Wellness: Health Care
Take a Deep Breath
Somewhere in northern California, a tiny dog is still prancing around on four paws thanks to hyperbaric oxygen therapy (HBOT). Unbeknownst to the dog’s owner, a piece of string had become wrapped around his paw, hidden in the dog’s dense fur. As circulation in the paw slowed down, skin and tissue began to slough off. By the time the owner realized what was happening, the paw was in such bad shape that the little dog’s vet, understandably, recommended amputation. The owner, however, wanted to try to save it. After a strict regimen of cleaning and dressing changes failed to promote significant improvement, the dog was referred for HBOT treatment.
Deep-sea and scuba divers have long used HBOT to combat the bends, and in the medical arena, it has been employed for more than 50 years to help people recover from serious infections and hard-to-heal wounds, among other ailments.
Now, this technology is being utilized to help companion animals and horses with conditions as varied as head and spinal-cord trauma, intervertebral disc disease, wounds and burns, infections, and inflammatory conditions.
The general theory behind HBOT is that it promotes healing by raising oxygen levels in the blood, allowing oxygen to diffuse into tissues at distances three to four times further than usual. Gary Richter, MS, DVM, medical director of Holistic Veterinary Care and Rehabilitation Center, Oakland, Calif., is among those who use HBOT in their practices. According to Dr. Richter, “When there’s inflammation, damaged tissues or injury, lack of oxygen is very commonly the limiting factor. By increasing the amount of oxygen delivered to tissues, we are stimulating these patients’ own healing abilities—immune systems, stem cells—to begin the healing process where other types of conventional medicine might not be able to achieve that goal.” (The dog with the damaged paw was treated at Dr. Richter’s clinic.)
Typically, HBOT treatments last about an hour and are given one to two times daily. A patient is placed in a hyperbaric chamber and breathes 100 percent oxygen at 1.5 to 3 times normal atmospheric pressure. The total number of treatments required depends upon the condition and how the patient responds. Being enclosed in the chamber doesn’t seem to distress the dogs or cats who use it; many reportedly go to sleep during treatment. Dr. Richter thinks that for the patient, it’s mainly boring; “as far as the animal’s concerned, nothing’s happening.” The cost and protocol are the same no matter how large or small the patient.
The therapy has essentially no side effects, although Dr. Richter says that it’s also important to select HBOT candidates appropriately. Dogs or cats with some types of respiratory problems or who are predisposed to specific types of seizures need to be evaluated before undergoing the therapy.
And sometimes, says Dr. Richter, the therapy may have positive side effects. Take, for example, the case of a cat with inflammatory bowel disease (IBD) so severe that she required a surgically implanted feeding tube. The surgical site became infected with Methicillin-resistant Staphylococcus aureus (MRSA), a bacterium responsible for several difficult-to-treat infections. HBOT was used to help the site heal and resolve the MRSA, but as a side effect, her IBD improved to the point that she no longer required intensive medical monitoring.
Despite being approved for use in humans for an array of medical conditions, HBOT is not without its skeptics, who say that the lack of clinical trial data supporting its claims puts it into the realm of experimental. However, based on the human experience, it would seem that HBOT has the potential to become another valuable tool in the veterinary health-care toolbox.
Good Dog: Behavior & Training
Eight ways you and your anxious dog can catch a break
It sometimes feels like the dog world is polarized between people who “get” anxious and reactive dogs and people who don’t. Worse, the people who don’t can be dismissive and unkind, not to mention make it difficult for you to navigate the world with your dog by not respecting personal space.
Lately, however, people are coming to realize that completely calm, bombproof dogs are closer to the exception than the rule. Many dogs have something they’re not good with, whether it’s alone time, storms, cats or children. This increased awareness has translated into more and easier tactics to help anxious dogs than walking them at 5 in the morning. Here are eight ways to make life with your anxious or reactive dog better for both of you.
1. Seek out a PR trainer. In recent years, modern trainers have learned that an overwhelming majority of dogs who lunge at, bark at and fight with other dogs and humans aren’t doing so because they’re “dominant” or because they want to be “pack leader.” They’re doing it because they’re scared. A frightened dog, especially one who feels like she can’t escape, will turn to aggression to “get him before he gets me.” Once we know that aggression is rooted in fear, we know to avoid trainers who “rehabilitate” aggressive dogs by dominating them. Hurting a dog doesn’t stop her from being scared, it just makes her shut down. Change the emotion, on the other hand, and you’ll change the behavior. A dog who isn’t scared of other dogs has no need to bark or fight. Find a good trainer, ideally one who follows positive reinforcement principles and is certified by CCPDT, and you can work wonders together.
2. Make her visible. This might sound like the last thing you want to do with an anxious dog—I’ve certainly spent my share of time hiding around corners and not opening my door until I’ve checked that the coast is clear—but drawing attention to your dog’s anxiety is a good way to tell other people not to approach. Put a yellow ribbon on your dog’s leash, or buy a bandanna or harness that says “nervous” or “no dogs” and you’re giving people a heads-up without having to yell at them.
