Wellness: Healthy Living
Greater choice made available to pet owners
As politicians and voters squared off this fall, a little bill sat in committee on Capitol Hill, awaiting action that in all likelihood won’t happen. If it expires, it will probably be reintroduced at the next Congressional go-around in 2013. But even if it dies on the vine, the bill has opened debate on an issue that affects virtually every pet owner — the cost and availability of veterinary medications — and promises to keep the discussion going for years to come.
If passed, the legislation (officially known as HR 1406: Fairness to Pet Owners Act of 2011-IH) will require vets to give clients a written copy of all prescriptions. It also will require them to notify clients, in writing, of the client’s option to have the prescription filled elsewhere, and to confirm (via fax or other means) any prescriptions sent to outside pharmacies. This is not a novel concept; a majority of veterinarians already do this for those who request it. The act would, however, make it mandatory for vets to provide the prescriptions without being asked.
The bill is modeled on the Fairness to Contact Lens Consumers Act of 2003, which required eye doctors to give their patients a copy of their prescriptions, thus breaking the medical monopoly on those lucrative little bits of polymer. This “prescription portability” was credited with changing the entire contact-lens market, giving consumers freedom to comparison shop (making prices more competitive) and also improving the quality and safety of the products themselves by streamlining the supply chain and distribution system. In the world of veterinary medicine, prescription portability would, at least in theory, reassure bargainhunting consumers that they’re shopping around in a truly open (and safe) marketplace.
HR 1406 was introduced April 2011 under the sponsorship of Representatives Jim Matheson (D-UT) and Lee Terry (R-NE) and was immediately sent to the Health subcommittee of the House Committee on Energy and Commerce, which must approve the bill before it can be voted upon by Congress. But because 2012 is an election year — one that most certainly hasn’t been dominated by debates over pet prescriptions — few observers predict any action. The legislative monitoring service GovTrack gives the bill a 1 percent chance of passing before the end of the 2012 session; not great odds, obviously, but not particularly bad, either, given that only about 4 percent of the bills introduced in 2009–2010 were enacted.
“Most often, bills like this take five to seven years to get passed,” says Andrew Binovi, federal legislative manager of government relations for the ASPCA, which is supporting the bill. Alyson Heyrend, communications director for Rep. Jim Matheson, adds, “There is no action expected on the bill before the end of the session — it’s an election year. But we’ll most likely be reintroducing the bill next time. It’s a good bill, good for pet owners, good for consumers. In this economy, every little bit helps, and lots of people aren’t even aware that they have options when it comes to pet medications.”
A Pocketbook Issue
Like everything else in Washington, the Pet Owners Act has both fans and foes. According to the Center for Responsive Politics, eight organizations are registered to lobby on HR 1406, including Walmart and the National Association of Chain Drug Stores. “This bill allows consumers a choice when it comes to prescription medications for their pets, and Walmart supports efforts that give our customers a say where they purchase medicines and enable them to save money,” says Molly Philhours, a media relations rep. This support is hardly surprising, as the act would be a boon for Walmart and other big retailers, drug and grocery stores, says David Sprinkle, research director for Packaged Facts, a market research firm. “What we’re seeing is a natural progression, as the pet-health market moves toward greater parallelism with human healthcare.”
However, the number of pets covered by health insurance is miniscule, arguably making the out-of-pocket cost of a pet’s prescription drugs an even bigger concern for consumers than their own meds. “Less than 1 percent of the cats and dogs in America are insured, so this is a huge issue for owners,” says Laura Bennett, CEO of Embrace Pet Insurance. “Even if this bill doesn’t go through, it’s already had a big impact.”
Bones of Contention
The proposed legislation has another downside for vets: loss of revenue. While the impact will vary among individual practices, Morgan says, most veterinarians today make between 14 and 28 percent of their income from in-house drug sales. In addition, vets typically charge fairly high mark-ups, an average of 129 percent over wholesale, according to the American Animal Hospital Association. Many also charge a “dispensing fee,” typically an average of $9 per script. Morgan adds that the proposed law would drown vets in paperwork, and require clinic staff to spend an inordinate amount of time communicating with outside pharmacies. Most veterinarians will be forced to pass those extra expenses on to their clients.
