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Special Guest: Veterinarian Nancy Kay

We’ve moved our open thread to Friday this week, so we can feature special guest Dr. Nancy Kay, a veterinarian, regular Bark contributor, and author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life. Nancy will be stopping by our open thread this afternoon. (If you can’t be here then, feel free to leave a question for Nancy and check back, or join the real-time conversation on any subject that suits your fancy in the meantime.)
 
Nancy is eager to talk about the veterinarian-client relationship, sharing hard-won insight into everything from saving money on your vet bills to setting reasonable expectations of your vet to getting the most out of check-ups and much more. While she can speak generally to health issues, she won’t be giving specific medical advice or making diagnoses.
 
A staff internist at VCA Animal Care Center, a 24-hour emergency/specialty care center in Rohnert Park, Calif., Nancy was selected by the American Animal Hospital Association to receive the 2009 Hill’s Animal Welfare and Humane Ethics Award and she was also the recipient of the 2011 Leo K. Bustad Companion Animal Veterinarian of the Year Award.
 
Newcomers, the open thread is a little like the dog park: Get out there and run, sniff around and play nice. Obscene, abusive, offensive or commercial comments will be taken down. We close the thread at 4 p.m. PST.

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Submitted by Anonymous | May 13 2011 |

Is it reasonable to expect a vet (+ staff) to cut the toenails of a 20-pound dog that is very squirmy? My vet seems to think the dog needs to be sedated. I don't agree, but don't have much experience with vets.

Submitted by Anonymous | May 13 2011 |

Do you think most vets are "in bed" with Science Diet and Royal Canin? I have had trouble finding a way to feed my dog that doesn't result in chronically soft stools. The vet told me to buy Royal Canin Fiber Response. That has mostly solved the problem, but I feel like I am giving my dog "junk kibble." Should I try to find a food which is not being "pushed" by my vet?
Thank you.

Submitted by Dr. Nancy Kay | May 13 2011 |

In bed with dog food? Yuck, that doesn't sound even remotely appealing?! No, I don't think MOST vets are so beholding to Science Diet or Royal Canin that they recommend it for unscrupulous reasons. I do believe that many vets believe they are high quality products that have been formulated on the basis of scientific research.

As mentioned in response to another comment, choose your battles wisely. You are not about to convince some vets and they are not about to convince you which product is best for your dog. I do encourage you to perform due diligence on any diet you feed your dog to make sure it is a balanced product for your pet's particular needs.

Submitted by Dr. Nancy Kay | May 13 2011 |

Some dogs simply HATE having their toes handled. They become all star wrestlers and it is ridiculous when 4 100 lb. plus people are needed to restrain a 20 lb critter! There are suggested ways to desensitize dogs to pedicures (best done when the dog is a youngster), but rarely do they work. If your dog really and truly needs a pedicure, some sedation (the equivalent of a couple of martinis) may be the most humane option for everyone involved. How about taking your little guy to the groomer to see if that person/environment produces a better outcome?

Submitted by Allison | May 13 2011 |

Thanks for your comments.

There was no better luck at the groomers. Weird thing is, he's fine having his feet touched by us (haven't yet attempted to clip myself b/c his quicks are so long). He's just new to us (a rescue).

Submitted by LD | May 13 2011 |

Hello Dr. Kay, thank you so much for doing this chat. I have a dog who his extremely vet-phobic, I suspect as a result of some very painful (but necessary) medical treatments he received while in rescue. He's completely non-aggressive in most situations, including the waiting room, but once he realizes he's being examined, the snapping and headbutting start. I've been asked to muzzle him during exams, which is fine, but I would like to find a way for him to relax during examinations. What can I do to help him be less afraid?

Submitted by Amy-E | May 13 2011 |

(not to butt in but...)

My schnauzer mix was the same way. I put her through mock exams on a table at home every day for a couple of weeks before annuals... with copious treats. And it turned out she was more docile without her Mom around, so I made it part of the script to leave and make heavy footsteps outside the door so she knew it was just her & the vet. E.R. trips were different matters, but for routine visits this worked surprisingly well.

