Wellness: Health Care
Orthodontics—braces—are actually the most gentle way of dealing with a malocclusion.
Wilbur, a four-month-old Dachshund with a dash of Papillon or Chihuahua in the mix, was to be my first foster pup. A standout at the shelter, his irresistible face and personality sealed the deal. Once I got him home, I noticed that his lower jaw was considerably shorter than the upper one. Although he appeared to be almost chinless, it made his smile more pronounced. No big deal, I thought— he’s so adorable.
Two months later, I had him neutered, and when I picked him up, a handwritten note attached to his aftercare instructions suggested that he should be seen by an orthodontist immediately. My first response, like that of most people unfamiliar with this veterinary specialty, was one of disbelief. I thought perhaps it was some kind of joke. But no. According to my vet, Wilbur had a malocclusion that required treatment —the sooner the better.
Luckily, in nearby Pasadena, Calif., I found Jennifer Lynn, DVM, who has dedicated her practice exclusively to canine and feline dentistry for the past 15 years. Dr. Lynn explained Wilbur’s Type II, base-narrow malocclusion to me. His mandible (lower jaw) was much shorter than his maxilla (upper jaw), resulting in what most people refer to as an overbite. In growing pups, the jaws sometimes develop at different rates, but Wilbur’s situation was so extreme that there was no chance of the lower jaw ever catching up.
This was more than an issue of looks. His mandibular canines, which normally wing out in front of the maxillary canines, were not only behind them, but were linguoverted—that is, angled inward toward his tongue. Since his permanent teeth were still erupting, they hadn’t had time to do damage, but eventually, this misalignment could prevent him from closing his mouth, as well as injure his palate. The good news was that, treated early, the teeth could easily be shifted to give Wilbur a healthy, comfortable bite.
Why not just pull them? According to Dr. Lynn, canine teeth are important. Their roots are roughly double the length of their crowns, so removing them requires oral surgery and, sometimes, a bone graft. Lower canines make up a good portion of the chin, help hold the tongue in place and are used for grasping.
What about crown reductions? In cutting the crown, the tooth’s pulp is exposed. A small portion of the pulp is removed and the top of the tooth is shortened and reformed. Called a vital pulpotomy it’s not without potential complications, and needs to be monitored with annual dental X-rays.
Ball therapy is another option. Teeth can sometimes be moved into place in response to pressure generated by the dog chewing on an appropriately sized rubber ball for fifteen minutes three times a day. If, like Wilbur, the dog has no interest in anything that’s not stickor bone-shaped, then you don’t get to try that approach.
Orthodontics—braces—are actually the most gentle way of dealing with a malocclusion. Rather than surgically removing the teeth, they are carefully coaxed into position.
So, on to braces, and yes, they do come with rubber bands, or elastic chains, as they’re also called. With Wilbur under anesthesia, buttons were cemented to the lower canines and molars at the back of his mouth. Guided by composite extensions, pressure supplied by elastic chains attached to the buttons would gradually shift his teeth to the desired position.
Keeping the elastic chains intact proved to be the biggest challenge. Almost daily, Wilbur managed to dislodge one while chewing on found objects. I became an expert on reattaching them. Once, he managed to pop off a button, and had to be anesthetized so a new one could be put on. Thankfully, treatment is of short duration, two or three months on average. Wilbur didn’t require a retainer, though some dogs do. Once everything’s in place, it tends to stay that way because the dog’s normal bite acts as a natural retainer.
Others I spoke with have had equally positive experiences. Following the devastating loss of a beloved dog, and much searching, Brenda Lyum and her husband, Mark, of Simi Valley, Calif., brought home a Brittany Spaniel puppy, whom they named Abbey. During their first vet visit, the doctor took one look at Abbey’s mouth and commented that her severe overbite, a genetic defect, was reason to send her back to the breeder. But the Lyums were committed to caring for their new companion, and Brenda and Abbey made weekly visits to Dr. Lynn’s office, an hour-and-a-half drive each way.
During Abbey’s treatment, everyone, including those at the referring veterinarian’s office, marveled at the five-month-old puppy’s orthodontic appliances, which included a palatal expander with acrylic splints on both sides in addition to buttons, chains and composite extensions. They were amazed at what could be done. At a price not significantly different from the cost of extraction surgery, the Lyums were able to save Abbey’s teeth. Unlike rambunctious Wilbur, Abbey kept everything in place until her corrections were complete.
Dr. JP Gonzalez-Torres, a general dentist (for humans), was surprised to find that Piper, his 10-month-old female Wire Fox Terrier, could be treated for a malocclusion resulting from a retained primary, or persistent deciduous tooth. When his veterinarian recommended that he take Piper to Dr. Lynn, Dr. Gonzalez-Torres was intrigued. “As a dentist, I got really excited about the idea of a pet orthodontist. I didn’t know they existed. We were able to correct the issue in a relatively short period of time. Piper did great throughout treatment. For those who question it, the price can be steep, but the end result is amazing. If you can correct a dental issue that could affect the life of your pet, wouldn’t you do it?”
Board-certified veterinary dentists Dr. Anson Tsugawa and Dr. Kristin Walker, who specialize in oral surgery for trauma, fractures and conditions such as oral cancer at Dog and Cat Dentist, Inc. in Los Angeles, believe that every dog is entitled to a comfortable bite. On occasion, however, they have had to explain that veterinary orthodontic techniques are performed only to improve function, for comfort and to eliminate traumatic damage to the mouth, not for cosmetic reasons. In fact, the AKC does not allow dogs who’ve had “work” done on their inherited dentition to compete in confirmation trials.
