. Déjardin for a consultation. Over the next few days, Dr. Déjardin spoke only to Dr. Frankmann. He also scheduled Monty for emergency surgery at MSU to reattach his implant. Needless to say, Ann and I were both sick with worry. We didn’t know what to expect or what would happen to Monty—would he be permanently disabled, or worse, would he even survive another operation?
We never did find out what might have caused this problem. Prior to Monty’s surgery, we heard only from the MSU nursing assistants and Dr. Frankmann, who detailed the severity and risk of the reattachment; Monty’s decaying bone structure and pelvic deterioration raised a concern that the repositioned prosthesis might not hold.
After the nearly eight-hour surgery Dr. Déjardin finally spoke with us directly. As it turned out, he could not save the implant; as Dr. Frankmann warned, it could not be readjusted or replaced. He immediately began a second operation while Monty was still sedated, performing an FHO (femoral head ostectomy), removing the head and neck of the femur to alleviate pain. The FHO is a salvage procedure intended to prevent total incapacitation; it basically allows Monty’s femur to “float” unattached, supported only by scar tissue that creates a false joint. Through physical therapy, he would build up muscle that would help secure the bone somewhat in place.
Two days later, during the five-hour drive to pick up Monty at MSU, I envisioned his feeble body after his first surgery two months prior and reflected on the pain he had endured. I also thought about how many pills he would now need to take; he was up to five medications at one point.
Upon seeing me, Monty couldn’t restrain himself. He tried to jump up but couldn’t because of the weakness in his right leg. He had been shaved, again of course, and seeing him was disheartening. I decided that the operations were finally over; no matter what miraculous cure/invention/procedure was discovered, I would not subject Monty to any more.
Then and Now
Monty has traveled a difficult path to get where he is today. He was diagnosed with “hip problems” as a puppy, but the severity of his condition wasn’t seriously investigated until shortly before he was a year old. Discarded and abused, he had at least three different owners before I adopted him from Joanne Dixon, president of Providing for Paws of Garden City, Mich., a nonprofit rescue organization helping animals in need. Patrons of PFP raised nearly $6,000 during the year leading up to Monty’s first surgery to help with its cost.
We received other financial help as well. Dr. Déjardin waived some of the charges associated with the first operation, and suggested Monty for MSU Veterinary Hospital’s Lucky Fund, which provides resources for specialized cases of dogs in need. The Lucky Fund donated $1,000 toward Monty’s cause.
Nonetheless, next to our home, Monty is our biggest investment, albeit a loving one, and well worth the sacrifice.
As he neared the completion of his weekly physical therapy sessions at Pawsitive Results Animal Rehab Center in Auburn Township, Ohio, his rehab vet, Kathy Topham, was absolutely astounded by Monty’s recovery and his ability to walk almost normally. “He probably won’t be great for search and rescue, but he’ll run, play, jump and maybe make a great therapy dog,” she said.
During our summer beach trip to North Carolina, Monty walked, jogged, swam and was eager to greet every beach-goer who meandered within petting distance. He has a marvelous outlook on life. As Ann said at one point, “He really has made adjustments to compensate for all his ailments; it’s amazing to witness how he moves around.” Monty plays like a normal, healthy, juvenile dog but close observation reveals his physical idiosyncrasies, the split-second adjustments he makes when he walks, runs, squats and lies down.
Monty has changed my outlook on life. We have that dog-human telepathy that most dog people have with their companion animals. However, he’s also “training” me to meet his needs, for which I couldn’t be more grateful.
Humans are ambivalent about life, but dogs are not. Our canine companions befriend us for our greater happiness, making us better people. They elevate our quality of life (teaching us to wag more and bark less, as the saying goes), and love us unconditionally without regard to the situation they’re dealt.
As Ann observed, he follows me everywhere, and watches and waits for me constantly. Now, she says, I owe Monty. I wouldn’t have it any other way. He’s the faithful companion every dog owner dreams about, and that’s my good fortune in this life.
Culture: Readers Write
Every day pets are exposed to various temperature levels from heat to cold, and while it is easy to forget, you really need to consider just how much your pets can be affected in extreme conditions. That’s where we come into play.
We are Pause4Paws, the voice for pets who cannot speak up for themselves. Pause4Paws is a group of sophomore Community Problem Solvers from Flagler Palm Coast High School, Florida. Community Problem Solvers (CmPS), is one of the four competitive components of Future Problem Solving Program, International (FPSPI). FPSPI is meant to stimulate critical and creative thinking skills, encourage students to develop a vision for the future, and to prepare students for leadership skills. In CmPS specifically, we identify real problems in the community, then create and implement real solutions. We all share a strong passion for pets. As Pause4Paws, our mission is to increase familiarity of the dangers associated with climate for household animals so that a healthy lifestyle for them isn’t compromised.
Because we live in Florida, our group knows all too well about how hot it can get. We are called the Sunshine State for a reason—our sunny weather and high temperatures. Occasionally, the heat can be too much for us, and it’s just too hot to stay outside. This does not just apply to humans, but also to our furry friends.
