Wellness: Health Care
Canine hemangiosarcoma is a disease of extremes: staggeringly swift and almost uniformly fatal. Accounting for about 7 percent of all forms of cancer in dogs, this highly aggressive sarcoma arises from cells that line blood vessels. It occurs most commonly in the spleen, but can also appear in the heart and the subcutaneous tissue. Middle-aged and senior large breed dogs, especially German Shepherds and Golden Retrievers, are its usual victims.
Exacerbating the difficulty, canine hemangiosarcoma is nearly impossible to detect before it is too late—when the primary tumor begins to hemorrhage. The observable signs of distress in a dog depend on how severely the tumor is bleeding. With a small bleed, dogs seem their usual selves until they have an episode of lethargy, an unspecific symptom that might easily be attributed to the weather or, in older dogs, to the normal course of their dotage. At the opposite extreme, life-threatening hemorrhage may result in a dog unexpectedly collapsing and not being able to get up again. Some dogs may even die suddenly, the only warning a vague bout of listlessness.
More commonly, however, an emergency trip to the vet results in a devastating diagnosis and few good options. Surgery to remove the primary tumor followed by a course of chemotherapy constitute the standard treatment. Yet, because the primary tumor grows so quickly, by the time a dog shows signs of the disease, advanced metastases that chemotherapy cannot eradicate may already be lurking elsewhere in the body, and chemotherapy may only slow down the disease. At best, the affected pooch has a year to live, although the median survival is only six months. What’s more, veterinarians still have no definitive way to screen for hemangiosarcoma. And even if a straightforward diagnostic blood test or imaging examination were available, how often would it have to be done to detect a disease with such a rapid course and for which there are no proven effective treatments to prevent progression?Searching for Solutions
As bleak as the situation may seem, an ongoing study at the University of Pennsylvania School of Veterinary Medicine (PennVet) in Philadelphia offers hope. Led by Nicola Mason, PhD, BVetMed, an associate professor of medicine and pathology, researchers are investigating whether a simple injection can stop the body from producing a substance called vascular endothelial growth factor (VEGF), which stimulates new blood vessel growth. (Dogs with hemangiosarcoma have elevated levels of VEGF in their blood.) To thrive, cancer cells need the oxygen and nutrients that new blood vessels supply, so turning off VEGF production prevents new vessels from generating, essentially depriving cancer cells of vital resources.
Mason’s experience with the disease goes back to her time as a resident at PennVet, when she encountered Buster, a formidable German Shepherd police dog whom she’s never forgotten. Mason was scheduled to examine Buster, who had been diagnosed with hemangiosarcoma, and provide a second opinion regarding treatment options. On the day of the appointment, however, neither he nor his owner were anywhere to be found, although they’d checked in at the reception desk. Eventually, Mason went outside and saw a police officer standing near a patrol car. Buster was lying inside. “I can’t bring him in through the front door because he can’t walk,” explained Buster’s partner. “I don’t want anyone to see him like this.” Mason, struck by their bond and how the officer looked out for his partner’s reputation and dignity, quickly arranged for them to come in through the back door. Sadly, “I could offer them nothing,” Mason recalls, lamenting how the disease destroyed their partnership. “It wasn’t good enough.”
The elegance of Mason’s new method, which is a type of treatment known as immunotherapy, is that it uses the dog’s own immune system to fight the disease. Rather than a drug, the injection delivers a disabled virus carrying a genetic instruction to the liver; this virus tells the liver and muscle cells to make an antibody against VEGF. If this instruction is effective, then VEGF production by the tumor cells should cease. This in turn would slow down or stop metastatic cell growth. It may even prevent metastatic cells from developing altogether, thus halting the progression of the disease. Mason, who is an immunologist as well as a veterinarian, says that the immune system works best on “minimal residual disease,” those smaller lesions that represent the spread of a primary tumor.
To determine whether the genetic directive actually works, Mason and her colleagues are conducting a pilot study focusing on dogs diagnosed with hemangiosarcoma whose primary tumor is in the spleen. The study works within the standard protocol: dogs diagnosed with hemangiosarcoma undergo a splenectomy (surgery to remove the spleen), then, two weeks later, receive the first dose of doxorubicin, a common chemotherapy drug. Chemotherapy continues for 10 weeks, with a total of five doses, one every other week. Dogs enrolled in the study receive the lone immunotherapy injection or a placebo one week after the first chemotherapy treatment. Then, two weeks after the last chemotherapy treatment and every month thereafter, they undergo imaging tests to restage the cancer.
PennVet provides all chemotherapy, immunotherapy and imaging free of charge at their location in Philadelphia, so dogs must be in the area for the approximately 10-to-12-week study duration. Because dogs cannot be recruited into the study until after they have undergone a splenectomy, enrollment can take place only within a crucial 10-day postsurgical window. In the interests of ensuring that the study’s results are scientifically sound and that the regulations for clinical studies involving animals are followed, Mason has had to make the hard decision to turn away dogs who were more than 10 days past surgery.
Mason and her group designed the trial to determine whether the immunotherapy is safe as well as whether it is effective. The doubleblind strategy, the gold standard of scientific research, means that no one involved—neither she and her colleagues nor the owners— knows whether a dog has received the immunotherapy injection or a placebo. Participants are assigned to one of the two treatment groups at random.
Knowing that their dog may not receive the immunotherapy treatment “definitely puts people off,” says Mason, and is another hurdle toward recruiting canine patients. Ultimately, the study will enroll 16 dogs. After all dogs have undergone every stage of treatment and all follow up results are in, researchers will “unblind” the study to see who received the immunotherapy. At press time, eight dogs have been enrolled, and all are doing well.One Dog’s Experience
Omaya, a 12-year-old Golden Retriever, is one of them. Her owners, Leigh Clayton and Jay McDonnell, both veterinarians, live in the Baltimore area. Last fall, after a few episodes of visible discomfort, Omaya didn’t eat her breakfast two days in a row. Clayton and McDonnell immediately took her to their vet. Her blood work showed that she was slightly anemic, and an ultrasound revealed fluid and a large mass on her spleen. Although Clayton hoped that the mass was benign, she also understood that its size indicated that Omaya probably had hemangiosarcoma. If so, she knew that she would opt for surgery and chemotherapy for their dog. “As a vet, it’s the world you live in,” she explains.