Until fairly recently, veterinarians were the sole source for prescription pet medications. But with the advent of online pet pharmacies, such as Drs. Foster and Smith (which began selling medications and other pet care products through its catalog in 1983 and online in 1998), price-conscious owners started taking their drug business elsewhere. And in 1994, with the passage of the Animal Medicinal Drug Use Clarification Act (AMDUCA), veterinarians could prescribe certain approved human drugs for animals. In many cases, this gave veterinary clients an option to choose between the animal and the human drug, and to buy those drugs from outside pharmacies.
But this just means that vets are behind the times when it comes to setting their prices, says Bennett. She notes that many veterinarians deliberately undercharge for some services to keep clients happy; like restaurateurs who exponentially mark up the wine they sell to make up for value-priced entrees, these vets count on the sale of medications to make the balance sheet work. “If you’ve been relying on drug sales all this time, this is a wake-up call,” she says.
Competition — and Choices
All of these outlets offer incentives to pet owners. Kroger, for example, sells a long list of generic pet drugs, including some of the most-prescribed for dogs — pain-relievers like tramadol and meloxicam and antibiotics like amoxicillin and cephalexin — at $4 per 30-day supply. Target’s PetRx program, available in more than 1,200 of its instore pharmacies, can fill veterinary prescriptions for animal-specific medications, and all Target pharmacies will fill pet scripts for human drugs (they offer many $4 generics, as well). At Walgreens, you can add your dog to your $35-a-year family membership in the discount pharmacy program. With that, you get reduced prices on pet prescriptions and access to over 400 generic medications priced at $12 for a 90-day supply. Stop ‘n Shop and Winn-Dixie stores fill human-equivalent scripts, and have arrangements with online pet pharmacies to get your dog’s meds to you in one to two days.
For those who’d rather shop online, there are currently 18 web-based pet pharmacies accredited with the National Association of Boards of Pharmacy through its Veterinary-Verified Internet Pharmacy Practice Sites (Vet-VIPPS) program, each of which has its own offers and incentives. (There are also countless websites that aren’t accredited — or properly licensed — which the Food and Drug Administration and other groups strongly suggest you avoid.)
All this competition is good news for consumers, says ASPCA’s Binovi, because it guarantees that pet owners will be able to fill prescriptions as cheaply as possible. “There are big benefits here for both pets and their guardians,” he says. “It’s not that the veterinarians were a problem, just that this bill would harmonize all the different state laws to guarantee that everyone has better access to these medications.”
Keeping the cost of pet ownership down is especially important in this economy, he adds. “We know that economics weighs into the decision to adopt an animal and even, in some cases, to surrender an animal to a shelter.” There are no statistics on the number of owners citing the high cost of prescription drugs — or any other expense associated with keeping a pet — as the reason for surrender, but it’s not a great leap to suggest that someone who’s facing serious financial problems might see the family dog as an expense that could be eliminated. And even for an owner who’s not in dire straights, every little bit helps. “It’s always good to have more choices and better access, no matter what you’re buying,” he says.
You can verify an online vendor’s Vet-VIPPS standing on the NABP website: nabp.net.
Wellness: Health Care
Something was wrong with Whiskey, and it wasn’t lethargy, whining or refusal to eat that tipped off his owners. It was chew sticks, unchewed. For the 10-year-old Small Munsterlander, chewing was a lifelong obsession. It had been a good life, one spent running down San Francisco city sidewalks; playing in the parks; exploring neighborhood shops; and, of course, chasing toys on the beach.
Whiskey’s owners, Tom Swierk and Robin Addams, indulged his appetite for beef tendons and other treats. The dog they had acquired as a young pup still had “lots of sass,” as Swierk describes him, or he did until last Thanksgiving, when his owners realized he had lost interest in chewing, one of his favorite pastimes. The Small Munsterlander, a hunting breed that originated in Munster, Germany, has been bred for centuries to thrive on chasing and retrieving. True to his roots, Whiskey was a friendly, devoted dog with an intense streak that his owners channeled into play. When Whisky ignored his chew toys, Swierk thought it was a problem with a tooth, and took him to the vet.
It was cancer.