Because older animals may take longer to treat, dogs should be evaluated as early as possible to prevent or correct dental problems. To avoid complications, multiple visits are required as treatment progresses, so proximity to the dentist is important. For those who must travel long distances and would appreciate fewer appointments, Dr. Tsugawa says some dogs can be fitted with an appliance that their guardian can tighten with a little wrench. Or sometimes, a mold of the dog’s teeth is sent to PetAlign, a New York company that fabricates a series of five or six progressive aligners that can be changed at home. Since each dog’s mouth is unique, a dental specialist or boardcertified veterinary dentist is the best judge of how to proceed.
While Wilbur’s treatment was successful, my fostering was not; he became a permanent part of the family the moment he first scampered through our door. And on our walks, his captivating smile continues to charm and start conversations with every person we meet.
Wellness: Health Care
What can be done?
As our pets age, you may begin to notice subtle changes in their movement, such as having a little difficulty going up or down the stairs, or seemingly slow to rise from a comfortable laying position. These can be early signs of arthritis, and early intervention is critical to slowing progression of the disease. I am currently experiencing this “slow down” with my 11 year old Dobie, and I thought it would be good to share some suggestions that you, too, can consider if you have a pet that is living with some degree of arthritis.
Like any lifestyle change, one of the most important things to do first is to ensure that there are no other causes for the changes you are seeing in your pet. An intermittent and subtle slow down can be caused by many things, such as a low thyroid level or even a slowly bleeding tumor on the spleen. X-rays, a urine sample and blood work are important to ensure the overall health of your pet before starting any treatment plan.
Today, there are a number of effective pain medications that are available to our pets, and a multi-modal approach to pain management is the best way to go. By using pain medications that address various pain pathways, you get more complete and synergistic pain management while actually using lower doses of medications. A cornerstone of arthritis management is a non-steroidal anti inflammatory, or NSAID. This provides excellent pain management in the early stages of arthritis, and then as the disease progresses, additional “layers” of pain management can be “added on.” These medications include such options as gabapentin, tramadol, and amantadine, with each one working to enhance the other.
Adequan is another medication that has been used in pets with degenerative joint disease or traumatic events such as a torn cruciate ligament. It works to help slow down the rate of decay of cartilage as well as stimulate new collagen and hyaluronic acid, a lubricant in joints. This is an injectable product that can be taught to be given at home underneath the skin and is initially given twice weekly for three to four weeks and then, once monthly. By the fifth or sixth injection, most pet parents usually see a more comfortable and agile pet.
Supplements such as glucosamine, chondroitin and omega-3 fish oils are good additions to managing arthritis changes. These supplements provide your pet's joints with building materials to help rebuild their cartilage and decrease the inflammation in the joints. Supplements are not an overnight fix, and they generally take at least six weeks before improvements can be seen. Products can be purchased over-the-counter and do not need to be labeled specifically for pets. However, not all nutrapharmaceutical products are FDA regulated, and there is quite a bit of discussion with regards to bioavailability between various brands; this is a case where cheaper is not always better and I would recommend purchasing only high quality and trusted brands. Your veterinarian can make recommendations for you. The standard dose for glucosamine/chondroitin is approximately 10 mg per pound of body weight once a day, for which you can round up or down to make tablet division or multiplying easiest. For example, a 20-pound dog could take half of a 500 mg tablet daily (250 mg), even though its “recommended” dose is 200 mg. Also, when you are considering fish oil, you want to be sure to base it on the omega-3 concentration of EPA. The dose is 20 mg EPA for every pound of body weight once daily, and for example, our 20-pound dog would need 400 mg EPA daily.
Another area of extreme importance is your pet’s body weight. I have to admit, I am a little guilty of letting this area slip and my boy and I recently went through a five-pound weight reduction program (I couldn’t let him “suffer” alone). How can you tell if your pet is a little too chubby? You should be able to easily feel your pet's ribs and backbone beneath the skin; if you cannot, then your pet may be overweight. Excessive weight is an added burden for already compromised joints, and you may be amazed how much better your dog will feel simply by shedding a few pounds. I can already see a difference in the way Bauer prances around.
Continued activity is also important—the old adage, “if you don’t use it, you lose it,” holds true for our pets, too. Working to keep up your pet’s muscle mass through activity can help provide stability and flexibility to joints. Low-impact exercise is best, such as long walks and swimming, and both are highly encouraged.
There are also newer concepts of arthritis management. One such treatment is known as Stem Cell Therapy. This is a procedure in which adult stem cells are injected into the arthritic joints, or into damaged ligaments and tendons, to aid in healing and repair. While continued studies are still needed, there are many reports of pets responding well and this therapy holds promise. Joint replacement is a surgical therapy and has been proven to be very successful. As an example, 95% of canine patients with hip replacement can return to normal function. There has also been the development of dedicated rehabilitation centers for pets, which are becoming more widely available as the demand for options grows. Trained professionals can offer additional treatments such as hydrotherapy, acupuncture, chiropractic, massage, physical therapy, cold laser therapy, and pulsed signal therapy. Complementary treatments can offer your pet a complete approach to management of its arthritis, and many of these singular modalities, such as acupuncture, are often offered by veterinarians in general practice. These newer approaches to arthritis management are areas that I can discuss in greater detail in another blog, if there is any interest. Let me know!