She wanted to prolong Omaya’s life and also wanted to make sure that her dog was happy and comfortable during the months of treatment. Omaya bounced back from the splenectomy almost immediately and was ready for the biweekly two-hour trips to Philadelphia—“She loves car rides,” Clayton says. Although Omaya was often nervous when she visited her regular vet in Baltimore, she happily left Clayton behind in the waiting room at PennVet and went with the resident to the treatment room. The chemotherapy made Omaya a little nauseous, which is not unusual. She also lost all of her hair, and although coat changes are not uncommon with chemotherapy, Omaya’s alopecia was particularly dramatic. Clayton and McDonnell were shocked by how different their dog looked, but Omaya didn’t seem in the least bit bothered. Now they make the drive to Philadelphia once a month for monitoring, and so far, all of Omaya’s imaging tests have shown no spread of the disease. She’s actually stronger now than she was before the surgery, an indication of how much the tumor had been bothering her.
No one yet knows whether Omaya received the immunotherapy treatment. And if she didn’t? “It’s totally worth it, to find better treatments,” Clayton declares unequivocally. Omaya has already contributed to helping researchers find a way to treat this insidious disease. The experience in turn has forced Clayton to be more aware of their limited time together and more focused on living in the moment and providing Omaya with positive experiences. “She’s my anchor to the world,” Clayton says. “She makes me laugh every day.”
Mason urges all dog owners to consider enrolling their dogs in appropriate clinical trials; regardless of the outcome, information acquired during the trial will certainly help others. Equally valuable, participation gives owners a measure of control in the face of a devastating diagnosis like hemangiosarcoma, as well as offering the possibility that something good might result. “That’s what we hope for and what we come to work every day to do,” says Mason. “I don’t want to see another Buster.”
Mason is still recruiting dogs for the study. If you or someone you know is interested in learning more, go to thebark.us/2uw0LI5, or contact Mason at firstname.lastname@example.org. All clinical animal studies in the United States, including Mason’s, are collected in a database maintained by the American Veterinary Medical Association.
Wellness: Health Care
New pain treatments for dogs with arthritis are on the horizon.
According to experts from the University of Pennsylvania School of Veterinary Medicine (Penn Vet), 60 percent of dogs over the age of seven suffer chronic discomfort from degenerative joint disease, more commonly known as arthritis. It often goes unnoticed by the dogs’ owners, however, because they are not familiar with the signs. Humans talk about pain, and express it by crying or wincing. Dogs will rarely vocalize unless the pain is acute—a toenail cut too short, stomach distress, a broken bone.
Signs of chronic discomfort are subtle and can come on so gradually that the dog’s person often doesn’t notice until a veterinarian points out the changes. A dog who’s uncomfortable may slow down, reluctant to run as fast or walk as far as she once did. She may be stiff after lying down, or take longer to get up and moving when it’s cold or damp outside. An uncomfortable arthritic dog may be grumpier, sleep more and decline to take part in games she used to love.
Unsure if your dog is suffering from arthritis? One of the easiest ways to tell is with a trial of pain medication. Talk with your veterinarian about your concerns, and request a week’s worth of anti-inflammatory medication. While your dog is on the medication, keep a diary and note changes in her behavior. People are often amazed at how youthful their older dogs act once their discomfort is relieved.
Penn Vet assistant professor of small animal surgery Kimberly A. Agnello, BA, DVM, MS, one of the nation’s foremost researchers in canine pain management, has some advice on how people can help their arthritic dogs feel better.
According to Dr. Agnello, one of the easiest, most cost-effective and beneficial ways to reduce pain associated with arthritis is to maintain dogs at their healthy weight. She described a recent patient with hip dysplasia who came to her overweight and in pain from arthritis. The dog was scheduled for hip surgery, but first the dog’s owner was instructed to put the dog on a diet. Turns out that when dog lost weight, he improved so much that he ended up not needing surgery. The dog felt better and his owner saved money on food as well as on the procedure.
Once the pain is controlled, strengthening in the form of rehabilitation exercises is vital to maintaining strength and mobility; even one visit to a canine rehab veterinarian for instruction in how to do these with your dog can be useful. Dogs can also be helped by alternative therapies such as joint supplements (high quality fish oil is an excellent choice; check with your vet for the appropriate dosage), acupuncture and cold laser.
When it comes to medication, non-steroidal anti-inflammatory drugs (NSAIDs) continue to be the mainstay of pharmaceutical treatment for canine arthritis. These drugs are relatively safe, and generic forms are available. Dogs on NSAIDs long-term require annual blood work to check liver and kidney function.
As with humans, one size does not fit all when it comes to NSAIDs. Most commonly, a veterinarian will start by recommending carprofen, which has been around a long time, is highly effective, more affordable in the generic formulation and tolerated well by most dogs. It may sometimes provoke an upset stomach or diarrhea, and abnormal changes in blood work may also be seen. In that case, most veterinarians will reach for a second or third NSAID, such as deracoxib, meloxicam or firocoxib.
A new anti-inflammatory drug, grapiprant, was approved by the FDA last year for management of chronic canine arthritis pain. A prostaglandin receptor antagonist, it specifically blocks the EP4 receptor, which is the primary receptor involved in arthritis pain. It is considered safer than many of the other NSAIDs available because its mechanism of action is so specific, meaning that it does not affect other systems in the body like other NSAIDS might. Grapiprant is labeled for use in dogs as young as nine months of age, which makes it a good drug for those with early-onset arthritis from hip or elbow dysplasia, but should not be used for dogs smaller than eight pounds.
