Wellness: Healthy Living
Q&A with Dr. Robynne Chutkan
Dr. Robynne Chutkan, one of the leading gastroenterologists in the country, is the author of a new book, The Microbiome Solution, in which she takes us on an exploration of our guts’ ecosystems. Her rousing endorsement of “living dirty” includes the benefits of living with dogs. Bark’s editor speaks with her about just how helpful dogs are to our health, inside and out.
Is it true that there are similarities between our microbiome and those of our dogs, and that dog-owning families have more diverse microbial colonies than dogless households?
Although we share many of the same microbes, dogs in general have a more diverse microbiome than we do. Not surprisingly, some of their additional species are soil microbes (rolling in the dirt from time to time may be a habit worth copying!). Close contact with our dogs is hard to avoid, and that’s a good thing, because they end up passing on some of their unique microbes to their owners, giving dog-owning households a microbial boost.
Dog owners who have children share more mouth bacteria with their dogs than they do with their children. Is this a good thing?
The microbiome in children under the age of three is still developing and as a result, is very different from that of an adult, although there are still lots of shared species with household members (and pets), given the proclivity children have for [putting] everything in their mouths. So, most adults (not just dog owners) have a very different microbiome from their young children. As children get older, their microbiome starts to more closely resemble that of the other household members—not just parents, but pets, too. The vast majority of microbes our canines pass on to us are helpful or benign, not harmful, so keep those doggie kisses going.
So bacteria aren’t species-specific? Is that why, as you note, owning a dog is a highly effective way to replenish and revive bacteria that are basically under attack by modern-day living?
Some bacteria are species-specific, but many are shared by both humans and dogs. Most dogs are much more in touch with the natural world than their owners are, and that’s exactly where lots of the health-promoting microbes come from: soil; unfiltered, unchlorinated water; and, of course, the poo of other animals that our dogs are constantly checking out. Dogs tend to go easy on the hand sanitizer and antibiotics and eat a less processed diet (all habits worth emulating), so they haven’t super-sanitized away as many of their microbes as we have. Some of these canine microbes can be passed on to us, helping to replenish our lackluster microbiome.
The high-fat, low-fiber food we eat, attracts a different range of microbial types; do you know if that is the same for dogs?
I’m not aware of any specific studies looking at variations in canine diets and the effects on their microbiome, but certainly, dogs who eat more processed grains and other foods not natural to their diet tend to have more health problems, and the same is true for humans.
You mention that it’s okay to be a little dirty and sweaty. Why do you think Americans are so obsessed with being hyper-clean?
In the pre-antibiotic era, epidemics of the plague, cholera and other highly infectious diseases wiped out vast numbers of people. The advent of penicillin in the 1930s is still one of the most important contributions to modern medicine, and antibiotics have saved countless lives. But now the pendulum has swung the other way; we’re currently in an era of overdiagnosis and over-treatment, and we’re seeing the emergence of new “modern plagues,” not from infection, but from not enough microbes.
However, the public still sees antibiotics as the life-saving miracle workers they were in the first part of the last century, not as the overprescribed menace they’re becoming. Plus, 80 percent of all antibiotics sold in the U.S. are used in the livestock industry, mostly to fatten animals for slaughter. Clearly, that’s not a lifesaving endeavor.
I think the pharmaceutical and personal-product companies also have a lot to do with it. They’re responsible for many of the public-health campaigns that incorrectly equate cleanliness with health, and of course, they make billions of dollars selling hand sanitizer and other anti-bacterial products.
It’s not just okay to be a little sweaty and dirty, it’s great for your microbiome and your overall health. We need exposure to dirt and germs (bacteria, fungi, protozoa and so forth) to train our immune systems to recognize friend from foe. Not enough exposure to germs, especially when we’re young, leads to a confused immune system that tends to overreact. The result is allergies and autoimmune diseases.
In defense of less bathing and shampooing: your body is really good at concocting the exact formula needed to keep your skin and hair moisturized and healthy. But what do we do? We scrub away our natural oils with harmful antibacterial products and then try to revive our skin and hair with store-bought products full of chemicals. Live dirty for a healthier— and better looking—you!
Many studies have shown the benefits to children of having a dog, including a decrease in eczema and asthma. Why else would you recommend that a family get a dog?
Having a dog is great for reducing stress and anxiety and lowering blood pressure. And we already know they improve the microbiome of the entire household.
