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Wellness: Health Care
DIY Physical Exam: An “owner’s manual” for your dog Part 4
Part 4 in 4 part guide
Doing DIY Physical Exams on Dogs

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.

ABDOMEN:

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.

Normal

  • No lumps, bumps, or masses
  • No discomfort on palpation
  • No distention of the belly

Abnormal

  • Any lump, bump, or mass may be abnormal
  • Palpation that causes groaning or difficulty breathing: any evidence or indication of pain is a serious finding and requires immediate attention; sudden and marked belly pain is what we refer to as “an acute abdomen” and can be caused by various conditions including pancreatitis (inflammation of the pancreas), sepsis (an infection in the belly that can be caused by a ruptured bowel or foreign body such as a foxtail), bleeding into the belly (such as from rat bait or a ruptured spleen), trauma, tumors or abscesses
  • If the abdomen feels hard or tense and it appears distended: this is one of the major signs of bloat or GDV and immediate attention is needed! 

MUSCULOSKELETAL:

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.

Abnormal

  • Lameness in any single leg: when a pet becomes lame, sources of the discomfort can be from the bone, soft tissue, joints, or tendon/ligaments.
  • A persistent, non-resolving lameness despite rest and medications: another thing that needs to be considered is a type of bone cancer called Osteosarcoma; this can be common finding in the long bones of large breed, older dogs and an X-ray can be performed to screen for this type of cancer; another typical presentation for bone cancer that I see is a pet that develops a very sudden and severely painful lameness following a “simple” act, such as jumping off the porch.
  • Swelling of the joints: common causes include infectious diseases (tick-borne disease, septic joints), immune mediated disease, vaccine-related reactions, and degenerative joint diseases.
  • Loss of function or paralysis in hind legs: some causes include disease processes such as a herniated disk, cancer, infection, narrowing between the vertebrae of the spine, or degenerative myelopathy; losing the ability to walk is an emergency and immediate care is needed to help improve your pet’s chances of regaining mobility!
  • Recurring, shifting leg lameness, pain, and fever in a young dog: Panosteitis is a disease of the long bones of mostly young, growing large breed dogs; German Shepherd males are most frequently affected but any large breed dog can be affected.
  • Limp tail: this is also known as “limber tail” or “cold tail” and is a condition in which a working dog suddenly develop a flaccid tail; affected dogs usually have a history of prolonged cage transport, a hard workout the previous day, swimming, or exposure to cold or wet weather; most dogs recover spontaneously within a few days to weeks but evaluation by your veterinarian should be done because there are other diseases that can mimic a “limber tail” such as a tail fracture, spinal cord disease, impacted anal glands, and prostatic disease.

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
Vet Advice: Relief for Your Dog's Itchy Skin
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?
One common cause of itching is dry skin. If you live in a region with low humidity, it’s more likely that your dog will have dry skin, which is fairly easy to recognize. When you part your dog’s hair, you see flakes of dandruff in the undercoat, and the skin itself may be cracked and tough. The slightest stimulation of the skin—your gentlest touch—can provoke your dog to scratch violently.

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.

 

Or Allergies?
Another common cause of itchy skin is allergies. Allergies may make your dog’s skin dry, greasy, or slightly dry and oily, and are accompanied by frequent scratching, licking or chewing. We are seeing significantly more cases of allergic dogs than we have in the past; many veterinarians believe that we are experiencing an “allergy epidemic.” While the reasons for this allergy epidemic are uncertain, some of the theories put forth include the aggressive vaccination protocols that many dogs have been subjected to, poor breeding practices and the feeding of processed pet foods.

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
Second Opinion: Magic Act
A Vet’s Perspective
Magic Act: Second Opinion

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
DIY Physical Exam: An “owner’s manual” for your dog Part 3
Part 3 in 4 part guide
Animal, Dog DIY At-Home Dog Physical Examinations

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:

Normal

  • You should not be able to hear your pet breathe at all (except with panting).
  • The act of breathing is for the most part performed by the chest wall; it should move “in and out” easily and rhythmically to and fro during respiration in an effortless way; each breath should look the same as the last.
  • The normal resting respiration rate is 15 to 60 breaths per minute; a sleeping or relaxed dog would be near the low end, while an active and engaged dog would be higher; and just like with heart rates, smaller dogs will tend to have a faster resting breathing rate than our larger dogs.