For Dr. Agnello, the most exciting and promising advances in the treatment of arthritis in dogs are likely to come from what are known as translational studies. Arthritic dogs are an almost perfect model for arthritic humans, which means that while researchers are developing new treatments for arthritis in humans, dogs also benefit (and vice versa). Treatments designed to resurface cartilage, partial joint replacements and transplanted ligaments are all being actively explored even as you read this article. Studies to improve blood supply to cartilage are also on the horizon, providing more options than ever before. It is truly an exciting time.
Dr. Agnello believes that joint-specific treatments are also the future of pain management. One such possibility is a compound called resiniferatoxin (RTX), a naturally occurring chemical found in red-hot sap produced by a Moroccan cousin of the chili pepper plant. When the chemical —which is about 1,000 times more potent than capsaicin, the active ingredient that gives chili peppers their kick—makes contact with pain-transmitting nerve cells, it spurs a rush of calcium into the cells, destroying them and providing relief from pain.
Presently, RTX can only be delivered by spinal injection, and patients must be anesthetized. When RTX is injected into the spinal fluid, pain cells are permanently ablated, or destroyed, and pain is eliminated. This selective deletion of pain-receptor cells has been coined “molecular neurosurgery” and has the advantage of sparing neurons that are in charge of other functions, such as gross motor movement and feeling. Consequently, the dog is pain free, can maintain coordinated movement, perform activities of daily living and experience a good quality of life.
The Penn Vet research team also studied RTX’s ability to reduce pain in dogs with bone cancer. Anyone who has ever watched a dog suffer from this disease knows that the pain can be debilitating. After receiving injections of RTX, dogs who were virtually immobile were able to run and jump almost as though they felt no pain at all. The cancer persisted—and eventually proved fatal—but owners reported weeks to months of happy times with their dogs. RTX could eventually provide veterinarians with another tool in the ongoing fight to relieve pain associated with arthritis. Other exciting advancements in arthritis treatment and prevention include research into joint-specific stem cells and long-lasting intra-articular treatments.
So, stay tuned: many new, exciting options will be available to veterinarians and pet owners in the near future.
Note: The interviews in this article were sponsored by Big Barker.
Wellness: Healthy Living
We look at ways to make their lives easier.
In your eyes, your dog will alway s be a puppy, even if she’s getting up there in canine (and human) years, or her muzzle is beginning to gray. However, eventually the day will come when you notice that your pup is panting a little bit harder after a long walk and struggling to climb onto your bed. It’s time to start adjusting to the lifestyle needs of an older dog.
When a dog is considered a senior largely depends on breed. Smaller dogs (such as Chihuahuas or Terriers) don’t reach their golden years until they’re 10 or 12, while a Great Dane may attain senior status at the age of five or six. Beyond size and breed, genetics, diet and environment all have an impact on a dog’s life expectancy.
Just as modern medicine has extended the lives of people, with the right combination of attention and preventive care, it can also extend the lives of dogs. If you want your older dog to have a long and happy life, consider incorporating these strategies into your pet care routine.
Remember your dog’s teeth. Dental hygiene is particularly crucial as your dog ages. Regular brushing and professional cleaning can prevent painful dental disease and decay (and help your dog avoid the chewing problems mentioned earlier). If your dog doesn’t enjoy having his/her teeth brushed, consider dental treats and toys instead.
Watch your dog’s diet. Mature dogs often have food issues, including problems chewing, lack of appetite, obesity and digestive difficulties. Consult with your vet on the best diet and exercise plan for your aging dog. Dietary changes may include adding more fiber to aid with digestion or decreasing carbohydrates to maintain optimal weight. Supplements such as fish oil or glucosamine can be added to alleviate joint pain.
Exercise your dog’s body and mind. Like people, aging dogs experience pain and have difficulty performing physical activities they used to enjoy. However, exercise continues to be imperative to their health and well being. Take your dog on short, gentle walks and monitor his/her breathing and gait to make sure nothing is amiss. Your dog’s brain needs plenty of exercise as well. Stimulating toys such as food puzzles help keep your dog sharp.
See the vet more often. Take your dog in for a vet checkup at least twice a year. Just as elderly people need to be aware of health issues and visit their doctors more often, aging pets benefit from more frequent visits. Older pets may need additional blood tests, dental care and examinations. Additionally, many breeds have predispositions toward certain ailments, including arthritis, hip dysplasia, cancer and diabetes. Early detection can help catch these before they become major problems.
“Seniorize” your house. Just as you once puppy-proofed your home, you now need to provide your older dog with special accommodations. For dogs with hip dysplasia or joint issues, consider a special ramp or stairs so they can still get in the car or join you on the bed. Keep food and water in areas they can easily reach, especially if they are vision-impaired. Heated beds can soothe achy joints, particularly if you live in a colder climate. Finally, non-slip surfaces will prevent falls and help your older pet maintain traction when rising.
Pay attention. Monitor changes in behavior; appetite; weight loss or gain; dental issues; and any lumps, bumps or lesions and bring them to your vet’s attention. (A journal is a great memory aid.)
Taking care of an older dog may involve a little more work than you’re used to doing, but caring for a lifetime companion is a deeply rewarding experience. Your dog has been good to you (and for you) for years—now’s the time to return the favor!
Wellness: Health Care
My career as a physical therapist shifted dramatically 11 years ago after I adopted a dog named Teddy. Teddy came to me with a limp, so naturally, I wanted to help him. The first step was to find out what could be done. Several veterinarians later, the conclusion remained the same: rest and nonsteroidal anti-inflammatories (NSAIDs). As a licensed physical therapist, I knew there had to be something more; after all, bed rest and medication for the treatment of human conditions had fallen by the wayside decades ago.
After Teddy landed in a vet ER with a horrifying reaction to a prescribed NSAID, I was determined to help him myself. I began by going online to explore the comparative anatomy and biomechanics of canines and humans. During this search, I discovered a whole new avenue I could take to not only help Teddy, but also, to help his species: a canine rehabilitation certification program available for licensed physical therapists and veterinarians.