Submitted by LD | May 13 2011 |

Not butting in at all! Thanks, that's very helpful. I've been advised to bring him into the office for treats, but it's not the office that freaks him out; it's the exams. I'll have to try the mock exams.

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Amy,

Great thought. Every once in awhile I get a dog or cat that is exceptionally difficult to work with, but become pussycats when their owners are out of the room.

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi LD,

Here are some possibilities:

- Try a house call veterinarian (and ask them to come right after they've showered so they don't smell like a vet- just kidding)
- Go to the veterinary hospital on a regular basis and ask the staff, including the vet) to provide lots of pets and treats without anything else happening to try to "decondition" the usual emotional response
- Try to tame your own emotional response- the minute you become apprehensive, that energy will shoot down the leash like a bolt of lightning into your dog's brain!
- If you have only worked with a male vet, try a female vet. I know this sounds rather sexist, but I've encountered many dogs that do great with a she-doc, but have a consistently poor track record with responses to male docs.
- If none of this gets you anywhere, consider sedation prior to the visit. This is not a failure, simply a coping strategy. Think about all those ads for sedation-dentistry!

Good luck with this. I know this is no fun at all, and I encourage you to try not to feel negatively judged (your doggie isn't feeling negatively judged!).

Submitted by LD | May 13 2011 |

Thank you, Dr. Kay! I will definitely try bringing him in more and being more relaxed myself. I admit, after one particularly nasty headbutting incident, I've been a bit anxious when I bring him in.

Submitted by Poosahkie | May 13 2011 |

Stella is a six year old lab, a SAR dog, who is in good condition. Within the last month, she had pymetria - I never spell that correctly. The friend who owns her has begun to take her on walks to build her endurance back up. How soon can a dog be expected to get back to an active routine once they have had major surgery such as this? What would be an acceptable distance and what would be too far for a walk? Is there anything to be concerned about by starting the walking regime?

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Stella,

Sorry, but I don't know what a SAR dog is- please enlighten me. Most veterinarians recommend extremely restricted activity until the kin stitches or staples are removed(typically at 12-14 days). After that, it is really important to chat with your vet, in terms of overall health and condition, about how quickly she can return to her normal exercise regimen. So, back to the surgeon you go for more discussion about your Lab.

Submitted by lauren | May 13 2011 |

Not a question for Dr. Kay, but a general Open Thread question: What did everyone think about John Bradshaw's appearance on last night's "Colbert Report"?

Submitted by AnniegJohnson | May 13 2011 |

I haven't watched it yet, but how was it?

Submitted by lauren | May 13 2011 |

You can watch it on Hulu (US only, I believe):

Submitted by Marie M. | May 13 2011 |

He did a pretty good job considering! I'm really looking forward to hearing more from him on Wednesday's episode of Fresh Air.

Submitted by anonymous | May 13 2011 |

It's pretty great that Colbert had Bradshaw as a guest. And I think he held his own pretty well. But a lot gets lost in the grab for laughs. But what came through for me was how we ask too much of our dogs, especially in being home alone too much. Makes me want to read the book to know more. Son of Sam joke was kind of funny.

Submitted by Claudia Kawczynska | May 13 2011 |

I, for one,, thought he did great. I had a nice long interview with Dr Bradshaw a couple of weeks ago (which will appear in the June issue) and at that time, he had never really seen a Colbert Report show! So I tried to explain to him what might be in store for him. I must admit I was nervous for him, but he held his own. His book is great and I truly recommend it to everyone. He goes into some detail about the prevalence of separation anxiety. His research, in the UK, posits that up to 50% of dogs have experienced this some time in their life. He emphasizes the importance of training dogs not to be anxious, especially relevant for shelter dogs (many come to shelters because of this problem and it is further exacerbated there). He covers so much ground in the book, including evolution, the importance of reward-based training, the problems with inline breeding (i.e. show dogs), behavior, etc. I really do highly recommend it. His interview with Terry Gross should be good, she can go into much more depth about these issues.