3. Muzzle up. If your dog is reactive and big enough that you could lose control if she lunges, consider a good quality muzzle. A muzzled dog is still seen by most people as a dangerous dog, which can lead to some unpleasantness for the owner, but thankfully, the Muzzle Up! Project is trying to get rid of that prejudice and spread the word that a muzzle is a sign of a responsible owner and a safe dog. By making those with aggressive dogs feel safer, muzzles allow both people and dogs to get more enjoyment from being outside.
4. Consider changing your vet if he/she isn’t tuned in to your dog’s needs. While some vets are great with nervous and aggressive dogs, others are still very old school; they don’t listen to owners and use invasive and rough handling. There are, however, new techniques out there for vets dealing with anxious dogs. Dr. Sophia Yin has developed a program for vets that focuses on low-stress handling, which can make a huge difference in your dog’s anxiety levels. And Dogs in Need of Space has a list of vets who go the extra mile for anxious dogs; if you do want to change your vet, it’s a good place to start.
5. Learn your dog’s body language. Your dog constantly communicates how she’s feeling, and the better you understand what she’s saying, the easier it can be to avoid stressful situations. Something that was fine for her last week might be too much for her to cope with today due to a phenomenon called trigger stacking (an increase in anxiety-related behaviors caused by the dog experiencing repeated stressful events without enough time in between for the associated stress hormones to leave her system). Avoid this by keeping an eye out for signs that tell you how your dog is feeling.
There are lots of resources for learning the basics; Lili Chin has made some lovely posters, and there’s even an iPhone app, so you needn’t run out and buy a textbook. Just remember that every dog is an individual, so you might not see all the signs of stress all the time. My dog only pants when she’s hot, for example.
6. Try medication. When I tell people, “My dog’s on Prozac,” most of them laugh; they think it’s a funny way of talking about her anxiety. It’s not: she really is on Prozac. Many of the same antidepressant medications that millions of humans use have been proven to help dogs with anxiety have the confidence to try new behaviors. A conversation with your vet is the first step on this route. Your vet can refer you to a veterinary behaviorist, a DVM who is knowledgeable about both training and medication; a vet behaviorist can give you a complete prescription tailored to your dog’s needs and, ideally, liaise with your trainer or applied animal behaviorist (a professional who specializes in dogs with behavioral problems but is not a vet).
Making the decision to try medical intervention can seem like a big step, but there is a lot of specialist information designed to make it easier. A good place to start is Debbie Jacob’s website, fearfuldogs.com. There are also numerous over-the-counter pills and products marketed to help anxious dogs, but be careful if you choose to experiment with them. Most “calming supplements” haven’t been tested, and evidence for the ones that have been is sketchy at best. Ultimately, it’s a personal choice, but do remember that treatment has its own kind of placebo effect.
7. Find a shared interest. It’s okay to be disappointed that your dog doesn’t want to go to the dog park, agility trials or pavement cafés. Try focusing on what you guys can do together instead. Set up indoor obstacle courses, go on quiet wilderness hikes, take nose-work classes or just chill at home. Don’t try to force the dog you have to be the dog you wanted. In the end, you’re likely to make her problems worse, not to mention strain your relationship.
8. Know your limits. If you’re really out of your depth, or your dog represents a serious danger to you or your children, it’s okay to consider rehoming. Training and medications are expensive, and anxious dogs often require a lifetime commitment. In some cases, it’s safer for you and better for the dog to find a new home where she can get what she needs if you don’t have the resources or the situation to provide it. You’re not a bad person or a failure—you’re making the wisest, kindest choice in the circumstances.
With these options, life with an anxious dog doesn’t have to be lonely!
Wellness: Health Care
Periodontal disease, the most common disease occurring in dogs and cats, is defined as plaque-induced inflammatory pathology of any part of the tissues that hold the tooth in the mouth. >Plaque is a soft biofilm that contains bacteria and toxins. It accumulates on the surface of teeth within hours after dental cleaning; if it mineralizes, tartar (calculus) forms.
>Gingivitis is the reversible form of periodontal disease, affecting only gingiva (the gums). As inflammation continues, the gum detaches from the tooth, creating a pocket. Toxins from plaque bacteria and enzymes from inflammatory cells cause further destruction of periodontal tissues.
>Periodontitis is the more severe form of periodontal disease. It results in attachment loss, gingival recession and loss of alveolar bone, which loosen the tooth and put it at risk of falling out. In multi-rooted teeth, the furcation between two roots becomes exposed. Bacteria, toxins and inflammatory mediators may also be released into the bloodstream, allowing them to travel throughout the body and cause harm to important organ systems.
Your pet should generally have an annual oral examination performed by a veterinary health care professional. The amount of dental deposits (plaque and tartar) and the condition of the gingiva (color, texture, shape) will dictate the need for placing your pet under anesthesia to have dental scaling and periodontal therapy performed.