I enrolled in the program offered by the Canine Rehabilitation Institute (CRI), which is partnered with Colorado State University’s College of Veterinary Medicine. During my course of studies, I gained an appreciation for the differences and similarities in canine and human anatomy. The CRI program confirmed that all the methodology and expertise I had gained in physical therapy school and human clinical practice could transfer nicely to serving our four-legged friends. While there are certainly important differences between the two species, in general, the years of training I undertook to obtain my advanced PT degree proved to be a huge asset to the profession and practice of my animal rehabilitation career.
The goal of animal rehabilitation (aka rehab) is the same as the goal for humans: improve quality of life through restoration of function, increased mobility and reduction of pain. The best way to determine if your dog is a good candidate for rehab is to ask your primary veterinarian. If the vet is unfamiliar with the services these specialized professionals offer, do some research and become better acquainted with your options. Though the specialty practice of animal rehabilitation has been around for nearly two decades in some areas of the world, it is still in its infancy in the United States. Fortunately, the field is rapidly growing.
Rehab can help any dog with a musculoskeletal or neuromuscular problem, from young puppies to seniors. Some of my canine patients participate in agility, flyball, dock diving, rally, and search and rescue. Others are companions who prefer to hang out and get plenty of nap time. Because conservative methods have proven to be successful a high percentage of the time, the rehab therapist makes every effort to help the patient avoid surgery. When surgery cannot be avoided, post-operative rehab has also been shown to be beneficial for a faster reduction of pain and a quicker return to a more fully functional lifestyle.
PT CAN HELP
• Soft tissue sprains and strains
• Post-operative orthopedic recovery from cruciate ligament repairs such tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA)
• Congenital and degenerative joint disease (dysplasia and osteoarthritis)
• Neurological rehabilitation following spinal decompression surgery (hemilaminectomy)
• Other forms of non-operative neurologic insult, such as fibrocartilaginous embolism (FCE) or spinal cord contusion
Before trying physical therapy with your dog, clear it with your primary veterinarian to ensure that it’s appropriate. There are underlying medical conditions that can rule out PT as an option, so a referral/medical clearance is essential for your dog’s safety.
Your dog’s first visit with a certified canine physical therapist or a rehabilitation veterinarian will involve a fullbody musculoskeletal and neuromuscular evaluation. This specialized, comprehensive, hands-on examination gives the practitioner information needed to develop an individualized treatment plan for your dog’s specific problem(s).
Once the problems have been accurately identified, the practitioner goes to work to address them. A range of approaches is used: skilled manual therapy techniques (joint and soft tissue mobilization), therapeutic strengthening exercises, range of motion/flexibility exercises, and proprioceptive and balance exercises. Additionally, physical agent modalities—“techniques that produce a response in soft tissue through the use of light, water, temperature, sound, or electricity,” according to the California Board of Physical Therapy—may successfully address pain and accelerate healing.
While physical therapy methodology and techniques transfer nicely from the human to the canine patient, canine PT has some important specifics that are beyond the entry-level competencies of human physical therapy programs in the U.S. Similarly, not all veterinary schools include physical rehabilitation as part of their core curriculum. So, finding the right practitioner with the right education is important. Physical rehabilitation rendered by a certified canine physical therapist assistant (PTA) or registered veterinary technician (RVT) is also an option, but these practitioners must be supervised by a qualified PT or DVM with additional training in canine rehabilitation.
State regulatory bodies across the country are currently looking at establishing better laws and regulations to govern this particular specialty. These are needed to allow both non-vet rehabilitation professionals—certified and licensed canine physical therapists—to practice and to determine competency standards for veterinarians.
In California, for example, these regulations have been hotly debated; efforts are being made to allow properly qualified animal physical therapists to practice on their own premises with a veterinary referral. Historically, the California Veterinary Medical Board has wanted to put qualified practitioners under the direct supervision of veterinarians, who may or may not have training in this specialty niche. A legislative task force has been created to work on more appropriate language.
Everyone who’s a consumer of veterinary medical services has a stake in this discussion. Get involved by letting your legislators know that being able to choose a qualified canine physical therapist is important to you. Those who live in California can find out more at caapt.org.
Wellness: Health Care
Treating lick granulomas with cold laser.
My first dog, Ouzel, a Lab mix, spent his last year worrying at a wart on his leg until it became a rough, raised, red patch—an acral lick granuloma. I tried bitter sprays, socks, steroid creams and an Elizabethan collar. I could not get him to stop. I was frustrated, he was obsessed. He died before I finished vet school and had learned about other treatment options.
The causes of this type of inflammation are many: referred pain from arthritis or disc issues, anxiety or boredom, food/flea/environmental allergies, wounds or lumps, cancer. Whatever causes it, once the licking starts, it’s hard to halt. The wound gets thicker, wider, deeper, becomes ulcerated and infected. The hair does not come back, and the skin darkens.
Lick granulomas occur most often in older, male, large-breed dogs, and treatment depends on what caused them in the first place. Deep infections often require six to eight weeks of oral antibiotics. Topical and oral steroids can help break the inflammatory cycle, and antianxiety medications can be tried. On the non-drug front, some dogs are calmed by the snug swaddle of an antianxiety vest; relaxing treats with L-theanine, an amino acid that raises dopamine— and perhaps serotonin—levels; Bach’s Rescue Remedy; a pheromone collar or diffuser; and consistent, ample exercise.
Holistic modalities are also important. Chiropractic can help disc-disease-related nerve pain, and an acupuncture approach I call “surrounding the dragon” encircles the wound with needles to reduce pain and inflammation. Finally, dog owners can elect surgery and CO2 laser, which uses highly concentrated light energy, to remove the sore.
Lick granulomas are recalcitrant and complicated, and a combination therapy may be more successful. Control rather than cure is common.
Vet medicine now has a newer tool to manage these granulomas, a Class IV laser, also called low level, or cold, laser therapy. Laser strength is described by class, and the stronger the wattage of the beam, the shorter the individual treatment. Lasers can be found in printers, CD and DVD players, bar-code scanners and light shows, but these are too weak to use medically. Toys like pointers, which some cats and dogs like to chase, are under 5 milliwatts and fall in the Class I-IIIa category. (Offtopic but important warnings here: never point any laser into the eye or at a reflective surface, like metal or glass. And laser-play can cause frustration in certain dogs, leading to obsessive-compulsive disorders.) Class II-III are used by dermatologists for skin treatments. Class IV’s light penetrates skin down into muscle, tendon, ligaments and bone.