Wellness: Healthy Living
Tips on keeping your dogs safe
It’s the season, in California and in other states, when foxtails are starting to rear their “ugly” and dangerous seed-heads. These days after our morning walk, and before I load the dogs into the car, I do a complete check-up on them. I need to comb Lola, because she has a shaggy, wired coat, and her high-leaping, coursing style of recreation, attracts burrs, seeds, and unfortunately the worst of them all, foxtails. Checking each toe, paw pads, nose, ears, eyes—I also pat around the other two short hair dogs, attention that they really enjoy. Here are two wellness articles from our two vet bloggers, Shea Cox and Nancy Kay, that will tell you everything you might need to know about keeping your dog safe from these flora pests. There was also a good article in Gun Dog magazine back in 2010. What that piece shows is that foxtails are spreading to other areas of the country.
P.S. A couple days after posting this blog, Charlie, my little Terrier, got one up his nose. Poor guy, he sneezed like mad, and then stopped. Some people believe that the stopping means a dog has expelled the foxtail through sneezing, but unfortunately that is not usually the case. Only means that the darn thing has moved further up the nasal passage. It is always wise to have a vet check it out.
Wellness: Health Care
In 2008, the Environmental Protection Agency announced that it planned to restrict sales of certain rodenticides containing second-generation anticoagulants (such as brodifacoum and bromadiolone) to pest control professionals and agricultural supply stores only. Rodenticide manufacturers came up to speed with compliance in 2011, and in doing so, began using bromethalin more and more instead of anticoagulants in their products.
While the change was designed to make rodenticides safer for our children, pets and wildlife, there has also been some devastating consequences. Unlike anticoagulant rodenticides, bromethalin does not have an antidote, and there are still many people and veterinarians that are not aware of its toxicity. There has been an uptick in the number of cases treated since these regulations have been put in to place, and this toxicity is once again being highlighted in veterinary publications in hopes of raising awareness.
If a dog had ingested a rodenticide in the recent past, it was very likely a D-Con-like product. Anticoagulant toxicities are relatively easy and cheap to treat if caught early as there is a 2-5 day lag time before bleeding actually happens. This type of exposure can also be diagnosed with a simple blood test, known as a PT test, which checks the clotting time of the blood and confirms exposure if it was not witnessed.
This is not, however, the case with bromethalin. Bromethalin is a neurotoxin which affects the cells in the brain by causing a rapid influx of sodium particles into its cells. When this happens, body water follows the sodium particles and leads to swelling in the central nervous system. The symptoms come on much faster and neurological signs can be seen within as little as 2 hours of ingestion. These signs can include depression, a “drunken” gait, rigid limbs, seizures and coma. Because there is no antidote, treatment is aimed at decontamination, intensive, and expensive hospitalization for support of the body and treatment of clinical signs if they develop.
I am sure many people are thinking, “Who would keep this stuff around when you have pets?!” I often have the same thought, but you would be surprised by the number of dogs we treat for this toxicity.
Here is the take home message:
* If you need to induce vomiting at home, you can administer 1 ml of hydrogen peroxide per 1 pound of body weight with a maximum of 45 ml being given. For example, a 10 pound dog would need 10 ml of hydrogen peroxide and 80 pound dog should get no more than 45 ml. Trying this at home is not without risk and there are words of caution to consider: ONLY attempt to induce vomiting if your pet is very alert and if you are further than 1 hour away from your veterinarian. Also, do not "force" the peroxide in—your pet needs to swallow the peroxide, and because it tastes bad, there is a risk of your pet aspirating the peroxide into the lungs if they are resisting and it is being forced. Another concern is the potential for aspiration during the vomiting process. Aspiration of peroxide during administration or through the process of vomiting leads to additional problems such as pneumonia. Another note: don't waste time waiting to see if your dog will vomit... gently give the peroxide, grab a blanket to cover your car seat, and begin driving immediately to your vet.
Wellness: Health Care
Home-brewing is a trend that is becoming more and more popular, and unfortunately, so is the occurrence of hops toxicity in dogs. Hops is the plant used in the process of brewing beer, and both the 'raw' or spent hops are toxic. True flowers or dried hops plugs tend to be more toxic than hops pellets (pellets have less residue), while wild hops have been found to be non-toxic. The diagnosis is generally made based on history of having home-brewing supplies as well as seeing hops in vomit.
The mechanism of toxicity is unknown, but may be related to essential oils, resins, phenolic compounds, or nitrogenous constituents within the plant. Many of the substances in hops are degraded or aerosolized during the brewing process, so the exact relationship between substance and toxicity remains unknown.
Clinical signs of toxicity can include agitation, panting, excitement, flatulence, rapid heart rate followed by life-threatening elevations in body temperature. Death has been reported in as little as 6 hours without appropriate treatment. I have seen rectal temperatures greater than 108 F, and these temperatures can be very difficult to control. The high end of normal of a dog’s temperature is 102.5 F, and any temperature above 106 F can lead to an “unwinding” of the body’s proteins as well as permanent brain injury, depending upon the length of time that the elevation in body temperature persists.
Treatment consists of aggressive decontamination measures including induction of vomiting, gastric lavage (“washing out” the stomach under anesthesia), administration of charcoal, and enemas. Active cooling by any means available is extremely important. There are also specific medications that can be given in the hospital to help control the clinical signs.
Prognosis for survival is generally guarded to poor, and unfortunately, many deaths have been reported. We have had 2 cases of hops toxicity this past year in the ER, and thankfully, both survived with aggressive treatment.
