Wellness: Health Care
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
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.
Wellness: Health Care
Old Dog Senility
Cognitive Dysfunction Syndrome, also referred to as “old dog senility” or “sundowner syndrome” is a common syndrome that is categorized as a slow, degenerative and progressive disorder in our aging pets. This process leads to changes in awareness, a decreased responsiveness to normal surroundings, and potentially increased signs of anxiety that usually worsen in the night hours.
There are many signs observed with cognitive changes and they can be lumped into some general symptoms as follows:
The above changes generally begin very gradually, so much so, that many pet parents fail to recognize the early stages of the disease and often attribute their pets subtle alterations in behavior to “simply getting older.” A recent study at the University of California School of Veterinary Medicine demonstrated just how common these observations are: out of 69 dogs participating, 32% of the 11-year old dogs were affected by this syndrome and 100% of the dogs 16 years of age older were affected (source: Veterinary Information Network).
The exact reason for this change in our geriatric pets is unknown, but it is thought that the body’s normal degenerative and age-related changes contribute to the dysfunction. These changes include central nervous system deterioration, oxidative stress, accumulation of free radicals, and cell death. Signs are unfortunately progressive and treatment is aimed at prevention and/or slowing the progression of disease for which lifelong therapy is required once diagnosed.
Treatment is the utilization of a multi-modal approach to managing signs, meaning, a combination of synergistic therapies that are based on the severity of the clinical signs. Selegiline is a prescription medication that is used to help control more severe symptoms, and it is thought to improve transmission of brain chemicals (dopamine) as well as have protective effects on the brain’s nerve cells.
There has also been the development of commercial and prescription “senior diets” that have demonstrated improvements in cognitive function, such as Hill’s b/d ("brain diet"). Natural supplements have shown promise in managing signs and slowing the course of disease by reducing the neurological damage caused by free radicals.They include antioxidants (vitamins C and E, selenium, flavonoids), gingko bilboa, Omega-3 fatty acids, and medium chain triglycerides to name a few. Pheromone therapy and melatonin may ease anxiety and promote a feeling of well being for dogs that experience increased anxiety at night. And finally, environmental enrichment such as brisk brushing sessions, massage therapy, interactive toys, and stimulating walks is thought to be an important cornerstone in slowing the progression by stimulating brain activity. Maintaining a stimulating environment, and engaging in as much activity as is practical for your pet’s age and health, may help prevent or delay the onset of cognitive decline as your pet moves into its golden years.
I will end with one of my favorite veterinary mantras, which is: “Old age is not a disease” (for which I am personally more thankful for each day), and with proper care, our senior “babies” can go on experiencing a good quality of life as cognitive changes develop.
Wellness: Health Care
A Kinder Cut? Advances in spay procedures
As a colleague of mine once said, “a spay is a procedure routinely performed, but it is not a routine procedure.” In the U.S., “spay” refers to the surgical removal of the ovaries and uterus. In Europe, however, removal of just the ovaries (ovariectomy) appears to be the most popular sterilization technique. Why are my European colleagues doing things differently, and is there evidence to suggest that they’re right? Is it possible to achieve the same surgical result using a less-complicated, less-involved procedure?
It’s been proven that an ovariectomy, which can be done via laparoscopy (or “keyhole” surgery), requires a smaller incision. Still, to date, no one has proven that removing both the uterus and the ovaries is more painful than taking just the ovaries, and no one has compared complication rates between the two surgical techniques.
However, other aspects have been assessed. In the Journal of the American Veterinary Medical Association, Michael DeTora, DVM, and Robert J. McCarthy, DVM, MS, DACVS, examined the two approaches.* Judging by their report, removing only the main hormone producers — the ovaries — has a lot going for it. Here are a few of their leading points.
One of the big benefits to spaying is the decreased incidence of mammary gland tumors, the most common tumor in female dogs. Sterilize before the first heat and your dog is 200 times less likely to develop breast cancer when compared to a sexually intact dog. Taking or leaving the uterus will not change this risk; rather, the benefit comes from removing the ovaries and their sex hormones.
It has been argued that there are two important reasons to remove the uterus. The first is the risk of developing pyometra, a uterine infection. Typically, pyometra occurs in dogs who have not been spayed and is attributed to the long-term influence of sex hormones, particularly progesterone, produced by the ovaries. In a study of 135 dogs, 66 had a regular spay and 69 had only the ovaries removed. There were no episodes of pyometra in either group up to 11 years after the surgery. In other words, leaving the uterus does not mean your dog will get a uterine infection. Remove the ovaries and you remove the source of progesterone, which means that pyometra cannot occur.
The second concerns the risk of leaving a redundant organ behind, potentially exposing the dog to a future uterine tumor. This appears reasonable until you consider that uterine tumors are extremely rare. In one study, just 11 of nearly 35,000 female dogs had a tumor of the uterus, and only one of these was cancerous. Benign uterine tumors are slow growing, don’t spread to other organs and are easily cured with surgery. The chance of your dog succumbing to uterine cancer is a lot slimmer than your lifetime risk of being killed in a car crash.
This leaves urinary incontinence, one of the most frustrating side effects of spaying. Reportedly, as many as one in five sterilized female dogs will have a tendency to dribble urine after surgery. Exactly why this happens is poorly understood, but the presence or absence of the uterus appears to make no difference.
As a veterinarian, one of my most important roles is to help owners make informed health-care decisions for their companion animals. Evidence-based medicine suggests that there is no recognized disadvantage to taking just the ovaries and leaving the uterus behind. Though inertia is always the biggest barrier to change, I may have a chance to influence the choice when asked the time-honored question, “What would you do if this were your dog?”
“Easy. Take the ovaries. Leave the uterus.”
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.
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