Regardless of where you live and what your weather conditions may be like, a pet still has the possibility of overheating in a matter of minutes. When left in extreme heat, a pet’s body temperature can reach 109 degrees, to the point where it can no longer cool itself to accommodate the heat, a term called hyperthermia. A heat stroke commonly follows elevated body temperatures. Upon reaching these conditions, the pet’s health may begin to take a dramatic turn towards organ failure, damage to the pet’s brain, heart, liver, nervous system, and in extreme cases, death.
By taking a few precautions before spending the day with your pet in the sun, you can decrease the likelihood of your pet from getting injured.
With winter approaching quickly, we can’t forget our friends in states that aren’t as sunny as Florida! While it may be enjoyable to play with your pet in the snow and cold, you need to know what actions to take to keep your pets warm.
As you can see, pets are at risk of danger during the hot and cold seasons. Considering that pets are a part of your family, you need to make sure they stay as happy and healthy as possible. It’s up to you as an individual to take a stand for your pets. After all, they rely on you heavily. You feed them, wash them, love them, and care for them. It’s all up to you! They deserve the best care available to them, just like Pause4Paws’ slogan says, “Best friends need best care.”
It may take more skill than a belly rub, but should massage only be allowed with veterinary supervision? California is the latest state to propose regulating the field of animal rehabilitation, and it could put many kinds of practitioners out of work.
With preventive health care booming, the state’s veterinary board wants to rein in non-veterinary businesses that cater to wellness, saying they “pose a grave danger” to pets and can increase costs for owners. The rule would mean only veterinarians, or physical therapists and registered vet techs, if supervised, could perform animal rehabilitation..
Opponents of the rule say the board has defined the field so broadly, it nets the use of electricity or biofeedback right along with exercise and simple massage used to soothe aching seniors, relax dogs that play sports, and socialize shelter pups.
“It is about defining everything as rehab, even swim facilities and pet certified fitness training,” says Linda Lyman, who attended a recent public hearing in Sacramento to air her concerns. Lyman says she has a PhD in physical education, has taken a canine medical massage course, and for seven years has operated Pawssage, a canine massage practice.
“I go to agility trials every weekend and massage dogs before, between, and after they run. My goal is always to make sure my client’s dogs can hike, walk, and do things with their owners while and when they quit agility.”
As the board’s proposal would have it, Lyman is practicing veterinary medicine without a license. Aside from the hands-on, she makes suggestions that could get her in trouble under the new law. At her recommendation, three clients bought pools for their dogs, for example.
In many states, a background like Lyman’s isn’t needed. Anyone can provide animal massage, including evaluation, treatment, instruction, and consultation. That currently includes California, where only “musculoskeletal manipulation” by the layperson is forbid. Other states call for direct veterinary supervision of the work, or allow it with a vet’s referral. Some require certification, like the state of Washington, where a 300-hour training course in general animal massage, first aid and more is needed.
Whether body workers massage humans, which calls for state licensing but not doctor supervision, or pets, “the good ones survive and thrive and the rest fall by the wayside, certification or not,” Lyman says.
In a few cases, lawsuits have accused vet boards that restrict massage of stifling competition. In Maryland, providers of horse massage successfully challenged the state vet board, and a recent Arizona lawsuit argues that massage is not a veterinary service.
Another meeting will be held on October 20-21, when the board will discuss comments received so far, and possibly vote on the final rule.
Lyman sees more at stake than massage, or any one service, she says. “This is about a pet’s access to all practitioners who can help it maintain a healthy lifestyle.”
Plus brushing tips
We’ve been hearing from a few readers about why one of the most popular dog toothpastes on the market, seems to have vanished off the shelves, they were hoping we could dig into the cause. Its popularity is such that there have even been reports about one tube of it being offered on e-Bay for $75! We did a quick search at our local stores, thinking perhaps this scarcity was limited to other parts of the country, but our sources were right, there is no C.E.T. to be found anywhere. With ingredients that include glucose oxidase, lactoperoxidase, sorbitol, dicalcium phosphate anhydrous, hydrated silica, glycerine, poultry digest, dextrose, xanthan gum, titanium dioxide, sodium benzoate, potassium thiocyanate, it would be hard to think there could be shortages in any of those substances.
We just got off the phone with a spokesperson from Virbac, the maker of this elusive C.E.T Enzymatic Dog & Cat toothpaste, and he said that this product, along with a few of their others, were undergoing a quality production upgrade, and they started to make it again back in July but it takes a long time to get back into the distribution chain, and will be back on the market within 60 days!
Hopefully for those of you who ran out of C.E.T. you will be using an alternative until that time. But here are some facts to underscore how important tooth brushing can be:
If you are new to brushing your dog’s teeth, keep in mind that with patience and a few positive techniques, you can help your dog be more cooperative. Or as Barbara Royal, DVM told us “If your pet won’t tolerate a toothbrush, wrap a piece of gauze around your finger, then dip it in some flavored dog toothpaste (not human toothpaste—it can be toxic!) or a paste of baking soda and water.” Also check out The American Veterinary Medical Association has an excellent instructional video, see below.
For years, I kept a supply of phenobarbital on hand, prescribed by my vet for my mixed-breed dog's seizure. It turned out to be a one-time thing, and eventually, I disposed of the drug. But I can testify that watching her in the grip of it was both scary and confusing.