Any breed of dog may be affected, but breeds that are predisposed to malignant hyperthermia (extreme elevation of body temperature for an unknown reason) tend to be more susceptible. These breeds include Greyhounds, Labrador Retrievers, Saint Bernards, Pointers, Dobermans, Border Collies, English Springer Spaniels, and northern breeds.
If you suspect your dog has been exposed to hops, seek veterinary care immediately! This is not something that can be managed at home. Quickly take a rectal temperature, and if it is found to be greater than 105 F, begin active cooling measures—such as dousing your pets body with cool water and wrapping icepacks in towels and placing them over its body—in addition to running the air conditioning in car while on your way to your veterinarian or local emergency clinic. This measure could help save your pets life and give him or her the best chance for survival.
Wellness: Healthy Living
When it comes to remedying diseases and disorders, dogs and people are in it together
Call it a movement, a philosophy, a revelation or a revolution.
Call it “one medicine,” “one health” or “zoobiquity.”
Call it something new, or—given that the “aha” moment on which the concept is based came in the 19th century—call it something old that’s been remembered and repackaged amidst the growing awareness that solving the mysteries of animal diseases and disorders, from injured spinal cords to cancer, can lead to possibly curing our own.
Over at least the past five years, there has been a rekindled recognition of the species-spanning nature of diseases, and of the value of species-spanning research. About 75 percent of recently emerging infectious diseases that affect humans have their origins in animals, according to the Centers for Disease Control.
On a theoretical level, the concept of “zoobiquity,” a term coined in the 2012 book of the same name, suggests that, no matter our species, we’re all in this together, subject to most of the same infirmities, capable of passing a lot of them back and forth, and more likely to find cures and treatments if we look at the big picture—at the earth and all its creatures —as opposed to focusing solely on humans.
On a practical level, species-spanning thinking—referred to by various monikers—has led in recent years to veterinary schools reinventing themselves; to a heightened spirit of cooperation between doctors and veterinarians; to new sources of funding for research; and to the realization that, when it comes to diseases shared by humans and animals, the latter may provide a quicker and less expensive route to a cure for all.
Where do dogs fit in? Right at the top. No other animal—if not physiologically, at least in terms of sharing our genetic markers and our home environment—is as close to us.
That’s why Texas A&M veterinarians and University of California, San Francisco, medical researchers have teamed up to study spinal problems in Dachshunds and other dwarf breeds and to test a new drug that blocks secondary infections. The research, which is funded by the Department of Defense, has potential application to battlefield injuries
That’s why, in New York, veterinarians with the Animal Medical Center have joined forces with physicians and researchers at the Memorial Sloan-Kettering Cancer Center to set up trials in which electrical impulses are used to treat tumors of the urinary tract in canines, with an eye toward possible human application.
That’s why the Mayo Clinic has partnered with two veterinary schools, a medical school and a private corporation to study the effectiveness of a device aimed at predicting and controlling epileptic seizures in both dogs and humans. While traditionally, research into canine epilepsy has been funded primarily by the American Kennel Club’s Canine Health Foundation and breed clubs, the Mayo Clinic collaboration received a $7.5 million grant from the National Institutes of Health.
That’s why Tobi, a paralyzed Golden Retriever, is getting stem-cell treatments that may help him walk again as part of a clinical trial headed by Dr. Natasha Olby, veterinarian and neurologist at North Carolina State University’s (NCSU) College of Veterinary Medicine. The trial will involve as many as 30 dogs over three years.
And that’s why Peggy, a Chihuahua from Albuquerque who was born with three legs, is being outfitted with a “bionic” paw at NCSU. Implanting the prosthetic device, which will have electrodes that connect to her nerves, will allow her to run and scratch, and could add to the growing use of comparable technology in humans.
Similarities between dogs and humans, especially when it comes to genes, are also the basis for Dr. Matthew Breen’s research into the most common cancer in dogs, non-Hodgkin’s lymphoma, at NCSU’s College of Veterinary Medicine. Breen and fellow researchers have, with help from the canine genome map, developed a test that can accurately predict how long a dog treated with chemotherapy will remain in remission. In collaboration with the Mayo Clinic and others, they’re in the process of converting the canine test to a human one.
“If that happens, it will be big news,” says Breen, a geneticist and professor of genomics. Breen lost his first dog to cancer when he was 12 and, as an adult, played a role in the mapping of the canine genome—a game-changing achievement that helped place dogs front and center when it comes to health research.
“It’s likely that we will learn more about cancer by looking at what happens in our dogs over the next five to 10 years than we will in the next 20 to 30 of looking solely at cancer in people,” he predicts.
But the key, he emphasizes, is looking at both at the same time.
“If we consider dogs as dogs, we’ll be able to do so much. If we consider people as people, we’ll do so much. But if we consider them both as mammals, and look at what’s common between them, we will find some intriguing answers.”
The possibilities extend well beyond non-Hodgkin’s lymphoma, and well beyond cancer. Dogs, long our antidote for loneliness, may hold the most promise of all animals when it comes to solving medical mysteries and curing what ails us.
“The answer to some of nature’s puzzles about genetics and disease,” Breen says, “has been walking right beside us for the last few hundred years.”
In reality, we’ve been turning to dogs for thousands of years, sometimes quite cruelly, to try to solve our human ills: from the time of Aristotle, who conducted experiments on live animals, and the era of Galen, whose second-century experiments earned him the title “the father of vivisection,” to the period of Pavlov, whose 19th-century experiments included severing the esophagi of living dogs to better study their digestion and, as a sideline, bottling and selling their gastric juices to the public as a cure for dyspepsia.
