health care
News: Guest Posts
Dog Food & GMOs
Should food that has been genetically modified be labeled?

Last November, California became the first state to put the issue on the ballot. Proposition 37, the “Right to Know Genetically Engineered Food Act,” called for such disclosure on the labels of some raw and processed foods sold in stores. It also prohibited them from being advertised as “natural.” And it didn’t give dog chow a free pass.

Although the measure targeted human consumers, the California Sherman Food, Drug and Cosmetic Law applies to both human and animal foods. So any pet food with a detectable level of genetically engineered content would also have to note on its label, “Partially Produced with Genetic Engineering” or “May be Partially Produced with Genetic Engineering.”

That would mean a lot of new label text in the dog food aisle. Over 90 percent of the nation’s soybeans and 85 percent of its corn is genetically modified, according to 2010 data from the U.S. Department of Agriculture. These crops, modified to resist pests or withstand high doses of weed killer, are common in processed foods such as cereals and dog food.

But even with strong consumer support, the label law failed to pass. The organic industry and other advocates were outspent by biotech companies led by Monsanto—the world’s largest supplier of genetically modified seeds—and the food industry, including Big Dog Food. Nestle, owner of Purina PetCare Company and Mars, the maker of Nutro and Pedigree dog food, donated funds to help defeat it.

The Pet Food Institute and Pet Industry Joint Advisory Council argued that the label requirements would increase costs for farmers, manufacturers and consumers alike. Heated editorials appeared on Petfoodindustry.com.

“Putting scary sounding labels on pet food packaging will likely mislead consumers and impact their purchasing choices,” states a “No on 37” Campaign flyer.

In one ad by the campaign, a befuddled-looking man held up a slab of meat and a pet food canister. The line read, “So dog food would need a label but my steak wouldn’t?” The ad aimed at exemptions in the law that might confuse consumers; in this case, that processed beef dog food would be labeled but beef from animals fed genetically engineered crops wouldn’t.

Label supporters say that, given the prevalence of genetically modified ingredients and the scale of the industrial supply chain, a label that covers many of these foods is a good start (for example, dog food with beef which may contain bioengineered ingredients, such as vegetable oils).

Some dog owners already consider mainstream pet food, with its uniform nubs of dry kibble or wet mush, mere canine junk food; fast, convenient, and nutritionally questionable. But are those genetically modified morsels unhealthy in other ways?

The science is inconclusive. A genetically engineered food is a plant or meat product that has had its DNA altered by the insertion of genes from other plants, animals, viruses, or bacteria. The traditional means—plant breeding—allows desired traits to be cultivated, or unwanted effects to be eliminated, over time. Gene-splicing also shortcuts the long process of adaptation and evolution that occurs between food and consumers,

The FDA has ruled that these foods are “substantially equivalent to conventionally produced foods,” and does not safety test them. Unless they contain a known allergen, there is only a voluntary consultation process with developers, who conduct their own testing. But scientists say that the potential for creating new allergens and toxicants in bioengineered foods is there. At the same time, corporate patent rights over seeds limit independent researchers’ ability to study them.

California’s failed initiative calls labels “a critical method for tracking the potential health effects of eating genetically engineered foods.” Dog owners may agree. How would anyone know if genetically altered foods are triggering disease in dogs? Shouldn’t vets know what the pets they attend to are eating?

One thing is clear: it isn’t over. Several states are now working on proposals for their own label laws.

Editor's note: Starting in 2018 Whole Foods will be labeling GMO foods. And even Wal-Mart has been looking at labeling as well.




Wellness: Health Care
Cracked, Broken or Torn Nails

A broken toe nail can be a painful and potentially expensive injury for our furry friends, and it is something that I often see in the ER. A common scenario is a pet suddenly begins to limp while out playing, and upon closer inspection, an injured nail is seen.  Some nails have just a minor crack with some bleeding, while other injuries put a toenail at a 90-degree angle (ouch!). Because they can be painful or have bleeding, a cracked or broken nail may be best treated by a veterinarian. With that being said, it may not necessarily require an urgent trip to the emergency room. A broken nail may be something you can care for at home, or, depending on the degree of injury, it may be reasonable to wait to see your regular veterinarian in the morning.   