What’s your personal dog “biome”?
My mother’s bridge partner, Eva, worked for the Swedish embassy, and when she moved back to Sweden, she left her beloved German Shepherd, Trygg, with us. He’d been used to spending all his time with Eva, and became immediately attached to my mom. We had to be super vigilant in the bathroom because he loved to drink from toilets (all kinds of rewilding going on!).
Hugo, our German Shorthaired Pointer puppy, came into our lives about six months ago. Getting a dog forced me to slow down my too-busy lifestyle and spend more time sitting on my front steps, stroking Hugo and literally smelling the roses. He’s super active, so my husband and I take turns running with him in the mornings and evenings.
We live near Rock Creek Park in Washington, DC, so, thanks to Hugo, there’s a whole lot of dirt and sweat happening on a daily basis. Our daughter Sydney loves him so much that we really can’t imagine life without him.
Hugo slobbers over everyone he comes into contact with, and since I frequently have meetings with the Gutbliss team at our house, he’s become our CRO—Chief Rewilding Officer!
Wellness: Healthy Living
Medical marijuana shows promise for ailing companion animals.
A Bulldog who spent two years either lying down or throwing up plays like a puppy thanks to a daily dose of medical marijuana. A Boxer’s skin cancer begins to disappear following topical applications of cannabis oil. A 12-year-old Lab mix diagnosed with liver and lung cancer regains his appetite and becomes more himself after his owner gives him a cannabis tincture purchased from a licensed medical marijuana dispensary.
These stories offer hope to those of us who live with aging and/or infirm dogs, hope that we can improve the quality of their lives and perhaps even extend them.
Even more hopeful is the fact that these aren’t isolated incidents, but rather, three in an ever-increasing narrative of companion animals and cannabis- assisted healing. Yet, veterinarians played little to no official role in them. Why? Because Cannabis sativa (aka marijuana, grass, pot, hash, ganja, et al.)— a plant cultivated for literally thousands of years for its seeds, fibers and medicinal value—is a federally designated Schedule 1 controlled substance, a “drug with no currently accepted medical use and a high potential for abuse.”
So, even if vets believe that medical marijuana could or would relieve a dog’s pain, nausea or seizures, their hands are tied, including in the 23 states and the District of Columbia where cannabis is legal for human medical use. Physicians in those states are exempt from prosecution, but veterinarians don’t have the same protection. Prescribing, or even recommending, cannabis for medicinal use exposes them to the loss of their license to practice.
It’s a difficult place for a vet to find him- or herself: to have a remedy that has been shown to have very real benefits but not be able to use it, or even mention it, without career-ending consequences. Nonetheless, some have put their livelihoods at risk by challenging that prohibition, usually for the same reasons given by the late Doug Kramer, DVM, of Chatsworth, Calif., in a 2013 interview with Julia Szabo: compassion, and to prevent owners from accidentally overdosing their animals in well-intentioned efforts to relieve their pain.
And that’s part of the veterinary quandary. Medical marijuana has been described as the new “dot.com” boom, fueled by a growing body of research that seems to be validating cannabis’s beneficial effects for people. When people are helped by a particular treatment, they tend to want to share it with their ailing companion animals.
With medical marijuana, they’re doing this in increasing numbers, acting on the belief that if it works for them, it can also work for their dog or cat … or horse, for that matter. In doing so, they’re not necessarily curing incurable conditions but rather, are helping their animals enjoy daily life with better appetite and less pain until age or disease ultimately catches up.The Backstory
The plant world has given us some of our oldest and most trusted—and, it’s true, sometimes abused—remedies. Pain relievers like codeine and morphine (poppy); colchicine, an antitumor drug (autumn crocus); the cardiac drug digitalin (purple foxglove); antimalarial quinine (quinine tree); and salicin, the chemical precursor to aspirin (white willow). The list is long.
When that plant has a cultural backstory like marijuana’s, however— “demon weed” in the ’50s, counterculture toke of choice in the ’60s, DEA Schedule 1 drug in the ’70s and onward —empirical evidence is harder to come by. Many barriers are placed in the path of those who want to find answers to questions about marijuana’s potential healing powers. Consequently, there’s a scarcity of rigorous research on the topic, particularly for veterinary application.