Oral cancer, both malignant and benign, is not uncommon in dogs. Unfortunately, Whiskey’s tumor wasn’t benign. The lesion on his lower left gum was malignant squamous cell carcinoma, the second most common oral malignancy in dogs. In humans, it accounts for 70 percent of all oral tumors.
The wrenching news came with a silver lining: the cancer hadn’t spread to other organs. “This type of malignant tumor metastasizes less than 10 percent of the time,” Swierk says. It is known for its aggressive growth, however, and the tumor had already invaded Whiskey’s jawbone. Nearby were lymph nodes, a ready target and a pathway for the cancer to spread.
What, then, could be done? The usual course of action was to amputate the affected bone, sometimes using chemotherapy and radiation. Another common treatment involved shaving the growth, Swierk says, but that would also mean subsequent periodic surgeries. With the diseased bone removed, Whiskey’s chances for a full recovery were good. A life without chewing, however, wasn’t so promising.
After amputation, the jaw is never quite the same. The teeth and bones gradually fall out of alignment, and the dog’s teeth can cause ulcerations in the hard palate. He could eat, but there would be no more chew toys. He could not play ball or tug of war.
As it turned out, there was another option. A team of vets at the University of California, Davis, had been working on a fix for pets who lost jawbone to disease or injury. It had only been used in five other dogs, but the results had been good. Their vet referred him to the UC Davis School of Veterinary Medicine, 73 miles east of San Francisco.
It was a done deal for Swierk and Addams, who were prepared to travel to New York, if that’s what it took to not only save their dog, but have him back whole, and to pay the $8,000 treatment cost. Whiskey was more than a pet to them — he was their companion.
“Whiskey is our world, plain and simple,” Swierk says.
Bone regeneration was seen as science fiction in 1948, when Dr. Marshall R. Urist, a UCLA orthopedic surgeon who pioneered the field, got started. Urist spent five decades at the bone research laboratory at UCLA, where he discovered how to use proteins to stimulate skeletal repair.
In 1971, he proposed the name “bone morphogenetic protein” (BMP) for the growth-promoting factors he used to prompt new bone growth in rabbits. The bone proteins act as signals to stem cells, which migrate to them and are converted into bone-forming cells. These cells then grow bone in the area where the BMP was placed.
Naturally occurring BMP is found within bone, but clinically useful amounts can’t be easily extracted from human donor bone and so must be genetically engineered in the lab.
At UC Davis, Whiskey was in the care of a team of vets who had been perfecting a new procedure to regrow damaged jawbone, work that drew on Urist’s research and other experimental and clinical treatments developed for humans. The team included Dr. Dan Huey, a biomedical engineer; Dr. Boaz Arzi, a veterinary surgeon; and Dr. Frank Verstraete, who heads the dentistry and oral surgery service at the veterinary teaching hospital. Their goal was to put biomedical approaches to bone replacement to use in veterinary practice. Once they had refined a technique that would work for dogs, they put out the word, and soon referrals from other vets were coming their way.
“It wasn’t an experimental study, just an innovative application of existing materials,” Verstraete says.
Over a two-year span, eight dogs have undergone the procedure, and to date, all are doing well, the vets say. Each dog spent three days at the teaching hospital for an exam, surgery and recovery, followed by three post-operative exams.
Whiskey, their sixth patient, had the largest lesion. There was no getting around it: he would lose much of his jaw. But with the help of a titanium plate, a sponge and some bone proteins donated by Pfizer, he would grow a new one in a matter of months.
The team’s first task was to decide how much bone to take in order to remove all of the cancer. That proved to be 2.5 inches, or about half of Whiskey’s lower left jawbone. Once the diseased bone was out, in went a titanium plate built by Dr. Arzi, which was screwed into place on the remaining bone.
But the titanium plate alone was not enough to hold the jaw together. The greatest risk was failure of the plate due to the large gap where the bone had been, Dr. Verstraete says. Over time, pressure on the plate would cause the surrounding bone to resorb.