As dog-lovers, most of us hope we're never faced with a number of canine health conditions. Seizures fall into that category. When they happen, however, it's helpful to understand what we're looking at and what we need to do next.
Seizures, which are caused by abnormal electrical activity in the brain, can indicate a variety of conditions, some transitory, some longer-lasting. Our old friend "idiopathic" --or, of unknown origin--also comes into play more than either we or our vets would like.
As explained on the Texas A&M newswire, "For some dogs, a seizure is a one-time experience, but in most cases seizures reoccur. An underlying problem in the brain could be responsible for reoccurring seizures, often resulting in a diagnosis of epilepsy. Between the many causes of seizures in dogs and the often normal lab results, idiopathic epilepsy proves to be a frequent diagnosis." Other causes include toxin ingestion, tumors, stroke, or another of several related neurological disorders.
Dr. Joseph Mankin, clinical assistant professor at the Texas A&M College of Veterinary Medicine & Biomedical Sciences, describes a typical seizure. “The dog may become agitated or disoriented, and then may collapse on its side. It may exhibit signs of paddling, vocalization, and may lose bladder control. The seizure may last for a few seconds up to a few minutes, and often the dog will be disoriented or anxious afterward. Occasionally, a dog may be blind for a short period of time.”
When a dog is in the grip of a seizure, there's little we can do, other than to keep our hands away from his or her mouth. Afterward, the most important thing we can do is take the pup to the vet for investigation into the cause. Fortunately, a number of treatments, ranging from allopathic (Western medicine) to complementary (including acupunture) exist.
Like most things, especially those related to health, knowing what we're dealing with is half the battle.
For more on this topic, read Dr. Sophia Yin's excellent overview.
News: Guest Posts
With their extremes of limb and coat, purebred dogs may seem more prone to health problems. And don’t breeders even compound defects, as they tinker with uniformity? Yet the dog of many varieties, a potluck of traits, outlasts them all.
Not quite, say U.C. Davis researchers in a recent study lead by Anita Oberbauer in Canine Genetics and Epidemiology. Their analysis of health records of 88,635 dogs, both purebred and mixed breeds, tilts assumptions. So does another recent study, in which they found both populations shared similar risk for 13 inherited disorders. One condition was even more prevalent in mixed-breeds.
Purebreds, and their health records, have made it easier to explore the genetics of diseases that get passed down, the researchers say. But as we hear about the studies, the belief that purebreds are less healthy grows. In fact, many breeds have proven more prone to some diseases, like Great Danes and hip dysplasia.
In this study, they sliced the data thinner. Could particular AKC breed groups, not just individual breeds, be the source? Do the diseases arise from dogs with genomic similarities like working and herding groups? The huge pack of canines, seen over 15 years at U.C. Davis veterinary teaching hospital, showed that ten inherited conditions are more common in purebred dogs. But surprise, not all purebred dogs.
A subset of pedigreed pups tied with mixed breeds for the disorders.
The conditions include aortic stenosis (narrowing above the aortic heart valve or of the valve); skin allergies; bloat; early onset cataracts (clouding of the lens inside the eye); dilated cardiomyopathy (enlargement of the heart chambers); elbow dysplasia (abnormal tissue growth that harms the joint); epilepsy (brain seizures); hypothyroidism (underproduction of thyroid hormones); intervertebral disk disease (affects the disks of the spine, causing neurological problems); and hepatic portosystemic shunt (abnormal blood circulation around the liver, rather than into it).
With a spotlight on the ten maladies, the researchers set out to learn which canines are more at risk. Purebreds were subdivided into categories, then compared to the mixed breeds.
For three conditions common across the purebreds—skin allergy, hypothyroidism, and intervertebral disk disease—many groups had higher prevalence than the mixes. But for seven others, most purebred groups were statistically neck and neck with mixed-breeds. (Aortic stenosis, gastric dilation volvulus, early onset cataracts, dilated cardiomyopathy, elbow dysplasia, epilepsy, and portosystemic shunt).
Terrier groups even bested the mixes for one problem, having less intervertebral disk disease.
Among the purebred groups, health differences were clear. Compared to mixed breeds, terriers and toys were more likely to have two disorders. Herding and hound groups were more burdened with four conditions. The non-sporting group, where pooches ranging from Poodles to Dalmatians fit in, were more likely to have five disorders. Working breeds, animals expected to have grit and vigor; six. Worst in health: the sporting group bred for outdoor stamina. They were more at risk for seven inherited disorders.
In fact, in three categories of dogs bred for endurance—herding, sporting, and working AKC groups—aortic stenosis, the heart condition present at birth, was higher. With narrower focus, other findings emerged. The researchers say the data “suggests that most breeds in the herding group are not at higher risk”—except the German Shepherd, which other studies have also found susceptible.
And while Retrievers were more affected by aortic stenosis, another sporting breed, the Spaniel, wasn’t. For a different malady, Spaniels were the unluckiest. Epilepsy was more prevalent in herding, hound, and sporting groups, particularly the Spaniel breeds.
Early onset cataracts beset both non-sporting and sporting breeds more often.