Determining whether or not to bring medical marijuana into general and legal use nationwide for humans and animals alike—and how to do it in a way that maximizes its benefits and minimizes its risks—requires this research. Stories, no matter how compelling and promising, are not science, and anecdotal evidence isn’t evidence in the scientific sense. Rather, hypotheses need to be tested in randomized, placebo-controlled studies, the results analyzed and conclusions drawn. The results are then retested and found to be replicable (or not) by others.
Until relatively recently, claims for cannabis’s medicinal values haven’t been supported in this way. As Hampton Sides notes in “High Science,” the June 2015 National Geographic cover story, “for nearly 70 years, the plant went into hiding, and medical research largely stopped … In America, most people expanding knowledge about cannabis were, by definition, criminals.”The Science
Now for the more technical aspects of the topic, greatly simplified and synthesized.
The first published research related to cannabis and companion animals appeared in 1899 in the British Medical Journal. Written by English physician and pharmacologist Walter E. Dixon, the article included Dixon’s observations on dogs’ response to cannabis. However, it would be almost 100 years before we understood where the response originated: in the endocannabinoid system (ECS).
All vertebrates, from sea squirts to humans, have an endocannabinoid system, which scientists estimate evolved more than 600 million years ago. This ancient system, unknown until the late 20th century, is named for the botanical that most dramatically affects it, Cannabis sativa. Cannabinoids are the ECS’s messengers. The system’s purpose is to maintain internal balance— to “Relax, Eat, Sleep, Forget and Protect.”
Marijuana, a complex botanical with more than 400 known natural compounds, contains at least 64 phytocannabinoids (plant-based cannabinoids). The two produced in greatest abundance are cannabidiol (CBD) and tetrahydrocannabinol (THC).
How do they work? According to the National Cancer Society, cannabinoids “activate specific receptors found throughout the body to produce pharmacologic effects, particularly in the central nervous system and the immune system.” The effects depend on the receptors to which they bind.
Robert J. Silver, DVM and veterinary herbalist of Boulder, Colo., provides another way to look at it. “Receptors are like locks, and cannabinoids are like keys. They fit together perfectly. Once the cannabinoid connects to the receptor and ‘turns that lock,’ a series of actions in the cell membrane occur; these actions are responsible for some of the cannabinoid’s effects.”
In his forthcoming book, Medical Marijuana and Your Pet, Dr. Silver notes that the ECS is unique in the world of neurotransmitters. Instead of releasing signals across a synapse (gap) in a forward direction, “the body’s naturally occurring endocannabinoids travel backward from the post- to the presynaptic nerve cell, inhibiting its ability to fire a signal. This is one way the ECS helps modulate and influence the nervous system.”
Research has revealed two distinct cannabinoid receptors, CB1 and CB2. As in other vertebrates, canine CB1 receptors are primarily found in the brain, but also appear in dogs’ salivary glands and hair follicles, while CB2 receptors are localized in canine skin, immune system, peripheral nervous system and some organs, such as the liver and kidneys.
Of the currently known cannabinoids, only one—THC—provokes a “mind-bending” response. CBD, on the other hand, has several well-documented biological effects, including antianxiety, anticonvulsive, antinausea, anti-inf lammatory and antitumor properties.
Terpenoids, components that give plants their distinctive odors, also play a role, helping cannabis cross the bloodbrain barrier and work synergistically. Ethan B. Russo, MD, associated with GW Pharmaceuticals in the UK, calls this the “entourage effect.” In an article in the British Journal of Pharmacology, Russo notes that terpenoids may make a meaningful contribution to cannabisbased medicinal extracts “with respect to treatment of pain, inf lammation, depression, anxiety, addiction, epilepsy, cancer, fungal and bacterial infections (including methicillin-resistant Staphylococcus aureus [MRSA]).” The entourage effect also suggests that in general, the whole plant, with all of its phytocannabinoids, is likely to be most effective for medicinal purposes.
Those who choose to treat their companion animals with medical marijuana generally give it to them in one of two ways: as an oil or as an edible —a food item made with marijuana or infused with its oil. While edibles intended for human consumption usually contain THC, those for dogs and cats more commonly use CBD from industrial hemp, strains of cannabis cultivated for non-drug use, which has almost no THC.
In 1996, California became the first state in the nation to legalize medical marijuana. It now has the largest legal medical marijuana market in the U.S. —not to mention an almost clichéd historical relationship with the herb— so it’s no surprise that many who are pushing the boundaries of its use with companion animals are based there.