Submitted by Carolyn | May 13 2011 |

Any idea when Terry Gross will interview Dr. Bradshaw? His book was recently featured on Dr. Patricia McConnell's blog as well. I'm looking forward to reading it!

Submitted by Deanna | May 13 2011 |

Hello Dr. Kay, and thank you for answering our questions! I have two senior dogs who have visited a holistic vet regularly throughout their lives (and at great expense: titers instead of vaccines, regular check ups, visits at every hint of a problem etc.) I recently suspected one of my two dogs had a UTI/bladder infection. After urinalysis, it was confirmed and she suggested a course of antibiotics and a follow up test to make sure the infection was gone. I was shocked when the vet charged me again for that follow up test -- a total of nearly $175 including drugs. Now it looks like he's developing another infection, and there is no way I can visit this vet every 3 months at that price! Is it customary to charge this much for treating a chronic ailment? What is the best way to express my feelings about this as a regular customer, or do I need to look for another vet? We've gone to her for 11+ years but I just can't afford her care at this rate, which is a shame.

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Deanna,

You are certainly not alone in the way you feel. I encourage people to lay their financial cards on the table. Rarely is their only one option for managing a patient in a way that creates a win-win situation. I may be sounding like a broken record in my responses here, but I encourage a face-to-face, candid respectful conversation with your veterinarian. What you both have in common is your desire to preserve your dog's health and comfort for as long as possible. Find out what other options exist.

By the way, I find myself wondering why your senior dog is suddenly developing urinary tract infections. If at some point finances allow, consider the option of looking for and trying to fix the underlying cause. If this is not feasible and your dog is continuing to have infections, ask your vet about long-term low dose antibiotic therapy and urinary tract acidification- two ways to potentially keep infection at bay.

Submitted by StacyDog | May 13 2011 |

This is just a general question. My dog is 13 and I've been wondering how much I should push her on exercise. I want her to be in the best shape she can be in because I know it's good for her and she likes being out--but I'm not quite sure when I should let up. I've noticed she breaths more heavily when we walk faster or longer, but how do I know if it's too much? This is my first senior dog and I'm wondering what other dog people have done.

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi there,

I love this question because it allows me the opportunity to discuss age as it affects medical decision-making. In my mind, a patient's functional age is far more important than their chronological age. As I mentioned when I had the honor of being interviewed by NPR's Terry Gross, "Terry, you and I could both be 80 year old women in need of knee replacement surgery. You might be a prime candidate for surgery and I might be a horrible candidate."

So, you can see why it is difficult to prescribe a specific exercise regimen equipped with simply a number. I would encourage discussion with your veterinarian along with a description of what your dog willingly does (some dogs are willing to do far more than they should in order to please their humans)in terms of exercise. Discuss the changes in breathing you've observed, run some geriatric screening tests, discuss joint supplements such as glucosamine, chondroitin sulfate, and fish oil, and discuss whether or not your dog's weight is ideal. All of these are important in making choices that are best for your dog's physical and emotional well being. Hope this helps.

Submitted by Daun P | May 13 2011 |

Shortly after switching to a new vet office, we had to take our lab in for pancreatitis. We did several labs, & we never received a call regarding the results. I have called multiple times with no return phone calls. We have issues getting our PB & Kbr results & follow up instruction as well. How does one politely address the issue? It happens to be the same office our rescue uses as well, so I don't want to jeopardize that relationship.

Side question: What's the best way to tell the vet you disagree with a treatment choice? We feed Acana, Solid Gold & Barking at the Moon because our dogs have protein & grain allergies, yet the vet was quite insistent that we must feed one of the I/D foods. I explained about our food allergies & that I wasn't comfortable feeding such a lower quality food (especially since it didn't meet the dietary requirements for the dog).

Thanks!!!

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Daun,

How frustrating! I would encourage having a sit down face-to-face respectful, but candid discussion with the hospital administrator and/or practice owner. The entire premise of the conversation should have everything to do with your common ground, namely your dog's best interest. That is hopefully everyone's first priority. I sure hope this works in your favor.