How did all of these health glitches arise? The study mentions other research that found some diseases, like elbow dysplasia, are more frequent in dogs of related ancestral origin. The so-called “liability genes” may hail from founding ancestors of related breeds, or be the result of human error in the quest for desired traits. This study, the authors say, “may shed light on the possible origin of certain inherited disorders in domestic dog evolution.”
For the ten diseases, the analysis found some purebreds genetically healthier than others. Flipped around, mixed breeds were no healthier than certain purebreds. But both populations may benefit from the work. According to the researchers, defining the lineage associations for such disorders may bring about new therapies.
Better, it could allow breeders to weed out the responsible genes to begin with. Especially at the local level. “Whether breeding reforms will mitigate inherited disorders in mixed-breeds will depend upon the locale,” the scientists say. That is, some regions have a greater potluck of breeds within their mixed-breeds.
Still, since most mixes have purebred ancestors, they say, improvement of the genetic health of purebreds “may trickle down to mixed-breed dogs.”
Wellness: Health Care
Aging pets benefit from close attention to their health
Most parents complain about how quickly their kids grow up. Within the blink of an eye, it seems, children go from diapers to diplomas. Now, imagine squeezing an entire life span into just 13 years, which is, on average, about how long dogs live. (People, on the other hand, have an average span of 77.6 years. ) Because dogs age nonlinearly, one human year can be equivalent to seven to 10 dog years. This means not only that puppies grow both physically and socially at a blazing speed, they also become senior citizens at an accelerated rate. And like their human counterparts, diseases such as diabetes, kidney failure, arthritis, dental disease and cancer become more prevalent with increasing age. While we cannot stop the aging process, there are measures we can take to ensure that our pets live long, healthy lives.
No one likes going to the doctor, and dogs are no exception. Nonetheless, geriatric dogs—defined as those seven years or older—should have routine veterinary examinations every six months. This may seem excessive, but it isn’t when you consider that six months is the equivalent of three dog-years. A yearly exam for a dog is equivalent to an exam every seven to 10 years for a human, and no medical doctor would advise seeing elderly human patients so infrequently. These routine exams are important, as they make it more likely that problems can be diagnosed and treated before they become more difficult to manage.
During these visits, the veterinarian will perform a complete physical and oral exam, and will also ask you about any changes you may have observed in your dog’s behavior or activity. Since dogs cannot tell us their symptoms, it is important that we observe them as we go about our daily routines, because changes in appetite, thirst, behavior and weight may signal the onset of disease.
Diagnostics Make a Difference
While dental disease is not unique to older dogs, it is usually more advanced in seniors due to years of neglect. Just imagine what your teeth would look like if you never brushed them. And it’s not just cosmetic—untreated dental disease can lead to more than just bad breath, but can result in difficulty eating, pain, tooth loss and the spread of infection throughout the body. A proper dental cleaning requires general anesthesia. While anesthesia in older animals may sound scary, age alone is not a risk factor. Here again, screening tests are important, since older animals are more likely to have conditions that require special care when using anesthesia. Your veterinarian will determine if your senior dog needs a dental cleaning and is healthy enough to undergo this procedure safely.
Lumps and Bumps
The shape, appearance, size and location of the mass can give your veterinarian clues as to whether the mass is benign or malignant. However, only a pathologist (who examines the tumor cells with a microscope) can make a definitive diagnosis. Your veterinarian will want to get a specimen, which can be obtained with fine needle aspiration or incisional or excisional biopsy, and send it to pathology. Once the mass is diagnosed, your veterinarian can discuss what treatment—if any—is needed.
The subject of cancer is as scary in pets as it is in humans, but fortunately, there have been significant advances in cancer treatment for our canine companions. Like us, our dogs can benefit from better imaging, such as MRIs and CT scans, and advanced treatment options, which include surgery, chemotherapy and radiation. Ultimately, the key to fighting cancer is early detection. Monitor your furry companion carefully.
Getting old is a normal and inevitable part of life. Though we cannot stop aging, we can take measures to ensure that our dogs’ senior years are truly their “Golden Years.”
Wellness: Health Care
It can’t be cured but it can be managed—partnering with your vet is the key.
Failure is a harsh word. It signifies loss of hope, or defeat. So when your vet diagnoses your dog with chronic kidney failure, how can your heart not sink? That’s why some DVMs call it chronic renal insufficiency (CRI) or chronic kidney disease (CRD) instead.
Maybe you made a vet appointment because your dog spends more time at the water bowl, seems overly thin and shies away from previously loved food. Some pets with kidney disease may also have urinary incontinence, vomiting, diarrhea, bad breath, blindness, depression or lethargy—all of which may be signs that the kidneys’ multitasking capacity is impaired.
These two bean-shaped organs are responsible for water conservation, blood pressure control, salt balance, phosphorus and calcium regulation, and the initial step in red blood cell production. When their performance of these jobs begins to falter, many of the body’s functions start to tumble too. Blood levels of BUN (blood urea nitrogen), creatinine, calcium and phosphate escalate; protein spills into the urine; potassium levels fall; red blood cell counts drop; and blood pressure rises. Your dog starts to feel very unwell, indeed.