Enter the scaffold: a stiff, sponge-like piece of material that was fitted into the space. It, too, was only part of the solution. The next step in building a new jaw would require Whiskey’s own stem cells, attracted to the bone proteins in which the scaffold had been soaked. Like a magnet, the bone proteins would draw stem cells from the dog’s surrounding bone and soft tissue to the scaffold, where they would attach and turn into bone cells, according to Dr. Huey. The new bone cells would eventually fill the entire void and integrate with native bone. On a molecular level, the new bone is the dog’s own, with a DNA makeup identical to other bones in his body.
There is no need to match the proteins to a particular dog, Verstraete says. “The BMP we use is synthetic, recombinant human (rhBMP-2). It doesn’t elicit any antibody response in experimental animals.”
Just as the vets borrowed from human medicine, their procedure for dogs will now find its way back into human medicine. Their success with the eight cases has given them material for a report on the work, which they plan to submit to a scientific journal.
What lies ahead for the promising surgery? The vets hope to be able to modify the technique for use with larger jawbone defects in animals. Also on the horizon: human arm and leg bones. There is more work to be done, however. “The technique that we used has not been done for weight-bearing bones yet,” Verstraete says.
Is the new method a cancer cure, or a quality-of-life issue?
“Both,” Verstraete says. “We only do the surgery for tumors that haven’t spread. Reconstruction greatly improves the quality of life compared to the previously used technique.”
Swierk knows there’s no guarantee that Whiskey will remain cancer-free. “The assumption is that it’s a cure, but the verdict is still out.” But based on Whiskey’s September checkup, it’s “so far, so good.”
Swierk says the bionic jaw is doing its job. “He eats all his yummies as he did before.” In addition to munching kibble, caulif lower and chew sticks, he’s back to chewing and chasing balls and toys. Swierk isn’t surprised that their dog has bounced back, or that the new technology was available right when he needed it. “We never doubted for one minute that Whiskey would succeed with this new cutting-edge surgery.” It’s all part of Whiskey’s good nature, Swierk says.
“He’s led a charmed life.”
Wellness: Health Care
A rare form of human meningitis has already claimed the life 5 people and caused illness in over 40 others. The culprit: an injectable back pain medication made by a Massachusetts compounding pharmacy that was contaminated with a fungal organism. This news has created an understandable ripple effect that leaves us to question: how does this affect our pets who take compounded medications to manage their disease?
As veterinarians, we often recommend the use of compounded medications for several reasons: to convert pills into chicken-flavored chewables or liquids, to create gels that absorb into the skin (for pets who refuse oral medications), to place multiple medications into a single capsule simplifying administration, or to scale down a large dose tablet for a tiny dog.
Since compounding pharmacies are not FDA regulated, and offer no guarantee of potency, stability, safety or efficacy, how can we be sure about the quality of the drug being given? This is a vital question when compounded options are needed, and are often the difference between therapeutic success and failure.
The best way to ensure safety is to have your veterinarian prescribe only through credentialed pharmacies, or those that are in the process of accreditation, by the Pharmacy Compounding Accreditation Board (PCAB). This board was established in 2004 as a voluntary program to ensure adherence to quality and ethical standards. If a pharmacy meets the incredibly rigorous standards set forth by the PCAB, then both veterinarian and owner can be assured that the medications are of the highest quality possible. The board has accredited 50 pharmacies in 40 states thus far, and just as many pharmacies are awaiting accreditation. You can find a list of these accredited pharmacies online here.
Another word of caution: do not bargain shop when it comes to compounded medications and follow your veterinarian’s recommendations. A recent case of compounding error was reported in a canine patient who was being treated at North Carolina State College of Veterinary Medicine. This dog was being treated with a medicated solution for treatment of Myasthenia Gravis. He was doing excellent on the treatment following discharge, but returned several months later, weak and unable to stand. The owner had taken her written prescription from the vet to a different compounding pharmacy than the one recommended to her. The well-intentioned pharmacist offered to compound the medication into a more “dog-friendly” flavor. Unfortunately, the pharmacist included methylcellulose in the formulation, which completely bound the active ingredient, making it unavailable for absorption into the body, causing a serious decline in condition. Thankfully, this mistake was realized before the pup was euthanized.
Because the compounding industry is growing faster than regulations, it is imperative to be diligent: listen to your veterinarian, do your research, ask questions, and if you are concerned about any safety issues, try to make standard formulations work for your pet.