Many of the medical treatments we now take for granted were either discovered through the use of dogs or tried on dogs first.
In England during the 1600s, the first administration of medication intravenously was accomplished in a dog, via tubes and a pouch made of an animal bladder. In the 1920s, experiments on dogs led to Frederick Banting’s discovery of insulin. Banting and fellow researcher Charles Best surgically stopped the flow of nourishment to a dog’s pancreas and, after it degenerated, removed it, sliced it up, froze the pieces then ground them up. They named the extract “isletin.” When it was injected into another dog in which they’d induced diabetes, the dog’s blood glucose level dropped.
In the 1960s—long before they were ever slipped into clogged human arteries—stents were inserted into those of dogs. When a ballooning version was developed in the 1980s, it too was first tested on dogs.
Currently, as humans wait to take full advantage of its purported promise, stem-cell therapy is becoming more common—though expensive, at around $2,500 per treatment—in treating dogs with arthritis, hip dysplasia and spinal-cord injuries. Removing, treating and reinjecting stem cells (and even differentiated cells) have led to some miraculous recoveries.
Dogs may have access to novel cures and treatments yet to be made widely available to humans, but there’s a trade-off. They are still, in a way, being used as guinea pigs. The difference is—compared to Pavlov’s day, compared to some of the unsavory experimentation on dogs that still goes on—they’re not healthy dogs, or dogs in whom diseases have been induced. Most often, they’re patients, sick dogs who have run out of alternatives and whose owners have enrolled them in clinical trials in hopes of, if not curing their own pet, furthering research that might help other dogs.
The canine cancer samples from around the country that end up in Breen’s lab come from willing donors, or at least willing owners, many of whom see contributing to such research as a way their dogs can leave a lasting mark.
“By providing that data point, it’s almost a legacy for their own dog,” Breen says. “Every dog we recruit, we ask the owner for a picture to put on our wall of honor. We have hundreds and hundreds of pictures of dogs. It helps ground people in the lab, and makes them realize what they’re dealing with is not just a piece of tissue but somebody’s beloved companion that needs to be treated with the same kind of respect.”
Under microscopes, Breen studies chromosomal changes within cancer cells, changes that have been shown to duplicate those that occur in humans. “If we look at what overlaps, it’s those shared genes that highlight the major drivers in the cancer process,” he says.
The aberration of particular chromosomes allows Breen to identify which therapies will offer maximum survival chances. In lymphoma cases, up to 90 percent of dogs respond to chemotherapy and go into remission, but only about half live longer than nine months. By looking at the genetic differences between the dogs who survive for short times and those who survive longer, Breen’s team has developed a test that determines how long a dog will stay in remission; this test will, it is hoped, eventually be available for use with humans.
Experts estimate that one in four dogs will develop cancer in their lifetime. About 50 percent of those over age 10 will die from it. The types, incidence and outcomes aren’t always identical to those in humans, but even in those differences, other clues and opportunities may be found.
Bone cancer, or osteosarcoma, for example, affects a whopping 60,000 dogs a year. In humans, there are only about 900 cases a year and, as a result, its research has never received the kind of funding awarded to work being done on more widespread cancers.
By looking at the disease itself, as opposed to its effect on a singular species, some less high-profile diseases (in humans) can get more attention, and progress can be made more quickly, Breen says.
“We ignore whether it’s in dogs or people, focus on the cancer and get to the biology faster.”
Down the road, such research might keep someone else from hearing those five fateful words Breen remembers hearing as a child, when his own Border Collie cross was stricken with cancer: “There’s nothing we can do.”
Rudolph Virchow, though he wasn’t credited for it in his lifetime, is considered the father of “one medicine.” The 19th-century pathologist coined the term “zoonosis” and created the field of comparative pathology.
“Between animal and human medicine there is no dividing line—nor should there be,” he said. “The object is different but the experience obtained constitutes the basis of all medicine.”
Two centuries later, a variety of factors breathed new life into his old idea. Recently identified zoonotic diseases, like swine and avian flus and West Nile virus, became major public health concerns. At the same time, dissatisfaction was mounting with research studies involving mice, primarily because their findings often weren’t transferable to humans. There was a growing recognition that all animals, both wild and domestic, serve—like the canaries once used in British mines—as sentries for environmental hazards.
Dogs, while at the forefront of much modern research, also played a large role in reviving the species-spanning way of thinking. On top of the tremendous diagnostic and research value it held for dogs, the successful completion of the canine genome map in 2005 showed how similar dog genes are to our own. It also reinforced how much more quickly canine health research can progress. Mapping the sequence of the canine genome cost about $50 million and took one year, while mapping the humane genome cost more than $3 billion over 15 years.
It was one year after that benchmark, in 2006, that the American Medical Association and the American Veterinary Medical Association issued a joint declaration encouraging more partnerships and information sharing between the two branches of medicine.
For far too long, doctors of human medicine and doctors of veterinary medicine—and researchers in the two fields—operated on separate planes. By coming together and sharing their findings, proponents of one medicine held, new opportunities could be realized and new cures, possibly, found.
To those involved with treating and researching animal diseases, the increased respect from those in the world of human medical research is palpable. Dr. Jorge A. Piedrahita, geneticist and professor in the Department of Molecular Biomedical Sciences at NCSU’s College of Veterinary Medicine, remembers a time when overtures from the veterinary medical community to the human one would result in “blank stares, as if they were thinking, What would we want with you?”