Where to Start
CRD affects one in ten dogs (compared to one in three cats), and the initial medical goals are to investigate and address an inciting cause in an effort to halt the disease. The origins of CRD are many: chronic bacterial infections, kidney stones, immune-mediated diseases, high blood pressure, congenital kidney malformations, leptospirosis, Lyme disease, grape/raisin or antifreeze poisoning, cancer. Often, we don’t find the specific reason. We also want to attend to the dog’s clinical signs—dehydration, nausea, weight loss, fatigue—with treatments fine-tuned by test results. If the dog’s getting nephrotoxic drugs like NSAIDs and certain antibiotics, we’ll take him off them too.
CRD is managed, not cured, and your vet will refine her treatment plan by regular monitoring of your dog’s health. Tests recommended every three months might involve a renal panel (CBC and chemistries), urinalysis, urine culture, urine protein/creatinine ratio and blood pressure.
The first signs of CRD—elevations in BUN and creatinine levels—typically occur when the kidneys have lost 75 percent of their function, which has made its treatment challenging. However, Idexx Laboratories now offers a blood test, SDMA (symmetric dimethylarginine), which catches CRD at the 40 percent mark and allows earlier intervention.
Treatment goals for CRD are life-long and supportive, aimed at improving quality of life and slowing disease progression. Since the kidneys perform numerous functions, various medications are used to address specific disorders. ACE (angiotensin-converting-enzyme)–inhibitors are prescribed for hypertension and/or urine protein loss, antacids like famotidine or omeprazole for GI ulcers and overly acidic stomach, maropitant and metoclopramide for nausea. When indicated, phosphate binders reduce nausea, and potassium supplements boost low levels.
Your veterinary team can teach you how to give subcutaneous fluids at home, if needed, to hydrate your dog and flush out toxins. You can also encourage your canine friend to increase his water intake by providing a pet water fountain, adding wet food to his diet, and placing clean bowls with fresh water in multiple rooms. Your vet will also likely suggest a diet change. Prescription diets like Hill’s K/D, Royal Canin Renal MP and LP, Iams Renal Plus, and Purina N/F restrict phosphorus and sodium, reduce protein and add omega-3 fatty acids with B and C vitamins, a combination that has been tested to increase lifespan and overall quality of life. Restricting protein too early, however, can lead to muscle wasting. IRIS, the International Renal Interest Society, endorses a kidney-specific diet when a dog’s creatinine level rises to 2.1 to 5 mg/dl (Stage III). You can also find online support for home-cooked CRD diets via veterinary prescription (see info box). To make it more likely that your dog will accept a new diet, make the switch slowly.
The body does not store water-soluble B-complex and C vitamins, so we need to replace them every day. When dogs have CRD, these essential nutrients wash out too easily with the dilute urine. Prescription foods compensate for these expected losses, and Renal Essentials by Vetriscience, a highly palatable and balanced supplement with vitamins, potassium, fish oil and herbs, can be given twice daily as well.
Studies document that high daily doses of oral omega-3 fatty acids enhance the function of joints, heart, skin, brain and kidneys. In one study, fish oils decreased mortality, improved renal function and diminished protein loss. The recommended dose of marine fish oil, omega-3 EPA and DHA, is 300 mg per 10 pounds of dog weight. Do not use cod liver oil, as it may have excessive A and D vitamins.
In the Manual of Natural Veterinary Medicine, Drs. Wynn and Marsden advocate traditional Chinese herbs for CRD, based on clinical experience. Studies in rats showed that Liu Wei Di Huang/Rehmannia 6 enhanced renal blood flow. Wynn and Marsden have also seen cats thrive for years when started in early-stage CRD on Shen Qi Wan/Rehmannia 8, another important formula. Rehmannia 8, with cinnamon and aconite, is warming, and this combination, when consistently used, can lower BUN and creatinine levels, reduce vomiting and thirst, boost appetite and weight, decrease urine volume, and increase urine concentration. Consultation with a TCVM vet is highly recommended for beginning and monitoring pets on Chinese herbs.
Rounding out a holistic kidney care plan, consider chiropractic to release spinal fixations and improve hind-end weakness that are common with CRD, and acupuncture to enhance the TCVM herbs’ effectiveness.
We who love dogs want our companions to live long and happy lives. If your canine has CRD, you can approach the disease from an integrative approach, maintaining quality of life and slowing kidney degeneration. Optimizing our dogs’ health may involve monitoring and close management, but they repay us with their company and more days of infinite joy.
Dog's Life: Work of Dogs
Expanding the frontiers of the canine capacity to help us carry on.
We can’t find our glasses, our car keys or the right word. We forget an appointment. We’re unable to bring to mind the name of a long-ago best friend. Many of us jokingly refer to these as “senior moments,” but the humor is only skin-deep. Underneath is the niggling worry that dementia—the term for a set of symptoms signaling a decline in mental abilities severe enough to interfere with our daily lives—lurks. This fear is fed by a sobering statistic: according to the Institute for Dementia Research and Prevention, in the U.S., at least 5 million individuals suffer from age-related dementias (Alzheimer’s disease accounts for roughly 70 percent of the total). These numbers will continue to rise as the population ages.