So, what to do if your pet is suddenly favoring a paw and/or you see bleeding?  First, get a good look at the paw—including in between the toes and webbing—to see if it is a cut, foxtail or other foreign object, insect stinger, or (you guessed it) possibly a broken nail. When doing so, be sure to look closely at the nail bed, as I have seen cracks and injuries in the nail that were actually hidden underneath the fur line, where the base of the nail goes into the toe. There are 3 general “types” of nail injuries: one where the nail has been completely broken off and is bleeding, one where the nail is cracked or broken but is loosely attached, and one where the nail is cracked or broken but remains firmly attached. 

Usually, the best case scenario is when the nail is fully broken off and some bleeding is noted. In these cases, bleeding is usually mild but can be worrisome if it continues.  These are the easiest types of injuries to treat at home as you generally only need to apply pressure with a gauze or clean cloth to the nail to stop the bleeding. The key is to hold pressure for at least 5 to 10 minutes with no “peeking to see” if the bleeding has stopped before this time is up. It is important to keep your pet calm during this time, as excitement increases blood pressure and works against a good clot forming. If bleeding continues despite applied pressure, you can apply styptic powder (such as Kwik Stop) and resume applying pressure for another 5 minutes or so. If you do not have styptic powder at home, sometimes a little baking soda can do the trick. If the bleeding continues despite these measures, then I would go to the ER rather than wait.

If you do happen to find a nail that is very loose and dangling, then you can attempt to remove it at home.  It is important to have someone help restrain your pet safely while you gently try to remove the nearly broken off nail with a quick pull motion. Caution: only attempt removal if the nail is very loose!  Think “loose wiggly tooth” like when you were a kid. Also, be careful during your inspection or attempt to remove a loose nail as this can cause a sudden and unpleasant pain sensation in which some dogs may nip or bite in surprise.  If bleeding is noted following the removal, you can then use some gauze and light pressure, and/or Kwik Stop, as previously discussed.   

Lastly, there is the type of broken nail that would ideally be treated by a veterinarian.  These are nails that are cracked, continually painful, may be bleeding, and are still firmly attached. Treatment for these stubborn injured nails is typically some form of sedation with pain medication followed by cutting off the damaged nail just above the level of the crack. Sedation is needed because you are cutting through the very thick part of the nail with a live blood vessel and nerve, which is very painful. This is usually followed by styptic powder application and a bandage that is left in place for about 24 hours. The bandage promotes a day of rest so that a solid clot forms and the minor wound does not continue to bleed if it gets bumped on something. Although these types of injuries require professional care, it is something that can wait to be seen the following day if you are unable to get an immediate appointment with your veterinarian (unless your dog seems excessively painful, then I would not wait).

Whatever the type of nail injury, dogs are very good at keeping the area clean all on their own with licking, and antibiotics are not needed. A little licking is OK, and it is what a dog would do “in the wild” to keep it clean. With that being said, some of our babies get a little obsessed, and their good intentions can actually make the area more irritated by their constant worrying at it. Because of this, you should continue to monitor the area for any signs of redness, increased swelling, cloudy discharge, or increasing discomfort.  The development of these complications is rare in my experience, but if noted, then an e-collar, pain medications and possibly some antibiotics may be indicated. No matter what kind of damage has occurred to the nail, it will generally regrow normally in all but a few situations. Sometimes the nail will regrow with a slight curve or different pigment, but usually returns to its normal appearance over several months - kind of like when us humans lose a nail. 

As always, it is best to seek veterinary care if you are uncertain about the severity of any injury, but hopefully this may save you an unnecessary trip to the ER if this happens to your dog during a weekend while you are out having fun!

Culture: DogPatch
Urban Animal
Smiling in Seattle
Urban Animal: Taya Maes; Cherri Trusheim, DVM; Rob Oatman, LVT.

The design sensibility at Urban Animal, a veterinary office that opened last year in Seattle, is part Airstream and part 1978 Ford truck—both of which practice founder Cherri Trusheim, DVM, owns.

Located in an old medical building in what is arguably the city’s hippest neighborhood, the warm modern space features funky vinyl chairs and second-hand medical cabinets, paint-by-number dog portraits, an enormous vintage print of a cabin in the mountains (the Irish Setter pointing in the grass was added by an artist friend later), and, in the corner, a photobooth.

Yep, a photobooth, and not one of those unsatisfying digital numbers. This booth uses film and dispenses slightly wet prints in four minutes (for $4). It’s here for clients and patients to amuse themselves and perhaps take some of the stress out of a visit, but non-clients are also welcome to pop in for snapshots.