Although anesthesia will never be 100 percent risk-free, modern anesthetic and patient-evaluation techniques minimize the risks, and millions of dentistry and oral surgery procedures are safely performed each year.
(Anesthesia-free dentistry by untrained individuals is inappropriate for several reasons, including insufficient cleaning of inaccessible tooth surfaces, oral discomfort and serious pain.)
An effective home oral hygiene program consists of daily tooth brushing and use of various oral health care products (e.g., rinses/gels, chew toys, dental treats). When oral hygiene is less than optimal, plaque can mineralize within two to three days, forming tartar that resists being easily brushed off. All you need is a soft-bristled and appropriately sized toothbrush, veterinary toothpaste, some patience and one minute each day.
Certain toys and treats can be used in combination with daily tooth brushing, oral health care products, yearly dental check-ups, and dental cleaning and periodontal therapy. Toys and treats should not be too hard, as very hard materials can fracture teeth; rocks and large ice cubes should also be avoided. Tennis balls are popular toys for many dogs; however, they are very abrasive and will rapidly wear down the teeth.
Wellness: Health Care
Your dog is sluggish, withdrawn and avoids his food bowl—is it inflammatory bowel disease?
See those beautiful lilacand plum-colored hills, dotted with darker stones on what looks like pathways? And the slopes that dive into valleys lined with translucent pebbles? But wait. These aren’t lavender-f lowered furrows. They’re a close-up view of the intestines in cross-section. The purple polka dots are inflammatory cells, out of place and infiltrating the tissues. This is inflammatory bowel disease, or IBD, as seen under a microscope.
These histological views, thin slices of stained tissue, are collected via endoscopic or surgical biopsy. They might be small but they reveal a lot, particularly about the kinds of inflammatory cells that are cramming the villi and crypts—the steep hills and valleys— of the GI tract. Crowds of lymphocytes, plasma cells, eosinophils, macrophages and/or neutrophils cause the bowel to thicken, and hinder its motility. They also block the gut’s ability to absorb nutrients, properly manufacture mucus to line the tract and originate hormonal signals.
What causes the GI tract to host the wrong type of cells? It’s not completely clear. Broadly speaking, the immune system overreacts, perhaps to diet, parasites or bacteria. The visiting immune cells then send signals, called cytokines, which create more inf lammation. The end result is an altered intestinal architecture and a host of symptoms: weight loss, diarrhea, vomiting, mucus and/or blood in the stool. The particular symptoms depend on where the inflammation lives, which can be anywhere from the stomach to the rectum.
Diagnosis begins with blood work, which may show protein loss, anemia, dehydration, altered B12/cobalamin and folate levels, elevated liver enzymes, and sometimes pancreatitis. For a definitive identification, a GI biopsy is the gold standard, but when possible surgical risk or cost is a factor, an abdominal ultrasound can provide a presumptive diagnosis; thickened bowel loops usually indicate IBD. (In rare cases, they may also indicate a cancer such as lymphoma; it can be difficult to suss out the subtleties between it and IBD on ultrasound. It’s important to be sure that lymphoma’s not in play because starting prednisone—a common steroid used to treat IBD—without ruling out lymphoma can make an accurate diagnosis difficult later and can create future chemotherapy resistance.)
Medical Treatment Options
Dogs who do not respond completely to diet change may be placed on steroids, antibiotics and, sometimes, stronger immunosuppressive drugs like cyclosporine or azathioprine. Each medication comes with its own list of possible side effects, so the goal is to try to taper the medication to the lowest effective dose. To cover all bases of possible inflammatory triggers, many veterinarians will also deworm dogs with suspected IBD.
Traditional Chinese Veterinary Medicine (TCVM) is another excellent tool. TCVM includes acupuncture, Chinese herbs, food therapy and tui na (a form of therapeutic massage). Rather than treating a dog for a list of symptoms, TCVM creates a picture of his health based on patterns. From indicators such as the dog’s tongue color and coating, pulse strength and character, time of day of the signs, personality, and preferences for cold or warm places, a TCVM vet develops an individualized treatment plan.
These specifics matter. Herbal formulas for chronic early-morning diarrhea are different than those used to treat acute bloody diarrhea. Formulas for acute diarrhea may only be used for a week, but herbs for chronic GI issues are usually given for one to three months. It’s important to use highquality, domestically manufactured formulas from suppliers like Jing Tang Herbal to guarantee low toxicity and uniformity. Herbs are medicine, with possible side effects and interactions, so it’s best to have a TCVM vet prescribe the correct formula for your dog.
Combining acupuncture and Chinese herbs is another powerful way to assist in the resolution of both acute and chronic GI issues. Acupuncture points are located in areas where nerve endings, blood vessels, mast cells and lymphatics are concentrated, and activating those points helps to strengthen the immune system, lower inflammation, increase circulation and reduce pain. Studies have documented that point stimulation also releases neurotransmitters such as beta-endorphin and serotonin.