Severe memory loss is no laughing matter. The brain, a mysterious and complex organ, is, among other things, the repository of the very essence of who we are: our memories. Generally speaking, memory breaks down into three broad categories: sensory, short-term and long-term. Things as dissimilar as childhood recollections and how to walk, hold a spoon or comb our hair reside in our memory As damaged nerve cells (neurons) cease to function, they take much of this information with them. This is where dogs come in.
Dogs love routine. People with dementia have difficulty with routine, everyday activities. Roughly a dozen years ago, two people had the idea to put them together. When Israeli social worker Daphna Golan-Shemesh met professional dog trainer Yariv Ben-Yosef, they chatted about their respective occupations. As Ben-Yosef recalled, “It was clear to us that Daphna’s expertise in Alzheimer’s and my expertise with dogs could result in something new.” Together, Golan-Shemesh and Ben-Yosef pioneered the idea of training dogs to help those with dementia to not only feel better but also, to assist with daily activities.
Fast-forward to early 2012, when Alzheimer’s Scotland secured funding to study the possibility that specially trained service dogs could benefit people in the early stages of dementia. Four students at the Glasgow School of Art developed the initial concept as a service design project in response to the Design Council’s 2011 Living Well with Dementia Challenge. Focused on “finding practical solutions to social problems,” the competition required entrants to “design and develop products and services that rethink living with dementia, and launch them as real initiatives.” The Dementia Dog project grew from this call to action.
Dementia Dog is a collaborative effort, with Alzheimer’s Scotland, Dogs for the Disabled, Guide Dogs Scotland and the Glasgow School of Art pooling their respective areas of expertise. Last year, the research phase was completed, and the group is now in the early stages of a small-scale pilot program. As noted on the Dementia Dog website, the program “aims to prove that dogs can help people with dementia maintain their waking, sleeping and eating routine … improve confidence, keep them active and engaged … as well as provide a constant companion who will reassure them when they face new and unfamiliar situations.”
They are also developing programs for two more assistive functions: intervention dogs, trained to help the client with specifically identified tasks, and facility dogs, who enhance the emotional well being of those living in residential care.
The program’s dogs receive instruction at the Guide Dogs’ Forfar Training School. After 18 months’ work, the first two dementia service dogs—Kaspa, a Lab, and Oscar, a Golden Retriever—were certified last year, and two more dogs are currently being trained.
As noted in the program statement, the dogs help their people with core needs: support for daily living (exercise, balance, alerting to hazards, environmental safety), reminders (prompts to take medication), “soft” support (companionship, a bridge to social interaction, confidence building), and physical and emotional anchoring (staying with their person while the partner/caregiver shops, or helping their person feel safe and secure when alone).
The dogs are also trained to provide another critical service: getting their people home safely. The dogs’ collars are fitted with a GPS unit, and if the person doesn’t give the “home” command, the device helps families or law enforcement zero in on the pair’s location. Unlike guide dogs for the blind, dementia dogs operate at the end of a six-foot leash, which allows them to most effectively steer their people in the appropriate direction.
Dementia service dogs are being trained in the U.S. as well. DogWish.org, a California-based charity that trains and sponsors service dogs, lists “dementia dogs” as one of their training options, as does Wilderwood Service Dogs in Tennessee.
This service dog program taps into our almost primal love for dogs in a very personal way. The dogs of our present, the dogs of our past: their names and quirks and the bone-deep understanding of their nonjudgmental and unconditional love often stay with us when much else has been lost. A person living with dementia may not be able to recall what she had for breakfast or where she lives, but the dogs she loved? That’s another story.
In a 1.28-minute YouTube video clip that’s been viewed by more than 5.6 million people (go to see it for yourself), an elderly man with Alzheimer’s who’s lost almost all of his speech talks to and interacts with the family dog. It’s hard to imagine a better example of the very real value that dogs—purpose-trained or not—provide to the most vulnerable among us.
Read deeply touching comments from family members and caregivers about the ways dogs help their loved ones cope at dementiadog.org.
Wellness: Healthy Living
Investigating the microscopic worlds in our dogs may reveal pathways to better health.
The microbiome is the invisible world of the hundred trillion bacterial, viral and fungal microbes that live on us and in us—on our hair and skin, behind our ears and inside our eyelids. The bulk of these miniscule microbes are good guys, gut microbiota that congregate in the digestive tract, where they bolster the immune system, manufacture vitamins and digest food to generate nutrients and energy.
Microbial equilibrium is a delicate balancing act, and a broad spectrum of inflammatory and autoimmune diseases is linked to having too many microbes—or too few. For example, researchers know that significantly lower bacterial diversity is found in both people and dogs with chronic inflammatory bowel diseases.
Teasing out the biological interaction of trillions of miniscule microorganisms that colonize the body, and the role they play in well being, is a new frontier. Will it be a watershed moment in veterinary medicine? Scientists are hopeful. The human microbiome has become a hot topic in biologic investigations, and canine research is fast catching up, much of it inspired by the success of the Human Microbiome Project, launched in 2007 by the National Institutes of Health (NIH). Using stool and tissue samples to isolate microorganisms, researchers are mapping the diversity and normal profile of the human microbial community.