The photobooth isn’t the only unconventional thing about Urban Animal. Dr. Trusheim, who’s worked as a relief vet and at an emergency hospital, has a different plan. In addition to its all-walk-in, open-weekends schedule, Urban Animal has a strong commitment to keeping care affordable, an approach that might include not pushing for the most extreme and costly interventions. In an industry with spiraling costs, these ideas are as surprising as, well, a photobooth in a vet’s office.

Wellness: Health Care
Hyperadrenocorticism or Cushing's Disease in Dogs:
Excessive levels of steroids in the body leading to disease

Hyperadrenocorticism, known as Cushing's disease, is a hormone imbalance that results from excessive cortisol in the bloodstream over a long period of time. Cortisol is produced and stored in the adrenal glands, which are two little glands that “sit” on top of the kidneys and is what is released in times of stress, preparing for a “flight or fight” response. However, if this system goes awry, and a dog's body is exposed to this hormone for a majority of the time instead of just in times of stress, it can become chronically debilitating. 

There are 3 main ways that a dog can get Cushing's Disease. The first way is from a tumor forming on the pituitary gland, and is known as Pituitary-dependent hyperadrenocorticism (PDH).  These tumors are generally small and non-cancerous, although rarely a cancerous tumor can occur.  The pituitary gland is located in the brain and is the “master gland” of the body.  One of its jobs is to detect when cortisol levels are declining, and in response, secrete a stimulating substance, called ACTH, that kicks the adrenal gland into gear causing it to secrete more cortisol. When the body reaches normal levels of cortisol, the pituitary gland stops this message from being sent, and production is halted. In the case of PDH, a tumor causes the pituitary gland to go into overdrive, telling the adrenals to produce excessive amounts of cortisol, despite there already being too much in the body. This is the most common form of Cushing's and accounts for about 85% of dogs with disease.  

Adrenal gland tumors are the next common cause, account for approximately 15% of dogs affected. This is a situation where a tumor is on the adrenal gland instead of the pituitary, and puts the gland into overdrive. The adrenals begin making excessive steroids all on their own, no longer “listening” to the pituitary when it tells the adrenals to shut off. These tumors are generally larger in size (usually detectable on ultrasound) and both cancerous and non-cancerous tumors are possible. Another problem that can happen with this type of tumor is that the pituitary “sees” that there is enough cortisol in the body, and subsequently stops producing ACTH.  As a result, the other adrenal gland (the one without the tumor) becomes shrunken due to nonuse.  

The last major cause is what is known as Iatrogenic Cushing's and is the result of the long-term use of steroids, or medications containing steroids. This is not from any inherent disease in the pet's system, but from the effects of the hormones given over the long term. Over time, the pituitary gland perceives that the body is getting enough steroids (thinking it is being produced from the adrenal glands-not knowing it is coming from medications) and quits sending its signal to produce more. In turn, the adrenal glands stop doing their job and also begin to shrink, temporarily loosing their ability to release cortisone on their own should their body require it to do so.  This inability to produce steroids naturally in the body can last for several months following the stopping of medication. This is why your veterinarian will instruct tapering doses of steroids instead of an abrupt stop: this gives these important glands time to recover and begin working on their own again.

There are a multitude of clinical signs that can be seen, and as always, can mimic many other disease processes. Signs are generally gradual, and because of this, they are often attributed to “normal aging” and disregarded. The most common signs that are easily observed in pets by their owners are increased drinking and urination, increased appetite (a good reminder that eating well is not always a sign of normal health), a “pot-bellied” appearance, thin skin and sparse hair coat, blackheads and/or darkening of the skin, and loss of muscle mass or muscle weakness.  Aside from these symptoms described, advanced or untreated Cushing's disease can also put a dog at risk for the development of bladder stones, diabetes and blood clots to the lungs.

If you notice any of these signs in your pet, a veterinary exam is in order. Your veterinarian can begin the process of testing for the disease, ensuring your pet is appropriately treated. If your veterinarian has reason to suspect Cushing's (based on history, physical exam and initial blood work), it will then be necessary to perform confirming blood tests and ideally, an ultrasound. This is not an easy diagnosis to make, and it requires several specific tests to positively identify not only the presence of Cushing's, but whether the problem is in the pet's pituitary or adrenal glands, as there is a different treatment for each form of disease.