Wellness: Health Care
Allergy sufferers who still want to share their home with a canine companion have been known to drop big bucks on breeds that are being touted as “hypoallergenic dogs.” These are dogs who are reported to have lower household allergen levels compared to other pooches. But before you throw out your bottle of Visine and handkerchief, a new study suggests that this just may be fur fiction.
Prominent allergen researchers have found that there is no basis to the claim “that certain dog breeds are hypoallergenic” and have found that allergen levels vary among individual dogs, not individual breeds. The American Journal of Rhinology and Allergy published a study in 2011 that revealed the amount of dog allergens found in households does not vary depending on the breed, and families with “hypoallergenic” dogs are living with the same level of allergens in their homes as people who live with a, shall we say, “common” dog.
The researchers measured the level of the most common dog allergen, Canis familiaris 1, in the homes of 173 families who lived with one dog and found that 163 of them produced measurable levels of Can f 1. The numbers of dogs of each breed were not large enough to allow for analyses by individual breed, but the researchers compared quantities of allergens found in the samples using various categories of purebred and mixed-breed hypoallergenic and non-hypoallergenic dogs. No matter how they did the comparisons- even comparing dogs suggested as being “more hypoallergenic” by the AKC against all other dogs- they found no statistically significant differences in levels of Can f 1.
The AKC does not actually recommend or endorse any specific breed, nor does it claim that hypoallergenic breeds will not affect people with allergies, but they do suggest 11 canine candidates that have “consistent and predictable coats” that may benefit allergy sufferers. Basically, these are the breeds that have more of a non-shedding coat, which in turn produces less dander, and therefore less allergens in the environment.
How then, was the legend of the hypoallergenic dog born? Good question, as no one really knows where the whole concept got its start. But perform an internet search with the terms “hypoallergenic dog” and you will see endless links touting the perfect allergy-free pooch. I was most shocked when I read about Simon Brodie of Lifestyle Pets, a controversial U.S.-based company that breeds and sells cats and dogs as “hypoallergenic” at a price of $16,000 each! And, no, that was not a typo with an extra one or two “0’s” on the end!
So, if there are no “real” hypoallergenic dogs, what can you do to reduce the sniffling and sneezing? Here are some tips:
• Make sure your pet’s essential fatty acid requirements are met. By assuring your dog or kitty has optimal levels of EFAs in the diet, you can reduce shedding and dander associated with EFA deficiency. Adding coconut oil has also proven to help reduce dander and shedding.
• Bathe your pet often. Even kitties can be bathed regularly, but take special care to use only safe, non-drying herbal animal shampoos. Whatever you do, avoid using people shampoo on your dog or cat, and skip any shampoo containing oatmeal.
• Invest in a good-quality vacuum designed for households with pets.
• Clean your home frequently and thoroughly, including any surfaces that trap pet hair and dander like couch covers, pillows and pet beds. This will also help control other allergens in your home that could be contributing to the allergic load of family members.
• Wash bedding frequently in hot water.
• If your pet rides in the car with you, consider using washable seat covers.
• Purchase a good quality air purifier for your home.
• If possible, remove carpeting, drapes and other fabric that traps animal dander. Tile or wood floors are much easier to clean of allergens.
By following these tips, you may be able to lessen the allergenic load in your environment and live more harmoniously with your canine companions.
Wellness: Health Care
Part 4 in 4 part guide
Welcome back for the last installment of the DIY physical exam for your dog! We have reached “the tail end” of things so to speak, and will be finishing up our discussion with learning some “belly basics” as well as what to watch out for with the musculoskeletal system.
The exam is pretty straightforward: touch and feel the stomach, starting just behind the ribs and gently press your hands into the belly. Like all other parts of the body, you will be getting a feel for what is normal, and then continuing to monitor for any future changes. If your pet has just eaten, you may be able to feel an enlargement in the left part of the belly just under the ribs (where the stomach “lives”), which can be normal just after eating. Continue by proceeding toward the rear of the body, passing your hands gently over the entire area.
There are many conditions that can all look like “a basic lameness” in our pets. Below are a few of the more common presentations I see and their potential causes.