A Class IV laser reduces inflammation, swelling, muscle spasms, stiffness and pain, and we use it at our clinic to address wound care, post-op incisions, otitis, pancreatitis, arthritis, limb edema and soft-tissue injuries. The light, which is slightly warming, also stimulates acupuncture points, which is good for patients who cannot tolerate needles. Animals tend to find the treatment relaxing.
How does light lead to recovery? On a cellular level, the laser enhances biological effects by increasing oxygen turnover in the tissues. Imagine a blood vessel as a moving sidewalk; as red blood cells cruise along under a spotlight (the laser), the beam heats the tissues and speeds up blood flow, which encourages oxygen uptake. With increased oxygen, more ATP (adenosine triphosphate) energy is made, which prompts healing. Present in every cell of the body, ATP is the body’s basic currency, energy used or stored in this nucleotide. When a group of atoms are cleaved off the side of ATP, energy is released to perform cellular activities.
Research conducted worldwide shows the widespread advantages of medical-grade lasers. Human studies found benefits for patients with fibromyalgia, tennis elbow, chronic neck pain, osteoarthritis, rheumatoid arthritis, traumatic neuropathic pain and compromised limb circulation. Wound healing and skin studies include positive effects for diabetic-ulcer healing, blood vessel growth, increased skin cell migration (fibroblasts), hair growth in canine non-inflammatory alopecia and survival of surgical skin flaps for wound coverage.
Laser treatment strength and duration are determined by the size of the area that needs to be addressed and whether the injury is acute or chronic, the wound is dermal or musculoskeletal, the fur is dark or light. After the veterinary team elects a treatment type, the machine calculates an appropriate and safe dose. Precautions are common sense: the light needs to be kept moving so that it doesn’t overheat skin, and it’s never used near a fetus or a tumor.
Laser treatments for lick granulomas focus on small areas. In fact, the less the light is diluted, the more successful the treatments tend to be. For example, if your dog has arthritis in his knees, back and wrists, it’s best to work on them one at a time.
Laser protocols for lick granulomas recommend starting treatments at two to three times a week for a few weeks, tapering to once a week, then to every two weeks as the wound shrinks over a month or so. The treatments have a cumulative effect, so it’s important to commit to the schedule.
With the addition of the Class IV laser, we now have a pocketful of treatment options for lick granulomas. Canine friends who spend their days and nights licking a limb might finally find the respite they need, which could improve our own sleep as well.
Is the Mars acquisition of VCA cause for concern?
An explosive, must-read article in Bloomberg Business Week looks at what happens when big business monopolizes the pet health business and how this corporatization might not be in the best interests for our dogs.
Ever wonder why many veterinarians do not heed the 2003 American Animal Hospital Association’s recommendation for core vaccines to be administered every three years? Instead a number of vets still prescribe annual vaccinations—with boosters for distemper, parvovirus and adenovirus. According to the Bloomberg article the immunologist, Ronald Schultz, from the University of Wisconsin School of Veterinary Medicine, was one of those researchers who recommended this three-year protocol in the 1970s. He recalls that the AAHA Canine Vaccination Task Force, facing a revolt from vets about the decrease in their future vaccine incomes, struck a compromise at three years instead of the once-in-a-lifetime approach that he and others recommended. But yet you can find that annual vaccines are still being recommended by the 1,000 Banfield Vet Clinics in this country. Another surprising fact is that pet vaccines seem to be the only vaccines where one size, seemingly, fits all—the doses are the same regardless of weight or size of the animal, so the same 1 milliliter is given to a Chihuahua or an Irish Wolfhound—very little research has ever justified that approach. Bloomberg points to an example from Banfield's software program "Pet Ware," used to instruct the veterinarians in diagnosing and prescription advice:
“the book shows a checklist of therapies for a dog with atopic dermatitis, or itchy skin. Doctors are encouraged to recommend a biopsy, analgesics, topical medications, antibiotics, a therapeutic dietary supplement, an allergy diet, and a flea control package. They’re required to recommend antihistamines, shampoos, serum allergy testing, lab work, a skin diagnostic package, and anti-inflammatories. It’s a treatment course that might run $900 for symptoms that, in a best-case scenario, indicate something as prosaic as fleas. The manual reminds doctors: You cannot change items that were initially marked Required. They must remain required.
No wonder the pet health industry is booming and going through a period of rapid consolidations, Banfield, located in many PetSmart stores, was purchased in 2007 by Mars, the candymaker and pet food giant (the largest in the world with over $17 billion in sales from brands like Pedigree, Cesar, Eukanuba, Iams, Natura brands, Royal Canin, Sheba, Nutro). Then in 2015 the Mars Petcare portfolio of vet clinics grew when they acquired BluePearl Veterinary Services, with an additional 55 locations.
Mars, seemingly, facing a slowdown in consumer purchases of prepared/package foods and sugary products, is acquiring even more veterinarian companies and it was announced that their newest acquistion that they are paying $7.7 billion is VCA, Inc., the veterinary and doggie day-care business based in Los Angeles. VCA owns 750 hospitals and employs 3000 vets and 23,000 people, and had a 2015 revenue of $2.1 billion. The Los Angeles Times noted that “VCA has used acquisitions to combine hospitals, diagnostic labs and veterinarians into its network. In 2014, the company even acquired a dog day-care chain called Camp Bow Wow.”
And similar to Banfield’s approach, the Times notes that “VCA has been criticized at times by some customers for requiring tests that can be costly, but VCA maintains that it’s against its policy to sell unnecessary tests or treatments.” But 41 percent of VCA’s operating profits comes from their company’s Antech Diagnostics that also does bloodwork and other tests for more than half of the country’s hospitals, including their own of course. As Bloomberg reported, Tom Fuller, VCA’s chief financial officer, puts it this way when he speaks to investors: “Diagnostics is what grows the industry.” And the company’s business strategy has been “to leverage our existing customer base by increasing the number and intensity of the services received during each visit” (as found in their annual financial reports by Bloomberg reporting.)