Abnormal

  • Any unusual noise heard while the dog is breathing could indicate a problem, especially if the noise is new for your pet.
  • A big concern: a change in your dog’s bark can indicate disease processes such as laryngeal paralysis (a common condition in our older large breed dogs such as Labs) or the development of a tumor in the airway.
  • Wheezing during expiration can indicate conditions such as asthma or allergic airway disease .
  • High pitched noises on inspiration indicate an obstruction of the upper airway and immediate medical attention is needed (see our previous blog).
  • Sudden or frequent sneezing can indicate foreign objects in the nasal passages, such as foxtails.
  • If there is noticeable effort by your dog to move the chest wall, or if the belly is actively involved in the process of inhaling and exhaling: these are signs of respiratory distress and can be caused by many conditions.
  • The onset of coughing in an older dog: coughing is one of the more common signs of the development of heart failure or lung cancer in dogs; x-rays of the chest will be needed to further evaluate if you notice this symptom.
  • Your dog stands with elbows held out further than normal, its neck extended out further than normal or, is unable to rest or lie down: these are all outward signs that your dog is having difficulty breathing and getting enough oxygen into its body.
  • An increased resting respiratory rate can be a sign that a previously diagnosed disease is progressing; for example: if your dog with heart disease has a normal resting rate of 15 breaths a minute, and then the resting rate goes up to 30 while asleep, then doubled rate means it’s time to see the veterinarian.

SKIN:

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.

Normal

  • Shiny and smooth haircoat (except for wirehaired breeds)
  • Soft and unbroken skin
  • Minimal odor

Abnormal

  • Sparse or patchy haircoat: this can indicate underlying endocrine diseases such as Cushing’s disease.
  • Lumps and bumps, which can be normal or abnormal: many older dogs can develop accumulations of fatty tissue known as lipomas; in order to differentiate these benign masses from cancerous ones, an aspirate can be performed (collection of cells with a small needle); this simple and quick procedure can help your veterinarian determine the nature of the lump and help you decide if further tests or treatment are needed.
  • Open sores or wounds, or any ulcerated area of skin.
  • Foul or rancid odor: this can indicate a bacterial or yeast infection in the skin.

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
Joint Relief
Second Opinion
rouxby.com

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
DIY Physical Exam: An “owner’s manual” for your dog Part 2
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. 

NOSE: 

Normal:  

  • Smooth, soft and clean; it is a misconception that a dry, warm nose means illness; sometimes a normal nose can appear slightly dry as well as warm to the touch; a healthy nose should feel like soft, supple leather; it is not necessarily always cool, wet and moist.

Abnormal: 

  • Excessively dry and cracked.
  • Colored nasal discharge; a green, yellow, or white discharge generally indicates a bacterial infection (scant, clear, watery discharge can be normal) .
  • Bleeding

EYES:

Normal

  • Bright, moist, and clear.
  • Centered between the eyelid.
  • Pupils are equal in size.
  • Whites of the eye should not appear colored (such as red or yellow) and should have only a few visible blood vessels.
  • Pupils should shrink equally when a bright light is shined into either eye and enlarge equally when the eyes are held closed or the room darkened (this is known as a pupillary light reflex and is part of a neurological exam).