The expected course of disease depends on which type of Cushing's is present, as well as response to treatment. PDH generally carries a good prognosis, and survival time for a dog treated with appropriate therapy is 2 years, with at least 10% of dogs surviving 4 years (this is better than it sounds, as dogs are generally diagnosed at an older age, usually 10-12 years old).  Dogs with non-cancerous adrenal gland tumors usually have a good to excellent prognosis; those with cancerous tumors that have not spread can have a fair to good prognosis, making early detection important.

Other tips and sidenotes:
I am often asked just how much water should a pet be drinking, to determine if the amount is excessive. As a loose rule of thumb, your pup should consume daily about 1 cup of water for each 10 pounds of its body weight. This is a loose approximation, as consumption will be variable depending on temperature of the environment, activity level, etc. The biggest thing to keep your eye on is if the amount seems to be steadily or suddenly increasing with no change in your pets daily lifestyle.
Here are two listserves available for owners of pets with Cushing's disease, and may be helpful resources for anyone living with a pet who has this disease.



Wellness: Health Care
Swabbing the Dog

Dog? Check. Buccal swab? Check. Apply the latter to the former, inside of cheek. Rub for 10 seconds. Voilà. DNA collected.

Until fairly recently, the garden-variety dog owner could only wonder if potential problems lurked in her dog’s DNA. Now, however, it’s possible to know—maybe not everything, but at least the possibilities. Which can be kind of comforting, since it allows you to focus your anxiety where it might be more useful.

As dogs age, they display a number of signs similar to those experienced by aging humans, among them, loss of muscle tone and strength. And, like humans, those symptoms can be chalked up to simple aging. For the  prone-to-worry among us, they can also be signs of something more dire, such as degenerative myelopathy, or DM (see Nick Trout’s column in the Spring 2013 issue for more on that).

For answers, we turn to our vets, and increasingly, to science. The Orthopedic Foundation for Animals offers much, much more than insights into a dog’s predilection for, say, dysplasia or subluxations. This nonprofit, which was incorporated in 1966 and began with the mission of evaluating and genetic counseling for those whose dogs were at risk of hip dysplasia, has evolved its objective: “To improve the health and well being of companion animals through a reduction in the incidence of genetic disease.” (They’re also including other companion animals these days, cats, for instance.)

So, when I started noticing hesitations and missteps in my large-breed, 14-year-old dog’s gait, I wasted no time. Going to the OFA website, I was able to request the DNA test for DM, pay for it online and have the kit sent to me. Once I received it, it was comparatively easy to do the cheek swab required (it would’ve been easier with just the tiniest bit more cooperation from the dog in question, but then, that would’ve been out of character). Some DNA tests require a blood draw, which needs to be done at a vet clinic, but many are equally reliable via cheek swab, which pretty much anyone can do at home.

The instructions were simple, as was the return. Within in days, I had a response from the University of Missouri’s Animal Molecular Genetics Lab, where the DNA was evaluated. I was glad to see that the test came back N/N, or no genetic markers for DM. But even if the results had been different, I would have at least known, and knowing is always better. Having this test done also meant I could provide my vet with one more piece of information that he could factor in to his diagnostic consideration.

Another benefit is that by having this sort of evaluation done, you—via your dog—are contributing to the larger body of knowledge on genetic diseases. The samples and associated information about the dog become part of a DNA repository, which may in the future provide answers to some of dogs’ more vexing health issues.

Wellness: Health Care
Bionic Limbs
Q&A with Denis Marcellin-Little, DEDV

Denis Marcellin-Little is an orthopedic surgeon at the College of Veterinary Medicine at North Carolina State University. Over the last seven years, he has been pioneering a remarkable intervention for dogs with missing legs, giving them prosthetic limbs that are permanently attached to their bodies. In the procedure, known as transdermal osseointegration, Marcellin-Little implants one end of a titanium rod into whatever remains of a dog’s leg, attaching the metal directly to the bone. The other end of the metal implant attaches to an artificial foot. So far, he’s outfitted six dogs and two cats with these bionic limbs, and he’s currently preparing three more canines for the procedure. We caught up with Marcellin-Little to ask him what it takes to build a pooch a brand new leg.