A TCVM vet will choose a series of points to relieve pain, vomiting and poor appetite, as well as to address heat in GI tract (blood) or a yang deficiency (warm-seeking). Thin, single-use, sterile needles are placed at specific sites, and are left in place from one to 30 minutes. The number of needles used depends on the dog’s age, personality and level of disease. Most dogs relax, yawn and even fall asleep after about 10 minutes. As with any chronic disease, it takes time to steer recovery in the right direction. For acupuncture, a good place to start is three to five treatments spaced at 10- to 14-day intervals.
When all goes well, combining Western and Eastern medical treatments results in weight gain, eagerness to eat and a reduction in GI pain. Not to mention the return of those wonderful, broad doggie smiles and whole-body tail wags.
Wellness: Healthy Living
DIY Paw Wax
Snow falls, cold winds blow. In northern latitudes, winter serves up a host of things for dogs and their people to contend with. Salt and other de-icing agents are hazardous to dogs’ paws and skin throughout the season, and moving from cool air outdoors to warm air indoors can result in dry, irritated skin.
There are several simple things you can do to help your dog deal. To prevent salt from irritating paws, apply a coat of Musher’s Secret paw wax, made from a blend of several food-grade waxes, before heading outside. When your dog comes in, wipe her paws with warm water to remove de-icing agents. (Don’t forget to check her legs and stomach, too.) If your dog has long hair, trim the hair between her pads to prevent painful ice balls from forming. Or, avoid these foot problems altogether by putting booties on your dog—which might be easier said than done.
Increasing indoor humidity will help alleviate dry, itchy skin. A simple oatmeal bath can ease irritated skin, but don’t bathe your dog too often, as this strips natural oils and further contributes to dryness. (Vets suggest a once-a-month bathing schedule.) Regularly grooming your dog with a soft brush like Pet+Me can also help improve her skin by stimulating the oil glands to produce more natural oils.
A number of supplements are considered to be helpful in maintaining a healthy skin and coat. Add Omega-3 and Omega-6 fatty acids (found in fish oil) to your dog’s food (this takes four to nine weeks to have an effect); vitamin E can be taken internally and/or applied topically. A deficiency in vitamin A may also contribute to skin problems; ask your vet about supplementing with vitamin A if the other options aren’t helping.DIY Paw Wax
Based on a recipe from Frugally Sustainable
Six 1-ounce tins (or about 20 standard lip-balm tubes)
Small pot or double boiler
2 oz. olive, sunflower or sweet almond oil
2 oz. coconut oil
1 oz. shea butter
4 tsp. beeswax
Optional: Essential oils
1. Over low heat, melt the oils, shea butter and beeswax. Stir continuously until everything is melted and well blended.
2. Pour the mixture into tins or tubes. Let cool.
3. Cap and label. Keep away from extreme heat.
A gathering of ideas
There is an astounding amount of research on dogs—academic studies, medical research, social and psychological testing, not to mention reams of data gathered from our everyday lives. Thoughtfully assimilated, all of this information can help us and our dogs live better lives together.
I was reminded of how fortunate dog enthusiasts are to share in this wealth of information upon my return last week from Purina’s Better with Pets Summit (November 3). The annual event, this year presented in Brooklyn, NY, was a gathering of pet experts sharing their latest findings with the media. The theme for the day was “exploring the best ideas for bringing people and pets closer together.” It was an apt description.
The day started out with an inspired presentation by Dr. Arleigh Reynolds, a veterinarian and research scientist who studies the impact of nutrition on performance on sled dogs. A champion musher himself, Reynolds’ talk focused not on a program he’s involved with in the Alaskan village of Huslia. This small coastal community was the home of George Attla, a famed champion musher and native Athabascan who ruled the sport for thirty years before retiring. In honor of his son Frank, who died at age 21 in 2010, Attla started the Frank Attla Youth and Sled Dog Care Mushing Program. The program serves many purposes—providing skills, lessons in cultural traditions, and a sense of belonging to the youth population while uniting all townspeople around a common activity, mushing. The program, as described warmly by Reynolds and in a short documentary film demonstrates the power that dogs can initiate in our lives.
Next up was a panel discussion titled “Are Millennials Changing Our Relationships with Cats?”—offering the interesting observation that a new generation of cat people have now formed a community on the internet—so as dog people connect at dog parks, cat lovers now interact online sharing their passion for felines. We met Christina Ha, the co-founder of Meow Parlour, New York’s first cat café. Can a canine café be in our future?
The most anticipated panel “Stress, Our Pets, and Us” featured animal behaviorist Ragen McGowan, PhD; architect Heather Lewis (Animal Arts) and Dr. Tony Buffington, professor of veterinary science. McGowan discussed the value of having dogs work for their food citing her studies with grizzlies, chickens and mice on the practice of contrafreeloading (working for food when food is freely available). Lewis’s architectural practice specializes in designing veterinary hospitals and animal care facilities around the country, meeting the unique needs of both workers and animals. It’s evident that good design can have an important impact on animal friendly environments—from soothing color palettes to calming lighting levels or the simple use of horizontal bars (less stress inducing) instead of traditional vertical bars. The key takeaway: Mental exercise for animals might be as important to their well-being as physical exercise.