“The human medicine field in the past has looked at us [veterinary schools] as technicians,” he says. “They came to us if they needed a pig or a dog, but they never saw us as partners. Now we sit with them really as equals.”
Piedrahita serves as director of the Center for Comparative Medicine and Translational Research, which was created seven years ago. Based at NCSU, one of the first vet schools in the country to fully jump on the one-medicine bandwagon, the center includes 116 researchers at five colleges. The thinking behind the center, he says, is “if we help one species, we’re helping all of them.”
Since then, Piedrahita says, the road between veterinary practitioners and doctors has become much more of a two-way street. “There have been an amazing number of new interactions, and we’re still a very young center. It’s really becoming almost like a partnership.”
Doctors and vets are not the only two cultures the movement has brought closer together, he notes. It has also led to “increased sharing between clinicians, or those working with patients, and researchers, who are confined to labs.” The result, he says, is faster and more efficient research, capable of reaching solutions sooner.
Breen’s cancer research is one example of that. Another is a project Piedrahita is involved with in conjunction with Wake Forest University’s Center for Regenerative Medicine, which is seeking a solution to urinary incontinence.
While it’s a significant issue for women, especially elderly ones, one might not think that dogs—generally a less-prone-to-embarrassment species—would rank it too high, even the spayed ones, in which it is most common. Piedrahita is quick to correct that thinking.
“It’s a very big deal,” he says. “It’s the reason many of them end up in shelters, or being returned to shelters. For the dog, it may not be that big of a deal, but for the owner, it is.”
Throw in its human applications, and it becomes even bigger.
Using cells from the patient—for now, canine patients—the treatment involves reinjecting cells, usually taken from a leg muscle, into the urethral sphincter itself, where they regenerate and build new muscle. The project has received funding from the American Kennel Club’s Canine Health Foundation, and clinical trials involving as many as 40 dogs were expected to begin in January.
Of all the microscopic matters detected in a typical veterinary research lab, irony is not usually among them. But here’s one that has surfaced.
Among purebreds, breeding for certain traits, and to get a certain look—most often accomplished by using dogs who are closely related—has led to recessive disorders, more than those found in any other animal except humans.
It’s believed to be why Boxers are prone to mast-cell cancer and brain tumors, Scottish Terriers to bladder cancer, and Bernese Mountain Dogs to histiocytic sarcoma. It’s why one in five Golden Retrievers is diagnosed with hemangiosarcoma.
But the limited genetic diversity that has led to cancer-causing mutations in many purebreds is also what has led to dogs becoming such a valuable tool in studying disease. Breen compares it to tuning in a radio station. With the dog genome, there’s none of the noise and static from competing frequencies—just a clear signal.
Pointing fingers is useless, Breen says. “I don’t blame anybody.” But he’s among the first to admit that limiting the gene pool has made purebred dogs “a very powerful tool for simplifying genetics.”
With their “less noisy” genetic make-up, purebred dogs offer a speedier research route. It takes thousands of human patients with cancer to identify risk factors, he notes, but the same can be accomplished with as few as 100 canine patients.
In the book Zoobiquity: What Animals Can Teach Us about Health and the Science of Healing, Barbara Natterson-Horowitz, a cardiologist who consults with the Los Angeles Zoo, delves into the many sicknesses we share with animals. (Editor’s note: For a review of Zoobiquity, see the October 2012 issue of Bark.)
Co-authored by Kathryn Bowers, the book points out that not only humans get breast cancer, but kangaroos, beluga whales, wallabies and sea lions—to name a few—do as well. Rhinos get skin cancer; gorillas get depressed; horses suffer from erectile dysfunction; and sexually transmitted diseases plague the non-human world as well, from syphilis in rabbits to chlamydia in koalas.
By looking at the big picture, we’re likely to further our understanding of species-spanning diseases, of the planet and of the environmental factors that contribute to ill health. Two annual conferences on zoobiquity have urged medical practitioners to do just that.
In terms of the latter, dogs, once again, serve as prime examples and perfect models. They sleep in our beds, share our food, lie on our flame-retardant-treated couches and frolic on our insecticide-treated lawns. When we go for a walk, it’s usually with them at our sides or pulling us along behind them.
They may soon lead the way in science as well, as rodents take a back seat when it comes to research examining the role environmental factors, such as secondhand smoke and household chemicals, play in causing disease. While much of it was going on years before the AMA-AVMA declaration was announced or the term “zoobiquity” was coined, research involving dogs (and cats) is increasingly looking at the link between pollutants and cancer.
On top of the fact that the canine genome is 80 to 90 percent similar to that of the human, dogs are constantly at our sides, making them perfect candidates for studying not just cures but also, causes.
Since dogs are such accessible and efficient, not to mention friendly, models, the question arises (or at least ought to): should one health/one medicine/zoobiquity—and more particularly, the view of dogs and other animals as sources of solution to our own diseases—raise animal welfare concerns?
Despite their all-inclusive, holistic and harmonious sounding names, none of the calls for a species-spanning approach to medicine state that all animals are our equals, or that their value parallels that of humans. Only that they get many of the same diseases we do.
As cures come closer and as dogs are increasingly seen as the road to such cures, could our zeal lead to what animal-welfare advocates might see as reckless driving?