I hope this systems approach to an “at-home physical exam” helps you to become familiar and stay in tune with what is normal for your pet. Performing this exam in the comfort of your own home is the best way to learn what is normal and helps you to recognize any early changes in your pets behavior. Consult your veterinarian if an abnormal condition exists or you are concerned about any exam finding. Early recognition can save the life of your pet!
By no means is this list exhaustive, and this information is intended as a general reference; it is not intended to replace professional advice or an examination by a veterinarian.
Wellness: Healthy Living
Addressing the second most common problem on the vet hit parade
Question: Recently, my dog's nighttime scratching is keeping both of us awake. Her fur seems dry and a bit dandruffy, and she also seems to be shedding more than usual. What can I do to help her?
Answer: Dogs itch for many different reasons, and sometimes, for no reason, and it’s not uncommon for the scratching to seem worse at night, when the house is quiet. Every dog’s gotta scratch some time, and that’s completely normal. But when a dog is incessantly licking, scratching, biting and chewing to the point of wounding herself, then scratching becomes a symptom of an underlying pathology.
The medical term for scratching related to excessive itching is pruritus. This is the second most common reason people take their dogs to the vet (gastrointestinal problems such as diarrhea top the list). The causes of pruritus can be quite complex, but there are two main reasons why dogs itch. The first has to do with the condition of the skin itself: Is it infected? Is it too oily? Is it too dry? Of these three, dry skin is a frequent occurrence. The second major cause of pruritus is allergies.
Is It Dry Skin?
Dry skin can be influenced not only by environmental factors, but also by diet. Commercial pet foods process out the good oils that contribute to healthy skin and a lustrous haircoat. Dry pet foods have an even more dehydrating effect on skin and hair and also stimulate increased thirst, which only partially compensates for the drying nature of these diets.
If you must feed dry foods, then by all means add digestive enzymes to your dog’s meals. In fact, digestive enzymes are good to use with any type of food. Enzymes improve the release of nutrients, and beneficial probiotic bacteria also assist in the digestive process. (Probiotics also help with allergies, as noted below.) A healthy digestive system absorbs fluids more readily from the food your dog eats, thus improving hydration and increasing the moisture levels of the skin and haircoat.
Whatever the cause, allergies are difficult to address. In the worst cases, afflicted dogs require strong (and potentially toxic) pharmaceuticals just to get some relief. Though allergies are rarely cured, early identification and intervention can keep them under control, and in some cases, can substantially diminish them.
Clinical research has shown that one important way to reduce the likelihood that dogs will develop allergies is to give them high-potency cultures of beneficial probiotic bacteria such as Lactobacillus acidophilus and Lactobacillus bifidus when they are very young. Probiotics are relatively inexpensive, absolutely safe to use, and can save both dog and the owner tons of grief—and visits to the vet—later in life.
Regardless of age, many dogs’ allergies are controlled by improving the quality of their diet, giving them high potency acidophilus cultures and high doses of fish oils; adding freshly milled flax seed; and, in some cases, giving them antihistamines. (It can take up to three months for this regimen to take effect; see sidebar for details and dosages.)
Determining which condition your dog is dealing with requires a vet’s evaluation, but implementing some of the suggestions provided in the sidebar can certainly help your pup be more comfortable in her own skin—literally.
Wellness: Health Care
A Vet’s Perspective
Every day in veterinary emergency rooms across the country, shocked, distraught and overwhelmed dog owners face tough decisions. In addition to medical complexities and ambiguities, they deal with guilt, fear, grief and, sadly, money. But for Kathy Noons and her seven-year-old Boston Terrier, Tessie, it was all about hope.
Although Ms. Noons had asked her dog-walker to keep Tessie leashed, the woman often let her run loose with other dogs, and Tessie clearly loved it. But then came the phone call: The dogwalker had lost Tessie. It was January. The little dog was found the next morning, miles away, lying in a cemetery.
When Tessie arrived at the Angell Animal Medical Center ER, she had a temperature of 86.7°F (normal is around 101°F), the bones of her pelvis were shattered and, as a result of spinal trauma, she was paralyzed and incontinent.
Barely responsive, Tessie was so cold that warming her up had to be done slowly over the course of several hours to avoid further shocking her system. Blood and urine were drawn and tested, she was X-rayed and an ultrasound was performed. Throughout it all, she received intravenous fluids and medications for pain.