“Raising Pets and Kids” featured Jayne Vitale of Mutt-i-grees Child Development Director; Ilana Resiner, veterinarian behaviorist; and Charley Bednarsh, Director of Children’s Services (Brooklyn). The Bark features an in-depth article in its Winter 2015 issue on Mutt-i-grees, a program developed by the North Shore Animal League that offers academic and emotional support to students from kindergarten through high school, teaching them how to be ambassadors for the humane treatment of animals. Bednarsh and her therapy dog Paz, team up to assist young witnesses of domestic violence navigate the judicial system (a similar program first reported in The Bark). We were reminded of the important contribution to the health and well-being of the children in these extraordinary programs, and also to common households. Note to self: Don’t humanize your dog—study, understand, embrace their dogness.
The afternoon offered a room full of experiential exhibits—interactive displays that provided lessons in healthy environments, cognition, reading your pet, nutrition and your pet’s purpose. Manned by teams of experts, the well designed displays presented an immersive course in Dog and Cat 101. I’d love to see the exhibits showcased to the general public, those most in need of education and guidance in the proper care of pet companions. The day was rich with ideas and notes that we’ll shape into future articles for The Bark.
Purina’s commitment to offering a forum of ideas is commendable. In a similar vein, the company hosted another notable event on November 7—a free live video cast of the Family Dog Project from Hungary—with over a dozen presentations by leading scientists and animal behaviorist exploring everything from canine cognition to sensory perception in dogs. Like the Pet Summit, it was a fascinating collection of concepts and dialogue, enriching to everybody who participated.
For more check out #BetterWithPets
News: Guest Posts
My dog and I both enjoy the arrival of autumn. I love the cascade of warm leaf colors, and she particularly loves rooting through the newly dropped leaves, as if there must be a treat hidden in there somewhere. We’re able to take much longer walks, no longer burdened by daytime heat spikes, scorching pavement, or the constant buzz of mosquitoes.
However, this time of year also brings another, less pleasant arrival: adult-stage blacklegged, or deer ticks. Wait a minute! Maybe you thought ticks were only a problem in the spring and summer? Well, they are active then. But blacklegged ticks are also a problem in the autumn. The tiny, poppy seed-sized nymphs that were nearly invisible all summer now have grown into the adult form and seem to be everywhere. These autumn days, when all other bloodsuckers are pretty much gone, adult blacklegged ticks can be found spending their days at the tops of tall grasses and low shrubs, legs outstretched, and waiting for a potential host to brush by.
The females are particularly dangerous to you as well as your pup. It’s currently estimated that around 50 percent of female blacklegged ticks are infected with the Lyme disease bacteria in the New England, mid-Atlantic and Upper Midwestern states, and the likelihood of transmission and infection increases the longer she’s attached and feeding. A lower proportion (about 15 percent) of these same ticks are infected in the southeastern and south-central states. And don’t be surprised if you see what looks like two types of tick on you or your pet. The all-black tick you may see is a male, usually just crawling around. He’s not interested in feeding (he’s only looking for the ladies). In addition to the Lyme disease bacteria, blacklegged ticks are also known carriers of the agent that causes canine anaplasmosis, another nasty pathogen that causes lethargy, lameness and fever in dogs.
While ticks pose a serious risk to you and your dog, they are no reason to hide indoors. A little TickSmart planning can help keep you TickSafe as you enjoy the beautiful fall weather.
Top 5 TickSmart™ Actions to Protect your Dog from Deer Ticks
•Avoid edges where ticks lie in wait.
•Perform daily tick checks on your dog.
•Protect your dog with a quick tick-knockdown product.
•Make sure your dog’s Lyme vaccine is up-to-date.
•Create a tick-free yard.
Wellness: Health Care
Senior dogs benefit from in-home vet care.
When I was in veterinary school, a house-call practice was far from the career I imagined. Yet years later, I found myself at a crossroads. I knew I wanted to work for myself, but the thought of opening my own vet hospital was daunting. So, I compromised, taking part-time jobs while building my in-home practice. Word spread, and within six months, I was able to focus entirely on veterinary house calls.
Though my practice was designed to offer full-service veterinary care to dogs and cats in all stages of life, it soon became clear that senior pets benefited the most. Elderly arthritic dogs with mobility issues are difficult to get into a car, and diabetic dogs with cataracts can become disoriented and anxious in a waiting area filled with young, active and noisy pets. Even routine vet-clinic check-ups can be distressing for old dogs.