Abnormal

  • Dull, sunken eyes: this can indicate severe dehydration.
  • Eyes that appear dry and “bloodshot” can indicate conditions such as uveitis, KCS (“dry eye”), severe dehydration, or other systemic illnesses.
  • Thick discharge from eyes: a little grey “eye booger” in the morning is normal, just like in us people, but be concerned if you notice any discharge with green or yellow color to it.
  • One or both eyes not centered: this can indicate a tumor or infection behind the eye, as well as other pathology.
  • Pupils unequal in size: this can indicate head trauma, a possible tumor, other neurologic problems to name a few.
  • Squinting or tearing of the eyes: this can indicate an ulcer or scratch on the cornea, which is the layer of cells covering the eye.
  • Abnormal colors that indicate problems are yellow (jaundice), or red (bloodshot); pay close attention to the color of the whites of your pet’s eyes.
  • The appearance of blood in the eye (known as hyphema): this can indicate exposure to rat bait or other causes of your pet’s blood not being able to properly clot.
  • Pupils fail to respond, or respond differently from one another, when a bright light is shined into either eye.

EARS:

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.

Normal

  • Skin smooth and without wounds.
  • Clean and dry.
  • Almost odor-free.
  • Typical carriage for breed.
  • Pain-free when you massage them, especially at the base of the ear.

Abnormal

  • Wounds, scabs, or any sign of rash.
  • Crust, moisture, or other discharge in ear canal.
  • Any strong odor.
  • Atypical carriage for breed; for example, a droopy ear in a breed with normally erect ears
  • Painful or swollen ears.

MOUTH:

Normal

  • Teeth are clean and white.
  • Gums are uniformly pink and moist to the touch (they should not feel dry or sticky).
  • Capillary refill time (CRT): to assess, press on the gum tissue with your finger or thumb and then release quickly; the part you just pushed on will turn white, and you will then watch the color return to the gums; this is a crude assessment of how well the heart and circulatory system are working as well as hydration status of you pet; a normal CRT is 1 to 1.5 seconds for the color to return; this can be a difficult test to interpret sometimes (for example, if your pet has dark or pigmented gums), and should not be relied upon as definitive evidence that your pet is sick or healthy.

Abnormal

  • Tartar accumulation around the base of the teeth.
  • The gums are red: this can indicate severe dehydration, shock, heat stroke, or sepsis (severe infection in the body).
  • Gums are bluish or purple: this indicates inadequate oxygen to the body; this can be noted with lung disease, heart disease, or any disease that impairs proper oxygen to the body.
  • Gums are pale: this is due to lack of blood or shock and possible causes are internal bleeding (such as a mass on a spleen that suddenly ruptures and bleeds- very common in older dogs), trauma or shock (such as when a dog has been hit by a car), and immune mediated diseases.
  • Gums that appear to have little bruises: this is known as petechiation and is generally seen with rat bait toxicity or other problems with the body’s ability to clot the blood
  • Gums are inflamed, “spongy” looking, or sore in appearance.
  • A sluggish CRT, or dry and sticky gums.

 

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.

 

Wellness: Healthy Living
Should you buy pet insurance?
Risk Management
Photograph: Steph Fitzsimmons

A year ago, one of patty Glynn’s three dogs, a five-year-old Chinese Crested named Merry, became ill and very nearly died. It turned out that she had inflammatory bowel disease and required transfusions, among other care. Blood work, emergency vet-hospital treatment and after-care expenses brought the total close to $5,000; luckily for Merry, Glynn and her husband, Stew Tolnay, were able to handle the bills.

However, that experience convinced Glynn that it was time to buy pet insurance for all three of their dogs. When she checked into it, she discovered that approximately 10 companies now offer pet insurance in the United States.

By asking friends and doing her own research, she eventually decided which was best for her situation. Of course, Merry’s earlier condition was considered preexisting and excluded from coverage. Still, the insurance allows Glynn and Tolnay to rest easier, knowing that if their pets develop a serious medical problem in the future, some of the costs will be covered.

By the Numbers
According to the American Pet Products Association’s 2011–2012 National Pet Owners Survey, in the U.S., about 78 million dogs and 86 million cats live with us. On average, dog owners spend $248 and cat owners, $219 per year on routine vet visits.