Normally, I would respond to your "side question" by recommending a candid, respectful, face-to-face discussion (see my earlier response to another participant). Oh my goodness, issues pertaining to nutrition have certainly been causing lots of disagreement between veterinarians and their clients. How would you respond if your physician told you that you could only purchase your food at Whole Foods and not at Safeway! Everyone needs to pick their battles wisely. If you thoroughly love this vet (even though he or she is not particularly open minded, about nutrition anyway), then don't discuss diet unless you absolutely have to. And if a product you do not favor is recommended, simply nod your head without verbalizing your opinion. Sounds like your vet isn't going to convince you and you are not going to convince you vet.

Submitted by Amy-E | May 13 2011 |

I took in two geriatric cocker spaniels as sanctuary fosters, and the rescue group has decided not to pay for Cushings testing for the boy who pees every hour or so or for an ultrasound for the other who has a slow, irregular heartbeat.

I would never treat my own dogs this way... which is why I'm broke and fostering instead of adopting. Is it really usual to let these things go? The peepee boy is 13-1/2 and the girl with the slow heartbeat is 14. They are amazingly healthy and spunky despite their age and these problems.

They both need dentals and have horrible breath. The rescue group has decided not to do those, too.

Is it normal for owners or rescues not to do these things for their dogs? How can I keep them comfortable without giving them the care I think they need?

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Amy,

Oh dear, these are such tough economic times. Everyone seems to be paying a price, including our pets. So sorry that you find yourself in this situation. Although dogs with Cushing's disease notoriously drink a lot of water, they should be able to hold their urine for more than an hour. Cushingoid dogs are definitely predisposed to urinary tract infections and I'm worried this is the underlying cause of the pollakiuria (increased frequency of urination) you are observing. This should definitely be addressed. A heartbeat of 14 beats per minute is not compatible with life- not altogether sure what the true heart rate is, but again, this along with stinky mouths should be addressed.

So, what to do? At the risk of tooting my own horn, in the short term, you or the rescue group can certainly check out the list of organizations that may be able to offer financial assistance (www.speakingforspot.com). If no funds are available, perhaps your veterinarian might be able to prescribe antibiotics as empirical treatment for a urinary tract infection and/or periodontal disease. Best of luck with this.

Submitted by Amy-E | May 13 2011 |

Thank you for the advice. My peepee boy doesn't have any other symptoms of Cushings and he passed his urinalysis except for not concentrating his urine, so no infection. I asked my vet about diabetes insipidis and he said the Cushings test is the next step regardless.

I'll ask about antibiotics. They could have a few years left -- who knows? I can't imagine letting treatable conditions diminish their qality of life.

Submitted by Carolyn | May 13 2011 |

Hello Dr. Nancy! My question has to do with both holistic and conventional medicine for our dogs. I try to do everything as "green and natural" as possible for my dog: home-made food & treats, non-toxic cleaning products, natural materials in beds and toys ... you get the idea. I think supplements and holistic treatments have their place and often are very valuable in maintaining health and even in treating illness. That said, I believe conventional veterinary medicine is valuable too. My conventional vet is great ... but she does roll her eyes when I discuss a holistic approach.

So how does one balance both therapy options for their dog? Are there any vets who practice both holistic and conventional veterinary medicine, that have a more diverse toolbox so to speak? I sort of feel that I have a foot in both camps and I'm not sure my dog is well served by one approach over the other.

Thank you,
Carolyn & Maggie (Belize)

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Carolyn,

How nice to hear from you. Please give Maggie a treat from me! You are correct- it is difficult to find a Western practicing veterinarian who embraces complementary medicine and vice versa. And, it is difficult to be extremely well versed in both disciplines. As you know, I am a big believer in picking and choosing veterinarians wisely. Certainly, open-mindedness is an important trait in any doctor, for us or our beloved pets.