Bark: How did you get interested in osseointegration?
Denis Marcellin-Little: I saw a very brief presentation, a few slides, on a cat that had received rod-like implants for both back legs in 2002 or 2003. It planted a seed in my mind. A little bit later on, in 2005, I had a cat that presented with no feet. Both back feet were missing. We worked with [a group of students in a biomodeling and biomanufacturing course] on designing a prosthetic leg that would actually be completely attached to the bone, and then we went on from there. We did the surgery. Over time, the process became much more sophisticated.

B: What kinds of injuries or ailments have your osseointegration patients had?
DML: They’re all over the place. Some of them are born without an extremity. Others have neonatal problems, like maybe the umbilical cord [was] wrapped around something or they have some injury during birth. Sometimes, patients get injured. Some of them have a wound that gets infected. And then you have tumors.

B: We know each case is a little different, but what’s the general procedure like? When a dog gets one of these implants, what happens?
DML: To be a candidate, the patient should have the right personality, the rest of his leg is working fairly well, he’s fairly docile, and he seems to be well loved and well taken care of. The patient and the owner have to be compatible.

The patient will get a CT scan, a good orthopedic exam, maybe some radiographs. And then we get to work. We make implants that are customized to the patient—what we call “freeform implants”—that are designed to merge with the bone. The next time we see the patient, we will be ready to do the surgery. By then, we have rehearsed that surgery, we know the implant is a perfect fit on the bone. And then we will do our surgery. We prepare the tissues, then we place the implant on the bone, and then we reconstruct the soft tissues.

B: How do you attach the implant?
DML: Our short-term strategies depend on the shape of the bone and the size. They rely on a combination of “press fit,” meaning the implant is firmly pushed in or on the bone. And if we feel that the press fit is not enough, then we will place screws or bolts inside the bone or on the surface of the bone. Our long-term strategy is “ingrowth.” The implants are made of [porous] titanium and the bone will grow into the titanium. Once you have ingrowth, you don’t really need your bolts anymore or your press fits. You have a very healthy, long-term, selfrenewing interface with the bone.

B: After the dog heals, you attach some sort of external foot to the prosthesis?
DML: There is a piece of metal that comes out of the skin and we usually put something round on it. The patients just start using these round little feet. We were absolutely amazed by our first patient—the cat that we did. We put a foot on him and he was running around like he was doing it forever. It was just amazing, the ability to recover. I realized very quickly that dogs adapt much more slowly than cats. They weigh more. The dogs need a little more rehabilitation, or a training period, where they start using their leg, they start trusting their leg. But once they trust it, they are very pragmatic and they will start to use it.

B: Some dogs get socket prostheses, which just slip on over their stumps. What’s the advantage of an osseointegrated prosthesis?
DML: Sometimes, we can’t use socket prostheses. In some specific locations they are not an option. They often are less energy efficient than the transdermal implant. They move out of alignment by an inch and suddenly, they don’t fit anymore. They become too loose or too tight or you have a lot of skin abrasions. If you’re going to go on a three- or four-mile walk, that would be very challenging. [With a socket prosthesis], there are very few dogs that can go on long walks. But with a transdermal implant, there is no limit to what you can do with your limb.

B: How do you think the procedure and approach will improve as time goes on?
DML: There are a number of things in transdermal osseointegration that are less than perfect and are continually evolving. The process is very different now than in 2005, and most likely will be very different seven years from now. It’s a complicated idea—there are a number of features, and they all can be refined and optimized.

One challenge would be to design a foot that is very ergonomic: it’s easy to put on and [take] off, it’s very stable when it’s on, it’s light, it’s strong, it’s wear-resistant, it has good traction. We could imagine that these things could become more sophisticated over time.

I foresee that the process will become more standardized; I also think that it will become more rapid. And, of course, we will know more about it. Right now, we don’t know much—it’s just one case here, four cases there. As you can imagine, the field can be greatly improved. I think it’s going to play a big role in medicine. I spend a lot of time and energy for a few patients that have very big problems, thinking that it will trickle down to other patients in the future. I would like people to know that there are options if a dog is missing a foot or two—or maybe three or four.

Wellness: Health Care
ASPCA Poison Control Center
Emergency help only a phone call away

ASPCA Poison Control Center, 888-426-4435: 10 digits every dog owner should know!

A number of calls we receive in the ER are inquires about whether or not a substance is toxic to their pets. These inquires can include questions about specific pet or people medications, vitamins and supplements, both common and unusual household items, as well as various food stuffs.