But what about the unexpected, like Merry’s illness, or the puppy who swallows a sock? Plus, specialty veterinary care is now available — ophthalmologists, oncologists, neurologists — which means that the costs of care are steadily increasing. Even the average cost of a typical corrective surgical procedure, for dogs in this case, are enough to give one pause: gastric torsion (bloat), $1,955; foreign-body ingestion (small intestine), $1,629; pin in broken limb, $1,000; cataract (senior dog), $1,244.

You’d think that, faced with these numbers, everyone who has pets would also have pet insurance. Yet less than 1 percent do. Should you buy pet insurance to cover your pet, and your bank account? Unfortunately, like many things in life, there’s no clear yes-or-no answer.

Some are fortunate in that they have the resources, or the willingness, to go into debt for their pet’s care if necessary; they are, in effect, opting for self-insurance. Others, perhaps without extra resources or who just want to sleep better at night, like Glynn, prefer paying a monthly insurance premium of anywhere between $20 and $60 (depending on the age of the animal and the coverage) in the hope that it will cover expensive vet bills down the road.

Like all insurance, pet insurance is, at its most basic, a gamble. We pay the premiums hoping we’ll never need to use the coverage. If we do, our gamble has, unfortunately, paid off.

Before You Buy
Pet insurance is a relatively new industry in the U.S. Veterinary Pet Insurance (VPI) offered the first policy in 1982. Today, many companies offer policies, which is good, but it also makes choosing the best policy for you and your pet more complicated.

Before you sign on the dotted line and write that first check, do your due diligence.

Read the policy very, very carefully.
Most of the complaints I read on various websites seemed to stem from the fact that the pet owner didn’t fully understand what was and wasn’t covered, and so was shocked when a claim was denied. Each insurance company offers a slightly different product, and you can’t assume that one policy is like another. Read them! If you don’t understand the terms, it’s worth the cost of a half-hour consultation with an attorney to make sure you do.

Understand co-pays, deductibles and caps.
Co-pays and deductibles are the amounts the policy requires you pay out-of-pocket for each claim. For example — keeping in mind that each insurance company has its own definitions for these terms — you submit a claim for a $500 ER visit that we’ll assume is covered. You have a per-incident deductible of $250. Your insurance covers 80 percent, so your co-pay is 20 percent. The insurance company will make the following calculation: (Claim x insurer’s copay)– deductible = insurance payment. So, altogether, you’ll pay $400 rather than $500 for that visit: ($500 x 80%) - $250 = $150; $250 + 150 = $400. Then, to complicate things, policies have caps. According to Adam Karp, an attorney specializing in animal law who agreed to analyze three sample pet insurance policies for me, those purchasing pet insurance “must be aware of the multiple-benefit caps, as an animal may reach one cap before another and lose out on further payouts. Generally, there are three caps in play at any one time: lifetime, period and per incident.”

  • The lifetime cap is the maximum amount the insurer will pay for the life of the insured pet. “Once reached, you may as well scrap the policy,” says Karp.
  • The period cap is the limit the policy will pay for that animal within a specified time frame, such as a year. Karp warns, however, that “because insurers can decide not to renew the policy for any reason before the end of the policy term, this makes the lifetime cap illusory”; after hitting one or perhaps two period caps, the insurance company may simply decline to renew that pet’s policy.
  • The per-incident cap limits how much the policy will pay for each “incident.” When reviewing policy terms, pay close attention to how this term is defined. As Karp notes, insurers tend to pool or stack conditions into one incident, which limits their exposure. Make sure your vet’s billing statements are very clear regarding what the various tests and procedures are for when you submit claims.
  • Know the policy’s exclusions.
    The list of conditions and treatments not covered by individual policies is specific to each policy and each company, and too varied to consider in this article. Again, another reason to read policies carefully, with your pet’s particular needs in mind. Be aware that some policies have breed-specific exclusions, and according to Karp’s analysis, few, if any, cover dysplasia and ligament-tear repairs. In some cases, you must purchase additional coverage for cancer and other conditions.

    Following are some of the terms included in policy exclusions that you should understand thoroughly before you purchase.