Eventually, Ms. Noons was presented with a long list of negatives that, when added up, suggested that euthanasia would be the kindest course of action. As she retold it, “That’s when I said, ‘C’mon, throw me a bone (no pun intended),’ [and] one doctor told me what I needed to hear. She said there’s always a chance.”
It took a few days for Tessie to stabilize, and that’s when I got involved. Ms. Noons later told me her biggest fear was that I would refuse to operate … that I would tell her it was futile. To be honest, it crossed my mind. Despite surgery, the risk of permanent nerve damage, incontinence and an inability to stand, let alone walk, was significant. But sometimes, if you put everything back in place, screw it all together and take a leap of faith, tissue heals. Tessie’s injuries were really bad, but not hopeless.
Though the odds were slim at best, I believed surgery offered her at least the possibility of a cure. An uncertain prognosis can be like a bad trip to Vegas, a gamble in which the only way out is through — risky, all or nothing. But that’s the hand we were dealt, and it was the one we played.
My involvement in Tessie’s recovery, while important, was brief and, to be honest, secondary. I reconstructed her broken pelvis with plates and screws, but the critical-care doctors and attentive technicians gave her the chance Ms. Noons sought. Yes, it takes a team to heal a “humpty-dumpty” dog, but in the jigsaw puzzle of putting Tessie back together, I only did one or two of the corners. Tessie’s primary-care team did all the tricky, thankless stuff.
Once Tessie was released from the hospital, Ms. Noons was committed to giving her the best possible chance to recover. Diapers, pain meds, hydrotherapy, acupuncture: Whatever Tessie needed, Ms. Noons provided. Ultimately, this level of commitment, this steadfast conviction, paid off. Three months after surgery, Tessie was running around, chasing other dogs and fully continent. Why this dog made it and a dozen others with the exact same injuries would not, I can’t say. Maybe a dog who can survive being hit by a car and a cold January night in Boston has an extra helping of luck.
“She was always a source of pride,” says Ms. Noons. “People would stop me and want to play with her. When they saw her in a diaper, barely able to walk, I could tell they were thinking, Is it fair what you’ve done to your dog?”
“How’s it feel today,” I say, “when you meet these naysayers in the street?” “It’s nice to be smug; I’m not going to say it isn’t. I’m proud of her, being fresh, going after bigger dogs. My princess is back.”
Ms. Noons marvels at what we did for Tessie and, though I appreciate (and am humbled by) her gratitude, it’s far more than I deserve. Perhaps the hands-on nature of surgery, the physicality of mending broken bones, the instant gratification of postoperative X-rays, makes it look as though the doctor with the scalpel created the cure. Truth is, I’m as amazed as she is, and under no illusion; in this magic act, I was nothing more than a willing assistant.
Wellness: Health Care
Part 3 in 4 part guide
Welcome back for part three in our four-part DIY physical exam! This week we are going to move down to the chest area, known as the thorax.
NECK, CHEST AND BREATHING:
The skin is one of the body’s major organs and it is an important indicator of overall health. The first things to do are to simply look at, smell, and feel your dog’s skin and haircoat.
SKIN TURGOR TEST:
The skin turgor test is one of the most helpful ways to determine whether your pet is well hydrated; although this test can be affected by several factors other than hydration status, such as weight loss, age and general skin condition, it can help you to make a rough determination of the hydration status. To perform this test, pull up the skin over the neck or back into “a tent” and release it quickly: it should return quickly to its resting position. If the skin returns slowly to position, or if remains slightly tented, then this is a good indication that your pet is dehydrated.
That sums up the thorax region of our pets, including one of the other major organs—the skin. Keep practicing your physical exam skills—it’s definitely a win/win for your dog! Not only does your pet get a good “once over” from you, he or she gets even more hands-on attention in the process. See you next week as we move to the last parts of the body which will include the abdomen and musculoskeletal system.
Check out DIY Physical Exam: Part 2 of this series if you missed it. Go on the next final part, DIY Physical Exam: Part 4.
Wellness: Health Care
I consider myself to be an optimist, a “glass-half-full” veterinarian. So why was I so worried about Zeus, a four-year-old Great Dane mix?