Just as most of us have different doctors for different needs, it's perfectly acceptable for your pets to also have different doctors for different needs. For example, some of the patients who frequent my hospital for orthopedic pain see a surgeon to figure out which nonsteroidal antiinflammatory and joint care supplements are worthy. They also see a colleague in another practice for acupuncture, and yet another specialist for rehabilitation therapy. The key is, all of the players are open-minded and their common goal is what's best for the patient. Can such a winning combination be found in every community? No, unfortunately not, but you won't know until you look.

Submitted by Beata | May 13 2011 |

Hi Dr. Kay, happy friday to you!

Our otherwise very happy 8 year border collie has had episodes of GI bleed for the past two years. We have seen several vets who are baffled it. All bloodwork is normal. The symptoms always manifest on empty stomach with discomfort, loud GI sounds (which sounds like high pitches gas bubbles squealing through tiny openings, followed by vomiting. The vomit often contains small blood specks as well as the stool has some residual blood on it.

This is obviously some underlying acid issue - what would be your recommendation for treating it?

Regards,
Beata
Vancouver, BC

Submitted by lauren | May 13 2011 |

Hello Beata,

Dr. Kay is only answering non-medical questions today. For medical advice, you will need to speak with your vet.

Submitted by Dr. Nancy Kay | May 13 2011 |

Oops, I managed to answer before seeing Lauren's comment!

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Beata,

Given the severity and chronicity of your Border Collie's symptoms my recommendation is to schedule an appointment with a board certified veterinary internist to look for the underlying cause. The most appropriate and effective treatment could be recommended only after a veterinarian has a clearer sense of what is wrong. Yes, this involves more expense, but when you consider the emotional price (for you) and physical and emotional price (for your dog), not to mention money spent on failed remedies,I think a consultation with an internist is a wise investment. Hope this helps.

Submitted by Laura Hidy | May 13 2011 |

Dear Dr Kay,
Have loved your book. I have a 4 yo male lab that has seasonal allergies. What supplements have you found really work to help his itching. There are so many out there and it is expensive!
Thank-you,
Laura

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Laura,

Thanks for your feedback about Speaking for Spot- greatly appreciated. There are no supplements that consistently work to control itchy skin in dogs. There are, however, supplements that work for some dogs. The thing to start with, if not already tried, is fish oil (omega-3 fatty acids). Check with your veterinarian about the dosage.

By the way, you may already know that Labradors are predisposed to atopy- seasonal allergies caused by inhaling dusts, pollens, molds, etc. from the environment. This is the doggie version of hay fever. Most affected dogs will become worse every subsequent season of exposure. Best of luck with this and I will keep my fingers crossed that fish oil makes a difference for your dog.

Submitted by Gregg | May 13 2011 |

My 2 year old Husky mix is on a monthly flea/tick medication (Frontline) that appears to work great for the first three weeks of an application, but I often find ticks embedded in his skin that last week of the month. I assume this is because the effect of the medication is wearing off. Would it be better to spread the application out, using 1/2 the amount every two weeks?

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Gregg,

I am concerned that 1/2 the amount every two weeks would not produce the desired effect. But, no harm in trying this. You might want to consider putting a good tick collar on your Husky during that last week of the month following application of the Frontline. By chance is your dog at a borderline weight for the Frontline dosage you are using? If so, perhaps bumping up to the next dosage up might provide more bark for the buck. Please check in with your veterinarian before making any such change.

Submitted by Gregg | May 13 2011 |

Great point I never considered. Our boy is 41 lbs and we're using the dosage for a 23-44 lbs dog, so maybe the next one up would be better. Thanks so much for pointing me in that direction. I'll speak to our vet about this as you suggested.

Submitted by Alaska | May 13 2011 |

Two part question about client-vet tech relationship.

1. When vet techs are asked by the vet to hold a dog for examination, vaccination, drawing a blood sample, etc., they often do their best to completely immobilize the dog by getting it in a lock-hold and clamping down hard. I try to train my dogs to cooperate with minor veterinary procedures, with good success. Yet it is often difficult to persuade a vet and/or vet tech to give the dog a chance to be a willing participant. Can you offer some guidance about when it's reasonable for me to make this request, and what would be the most effective way to convince the vet to give it a try and the vet tech to back off?