    • Congenital condition: A discoverable condition that the pet was born with. These occur in every breed, often from inbreeding, or can be caused by mutation. Examples include limb deformity, cleft palate and deafness.
    • Hereditary condition: An inherited condition that may or may not be obvious at birth. Indeed, in some cases, it may not manifest itself until the pet is elderly. Common examples include hip or elbow dysplasia, certain eye conditions, and OCD (osteochondritis dissecans), an abnormality in bone development often seen in large dogs.
    • Developmental condition: A condition resulting from a failure to develop normally in some way early in life. These are usually structural — for example, a kinked tail, cleft palate or a heart anomaly — caused by trauma, malpositioning, infectious agents (virus, bacteria, parasite) or reaction to drugs or toxins while developing in the womb.

    (Note that some conditions fall into two categories. For example, cleft palate can be congenital or developmental. Deafness can be considered a hereditary congenital condition.)

    According to Karp, in all policies, unless an additional rider is purchased, “congenital conditions are deemed preexisting and not covered. Some policies bar hereditary and developmental conditions as well, unless additional coverage is purchased.” Karp notes that a policy he recently reviewed was one of the few to define a “chronic condition” to mean “not curable.”

    “Thus, even if the condition went into remission for a year, if the initial onset preceded the effective date of the policy, it will be deemed an incurable and preexisting condition,” he says.

    Make sure your current vet qualifies under the terms of the plan you choose.
    Some insurers define a primary vet as one who is licensed and is also a member of the American Veterinary Medical Association (AVMA). As an aside, vets don’t have to join the AVMA in order to practice; it’s voluntary. Some choose to join the Humane Society Veterinary Medical Association (HSVMA) instead, yet under such a policy, if your vet chose HSVMA over AVMA, her services wouldn’t be covered.

    “Another concern,” says Karp, “is that [few] policies cover experimental, investigative or non-generally accepted procedures, as determined by the veterinary medical community.” That is the sort of language lawyers love. Does it mean the AVMA? The HSVMA? Or some other more vague, local medical community?

    Have a headache yet? Believe me, this is just the tip of the insurance-lingo iceberg. It’s complicated, confusing and a little terrifying, because the financial investment you make when you purchase insurance is significant and you want to be sure it pays what you hope and need it to pay. Each company’s policy includes numerous terms, conditions and exclusions, as well as dispute- resolution provisions. You need to understand them all.

    Rolling the Dice
    So what are you really insuring against when you purchase a policy? The short answer: anything that would cause you financial hardship and make you ask yourself if you can afford the care your pet needs. None of us wants to be in the position of making an important decision about our dog’s care based solely on cost.

    Here’s an illustration that makes this issue very real.

    In 2002, Dana Mongillo, dog trainer and owner of Fuzzy Buddy’s Dog Daycare in Seattle, Wash., purchased pet insurance with a cancer rider for Mango, her healthy young Boxer. It initially cost her $20 a month. Over the next few years, Mango remained healthy and no claims were made on the policy. Then, the premium increased to about $50 a month. “Paying $600 a year for nothing is a little indulgent,” says Mongillo, “and I remained on the verge of canceling the policy for months. But then a vet visit for a slight limp ended up with the worst diagnosis possible: Mango had cancer.” The diagnosis came in 2008. Mango received treatment and care for two years before he finally succumbed in 2010, at age eleven. “While I helped Mango through the final weeks of his life, the insurance was suddenly very wonderful,” says Mongillo. “Every time I got a quote for treatment options, I knew the final amount I would pay would be less. That made it easier for me to consent to treatments that might help Mango, or at least help us find out the extent of the problem. In the last six weeks, he had a whirlwind of vet appointments, two sets of X-rays, an MRI and weekly acupuncture. Insurance removed the huge burden of the financial, leaving me able to focus on what was best for Mango and not what was best for my wallet.”

    Here’s the tally for Mango’s insurance and vet expenses: Total premiums paid (2/2002–3/2010): $3,098. Total vet bills paid (3/2008–4/2010): $4,802. Total amount not covered (3/2008– 4/2010): $2,705.