The book Zoobiquity points out that in virtually all of the examples it uses, animals involved in the research were already sick. When, on ABC’s “Nightline,” Natterson-Horowitz was asked if the concept could lead to testing on healthy animals—if the Hippocratic Oath of “do no harm” should apply, for instance, to hippos—she replied, “I can’t give you a simple answer, because it’s a very complicated, nuanced question.”
Breen, for his part, doesn’t hesitate. “We don’t induce cancers in dogs. The key issue about cancers, and many genetic diseases in our dogs, is that these are all spontaneous conditions … All the dogs in our study are part of a family, sharing their homes and their lives. The path to discovery involving cancer and our dogs is one we walk along side-by-side with the owners.
“We have access to state-of-the-art technologies to ask key questions, but these are worthless without the willingness of the dog-owning community to collaborate by submitting cancer specimens from their dogs. By building a strong relationship with pet owners, and realizing that their pets are like family members, like a child … it actually means the chances of ever inducing disease are less. I just can’t see it happening; it wouldn’t happen in my lab, let’s put it that way.”
Breen’s bigger fear, when comes to biomedical research, “is that all this will raise people’s hopes too high and too soon.”
That applies to the owners of afflicted pets as well as those who are afflicted themselves, or have human loved ones suffering from a disease. We’re eager to find cures. Dogs, being such perfect models for study, provide what may be one of the quickest routes to them. While a resurgence in the use of otherwise healthy dogs in intrusive experiments isn’t likely, the future (which seems to be getting here faster and faster) isn’t crystal clear.
This much is, however: fairly early in their domestication—and in what was perhaps one key component leading to it—dogs exhibited their ability to stand sentry, to serve humans by warding off dangerous, life-threatening intruders.
In a way, thousands of years later, they’re doing it again.
Wellness: Health Care
A recent request by a Bark reader was, “how can I treat a hot spot at home without seeing a vet?” Hopefully I can begin to answer this, but first, one must be able to “spot” a hot spot.
A hot spot is a superficial skin infection that happens when normal skin bacteria overrun the skin’s defenses as a result of damage to its surface. This damage is most often started by the dog chewing, scratching, licking and gnawing at itself. In the first stages of the formation, the skin becomes moist, red, itchy, and infected. Pus begins to ooze from the traumatized skin as infection sets in. Then, the dried pus and damaged skin surface will work to form a tightly-adhered crust, and you will likely notice hair loss over the infection site. This can be a very painful process, and frequently, dogs will show pain when the area is touched.
Dogs are their own worst enemy when it comes to hot spots, and they are generally created by their own over-zealous self-licking and chewing. They can arise surprisingly quickly: a few minutes of “work” can create an impressive area of self-inflicted trauma. The good news is that they almost always look worse than they actually are, and infection is usually superficial—often resolving with topical treatment alone.
So, what causes our dogs to begin self-chewing and licking in the first place? Good question, with a common denominator being anything that creates irritation to the skin, causing the dog to chew or scratch at the site, can cause a hot spot. Think insect bites (fleas, flies), skin allergies, excess skin-surface moisture, dogs with heavy or dense hair coats, matted hair, saliva accumulation under the fur (think of the pet that is always licking its feet), skin scrapes, or excessive humidity in the environment can all be sources for a hot spot to develop. Another interesting cause: good old-fashioned boredom.
The location of the hot spots may help your veterinarian determine the underlying cause of the problem. For example, a hot spot over the hip area could indicate flea infestation, hip arthritis, or an anal gland infection. Similarly, a hot spot near an ear could indicate an ear problem, an allergy, or a dental/nerve irritation.
What you can do at home:
If the hot spot is small, non-painful, recognized early, and is uncomplicated, it may be possible to begin treatment at home with over-the-counter products made for this use. There are an array of topical sprays, medicated shampoos, and herbal therapies available—too expansive a list to discuss here. The important thing is to ensure that it is a pet-approved/pet-safe product and it is always a good idea to call your veterinarian and ask if your choice seems reasonable. You need to be very careful not to use human topical products as these may be toxic to pets when licked and ingested. For example, zinc oxide can be toxic when ingested and it is a common carrier in many human skin ointments.
The basics of home hot spot treatment are:
Tips on prevention:
When you can’t do it alone:
The bad news is that about 30% of the pets who develop hot spots actually have some other kind of skin disease such as a deeper skin infection, a bite wound or other trauma, or even immune-mediated disease. If you have any concerns whatsoever, it is best to have your veterinarian assess them.
Another time that veterinary intervention is needed is when the hot spot becomes so big and painful that it requires sedation to properly clip and clean it (can you imagine what it would feel like to have running clipper blades go over raw flesh? Ouch!).
An additional potential concern is if a hot spot is accompanied by deeper skin infection, which would require more extensive therapy such as oral pain medications, oral anti-inflammatory medications and oral antibiotics in addition to topical treatments. The treatment your veterinarian chooses will depend on how bad the problem is, how much pain your dog is in, how long the problem has been going on, and if the problem is a recurring one. Some dogs may get one or two hot spots and then never get another one again (luck dogs!), while some may have frequent recurrences.
Hopefully this helps take off some of the heat of hot spots, and thank you for the suggestion, Mona J!
Wellness: Health Care
A Vet’s Perspective
Like so many of life’s firsts, first dogs have a special place in our hearts. Patch, the handsome and powerful German Shepherd of my youth, was no exception. I was a teenager when Patch’s healthy body began to deteriorate. At the time, I resigned myself to our family vet’s opinion that my 13-year-old dog was suffering from the chronic effects of hip dysplasia. However, with hindsight (and a veterinary education), I realize that Patch must also have been suffering from degenerative myelopathy (DM), a debilitating neurological disease of the spinal cord, which robbed him of his dignity during his final year of life.