2. In the situation where the dog really does need to be restrained, at least to some degree (e.g. drawing a blood sample, when the vet does not want the dog to move suddenly just as the needle is going in), when is it appropriate for the client to hold/restrain the dog?
I realize vet techs sometimes have training that the owner does not, but I hate handing my dogs off to the vet tech to hold when I'm right there in the room with the vet.

I put an enormous amount of time and effort into training my dogs to be polite members of society, and in return my dogs trust me to look out for them. By far, the most stressful part of the vet-client relationship for me is being forced to hand off the dog to vet techs who obviously have limited dog handling and communication skills. Gah, I'm getting stressed out just writing this :(

My favorite vets have all been ones who allowed me to be present and a participant in as many procedures as possible. Vet techs have many useful functions (in the OR, caring for animals pre and post op, etc., and yes, holding animals during examination when the owner does not have the necessary skills or does not want that responsibility), but to me it seems that they are often overused. Your thoughts?

Submitted by Maureen - Washi... | May 13 2011 |

Well said, Alaska! I feel exactly the same way, for all the reasons you state. As a former vet assistant I not only understand the need to have my animals behave appropriately at the vet, I DO know how to restrain for blood draws, etc.

It is very upsetting to me to hand over the leash, and asking to be present seems to be some sort of challenge. I explain my experience in an effort to reduce the "performance anxiety" aspect (my elderly, now deceased, Rottweiler had skin like a dinosaur and kitten-sized veins and that were next to impossible to hit - the good thing is you could stick needles in him repeatedly (because we had to) with ZERO negative reaction from him).

Why do I feel I am labeled a difficult client when I just want to be there for my dog? I am low key and understanding (like I say, I've been on the other side, so I get it), yet any reasonable request such as this is met with some resistance 9 times out of 10. Would a human doctor expect a mother to hand over her child when they needed to do a blood draw or other minor procedure behind closed doors? I dislike using this analogy(my dogs are dogs, not "furbabies"), but it really is the closest I can come to my feelings of responsibility toward my companion animals. Yes, this is a stressful topic.

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Maureen,

I wrote a series of blog posts awhile back about Reasonable Expectations- things that you, the client, should reasonably expect when you visit the veterinary hospital. One of those reasonable expectations is access to the back of the hospital. Now, there are some animals that are much more difficult to handle when Mom or Dad are present. The vast majority of my patients are either happier or indifferent if their humans are in the room with us. So, if a client wants to accompany their pet to the "back" of the hospital, I'm all for it with the caveat that if their pet has a hard time being still/quiet, we might send their human back to the waiting room. By the way, I always make that human promise me that they won't faint when they enter the "bowels" of the practice. The bonus for me is that, with the client in tow seeing the abnormality I am seeing on the ultrasound examination, it is far easier to explain what the problem is and why we would wish to proceed with the next step. By the way, clients are definitely not allowed in the room when we take X-rays (in fact no humans are- we use sandbags and/or sedation for restraint).

Why don't all veterinarians welcome their clients' company beyond the exam room? I suspect they feel it will slow them down (more conversation required), they will be doing things that they don't want their client to see, or they are not proud of their facility. Good thing that everyone has a choice when it comes to the veterinarian they work with!

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Alaska,

Those of us who have worked with plenty of animals in a veterinary hospital setting knows that flexibility is the key to great restraint (comfortable for the pet and safe for everyone who is working with that animal). In other words, some animals are best when restrained on their sides, some while sitting, some while laying down sternally. Some do best with a humane muzzle or something covering their eyes so they can't see what is going on. Others react strongly to a muzzle or blindfold.Some animals need to be held firmly while, for others, "less is more". So application of a "one restraint fits all" approach doesn't make good sense. It may work for some of your patient population, but certainly not all (and we should attempt to be successful with each and every patient we see).