In-home care guarantees a relaxed, familiar setting conducive to in-depth examination. And when dogs are at the very end of their lives, quality-of-life assessments, palliative and hospice care, and euthanasia are all most comfortably done at home. Two years ago, when I introduced Your Senior Pet’s Vet, a subdivision of my general house call practice, the response was overwhelmingly positive.
House calls for seniors don’t have to wait until dogs are in the last stages of a terminal illness. Most of the issues that arise with older animals can be addressed in the home, and when radiographs or surgery are necessary, the dog can be transported to a base animal hospital for tests and treatment. My senior house-call patients tend to tolerate less-frequent hospital care with ease, possibly because they have been conditioned to consider me a friend from home.
My clients are also much happier with this type of personalized service. Like their elderly dogs and cats, people also experience increased stress associated with vet-clinic visits. Taking the car ride, waiting-room delays and steel exam tables out of the equation is a great relief. Additionally, home visits make it possible for owners to evaluate my caregiving style on a more intimate basis than is possible with a quick hospital visit, resulting in a higher degree of trust and comfort when it comes to my treatment of their special pets.
Katie and Poppet, 13-year-old Jack Russells, lived with Patsy, who was in her early 80s at the time. She and her two terriers walked a couple of miles to the beach and around the golf course every day. I made my first visit in response to a handwritten letter Patsy left in my mailbox requesting a house-call appointment for Katie and Poppet’s routine check-ups. This was also the start of a wonderful friendship; Patsy gave me parenting advice and told me stories of her years as a nurse and a law student, and of past dogs in her life.
Eventually, Katie developed congestive heart failure that required medication and regular rechecks. Poppet survived a serious case of leptospirosis, but ultimately slid into canine cognitive disorder. After Patsy had lost both dogs, I helped her adopt a new senior Pomeranian from the local shelter. Billy moved in, and I continued to be Patsy’s on-call vet.
I share this story as an example of the benefits of in-home vet care for senior dogs such as Katie and Poppet. Whether the issue is simple old age or a chronic, debilitating problem, an objective professional evaluation and consult can make it possible for a dog to continue to live comfortably at home. Sometimes, people are sure it’s time to let their dog go, but in many cases, I am able to alleviate their worries and help them find ways to keep their dogs with them longer than they thought was possible. As dogs and cats transition into the final phase of their lives, in-home visits coupled with pain-management therapies, changes in treatment protocols and environmental accommodations (ramps, carpeting on slippery floors, support harnesses and slings) can make all the difference.
When I met Rocky, a 13-year-old, 75-pound Pit Bull mix, his family was very upset. Not only was he incapacitated by severe arthritis, he also had a large mass at the base of his tail and had been diagnosed with Cushing’s disease. Because his family couldn’t get him into the car, Rocky had not been to his regular vet in over a year. When I first saw him, he was lying on a piece of carpet surrounded by small sample-sized carpet squares, panting and wagging his tail as three adorable small children doted on him, petting him and offering him water. The children were interested in the equipment in my house-call box and asked questions about what I was doing with Rocky. The parents and grandparents waited anxiously to hear what I had to say about their amazing old boy.
The mass was large and open, and Rocky’s nails were very long. After reviewing all aspects of Rocky’s situation, we made a plan to treat the infected mass with antibiotics, cut his toenails so he would have an easier time with foot placement, and cover the slippery wood floor with larger carpeting and runners. We also started conservative but effective pain-management medications. We discussed harnesses and slings that would make it easier and more ergonomic to get Rocky from place to place within the house and yard.
He was a cooperative, friendly patient, and I was able to draw blood for the necessary full senior dog panel before putting him on anti-inflammatory medications. Rocky’s response to these interventions was remarkable. His family was delighted at his increased comfort and improved ability to get up and down, and they had a much easier time caring for him.
Eventually, his arthritis worsened, the mass grew and his overall quality of life deteriorated. We met a number of times after our initial visit, and had many email and phone conversations. Over a period of about eight months, I was able to guide them smoothly through their transition to saying good-bye to their sweet Rocky. When the decision was made to let him go peacefully, Rocky left this life on his bed, in his own home, surrounded by his loving family,
In-home euthanasia is a gift to beloved old animals and to their families as well; it makes the final goodbye comfortable and natural. Take Petey, for instance. To a man and his three daughters, the 16-year-old Bichon was not only a cherished companion, he was also a living link to the wife and mother they had lost to cancer nine years earlier. However, Petey’s quality of life had diminished to the point that he couldn’t eat and was vomiting and in pain. It was clear to the family that it was time to let him go, but they were distraught and having a very hard time with the process.
We discussed keeping the focus on what was best for Petey; what an important, special friend he was; and that they would always have pictures and beautiful memories to keep him with them. We set a time for in-home euthanasia, and when the day came, the weather was perfect. We were able to go outside to a beautiful grassy area in their back yard. After a very long goodbye, I euthanized Petey. The family agreed that I should make ink paw prints and clip some hair for them to keep. For this family, being together in the privacy of their back yard was the only way this could have been done.