“He’s been lame for a couple of months,” said Jeff.
“And he’s very active,” added Jeff ’s girlfriend, Adrian. “We run six miles, five times a week, and go to the dog park for an hour or so every evening.”
Zeus had been referred to me for a torn cruciate ligament in his left knee — a perfectly reasonable diagnosis. But what I was seeing didn’t align with it. For starters, he held his withered leg totally off the ground, and when I palpated his knee, it felt stable. His X-rays confirmed the presence of arthritis, but it was mild, not enough to account for his apparent discomfort.
“Something doesn’t add up,” I said, trying not to sound like a pessimist. “I’m worried that I may be missing a bigger problem.”
Jeff seemed wary and Adrian looked alarmed, though she later confessed that she had suspected as much.
“I’d like to anesthetize Zeus and feel the knee when he’s totally relaxed, then take another X-ray. If everything jibes, we’ll go straight to surgery and fix the problem.”
However, my examination while Zeus was anesthetized failed to expose joint laxity, and I began to worry that the changes I saw on the X-ray weren’t the result of arthritis but rather, a tumor in the joint.
“I’d like to take a biopsy,” I told Jeff. If he was losing patience, he kept it to himself. When the results came back normal, I had to make another difficult phone call — difficult because I still didn’t have an answer.
“I don’t want this to be something bad,” I said, “but I’d also hate to put Zeus through a surgery that doesn’t address the real problem.”
“What do we do now?” Jeff’s flat tone revealed his waning confidence.
“Let’s put a scope, a camera, inside the knee. If the ligament’s damaged, I’ll see it and repair the knee. If not, I’ll keep hunting for what’s wrong.”
I tried to put myself in Jeff and Adrian’s position; they must’ve felt as though they were dealing with a cagey Dr. Doom. They wanted me to fix their dog, not speculate on the ways in which Zeus’ problem has failed to match up with my textbooks. Would they seek another opinion? After all the money they’d spent, poor Zeus was still not better.
Fortunately, I got my chance to look inside the joint, discovered that the ligament was partially but significantly torn, and verified the need for corrective surgery. Even so, when Zeus returned for his six-week recheck, I braced for the worst: a dog still struggling to get around on three legs.
Sometimes, it’s good to be wrong. Zeus was bouncy, fresh, eager to play and using the leg very well for this stage of his recovery. Now that we were out of the woods, I felt as though I could speak frankly with Adrian about my concerns, and encourage her to come clean about her own perspective on the process I’d put them through.
“It was frustrating,” she said. “Jeff and I definitely got into a lot of … disputes. We thought about not doing surgery, about going somewhere else. In the end, I realized you were just being thorough.”
I made sure Adrian knew how grateful I was that she had kept the faith. Though I’m a surgeon, I’m not married to the adage, “cut to cure.” Despite my initial negativity, I had done my best to be honest, voice my fears, take time to listen, be rational about my approach and, most of all, make sure they understood that my hesitation was rooted in what mattered most: doing right by Zeus.
“When did you know he had turned the corner?” I asked.
“The first week was tough,” said Adrian. “I was still worried. But Zeus loves two things in life. He loves to chase his tail, and the day I saw him spinning around on his back legs trying to catch it, I cried because I knew my boy was back.”
“What’s the second thing?”
“His orange ball. For the first time in months, he found it and brought it to me because he wanted to play fetch. No doubt about it, he’s on the road to recovery.”
I smiled and kept a reprimand about premature ball-chasing to myself.
Wellness: Health Care
Part 2 in 4 part guide
Hello again, Bark readers! Welcome back for the second installment of the DIY physical exam. We are going to start at the head today, continuing to move down the dog body over the next couple of weeks.
Chronic ear problems are common in pets, and are often a result of allergies to inhaled pollen (like hay fever in people) that are then complicated by secondary infections with bacteria or yeast. Ear infections can be painful and head shaking can lead to an accumulation of blood in the floppy part of the ear, known as an aural hematoma.
That completes the head! Please feel free to ask any questions and see you next week as we discuss and learn about the chest area, known as the thorax. Check out DIY Physical Exam: Part 1 of this series if you missed it. Next, DIY Physical Exam: Part 3.
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