Pushing tests unto clients is “good” for business, if not always for their clients’ pets,
"according to Wendy Beers, a veterinarian who resigned in 2014 from a VCA hospital in Albany, Calif. 'Every month they would print out things to say how many packages you sold, how many procedures you did,' she says. 'And if they came out and said, ‘This month we want everyone to do 20 heartworm tests,’ and you only did eight, well, next month you have to do better. I don’t feel when they’re lecturing us that their chief interest is to make sure animals get the best care.'”
According to Ken Shea, an analyst at Bloomberg Intelligence, who says that with Mars’ expanding presence in animal hospitals, the company will have an opportunity to use the facilities to sell even more of its pet foods. Is this troubling news for pet parents? A recent class action suit brought on behalf of consumers by a San Francisco law firm thickens the plot further when you consider that this suit contends that pet food manufacturers (including Mars) and retailers (such as PetSmart) are using "prescriptions" to justify overcharging consumers for food that contains no restricted ingredients. Neither the FDA nor any other government agency mandates such prescriptions.
Bloomberg clearly makes the case why all these things, like over vaccinations, unnecessary testing, false prescriptions for pet food matters is that veterinary medicine is largely unregulated. And one of the reasons why businesses like Mars find the pet industry a good investment strategy is that
“...pet owners pay cash: Vets don’t deal with insurers haggling for better prices or questioning whether that vaccine or ultrasound or blood panel is really necessary. (A small percentage of pet owners carry insurance, but they pay vets upfront, like anyone else, and then take on their insurers for reimbursement.) What’s more, when veterinarians make fatal mistakes, they face no real financial consequences. The law hasn’t changed to reflect the attitudes of the average pet owner; courts still treat pets as property. Damages paid to owners whose pets have been killed or injured are so low that a typical medical malpractice insurance policy for a veterinarian costs less than $20 a month. Damages are so low, in fact, that few pet owners can find a lawyer willing to take even the most egregious case of veterinary malpractice.”
So, yes, it should matter, and as always, it is good to understand what you are up against, what to expect if you use any of these services, to double check before you agree to over vaccinations, or receive a “prescription” for pet food, you are after all the only advocate your dog has and the better informed you are, the better decisions you will make. Nancy Kay, DVM, author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life, added that she “feels truly disheartened for my profession” about this expansion of Mars’ vet monopoly. Be sure to read the Bloomberg story and get the word out.
Wellness: Health Care
Let’s just get it out there: for a dog, coughing is never “normal.”
As a small-animal veterinarian, I hear this all the time. Clients tell me that their dog has been coughing for a while/off and on/when he’s excited/after pulling on the leash/after going to the groomer and so forth, but that they think he’s “okay.” However, a healthy dog should not cough, and a history of coughing always raises a red flag with me.
Coughing is caused by an irritation or inflammation of one or more of the respiratory organs. A problem anywhere in that system—the larynx, in the back of the throat; the windpipe; the airways (bronchi); or lungs—can cause your dog to cough. Heart disease, which is closely tied to the lungs and airways, also causes coughing.
Sometimes, the cause is benign, like a small bout of tracheobronchitis (an paralysis or a cancerous tumor that is pushing on respiratory structures can all cause a dog to cough.
When coughing is due to a problem in the laryngeal area, it can be a real pain in the neck, both literally and figuratively, and new research is showing that more coughing dogs have laryngeal problems than previously thought.
The anatomy of a dog’s throat is much the same as that of a human’s. The larynx (the area between the nose and the trachea), trachea (windpipe), epiglottis (a f lap of cartilage at the root of the tongue that is depressed during swallowing to cover the opening of the windpipe) and esophagus are the same in both. As well as housing the voice box, the larynx serves to protect the lower airways—trachea, bronchi and lungs —from foreign material and germs. The larynx is lined with secretory membranes, and comprises muscles, cartilage and ligaments.
Also like humans, dogs can develop laryngitis, an inflammation and swelling of the larynx secondary to infection, irritation by dust or smoke, inhaled foreign bodies (grass, bones), or trauma due to excessive barking or pulling against a collar. Older dogs can also develop laryngeal paralysis, a condition in which the muscles that move the arytenoid cartilages (a pair of pyramidshaped pieces of cartilage that open and close during breathing) stop working.
Dogs with laryngeal disorders typically exhibit what are called “upper airway signs” such as changes in their bark; loud breathing that sounds like “roaring”; and a dry, hacking cough that can be exacerbated by pressure on the larynx. Other upper airway signs that clue veterinarians into a laryngeal problem infectious inflammation of the airways more commonly referred to as kennel cough) that resolves easily with medication. Sometimes, the cause is more sinister; collapsing airways, pneumonia, a piece of grass or bone stuck in the back of the throat, parasites, the previously mentioned heart disease, laryngeal include difficulty swallowing, bad breath and an extended neck. A dog with laryngitis looks like he has a sore throat. When veterinarians see these signs, we suspect laryngeal disease and point our efforts in that direction. If we don’t see them, we look for other causes of coughing farther down the respiratory tract.
Generally, coughing dogs are not extensively evaluated for problems with their larynx. However, a study conducted by Lynelle Johnson, DVM, PhD, at the University of California, Davis, School of Veterinary Medicine and recently published in the Journal of the American Veterinary Medical Association* showed the importance of checking all chronically coughing dogs for signs of laryngeal issues. What’s interesting about the UC Davis study is that it found that a majority of coughing dogs who didn’t exhibit classical upper airway signs associated with the larynx had a laryngeal disease that may have gone undiagnosed. This study showed that they should be, and that we should be aware of the possibility of a hidden condition.