Whether for routine, palliative or end-of-life care, senior dogs and cats benefit from in-home veterinary visits—compassionate support in the most comfortable environment they know. When I was searching for my niche within the veterinary profession at the beginning of my career, I never would have guessed how rewarding house calls and senior pet care could be. It has been profoundly gratifying to see the difference it makes in the lives of so many animals and their owners.
Wellness: Healthy Living
Online courses are all the rage. Here’s one from Udemy that caught our interest: Dog CPR, First Aid & Safety. Taught by Melanie Monteiro, author of The Safe Dog Handbook and a canine CPR and first-aid expert. Monteiro offers workshops and private consults in California and Oregon, and now, you can learn from her in the comfort of your own home. There are 36 lectures (three hours of video), covering pet CPR, canine Heimlich, how to stock a first-aid kit, how to take and read vital signs and more. Important techniques like how best to approach and capture an injured dog and restrain her for treatment, and how, why and when to use a muzzle (or not) are covered, using real dogs as subjects. Also included are tips on puppy-proofing your home as well as special pointers for dog walkers, sitters and pet-care providers. At only $60, it’s a great value. Learn more at udemy.com.
Wellness: Health Care
Would this breakthrough procedure improve a young Lab’s severe dysplasia?
Montilius (Monty) Tiberius is our two-year-old yellow Labrador best friend and faithful companion. On March 12, 2015, he became just the 15th dog in the world to undergo a groundbreaking procedure that, we hoped, would reduce his severe bilateral hip dysplasia and give him a chance at a normal life.
How difficult was the procedure? “On a scale of one to 10, the operation was a 12,” said veterinary orthopedic surgeon Dr. Loïc Déjardin of Michigan State University Veterinary Medical Center in East Lansing, who performed it. Dr. Déjardin is regarded as one of three surgeons worldwide able to execute this delicate operation.
The surgery on Monty’s right hip took nearly four hours. “There were some difficult areas through the surgery, finding just the right depth and shaving some bone away so Monty can access total mobility. Now, we wait and see,” Dr. Déjardin told us afterward. Monty would be closely monitored at six-week intervals for six months post-op.
Taking it slowly was key to Monty’s healing process. As Dr. Déjardin pointed out, “It’s up to you to make sure Monty heals properly, and having him take it easy is important.” My wife Ann and I took his advice seriously. For the next 10 weeks, Monty went outside on a leash to “get busy” as often as necessary; otherwise, he stayed in and rested. During the first four weeks in particular, we handled Monty oh-so-carefully, and our other dogs were kept away so they wouldn’t jump on or play with him.
A New System
Dr. Déjardin had given Monty a Centerline BFX Prosthesis. This trademarked prosthetic biologic fixation “hip system,” created by BioMedtrix Company of Boonton Township, N.J., uses an implant that is approximately eight inches long and made of steel (picture a skinny, steel ice cream cone with a scoop on top).
Unlike standard canine hip replacement implants, which are inserted down the central axis of the femur itself, the Centerline-BFX is hammered into the center of the femur neck; its base protrudes from the bone, allowing it to be secured at the top, attached without being cemented into the pelvis. It’s described as a lever (femur) and fulcrum. In order for Monty to regain complete range of motion, the prosthesis had to be inserted in exactly in the right spot, which required shaving off bone in the pelvic region.
This prosthesis and the procedure required to insert it are so new that they have not yet been fully documented in medical journals. Veterinarians with patients who are candidates for such a procedure would certainly review and study Monty’s case. Particularly if the operation was completely successful, which wasn’t a given.
What made Monty’s individual case special was the fact that he had severe dysplasia in both hips. The femoral head (the “ball” of the ball-and-socket joint) and pelvis area were seriously deteriorated, and he was almost completely lacking a hip socket (the acetabulum).
Before the surgery, when Monty walked, his left back leg dangled and flapped; when he ran, it was as if both hind legs vibrated. On his right side, his leg moved in an awkward semi-circle, like a leaf dangling from a branch. The right hip had the severest degree of lameness and, we were told, made Monty an excellent candidate for the procedure.
The regular prosthesis used for canine hip replacement wouldn’t work for Monty. Rather, in time, it would render him totally lame. During our initial September 2014 consultation with Dr. Déjardin, he explained Monty’s rare condition. He also made it clear that there was no guarantee of complete success. The specialized prosthetic implant would need to be precisely angled into the bone and secured around muscles that had already formed, which was risky. Additionally, the depth of the implant couldn’t be known until the actual surgery, another risk factor.
Before the surgery, Proto-Med Company in Colorado made 3D models of Monty’s hip (pelvis) and femur from CT scans. Dr. Déjardin practiced on the models, rehearsing the surgery to reduce the margin of error.