    For Mongillo, it was worth every penny, and she would do it again. She recognizes that in her case the insurance gamble paid off and Mango received the level of care she wanted him to have. Had he not developed cancer, she would have paid for insurance that she never used, but insists she would have been happy to “lose” that particular bet.

    DIYing It
    There are at least two other options to consider. The first is self-insuring. Set up a savings account for your pet and deposit in it the amount equal to what you would pay as a premium, then use it only for extraordinary care. This works best if you’re disciplined and if your pet doesn’t require expensive care early in his life. Better yet, start out with a large initial deposit and add to it each month.

    The second is CareCredit. This is a line of credit specifically for use at participating veterinary clinics. Stacy Steele, DVM, of Ocean Shores, Wash. (profiled in “World Vets” in the Sept/Oct 2011 issue) recommends this to her clients, almost none of whom have pet insurance. Like a credit card, this line of credit can be used for routine care and/or extraordinary care. There are no up-front costs and you select the monthly payment option you can handle. Depending on the amount put on the card, you can take from six to 60 months to pay off the balance (check the annual percentage rate before you sign up).

    The bottom line: choose the option that will allow you to sleep well, knowing that if your beloved companion requires expensive diagnostics, treatment and care, you have the resources available to pay for them. If you choose pet insurance, read every word of the policy very carefully and understand what the terms mean before you purchase. Then, go have fun with your pup!

    Wellness: Health Care
    DIY Physical Exam: An “owner’s manual” for your dog Part 1
    Part 1 in a 4 Part Guide
    Dog Exam - DIY Dog Physical Exam at Home

    To identify an illness or abnormal situation, you must first be able to recognize what is normal for your dog. You know your dog better than anyone else and you will have to decide when an abnormal situation warrants professional help. Sometimes the condition is so serious it leaves no doubt. Frequently, however, the changes are subtle, or happen over a longer period of time, making noticing a problem more difficult.  

    Over the course of the following weeks, I will provide you with information on how to perform an at-home physical exam, helping to determine and establish what is normal for your pet. It is recommended that you occasionally perform this exam- while there is nothing wrong- so that you can begin to get used to what is normal. This practice will help allow for the early detection of changes in your dog’s health.  

    I will start with the basics this week: A good look, temperature, and how to obtain a heart rate. Next week will continue with a systems approach beginning with the head area, followed by the chest, and lastly, the abdomen. At the completion of these 4 blogs, you should have a complete home guide on how to perform a screening exam.  Ready?!

    THE BASICS:

    First, before you start your hands-on exam, stand back and just simply look at your dog for a few minutes. The posture, breathing, activity level, and general appearance can really tell you a great deal. Get a good picture of your dog’s “normal” in its relaxed home environment—this mental snapshot will help you notice any subtle change.

    TEMPERATURE:

    Taking your dog’s temperature is an easy and important procedure. Use a digital rectal thermometer (the ear type is less reliable and mercury thermometers can break!). Lubricate the end with petroleum jelly and gently insert the thermometer into the rectum about 1 inch for small dogs and about 2 inches for larger ones. If it does not slide in easily, do not force it. And do not risk taking your pet’s temperature if you feel there is a risk of being bitten.

    Normal

    • A normal temperature is between 100 F and 102.5F
    • The thermometer is almost clean when removed

    Abnormal

    • Temperature is below 99 F or above 102.5 F
    • There is evidence of blood, diarrhea, or black, tarry stool on the thermometer; black/tarry stool can indicate a bleeding ulcer in the stomach or small intestines, or point to other sources of disease

    PULSE AND HEART RATE:

    Learn to locate the pulse on your dog before a crisis. The best place on a dog is the femoral artery in the groin area (see picture).

    Here’s how: place your fingers around the front of the hind leg and move upward until the back of your hand meets the abdominal wall. Move your fingertips back and forth on the inside of the thigh until you feel the “roll” of the artery and the pulsing sensation as the blood rushes through it. Count the number of pulses in 15 seconds and multiply by 4. This will give you the pulse rate in beats per minute. Pulse rate is a highly variable finding and can be affected by recent exercise, excitement or stress. Do not use the heart rate at the sole evidence that your pet is sick or healthy.