With literally thousands of medications and oddities that our pets can get into, it becomes nearly impossible to know what is toxic, at what dose toxicity becomes a concern, and the treatment for each of these substances. Because of this, when we receive a call, we frequently refer pet parents to the Animal Poison Control Center for further information regarding the “dietary indiscretion.” This amazing service provided by the ASPCA is truly invaluable when there are questions or concerns about the potential for toxicity of any given substance. The center is staffed 24/7 by veterinary toxicologists who have at their disposal an expansive data base that includes every imaginable substance ever to have been known to meet a dogs mouth.

There is a nominal fee of $65 for this service, but a call might actually save you a trip to the ER or to your veterinarian, as well as give priceless peace of mind. When you call from home, you will actually be able to find out whether or not your pet needs medical attention, if you can induce vomiting at home (this becomes especially important for those people who live far away from veterinary care), or if you can potentially give some other home treatment. At the completion of the call, owners are given a case number that can be referenced again later should your pets condition change or clinical signs develop. If your pet does happen to need medical attention, once you arrive at the hospital for treatment, your veterinarian can call the center, also referencing this number, and can continue your pets care based on the toxicologist's recommendations.

This is truly priceless information, especially considering all the misinformation you can come across during a consult with Dr. Google. In fact, I have had to treat pets whose condition actually worsened because of an inappropriate treatment given at home. A situation that comes to mind was a good-intentioned owner who induced vomiting at home, based on what she read, after her dog ate Tide laundry detergent. Detergents can be very caustic (making vomiting a big no-no) and her dog subsequently suffered from erosive ulcers along the entire length of its esophagus as a result. Her pup required the placement of a feeding tube to bypass the esophagus, allowing it to heal. 

I would also like to add that part of our responsibility as veterinarians is to call back the toxicologist and report the response to treatment. This follow-up information continues to help others in the future as each toxic exposure, treatment and response to treatment gets added and stored in the ever-growing data base.

I cannot say enough good things about this invaluable pet resource. Every pet owner should have the ASPCA Poison Control number (888-426-4435) on their speed dial or refrigerator—this number may save your pets life as well as help other pets in the process.


Wellness: Health Care
The Gift of Good-bye
Caring for dog, Hospice

What would you give to be able to spend another month, another week, or just another precious day with your best friend? Anyone who has ever loved and lost a pet has probably had such a wish.

Pets are no longer just pets; they fill the role of family, child, companion and guardian. As such, their dying process can carry a burden equal to the loss of our two-legged loved ones, and it is during this time that both pets and their people can benefit from animal hospice. Hospice allows our pet’s final journey to be experienced with dignity while surrounded by love in the familiarity of their home. It allows our pets to live out the remainder of their lives as fully as possible until the time of death, whether a “natural death” or compassionate euthanasia is elected.

As with human hospice, animal hospice exists to provide support and care for pets in the last phases of incurable disease or at the natural end of their lives. It helps facilitate the availability of resources to educate, support comfort care, manage pain and allow for a good quality of life, whether that is days, weeks or months. Hospice care also grants pet parents time to plan, grieve and say good-bye to their companions while providing a way for them to bring their pets home for their final days instead of being in the confines of a hospital setting or an unfamiliar exam room.

These are just a few reasons why I feel hospice care is so incredibly important and why it has always resonated with my heart. Prior to my veterinary career, I worked as a registered nurse, and it was during this time that I was first exposed to the concept of hospice care. Over the past several years, I have found myself drawn back to these roots, and have since started a pet hospice service within the referral hospital where I practice emergency medicine.

To highlight what a difference hospice care can make to a pet and a family, I would like to share the story of my first hospice patient, Sunny, who was one of the most loving and happy girls I have ever met. She quickly earned the nickname “Kissy Girl,” as I couldn’t be within a tongue’s length of her lest I be the receiver of her spirited attempts to lavish an endless stream of wet and cold-nosed kisses on me.

Our paths first crossed during a typical Sunday in the ER. As I was getting ready to see my next patient, who was having trouble urinating, I thought: diagnosis, UTI. But  during the physical exam, my heart sank as I realized that the source of her straining to urinate was not an infection, but rather, a tumor that was compressing her urethra. An ultrasound revealed that it was inoperable, and chest X-rays confirmed that the cancer had already spread to her lungs. Looking at that sweet and happy face, you would never guess that all that badness was living inside her.