To investigate the prevalence of laryngeal abnormalities in this class of coughing dogs, Dr. Johnson enrolled 138 dogs in the study, which lasted for 13 years. Dogs were assigned to one of three groups, based on the duration of their cough: acute (less than two weeks), subacute (two weeks to two months) and chronic (more than two months). As part of the study, the dogs were sedated and their throat and airways were examined via endoscope (a medical device with a light attached), a procedure also known as “scoping.”
Interestingly, Dr. Johnson found that 19 percent of the dogs examined because of cough alone (no upper-airway signs) also had some form of laryngeal dysfunction, ranging from laryngitis to swelling to laryngeal paralysis. Dogs with an acute cough were not observed to have laryngeal inflammation, but it was noted in more than half of the dogs who had been coughing longer than two weeks.
Results also indicated that dogs with a cough of more than two weeks’ duration commonly have laryngeal swelling regardless of the underlying problem. This makes sense, as chronic coughing irritates the throat. Laryngeal paralysis or partial paralysis was also fairly common, seen in 19 percent of the dogs with a cough of more than two weeks’ duration. Remember, these dogs had none of the classic signs of laryngeal paralysis (such as excessive panting and loud breathing); the problem was only diagnosed when their throats were scoped.
Once their laryngeal problems were correctly diagnosed, the dogs received focused testing and treatment.
In dogs with laryngitis, treatment includes antibiotics if appropriate, as well as anti-inflammatories and pain medication. (Laryngitis hurts!) When the inflammation is caused by allergies, the allergies are addressed. A dog with a swollen larynx also benefits from humidified air; a warm, clean environment; and soft food. Dogs with a weak or paralyzed larynx can be treated surgically, or may require hormone therapy; there is anecdotal evidence that laryngeal paralysis may be related to hypothyroidism. Those whose dogs have laryngeal paralysis need to be advised on how to prevent overheating and aspiration pneumonia as well as informed of the links between paralysis and systemic neuromuscular diseases and megaesophagus.
The finding that dogs can have laryngeal disease even when they don’t have the classic signs has significant implications. If we as veterinarians aren’t scoping these coughing dogs, we might be missing something. The bottom line: if your dog has been coughing for more than two weeks, or if the cough doesn’t resolve with medication, talk to your vet about further medical evaluation.*Johnson, L.R. 2016. Laryngeal structure and function in dogs with cough. JAVMA 249(2):195–201.
Wellness: Health Care
A new device as a way to avoid osteotomy for cranial cruciate ligament (CCL) injuries.
THE CANINE KNEE—known as the stifle—is a large, complex and vulnerable joint. Damage to one of its four main ligaments, most commonly the cranial cruciate ligament (CCL), results in pain and lameness and is the reason many dogs wind up in their vet’s exam room. The CCL connects the thigh bone with the lower leg bone and helps stabilize the knee. When it’s torn or ruptured, surgery may be required, particularly for large or very active dogs. In the U.S., the most common surgical repair techniques are the tibial tuberosity advancement (TTA) and the tibial plateau leveling osteotomy (TPLO), both of which require implanted hardware as well as cutting the bone(s) around the stifle joint, a procedure called an osteotomy.
However, an innovative technique utilizing a newly designed device—the Simitri Stable in Stride™—makes it possible to skip the bone-cutting. A Simitri stifle repair involves putting a small plate on the bones on each end of the knee (the femur and the tibia) and connecting them with an interlocking hinge.
Developed by Neil Embleton and Veronica Barkowski, Canadian veterinarians with extensive experience in orthopedic surgery, as a way to avoid osteotomy and preserve maximum joint motion, the device provides immediate joint support with minimal change to its form or biomechanics. It also offers a potentially quicker and less painful recovery.
Partnering with a U.S.-based veterinary implant manufacturer, New Generation Devices (NGD), Embleton and Barkowski developed and tested the Simitri in medium and large dogs. Although the procedure is too new to have good data on its long-term outlook, initial clinical trial results have been promising. (It’s worth noting that there’s also a shortage of evidence-based info on long-term TTA and TPLO results; most of the literature reflects information from their initial development.)
The current sizes of the Simitri Stable in Stride implants are most suitable for dogs 40 to 90 pounds (20 to 40 kg); per correspondence with Dr. Embleton, he is now trialing a device for dogs 15 to 35 pounds (7 to 15 kg), and a version for dogs more than 90 pounds (40 kg) is currently in development.
Interested in exploring this option for your dog? Dr. Embleton suggests that you ask your vet about it, or contact NGD to see if a vet in your area already has experience with the Simitri.
Dog's Life: Humane
WHEN A DOG OR CAT is surrendered to a shelter or dies of a disease that could have been prevented, some want to blame the owners. If they couldn’t care for the animal, they should never have gotten it in the first place, right?
But people’s lives can change in an instant; jobs end, children get sick, families lose their homes. A national survey conducted in January 2016 found that six out of 10 Americans couldn’t cover an unexpected $500 car repair or $1,000 medical bill.
That doesn’t leave much slack for the family dog. Paw Fund, a San Francisco Bay Area nonprofit founded five years ago by animal advocate and longtime activist Jill Posener, has very deliberately disconnected from the blame game. Preventable diseases, uncontrolled breeding and overflowing shelters are crises not just for pets and owners, but also, for our communities as a whole. That’s why Paw Fund provides the pets of homeless and low-income residents of Alameda and Contra Costa counties with free vaccinations; free or low-cost spay and neuter; basic wellness care, such as dewormers and flea preventives; and sometimes even nail clipping. The goal is what Posener, Paw Fund’s executive director, calls “harm reduction.”
“The truth is that relatively small interventions can keep dogs and cats healthy, in their existing homes and out of the shelters,” Posener says.
It started in 2011, when an outbreak of canine parvovirus raced through the camps of homeless youths in People’s Park in Berkeley. Parvo is easy to prevent, but making sure their pets get a series of vaccinations can be challenging for street kids. Posener sprang into action. She recruited a vet tech, loaded vaccines into her car and took the lifesaving shots right to the animals who needed them, week after week, until the epidemic abated. And with that, Paw Fund and its harm-reduction approach was born. People trust Paw Fund to be there for them without judging them, and Paw Fund trusts its clients to truly need its services. “We don’t ask for proof of income,” says Posener. “People feel bad enough when they can’t provide for their pets. We don’t need to rub it in by making them prove they have no money.”