Sometimes owners wish to be involved with restraint. I know plenty of vets who are dead set against this for fear of liability should the owner be injured, and I can't say as I blame them. I do let owners be with us, but I discourage having them perform restraint unless they are clearly savvy and I have a clear sense that the animal's disposition will be compatible with this. I find that the only time owner restrain is consistently useful and practical is with law enforcement dogs who only want to be touched by their partner (and these dogs are typically muzzled for whatever we do). In most cases, if the animal needs the owner as a "calming presence" simply having the owner in the room and visually present is adequate.

So, how can you ask your veterinarian to be more receptive to doing things a different way? I would encourage a respectful conversation about this- not while you are in the exam room with the patient and client. Rather, schedule a meeting time. Let the doctor know what your observations have been and how others (like me) feel about this. Dr. Sophia Yin has written a wonderful book about in hospital restraint techniques. The title begins with "Low Stress Handling, Restraint, and Behavior Modification". Perhaps the hospital can purchase the book and you can both read it and then have a discussion.

Submitted by Jennifer B | May 13 2011 |

Dear Dr. Kay,
Thank you so much for being here today to answer some questions! Here's mine:
I have an eight year old beagle who is in pretty good shape. He has a huge yard to run around freely in with his two sisters (non Beagles). We feed him the healthiest food that we can afford, and yet every so often that boy will drop down on the rug and scrape his butt on the floor. When we go to the vet we get his anal glands expressed. The vet says I can do this at home,, but I don't want my boy to look at me like he does his doctor so I just bring him in. Is there anything I can do to make this happen less often? I never see the girls doing it. Is this unhealthy for him? I really don't like that it takes place on my carpet but you can't catch him until he's down!
Thanks for any ideas you might have!
Jennifer

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Jennifer,

You didn't mention if the scooting goes away after the anal sacs are emptied, but assuming this is the case.........

Most dogs empty their anal sacs during the course of passing a bowel movement. The pressure of the feces with the anus creates pressure on the sacs causing them to empty (so sorry if I am getting too graphic here). The anal glands are constantly producing their absolutely awful smelling material so the anal sacs are constantly refilling.

One can try making the stools more firm by adding fiber to the diet (please don't do this without consulting your veterinarian). The hope might be that the firmer stool might be more effective at emptying the anal sacs.

Yes, you can learn to empty your dog's anal sacs at home. When done properly, it should not create pain or discomfort for the dog (but the looks on their faces always suggest, "What in the *!x!! are you doing back there?" I coach clients to do many things at home to help them save money and minimize trips to the hospital, but when they express reluctance to empty their dog's anal sacs, I don't push. No one in their right mind really wants to do this!

So, if the trips to the veterinary hospital or groomer to have this done on a regular basis are becoming stale, you might consider surgery to have the anal glands and sacs removed. If you choose this route, be sure to work with a surgeon who has performed this surgery many times in order to avoid the dreaded complication of fecal incontinence. Good luck with this!

Submitted by Cathy | May 13 2011 |

Thank you for being here. I was wondering if you had any suggestions for lick granulomas?

I have a 5yr old lab mix. She has been check by two different vets and there is nothing physically wrong. She gets two walks a day, has a backyard to play in, and a 20 month old companion who keeps her running/playing. Most of her licking is done at night while we are sleeping so I can't real catch her in the act.

I have tried several different "yuck" sprays with no effect. She pulls off any bandage or just starts a new spot.

Thank you,
Cathy

Submitted by Dr. Nancy Kay | May 13 2011 |

Hi Cathy,

Boy oh boy do I wish I had an easy clearcut answer for you. For the sake of other readers, I'd like to explain that lick granulomas (aka acral lick granulomas) are skin sores created by self-licking behavior. These typically occur in large breed, longer legged dogs. For reasons we truly don't understand, dogs pick a spot, typically on the end of one or more legs and begin licking...... and licking, and licking and licking. The effect on the skin is no different than if you picked a spot on your arm and began incessantly scratching it. What results is a chronic appearing, firm, often ulcerated focal skin surface that has the potential to become infected.