Bad turned to worse when I found out that Sunny’s dad, Jeff, was in another state attending his own father’s funeral. Besides the devastating news of her cancer, the most difficult thing for Jeff to endure was the fact that he would not have a chance to say goodbye, nor be by her side when she passed away. He was torn: in his heart he wanted to be with her once more, while in his mind, he did not want to delay the inevitable and risk her being in discomfort. This broke my heart, and I shared his sense of helplessness.

My hospice service wasn’t set to officially begin until the following month, but I could not let Sunny pass without her dad having had the chance to see her just one more time. I offered a hospice situation for her, and helped her by placing a catheter so she could urinate despite the tumor. Jeff took a red-eye flight home that very night and reunited with her the following morning. She erupted in sheer joy the moment she saw her dad, and Jeff easily learned how to manage her urinary bag.

Hospice care allowed Sunny to have another amazing week at home—one that included heaps of love, trips to the park and her favorite beaches, and a  doggy party where filet and ice cream were served. It also allowed Jeff time to return home, spend more quality days with her and begin the process of saying good-bye to his best friend.

At the end of the week, I spent an incredible afternoon with Sunny’s family, celebrating and toasting her life, as well as getting more of those famous kisses. I helped her cross the Rainbow Bridge from her favorite sunshine-filled spot in the back yard, surrounded by those who loved her. You see, Sunny was not just “any dog”: she was also the rock who helped Jeff through the death of his first wife due to cancer.

As I reflect on my life’s path, it seems strangely paradoxical: I spent the first eleven years of my veterinary career doing everything possible to save lives in an ER setting, and now I am working just as fervently to end them as beautifully and as peacefully as I possibly can.

I am often asked, “Aren’t you always sad? Isn’t this just so difficult to do?” The short answer to this multi-layered question is “yes,” and in fact, I still cry during every euthanasia. Although it can be a heart-wrenching journey to take with another, it is through these experiences that my life becomes more blessed and made richer. For what people often don’t realize is that my tears well from being in the midst of great love, from experiencing the tremendous bond between family and pet, and from being able to give another the precious gift of good-bye.

Wellness: Health Care
A bacterial disease that's spreading

Leptospirosis is a bacterial disease of great importance as it can affect both humans and animals, and can readily be spread from one species to another (i.e., from our dogs to us). For many years the occurrence in pets was rare, however, in the past few years, the disease has become diagnosed more frequently-I myself have treated four dogs suspected of having Leptospirosis just this past year. The disease is caused by a bacteria that is spread through the urine of infected animals into the soil and water where it can survive for up to 180 days, given the right conditions. Then, as other animals come in contact with this contaminated area, the bacteria can then be taken up through their skin and mucus membranes (gums, nose, eyes) or through drinking the contaminated water (another reason to stay clear of puddles!).  

There are several environmental factors conducive to letting this bacteria flourish and increase risk of exposure. Warm, moist environments favor this bacteria, and they especially love stagnant water. With that being said, Leptospira do need water or damp soils to survive, and they will rapidly die on dry surfaces. The density of animal population, such as kennels and urban settings, also increases urine contamination and thus exposure. Also, areas that are heavy populated with rodents or wildlife also increases risk; they serve as “innocent hosts” meaning they are not affected by disease, but they continue to spread it to the environment through urination.    

The clinical signs of disease can be vague and mimic many other disease processes.  Signs can include fever, lethargy, loss of appetite, muscle stiffness or soreness, or vomiting and diarrhea to name a few. If the liver is involved, a yellowish discoloration of the gums or whites of the eyes can also be observed. Because Leptospirosis can look like any other disease, confirming the infection is generally not an “ah ha!” diagnosis when your pet walks into the exam room. This is something I tend to diagnosis by a “second round of tests” when the initial blood work and urinalysis look suspicious for disease. What can raise a suspicion of a Leptospira infection is an elevation in both kidney and liver values and sometimes the white blood cell count. If this is observed, your veterinarian will then recommend a special blood and urine test be sent to an outside laboratory. These results can take several days, and so antibiotic treatment is often started prophylactically pending the confirming results.

Most infections are subclinical, which means no signs of disease will ever develop and your pet will never experience illness. However, if your pet does develop sudden signs of disease, and those signs appear severe, we generally give a guarded prognosis (50/50 chance of survival). If your pet becomes ill, the extent of care needed depends on the severity of disease, but in my personal experience, the treatment generally requires a hospital stay with extensive supportive therapy. Without treatment, Leptospirosis can lead to kidney failure, liver failure, and even death. Blood or plasma transfusions are sometimes needed if the body losses its ability to clot due to liver compromise. Yes: this can be one bad bug.  