In weeks five to eight after his surgery, Monty was walking very short distances, which we were told was appropriate in order for him to begin strengthening the muscles in his right leg. But during week nine, something seemed to be amiss. One morning, he was fine when he went outside to get busy, but in the afternoon, when it was time for his short walk up and down the driveway, I noticed that he was seriously limping on his right hind leg. When Ann came home from work, I told her about it. She asked me if he’d done anything unusual, and I made what I thought was a joke: I said he ran around the neighborhood and seemed fantastic, which nearly put me outside in our decorated antique doghouse. In reality, I took this development very seriously, and myriad “what-ifs” raced through my mind.
I immediately made an appointment with Monty’s veterinarian, Dr. Thomas Frankmann, at the Animal Clinic of Chardon, who took X-rays. “It’s not good,” were Dr. Frankmann’s first words after he looked at them. “The Centerline implant has completely moved out of the pre-made socket [acetabulum] and is rubbing against bone. This, I suspect, is causing the limp and some discomfort.”
Dr. Frankmann said that he’d never had seen anything like it. “It’s not supposed to do that—these implants are secure. It’s bewildering.”
Dr. Frankmann called Dr. Déjardin for a consultation. Over the next few days, Dr. Déjardin spoke only to Dr. Frankmann. He also scheduled Monty for emergency surgery at MSU to reattach his implant. Needless to say, Ann and I were both sick with worry. We didn’t know what to expect or what would happen to Monty—would he be permanently disabled, or worse, would he even survive another operation?
We never did find out what might have caused this problem. Prior to Monty’s surgery, we heard only from the MSU nursing assistants and Dr. Frankmann, who detailed the severity and risk of the reattachment; Monty’s decaying bone structure and pelvic deterioration raised a concern that the repositioned prosthesis might not hold.
After the nearly eight-hour surgery Dr. Déjardin finally spoke with us directly. As it turned out, he could not save the implant; as Dr. Frankmann warned, it could not be readjusted or replaced. He immediately began a second operation while Monty was still sedated, performing an FHO (femoral head ostectomy), removing the head and neck of the femur to alleviate pain. The FHO is a salvage procedure intended to prevent total incapacitation; it basically allows Monty’s femur to “float” unattached, supported only by scar tissue that creates a false joint. Through physical therapy, he would build up muscle that would help secure the bone somewhat in place.
Two days later, during the five-hour drive to pick up Monty at MSU, I envisioned his feeble body after his first surgery two months prior and reflected on the pain he had endured. I also thought about how many pills he would now need to take; he was up to five medications at one point.
Upon seeing me, Monty couldn’t restrain himself. He tried to jump up but couldn’t because of the weakness in his right leg. He had been shaved, again of course, and seeing him was disheartening. I decided that the operations were finally over; no matter what miraculous cure/invention/procedure was discovered, I would not subject Monty to any more.
Then and Now
Monty has traveled a difficult path to get where he is today. He was diagnosed with “hip problems” as a puppy, but the severity of his condition wasn’t seriously investigated until shortly before he was a year old. Discarded and abused, he had at least three different owners before I adopted him from Joanne Dixon, president of Providing for Paws of Garden City, Mich., a nonprofit rescue organization helping animals in need. Patrons of PFP raised nearly $6,000 during the year leading up to Monty’s first surgery to help with its cost.
We received other financial help as well. Dr. Déjardin waived some of the charges associated with the first operation, and suggested Monty for MSU Veterinary Hospital’s Lucky Fund, which provides resources for specialized cases of dogs in need. The Lucky Fund donated $1,000 toward Monty’s cause.
Nonetheless, next to our home, Monty is our biggest investment, albeit a loving one, and well worth the sacrifice.
As he neared the completion of his weekly physical therapy sessions at Pawsitive Results Animal Rehab Center in Auburn Township, Ohio, his rehab vet, Kathy Topham, was absolutely astounded by Monty’s recovery and his ability to walk almost normally. “He probably won’t be great for search and rescue, but he’ll run, play, jump and maybe make a great therapy dog,” she said.
During our summer beach trip to North Carolina, Monty walked, jogged, swam and was eager to greet every beach-goer who meandered within petting distance. He has a marvelous outlook on life. As Ann said at one point, “He really has made adjustments to compensate for all his ailments; it’s amazing to witness how he moves around.” Monty plays like a normal, healthy, juvenile dog but close observation reveals his physical idiosyncrasies, the split-second adjustments he makes when he walks, runs, squats and lies down.
Monty has changed my outlook on life. We have that dog-human telepathy that most dog people have with their companion animals. However, he’s also “training” me to meet his needs, for which I couldn’t be more grateful.
Humans are ambivalent about life, but dogs are not. Our canine companions befriend us for our greater happiness, making us better people. They elevate our quality of life (teaching us to wag more and bark less, as the saying goes), and love us unconditionally without regard to the situation they’re dealt.
As Ann observed, he follows me everywhere, and watches and waits for me constantly. Now, she says, I owe Monty. I wouldn’t have it any other way. He’s the faithful companion every dog owner dreams about, and that’s my good fortune in this life.
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