    The heart rates that are listed are for healthy dogs at rest in their home, not for animals that are evaluated in a veterinary clinic where higher heart rates might be detected due to excitement, stress of a visit to the clinic, or disease.

    Normal

    • Dogs: 60 to 160 beats per minute (bpm): relaxed, large breed, or athletic dogs tend to have slower heart rates, while small breed dogs and puppies tend to have higher heart rates. This marked variability in heart rate stresses the importance of knowing what is normal for your pet.
    • The pulse should be easily felt and the quality of it should be strong and regular

     

    Abnormal

    • Too rapid or too slow
    • Pulse is weak, irregular, or hard to locate

     

    Practice these essential skills and I’ll see you next week for all things head related, including the ears, eyes, nose, and mouth! See DIY Physical Exam: Part 2.

    Wellness: Health Care
    Ick! It’s a Tick on My Dog!
    The top 5 tick myths dispelled

    Disease-carrying ticks can pose serious health risks to both dogs and people, no matter what state you live in. The U.S. Centers for Disease Control (CDC) reports that ticks in every state can carry disease, and the number of tick-borne diseases is on the rise. Here in Northern California, they seem to be everywhere, and it is not uncommon for me to find an “incidental tick or two” during my physical exam.  This usually leads to a tick-related conversation where I sometimes have to dispel a tick myth or two.

    Fiction: “I heard that the best way to remove a tick is with a lit match, petroleum jelly, or alcohol”

    Fact: None of these methods cause a tick to “back out” of the skin and can actually cause more injury. When you try to remove an embedded tick in this manner, you can actually aggravate it, causing the tick to deposit more disease-carrying saliva into the wound, and increasing the risk of infection. The best way to remove a tick is by using tweezers, grasping it as close to the dog’s skin as possible, and pulling the tick out with a steady motion. Dispose of the removed tick down the toilet or by placing it in rubbing alcohol.You should clean the skin with mild soap and water after its removal. You may see a little red circle (like a bull’s eye) or bump of redness on the skin at the insertion site following removal- this can be normal and may be visible for up to a couple of days. You should see your veterinarian if the region of redness increases in size or if it doesn’t go away within 2-3 days.

    Fiction: “My dog doesn’t go hiking in the woods, so I don’t have to worry about exposure”

    Fact:  Ticks live on the ground no matter the locale, and this includes our urban parks and rural areas. Ticks typically crawl up blades of grass, looking to hitch a ride as our pets pass by. Ticks like to migrate upward, which is often why they’re found on the head.

    Fiction:  “Ticks aren’t a problem in the colder weather, so I only have to worry in the summer”

    Fact: In most areas of the country, “tick season” runs from April to November, however, infection can occur any time of the year. For example, in the winter, some tick species actually move indoors, while other species make a type of “internal antifreeze” to survive during the winter months. This is often why veterinarians will recommend year-round tick prevention.

    Fiction:  “Lyme disease is the only illness that ticks can transmit to dogs (and their humans)”

    Fact:  While Lyme disease is the most widely known and common disease caused by ticks, there are other diseases including Rocky Mountain spotted fever, babesiosis (one of the newer discovered diseases, see Jane Brody’s article about it), and ehrlichiosis. These diseases can have equally devastating effects on our pets.

    Fiction:  “If I find a tick on my pet, or if I see the “bull’s eye” red ring on my pet’s skin, I should get a blood test because this will tell me if my pet has disease”

    Fact: If your pet is ill, and you are aware of tick exposure, a tick-borne disease screen is highly recommended.  However, it should be noted that lab tests run for tick-borne diseases are often negative on the first sample and require a second test in two to three weeks to confirm infection. Therefore, a negative test does not necessarily mean that your pet is free from disease. It should also be noted that many dogs with tick-borne illness do not experience any symptoms, especially in the early stages of disease.