Constance Finley, founder of Constance Pure Botanical Extracts (a Northern California legal medical cannabis collective) became involved in cannabis use with dogs when her 10-year-old service dog was diagnosed with hemangiosarcoma and given six weeks to six months to live.
Finley had been using cannabis oil herself to treat the effects of a debilitating autoimmune disease that began when she was in her mid-40s. The prescription medication she took almost killed her, she says, an experience that inspired her to set aside her long-held bias against marijuana and give it a try. The oil provided both pain- and symptom relief, and Finley went on to study cannabis cultivation and the complicated laws around its use. She eventually developed proprietary blends of highly concentrated oils from multiple strains of cannabis, extracted with organic, food-grade solvents.
So, when her much-loved dog was struggling with cancer, she says she dithered, then began giving the dog small amounts of cannabis oil, wiping it on her gums. Within days, the dog started to move around normally and eat; after three weeks of treatment with the oil, her vet could find no signs of the cancer. Unfortunately, she didn’t completely understand how cannabis worked; she figured her dog was cured and stopped using the oil. Within six months, the cancer was back, and ultimately it claimed her dog’s life.
However, the experience made her a believer in its value for companion animals. While to date, there’s been no dog-specific research on its medical use, Finley is confident that cannabis oil has a place in the veterinary toolbox.
In her work with human clients, Finley says she has yet to see a conflict between conventional medications and cannabis, although anyone using it with dogs needs to be aware of the dog’s entire situation. It’s critically important, she says, that the dose be correctly titrated so the dog’s system isn’t hit with too much THC too quickly. She also notes that the effectiveness of an individual dog’s endocannabinoid system, not the dog’s weight, determines the dose. To establish the correct dose, it’s necessary to work with and observe the dog.
A dosage protocol for dogs is one of the areas in need of study and standardization. In the mid-1970s, researchers found that dogs have a high concentration of CB1 endocannabinoid receptors in their hindbrain and medulla as well as other areas of the brain. This suggests that, in terms of compounds that include THC, dogs require less to get the desired effect. (One of the diagnostic signs of THC overdose is something called “static ataxia,” first described in the 19th century and unique to dogs. Dogs in this condition rock rigidly back and forth and drool, their muscles tense up, and their pupils dilate.) According to Dr. Silver, when it comes to dogs and medical marijuana, “The ratio of brain weight—and by extension, receptors— to body weight is not linear.”
Finley also observes that there are at least two myths about medical marijuana that need to be dispelled. First, that CBD is good and THC is bad; each has its uses, but for cancer in particular, she says, THC is the workhorse. Second, that hemp and cannabis are the same; they are different varieties or sub-species, and while CBD can be refined from hemp, she feels that cannabis provides oil that is more easily used by the body.
In Oakland, Calif., Auntie Dolores has been making cannabis-infused edibles for California’s medical marijuana users since 2008. It recently launched Treatibles, a new, locally manufactured product for dogs and cats. The active ingredients are CBD, CBN (cannabinol) and CBG (cannabigerol) distilled from European industrial hemp, which, founder and CEO Julianna Carella notes, is “non-toxic, 100 percent safe and non-psychoactive. Even dogs who do not have health problems can use the product as a preventive measure.”
Each bag of Treatibles, about 40 pieces, contains 54.6 mg of CBD; each t reat contains about 1 mg. Carella says that the company guarantees 40 mg per bag, but often the consumer gets a bit more. “We feel that all products purporting the health benefits of CBD should have at least enough of the material in the product to warrant the price, as well as to provide a medicinal dose. Even so, dogs are more sensitive to cannabinoids and generally need less than humans.”
Carella says that she was inspired to develop edibles for companion animals by cannabinoid science and research into the endocannabinoid system as it relates to all animals. Like others in the field, she is dismayed by cannabis’s current federal legal status. “Unfortunately, research on cannabinoids and animals is delayed due to the status of cannabis and the Controlled Substance Act, which has disallowed research into its medicinal value. CBD has become part of this controversy, even when derived from hemp.”
Initially, Treatibles was sold only through the company’s Treatibles website, but Auntie Dolores has recently been making it available in California medical cannabis dispensaries and local pet retail outlets. Holistic Hound in Berkeley, Calif., is one of the first stores to carry the product. While its name includes the word “treats,” store owner Heidi Hill considers Treatibles to be more closely aligned with supplements— i.e., to have health benefits. She says her customers have given Treatibles an enthusiastic reception, with most reportedly using the edible to alleviate their dogs’ anxiety and, in some cases, pain.