So, how can you keep you and your pets safe? In addition to good sanitation practices and limiting your pets access to areas with standing water, there is a vaccine available. Vaccines contain what are known as “serovars,” which are “components” of the bacteria used to stimulate protection from disease. However, there is a catch. There are at least nine serovars, or strains, that can cause disease, yet the vaccine contains only a fraction of these, offering incomplete protection. Often people think their dog is safe from disease because it has been vaccinated, but sadly, this is not the case.  Additionally, immunity may only last 6-8 months, and some veterinarians recommended that you should vaccinate high-risk dogs (such as dogs who hunt, show dogs, dogs with access to lakes and ponds, and endemic areas) every 4-6 months. Vaccines do not come without risk, and the use of this vaccine with regards to risk vs. benefit is definitely a conversation to have with your veterinarian. Your veterinarian can assess your dog's risk of exposure, discuss the most common “local” serovars found in your specific area and can recommend a vaccine protocol that makes sense for your pet.


Wellness: Healthy Living
Fighting Fleas on Pets...Safely

Scratch, scratch, scratch....

The sound of Cricket's toenails digging into his belly woke me last night at 3:00 AM. How annoying. The little guy has a flea, and that means today's bath day. Our dogs recognize the bath day ritual pretty quickly. When their beds get stripped and everything goes into the washing machine, they both get that worried look. Then when I put on the red running shorts, they know the time has come. In the past, Cricket - the little scamp - would try to flee and we'd have to chase him down, corner him, scoop up his 30 pounds of indignation, and carry him into the shower. Kanga had a more Gandhi-esque approach to the whole thing. She would curl up on the couch and refuse to move. Since she weighs a full 60 pounds, we'd sometimes practically need a crowbar to get her up and prod her toward the bathroom. Now they seem to recognize the inevitability, so both dogs come - heads hanging low - and submit to the indignity. Afterwards they cavort in gleeful joy for having survived yet again. That night Cricket asks to hop up on the bed, and sometimes we let him because he's so clean, fresh and fluffy...not to mention cute.

Lots of people ask me how to control fleas on pets, and as a pet owner I can relate. I hate fleas. But a trip to the pet store can be a bewildering experience, with all kinds of pesticide products on the shelves marketed to protect our best friends from vermin. Over the past year or so, my team of researchers at NRDC has been looking at these products and we've learned a few things that made me go with my current shower plan.

First of all, just because a pesticide is legally on the shelves doesn't mean it's safe. Many of these products contain potent chemicals that can have adverse effects on pets and kids. I'm especially concerned about flea collars because many of them contain really toxic chemicals - such as tetrachlorvinphos and propoxur - that should probably not be on the market anymore. The collars are designed as a 'slow release' device for the pesticide, and spread a pesticide residue across the animal's fur for weeks. That's fine unless you ever touch your pet. The problem is that the residue gets on your hands (or worse still children's hands) and then can be absorbed through the skin or accidentally ingested.

Even some of the "natural" flea control products can be a problem, since some of these chemicals can cause allergic reactions such as dermatitis and even asthma in sensitive people. There are lots of products out there, but we found relatively few that we can really recommend as safe. For information about specific flea control products that you use, check out the product guide on the "Green Paws" website.

In medical school, I took a course on the history of medicine. I learned the disgusting fact that in the past people were routinely infested with vermin such as lice and fleas. All kinds of chemicals, including DDT, were used for de-lousing humans even within the past 50 years. Fortunately, vermin on people isn't generally a problem in the United States today. That's because most of us bathe and wash our clothes on a regular basis. So why not apply this same rule to our pets? In my house, every two weeks, the dogs get a bath and all of their bedding gets cleaned. Every week the carpets get vacuumed well to remove any possible flea eggs. Guess what - it works! Every so often one of them picks up a flea at the dog park, but as soon as we see the scratching, out comes the flea comb, and that little blood sucker is soon drowned in a cup of soapy water. It's really easy once the whole family has the routine down. And it's great to have dogs that smell and feel clean.  Better still, it's great to have dogs that aren't covered with a toxic residue.

This article originally appeared on Gina Solomon's Blog on Switchboard, from the NRDC website, in Oct 2008.