The Paw Fund model seems to work, and it’s catching on. It’s not unusual to find 80 people and up to 150 pets at its monthly open-air clinics in Berkeley, patiently waiting as long as two hours in the sun, rain or Bay Area fog. Since its founding, Paw Fund has provided care to more than 5,000 at-risk dogs and cats, coordinated more than 1,500 free or low-cost spays and neuters, and given more than 10,000 free vaccinations at its monthly clinics and pop-up clinics in trailer parks and inner-city neighborhoods across the East Bay. It also mentored two startup organizations with similar goals in Brentwood and Oakland that are now self-sustaining.
Traditional rescue per se isn’t Paw Fund’s primary mission, but sometimes, people beg to surrender a basket of puppies or kittens. When that happens, Paw Fund often persuades the owners to spay or neuter the parents, and picks up the tab.
Many people want to have their pets sterilized but literally can’t make it to the vet appointment. They may be afraid to take time off from work, or don’t have a driver’s license, or live under a freeway overpass. Paw Fund volunteers will pick up a dog or cat at the crack of dawn and deliver the animal back after the procedure. That kind of block-by-block, pet-by-pet outreach led the City of Berkeley to award Paw Fund the contract to run its free spay/neuter program in 2016 and then to extend the contract into 2017.
Paw Fund, a 501(c)(3) based in Emeryville, Calif., is staffed largely by volunteers; vets, vet techs and even a tax preparer work pro bono. In 2017, plans include hiring a part-time medical director to oversee clinics and to make home visits and treatment possible, including humane euthanasia at home. Because, no matter how rich or poor their people are, every pet deserves to live as healthy a life as possible and then to go peacefully when the time comes.
To learn more visit pawfund.org
Wellness: Health Care
Fatty turkey trimmings can set the stage for pancreatitis
Next week is Thanksgiving, and for many families this means the tradition of spending the day preparing and enjoying a delicious turkey dinner with all of the trimmings. Us humans are not the only ones who look forward to this meal, and I see many dogs in the ER after they have decided to help themselves to a serving or two. While our pets may find this to be an initially satisfying (albeit naughty) indulgence, it can set them up for the development of pancreatitis, a potentially life-threatening disease.
What is the job of the pancreas?
The pancreas is an organ that sits cozily just under the stomach and along the first part of the small intestine. The pancreas is all about secretion and it has two main jobs. The first is the secretion of digestive enzymes to help break down food, and the second is the secretion of insulin and glucagon (to regulate sugar metabolism). The digestive enzymes are the part of the story that concerns us in pancreatitis.
Just what is pancreatitis?
Put simply, pancreatitis is inflammation of the pancreas that disrupts its normal integrity. Digestive enzymes that are normally safely stored are released prematurely, beginning to digest the body itself, and the result can be a metabolic catastrophe. As the tissue becomes further inflamed, the damage begins to involve its next-door neighbor, the liver. Toxins released from this progressive party of tissue destruction can circulate more broadly, causing a body-wide inflammatory response. If the pancreas is severely affected, its ability to produce insulin can be affected and diabetes can result.
The good news is that most commonly the inflammation is confined to the area of the liver and pancreas, and most pets make a full recovery with support.
What causes pancreatitis?
In most cases, we never find out what causes it but we do know some events that trigger it. These can include:
Miniature Schnauzers are predisposed to pancreatitis as they commonly have altered fat metabolisms.
Signs of Pancreatitis
The classical signs are appetite loss, vomiting, diarrhea, painful belly, depressed attitude and fever.
Making the Diagnosis
Until recently, a reliable blood test has been lacking. A new newer generation option called the SPEC cPL (specific canine pancreatic lipase) test has come to be the lab test of choice. For dogs only, the SPEC cPL can be run overnight by a reference lab and is able to detect 83 percent of pancreatitis cases and exclude other possible diseases in 98 percent of cases.
This test should not be confused with the “in-hospital” pancreatic test, which resembles a “pregnancy test” and gives you an answer of “abnormal” or “normal.” I am personally not a huge fan of this test because other disease processes (such as liver or gastrointestinal disease) can cause an “abnormal” result.
Ultrasound detects 68 percent of cases and provides the opportunity to look at other organs. Since pancreatitis can be accompanied by a tumor near the pancreas, ultrasound is an important tool for catching such complicating factors. I discuss and recommend this diagnostic for all patients I suspect have pancreatitis.
The passage of food through the intestine is a strong stimulus to the pancreas, which is what we want to avoid. Essentially, we want the pancreas to “rest.” This generally means no food or water for 2 to 3 days (in our very ill patients) using IV fluid support to prevent dehydration. Fluid support generally requires electrolyte supplementation and a critical patient will need 24-hour care with blood-test monitoring several times a day. A plasma transfusion represents a specific type of fluid therapy and may be of great help in severe cases.
Pancreatitis can be a very painful condition and pain management is of utmost importance in recovery and is a cornerstone of treatment. Untreated pain affects the immune system and has been shown to increase death rate. Medications to control nausea are also used. Antibiotics are used because even though pancreatitis is not a bacterial disease, bacterial invasion from the diseased intestine is a common occurrence.
Once the patient has started to eat again, a low-fat diet is important to minimize pancreatic stimulation. Since there is potential for the pancreas to always have a smoldering bit of inflammation, long-term use of a low-fat diet is likely to be recommended.
Pancreatitis can be a very severe disease to experience and treat and I hope this helps raise awareness of a potential source of calamity. Please remember to keep your countertops pet-safe: Take all garbage outside promptly and be extra vigilant of the fact that even the most well behaved pets can be tempted with all of the food festivities.
Here’s to a SAFE, happy and wonderful Thanksgiving!
Copyright © 1997-2017 The Bark, Inc. Dog Is My Co-Pilot® is a registered trademark of The Bark, Inc