Another undertaking, the Human Food Project, invites the public to submit personal and family microbial samples along with samples from family dogs to better understand how a person’s microbiome compares to that of animals living in the same environment. (The project’s dog segment has been discontinued.) The analysis centers on the anthropological co-evolution of humans, animal and plant microbes to understand modern disease against the backdrop of our ancestral/microbial past.
It’s all about dogs at Companion PBx, a new startup that primarily targets the canine digestive tract. Its goal is to build a cumulative gut flora database and develop dietary products customized for dogs’ digestive health. In January 2015, the company launched a Kickstarter campaign to raise money for construction of the database.
According to Companion PBx Chief Science Officer Kelly Scott Swanson, PhD, who’s on the faculty at University of Illinois, Urbana-Champaign’s Department of Animal Sciences, “By sequencing the microbes in your pet’s sample, we obtain a fingerprint of the microbial community in your pet’s GI tract.”
Microbes in Common
Affected by age, environment, ancestry, evolution, genetics and diet, microbial communities vary widely between species and across individuals within a species. A recent study suggests that our housemates—including the family dog—may also affect the composition of our personal microbial signature.
If you and your significant other kiss, hug and/or share a bed with your dog, the three of you have more in common than you think. A study conducted by researchers at the University of Colorado, Boulder, revealed several similarities: Adults who share a dog have more similar mouth microbes than those who don’t. Dog-owning families have more diverse and different microbial colonies than dogless households. Parents tend to share more kinds of mouth bacteria with their dog than they do their children. And children raised with dogs have a wider variety of microbes than dogless kids (Song et al. 2013).
Whether these spit-swapped microbes serve a purpose or are just passing through is not clear. But research shows that children raised with dogs are less likely to be afflicted by eczema (Epstein et al. 2010) and asthma (American Society for Microbiology 2012).
The notion that microorganisms in the canine gastrointestinal tract might have unique properties is not new. Early Romans understood the medical value of a well-run therapy dog program. Health temples, the ancient equivalent of modern-day outpatient clinics, were staffed with live-in cynotherapists, gentle dogs who wandered about the grounds greeting patients and licking wounds. Were the dogs healing only psychosomatic injuries? Time and additional research funding will tell.
The idea that our microorganisms may to some extent be collectively beneficial is intriguing. People and dogs have been exchanging microbes for at least 30,000 years, since the first little cave girl kissed the first proto-dog puppy smack on the muzzle. That’s a long history of sharing. It’s possible that our microorganisms are at least symbiotic, and perhaps even played a role in the dramatic domestication of the dog.
Theoretically, many thousands of years ago, a population of carnivorous wolves or ancient proto-dogs (depending on where you stand in the dog-domestication debate) transitioned from a meat-heavy diet to one laden with grain, a consequence of the agrarian revolution.
Scientists know that the acquisition of a new diet is a fundamental driver for the evolution of a new species (Dale, Moran 2006). When species transition from carnivorous to omnivorous diets, the gut microbial community co-diversifies with the host and drives further evolution (Ley et al. 2008). As human diets changed, so too did those of Canis familiaris. Over time, as we incorporated these unique animals into our daily lives, we continued to reshape them.
In humans, autoimmune and inflammatory diseases are on the increase. Scientists can’t verify a similar pattern in dogs because epidemiological studies are rarely conducted in veterinary medicine. Additionally, many autoimmune conditions are diagnosed based on the patient’s subjective description of symptoms.
But this is not the case with itchy skin. Dogs who scratch themselves incessantly are highly likely to have allergies. When researchers compared microbial colonies on the skin of healthy dogs to those of dogs with allergies, they found that non-allergic dogs have much richer and diverse skin microbial communities (Hoffmann et al. 2014).
But when it comes to proving causality, scientists wisely err on the side of caution. It’s not understood if a change in the microbiome causes certain conditions, or if it occurs as a consequence of the conditions. Nor is it absolutely clear that more diversity is better than less. At this point, scientists cannot say with confidence exactly what a healthy microbiome should look like in the dog.
Moreover, what seems logical may not be so. For instance, anyone who has lived with a poop-eating pooch has wondered why some dogs do and other don’t. Are coprophagic dogs seeking microbes lacking in their gut? Surprisingly, research involving mice suggests that this might not be the case; coprophagia in germfree mice is the same as in conventional lab mice (Ebino et al. 1987).
Other questions arise: Are the microbiomes of individual dog breeds more similar to each other than they are to those of other breeds? And could these isolated microbial communities drive breed-specific ailments?
Jan Suchodolski, DVM, a Texas A&M veterinary medical and biomedical sciences researcher who studies dog and cat gastrointestinal diseases, says that this doesn’t seem to be the case. As he noted, “So far, we do not have any clear evidence that gut microbiomes are more similar within breeds. Environmental influences such as age, diets and antibiotics, and especially the effects of GI disease, are larger than any breed effect.
“It may be possible that we missed an effect, as we have not evaluated thousands of animals. But if there were a breed effect, it would probably be very minor. Even within puppies of the same litter, the microbiome shows huge inter-animal variation, so the animal effect is much stronger than any other effect.”