From his belly forward, he was a normal dog—bright, eager to please and utterly without pain, defying time gracefully. Not so the back half, which was progressively turning into Jell-O. It was as though his body was controlled by two actors in a dog costume: the guy at the front was alert and coordinated, the guy at the back was falling-down drunk. I watched my best friend become trapped inside a dying body, the absence of pain making it worse, somehow. His heart was perfect. Mine was breaking.
Fast-forward 30 years, and it’s a clumsy Newfoundland named Tonka who has me thinking about Patch again. That’s because Tonka displays similar signs: stumbling and progressive weakness of the back end.
“Her spinal MRI was clear,” said her owner, “and that new test for DM was negative. So this has to be about her hip problems, right?”
As it happens, I agreed, but my confidence that Tonka could not be suffering from DM was based on more than the “new test,” a DNA analysis recently offered by the Orthopedic Foundation for Animals (OFA), working with the University of Missouri.
As a 2009 study* revealed, DM has an associated genetic marker, SOD1. To simplify the process, let’s say the abnormal gene influencing DM is A, and its normal equivalent is N. Since every dog gets one copy of each gene from each parent, there are three possible combinations—N/N, a dog who is highly unlikely to contract or pass on DM to its offspring; A/N, a dog with a low risk for contracting DM but the capacity to pass on an abnormal gene; and A/A, an at-risk dog who will always pass on a mutated gene to its offspring.
The test is simple, requiring only a saliva swab from the inside of the dog’s cheek and payment of $65, which covers the cost of the test kit, processing and registration in the OFA database.
Without doubt, this is a wonderful tool in the fight against DM, but as the University of Missouri takes pains to point out on its website, having two copies of the mutated gene does not necessarily result in disease. Many A/A dogs are completely normal, although they may develop DM later in life. Other now-unknown risk factors may also be involved.
The list of DM-affected breeds is extensive; among those on it are Golden Retrievers, Boxers, Corgis, Chesapeake Bay Retrievers, Bernese Mountain Dogs, Pugs, Poodles, Rhodesian Ridgebacks and, of course, German Shepherds.
To date, there is no scientifically proven treatment for DM. The best hope is prevention via responsible breeding programs guided by knowledge and understanding of an individual dog’s genetic makeup.
To be absolutely certain a dog has DM, the affected part of the spinal cord must be examined under a microscope, something that unfortunately cannot be done on a living dog. Barring that, the gold standard diagnostic tool is an MRI of the spine, says neurology specialist Dr. Avril Arendse, my colleague at MSPCA-Angell.
And this brings me back to Tonka and why I felt confident that all I had to worry about were her poor hips. Yes, her DM genetic test was normal, but more importantly, her spinal MRI ruled out the possibility of disk disease, tumors and other neurological causes of her clinical signs. Looking forward, Tonka has plenty of options, unlike my much-loved Patch, who, to this day, gave me my first and best lesson for owners nursing dogs with disabling diseases: empathy.
Wellness: Health Care
February is national Pet Dental Health month— do you know where your dog’s toothbrush is? If not, put one on your list of things to pick up the next time you’re out, along with a tube of made-for-dogs toothpaste (human brands can upset a dog’s stomach, among other things). Daily brushing is one of the easiest things you can do to protect your dog’s overall health. Granted, few dogs will step up to the bathroom sink and let you give their teeth a good scrubbing, but with patience and a few positivereinforcement techniques, you can help your dog be more cooperative. (The American Veterinary Medical Association has an excellent instructional video on YouTube—see it here.)
When your dog goes in for her annual examination, your vet will check out her teeth and gums and may recommend a thorough cleaning, which requires anesthesia. Anesthesia free dental cleaning is also an option, though it too is best performed in the vet’s office; it has its advantages, but it’s not for all dogs, and ultimately, doesn’t result in as good a cleaning as one performed under anesthesia.
When all is said and done, the few seconds a day it takes to whisk a brush across your dog’s pearly whites will pay off in better health, not to mention sweeter kisses.
Facts and figures:
A story from the New York Times brings up a different twist to a quandary that many might have to face. If a senior dog needs surgery how much is too much to extend a pet’s life? The twist is that the dog didn’t belong to writer Roz Warren. It was Max, her son and his wife’s 13-year-old dog, who needed the gall bladder surgery costing $6,000—and it was Roz who offered to pay a third of it.
We didn’t want to let Max go. We wanted to try to save his life.
Was this crazy? “Would you pay $6,000 for a 70 percent chance of buying two extra years of life for an elderly dog?” I asked my dog-owning friends.
“In a heartbeat,” one said.
“No way,” another said. “When it’s time to go, it’s time to go. You grieve. Then you get another dog. Preferably from a shelter.”
Another friend admitted that when the vet told her a couple of years ago that her ailing Shih Tzu needed an expensive procedure to save his life, she had blurted: “Do whatever you have to do! I love this dog even more than I love my husband!”
“And I really do love my husband,” she told me sheepishly.
Luckily all went well with Max, even though the surgery found that his gall bladder had already ruptured, he recovered.
Even if he hadn’t made it through, knowing that we had done all we could for him would have been worth that price. More important, the whole experience has made me very hopeful about how Tom and Amy are likely to treat me when I’m old and frail.
That was a great gesture for a dog-grandmother to make. What do you think you would have done?
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