    And one last tip to throw into the mix:  if you do attempt to remove a tick at home, make sure that it is actually a tick!  I cannot tell you how many times I see a pet on emergency for an accidentally removed nipple!  Ouch!

     

    Wellness: Health Care
    Vet Advice: Seizures in Dogs and Canine Epilepsy
    Don’t delay—see the vet today for a thorough workup

    Few events are as terrifying as witnessing your pet in the throes of a full seizure. One second, he looks perfectly normal, and the next, he’s on his side, eyes glazed, muscles twitching frenetically. He may even lose control of his bladder or bowels. A result of abnormal electrical activity in the brain, this episode may last only seconds, but when it happens, time seems to move in slow motion.

    For some dogs, this is a one-time experience, but in most cases, seizures recur. If so, and if the abnormal electrical activity is caused by an underlying problem within the brain, the condition is termed epilepsy.

    You might think that because epilepsy is fairly common, diagnosis and treatment are straightforward. Unfortunately, that’s not the case. Patients often show no signs; diagnostic tests are frequently negative; and, at least initially, the actual seizure events can be few and far between. These factors can contribute to a decision to take a wait-and-see approach, which can lead to problems later on.

    As Dr. Michael Podell, a veterinary neurologist at the Animal Emergency and Critical Care Center in Northbrook, Ill., notes, “It’s important to identify—as much as possible—the underlying cause … Sometimes it’s easy to take the conservative approach … [but] unfortunately, it can often be a more serious problem.”

    Consider, for example, one of Podell’s recent cases. “I saw an eight-year-old Shepherd mixed-breed who had her first seizure almost a year ago. The second one was several weeks later. Her regular veterinarian performed blood work and radiographs, and all was OK. She did not have another [seizure] until January. Then she had two more. Then the owners brought her to see us.” Though she looked normal, with no obvious neurological problems, says Podell, “she had a meningioma in her olfactory lobe the size of a golf ball.” Fortunately, these benign tumors, the most common type of brain tumor, can be treated with good success by veterinary neurologists.

    Because there are so many potential underlying causes of seizures, the workup must be step-wise and thorough, a comprehensive attempt to parse the possible culprits: disorders originating within the brain (tumors; viral, bacterial or parasitic infections; strokes; head trauma) from those originating outside the brain. For instance, nutritional deficiencies as well as toxins like lead, insecticides, moldy foods and some human supplements can provoke brain changes that lead to seizures. Additionally, metabolic abnormalities such as liver or kidney disease can cause seizures, and some anesthetic agents and medications may also trigger them in sensitive animals.

    The workup starts with a history, including information on vaccinations, diet, exposure to toxins, and the time relationship between seizures and other activities. In most cases, blood chemistry, a complete blood count and urinalysis will help systematically rule out many of the extracranial causes. If no underlying disease process is found and the animal is between one and five years of age, idiopathic (cause unknown) epilepsy may be diagnosed. If the dog is less than one year of age, he is more likely to have a congenital abnormality, and if he’s older than five to seven years of age, specific disorders of the brain are more common. In turn, these cases (as well as those with difficult-to-regulate idiopathic epilepsy) will require further workup, which may include an MRI and cerebral spinal fluid tap.

    Regardless of age and the likelihood of finding idiopathic epilepsy, early treatment is important, because with each seizure, more nerve cells within the brain will begin to fire randomly. As Dr. Podell notes, “The brain’s threshold for seizure may lower on a constant basis.” In other words, each seizure makes it more likely that another one will occur. This in turn can make the seizures progressively more difficult to manage.

    So, to the bottom line: In general, Dr. Podell suggests, “If a dog has had two seizure clusters [two or more seizures occurring over a short period of time, with the dog regaining consciousness in between] in a year, or two or more regular seizures within a six-month period,” he should receive appropriate diagnostic workup and treatment as soon as possible. Early diagnosis and treatment with anti-seizure medications where indicated are critical to a successful outcome.

    To find out more about canine seizures and epilepsy, start with a visit to the Canine Epilepsy Network.

     

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