Idiopathic canine inflammatory bowel disease (IBD) is a gastrointestinal condition in which the digestive tract is chronically inflamed. Symptoms include vomiting, diarrhea and weight loss. Dogs with IBD have significantly lower bacterial diversity as well as microbial communities that are distinct from those of healthy dogs. In 2014, Dr. Suchodolski and his colleagues conducted a study of 22 companion dogs, half of whom suffered from idiopathic IBD (Minamoto et al. 2015). They wanted to know if traditional treatments—steroids and special diets—directly or indirectly created a more robust microbial community.
After treatment, the sick dogs felt a lot better. However, there was no change in their gut microbiota. The researchers concluded, “This study demonstrates intestinal dysbiosis [microbial imbalance] and altered serum metabolite profiles in dogs with IBD. But medical therapy doesn't seem to affect the intestinal dysbiosis.”
It could be that, rather than triggering the condition, microorganisms are compromised by it. Researchers also suspect that biological environmental stresses are involved in ways not yet understood. Dr. Suchodolski added, “It may be that we need longer follow-up periods of treatments to see potential improvements. Another reasonable theory is that with the current standard therapies—for instance, immunosuppression—we just control clinical signs, but the underlying etiology of the disease is ongoing.”
When it comes to treating dogs for myriad problems, vets often prescribe antibiotics, and for good reason: antibiotics save lives. But the war on infection sometimes puts good bacteria in the line of fire, too. When assaulted by repeated antibiotic use, some classes of gut bacteria struggle to recover. If the affected bacteria play a pivotal role in autoimmune health, overuse of antibiotics may coincide with a decrease in healthy autoimmune responses.
Antibiotics are not the only culprits. Scientists suspect that in human births, Cesarean deliveries may contribute to an increase in autoimmune weaknesses as well. In a vaginal birth, the fetus departs the womb without a single microbe but acquires them by passing through the mother’s birth canal. By the time the newborn takes his first breath, he is covered with colonies of bacteria that kick-start his immune system, establish a healthy digestive tract, help shape his growing brain and even protect him from psychiatric disorders. C-section babies start life without the microbes they would have picked up from vaginal delivery, suggesting that the colonization of the newborn might be delayed (Jakobsson et al. 2014).
Medical disorders connected to non-vaginal delivery and the slow introduction of protective bacteria have not been studied in the dog. Considering that a number of breeds with exceptionally flat, wide skulls—such as the Boston Terrier, French Bulldog and Bulldog—must have their pups delivered via C-section, it’s an area that deserves further study.
Or is diet the problem? Commercially manufactured dog chow was introduced in the U.S. in the mid-1920s. By the 1950s, processed dog food like Friskies, Sergeant’s and Purina were widely available through local grocery stores. Today in the U.S., we spend more than $10 billion a year on commercial pet food. The question arises: has the increase in autoimmune diseases paralleled the rise in popularity of processed dog food?
Because veterinary practices typically don’t collect this type of empirical data, the answer is, at best, a guess. But many dog owners think so, and have eliminated or cut back on processed foods in favor of raw meat and vegetables. However, as of now, there is no definitive evidence to show that fresh foods modulate the gut microbiota.
Sophisticated DNA sequencing technology has opened up the invisible world to scientific scrutiny. But determining its impact on the host species is difficult and time-consuming. Researchers need to locate and identify a microbe’s fingerprint, then remove a sample and grow it in a culture, a process especially difficult with shyer microbes that are destroyed by oxygen or stomach acid.
To figure out why we get sick and the role microbes play in illness, researchers must first determine how these trillions of organisms interact with each other. And the fact that scientists can prove a problem exists doesn’t mean they know how to fix it.
Developing therapeutic dog foods that target specific vulnerabilities may help, but will take time to develop. Although the probiotic movement may oversell their benefits, probiotics (friendly bacteria like those that live in the gut) are effective in some cases. And prebiotics, foods that encourage growth of good bacteria already present, may help as well.
The University of Pennsylvania School of Veterinary Medicine (Penn Vet) is recruiting dogs with acute symptoms of diarrhea and/or vomiting for a new clinical trail that will evaluate the role of the intestinal microbiome—the community of “good” bacteria that live in the gut—on chronic gastrointestinal diseases. Therapy will include simple diet change, treatment with antibiotics or combination therapy with steroids for more complicated cases.
Penn Vet researchers anticipate that their study may reveal how gut microbiota influence and respond to treatment, which in turn could lay the groundwork for future projects using treatments such as prebiotics, probiotics or fecal transplants (transferring “good” microorganisms from a donor’s healthy stool to the patient’s gastrointestinal tract). According to Research Assistant Professor Dr. Daniel Beiting, “Whereas past studies have used a single method to sequence bacterial DNA, the Penn Vet study will use a more sophisticated approach called metagenomics, generating a much more comprehensive catalog of bacteria in the stool and providing insight into what they might be doing.”
Penn Vet is currently looking for dogs with chronic gastrointestinal problems. People interested in enrolling their dog in the study—Evaluating the Role of the Microbiome in the Resolution of Canine Chronic Enteropathy—should email Penn Vet’s Veterinary Clinical Investigations Center at firstname.lastname@example.org, or call (215) 573-0302.
Future possibilities are exciting. In the meantime, kiss your dog. It’s good for you in more ways than one.
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