Acral lick granulomas are thought to represent a self-soothing behavior, (like thumb-sucking) and may be associated with release of endorphins. And it's not unusual that if one is savvy enough to get the dog to stop licking at the site they begin turning their tongue attention to a different site on a different leg.

While it is possible that some of these dogs have an underlying issue such as arthritis (like people who rub their stiff hands, perhaps dogs lick the skin over their stiff joints). It's not wrong to take an X-ray to look at the underlying bone, but rarely will an abnormality be found.

So, what can you do to break the licking cycle? Trying to tucker your dog out is one option. It sounds like you are already giving this your "all" and given the "Labrador ingredient" wearing your dog out might not even be a possibility! Most dogs I know with this problem are so used to being "mouthy" with the affected body part that they have no qualms about removing the bandage or sock or scarf or tin foil or whatever else you choose to put over the skin sore. In fact, they may readily eat whatever material you choose. Taste deterrents rarely work- again, dealing with a big dog mentality here. The most reliable way to keep the tongue away from the skin surface is by using an Elizabethan collar- one of those plastic satellite dishes that forces you to clear the house of anything fragile along with an antiinflammatory medication applied directly to the affected skin site. Bear in mind that acral lick granulomas are often a lifelong proposition that require truly chronic therapy. Some dogs will give up the bad habit for a lengthy period of time and then go back to it (certainly sounds like some humans I know).

Cathy, do keep in mind that not all lick granulomas need to be treated, particularly if they are not becoming severely ulcerated or infected. They do not cause any lameness issue unless horrifically advanced. So, if the sound of licking is not interrupting your sleep and your Lab mix isn't creating a sore that appears progressive, you might just let her "win" on this one. Given she is a nocturnal licker, consider thinking about other things that might provide nighttime stimulation for her such as a Kong toy filled with peanut butter! Sorry I don't have any magic to offer. Good luck with this.

Submitted by debra | May 13 2011 |

Hi Dr! - My question is about dogs marking inside. I just rescued a 2.5yr old neutered Pug. I have 2 spayed female mutts at home, one is 16yrs, the other is 3yrs. All 3 dogs are non alpha type dogs, my females both are shy and not aggressive or domineering in anyway. Day 3 after i brought the Pug home, I caught him marking twice ( and redirected him outside) and three other times just saw evidence. He is successfully using a doggy door. I got some belly bands and kept them on him for a week or so and the markings stopped. But now started up again 4 weeks later, mostly when he is left alone for more than 2-3 hrs., always in the same place near the back door on the tile floor of kitchen and bathrooms. I went back to the belly bands, and also moved his food bowl right to the place where he was marking as it was pretty near by anyway. Im firm with him about listening to me, sitting before eating and staying off the furniture. I have no other issues with him - tho he can be a bit stubborn in listening to me. Is there ANY thing else I can do? I read somewhere that I should start feeding him first before the other two dogs - so that he would feel dominant and the markings would stop. Any truth to this? I do feed him last - within seconds of the other dogs, but he is last. Oh, and his foster and previous owner said he did NOT mark in their homes. And I am thoroughly cleaning markings after I find them. Thanks!!

Submitted by Dr. Nancy Kay | May 13 2011 |

First and foremost, congratulations to you and kudos to you for rescuing your new dog. Any way of knowing if this new little Puglet was ever well house-trained in any previous home situation (assuming he was in a home). Perhaps his inappropriate urination is simply his habitual behavior rather than a result of sharing you and his new home with two other doggies.

I encourage you to set up an appointment for the new guy with your veterinarian for a thorough physical examination, urinalysis, urine culture and blood work. Certainly, things like bladder stones and urinary tract infection can be a cause of what you've described. If he gets a clean bill of health, I recommend moving on to working with a savvy trainer or behaviorist. Back to basics crate training may be in order. Feeding this new guy earlier than the established two is certainly an easy thing to try. And then when the other two are eating, you can be outside with the new guy praising the living daylights out of him every time he urinates in the appropriate place. I hope this helps get you started.

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