Hill says she gives Treatibles to Pearl, her aging, arthritic Siberian Husky, and has observed an improvement in her appetite and energy level. The quality of its other ingredients—among them, organic, gluten-free oat flour; pumpkin; peanut butter; organic coconut oil and coconut nectar; organic brown rice flour; applesauce; turmeric; and cinnamon— also recommends it, she says.Change Is Coming
While many have seen positive outcomes, some veterinary professionals worry about people extrapolating from their own experiences with medical cannabis to their dogs’ health problems and giving dogs inappropriate amounts. “Sometimes public sentiment and activity get ahead of the scientific background, and that can be dangerous,” Barry Kellogg, senior veterinary adviser to the Humane Society of the United States, has said.
To date, the American Veterinary Medical Association has not taken an official position on the use of medical marijuana with animals. The American Holistic VMA is the first, and so far only, veterinary organization to officially encourage research into the safety, dosing and uses of cannabis in animals. In 2014, the group released a statement that said in part, “There is a growing body of veterinary evidence that cannabis can reduce pain and nausea in chronically ill or suffering animals, often without the dulling effects of narcotics. This herb may be able to improve the quality of life for many patients, even in the face of life-threatening illnesses.”
Other developments are on the way. In March of this year, Nevada state senator Tick Segerblom (D-District 3) introduced Senate Bill 372, which makes a variety of changes related to medical marijuana in the state. Among its provisions is one that would allow officials to issue medical marijuana cards to companion animals whose owners are Nevada residents and whose vet is willing to certify that the animal has an illness that might be helped by marijuana (the illness does not need to be fatal).
California is also in the process of creating a structured regulatory system. In the June 4, 2015, edition of the Sacramento Bee, reporter Jeremy White summarized Assembly Bill 266: “[It] would create what’s called a dual-licensure system, with cannabis entrepreneurs needing to secure permits both from local authorities and from one of a few state agencies. The Department of Public Health would oversee testing, the Department of Food and Agriculture would deal with cultivation and the Board of Equalization would handle sales and transportation—all under the auspices of a new Governor’s Office of Marijuana Regulation.”
According to Constance Finley, the fact that the marijuana industry is unregulated has been part of the problem regarding access. But next year may be the tipping point. If California’s AB 266 is passed and the marijuana industry comes out of the shadows into effective regulation, particularly in terms of verifiable cannabinoid content and freedom from contaminants, the rest of the nation could follow. The state’s size, market potential, and trailblazing environmental and technology industries have historically inf luenced trends nationwide, and that dynamic is likely to drive the discussion in this case as well.
Veterinary professionals are generally in agreement that more study is needed. In a 2013 interview with R. Scott Nolen, Dawn Boothe, DVM and director of the Clinical Pharmacology Laboratory at Auburn University’s College of Veterinary Medicine, commented: “Veterinarians do need to be part of the dialogue. I can see a welldesigned, controlled clinical trial looking at the use of marijuana to treat cancer pain in animals. That would be a wonderful translational study, with relevance to both pets and their people.” (In translational research, laboratory science and clinical medicine combine their efforts to develop new treatments and bring them to market.)
Narda G. Robinson, DVM, director of Colorado State University’s Center for Comparative and Integrative Pain Medicine, agrees. In an email exchange, Dr. Robinson said, “There is a big gap that needs to be addressed between those who are already using hemp products and finding value for their animal and science-based practitioners who want to make sure that their patients are receiving safe and effective treatment. Research will help bridge that gap.”Next Steps
Clearly, veterinarians—our partners in keeping our animals healthy—need a voice in this debate. While interested in the herb’s potential, many are leery about trying it, not only because of the legal consequences but also, because there’s so little evidence-based information. On the other hand, dog owners who have found it useful for themselves feel that not including it in the vet-med repertoire is a missed opportunity.
Although the tide is slowly turning in its favor, the debate about the utility of medical marijuana and its related components for both people and their pets is often mired in personal bias and opinion. Regardless of what position we take, it would seem that the best way to come to a resolution is to focus on the science. Controlled studies that determine cannabis’s therapeutic and toxic ranges in veterinary use and standardization of THC and/or CBD content have the potential to make a potent natural ally legally and safely available to our four-legged companions.
In transforming anecdote to evidence, we can move from what we think, what we believe and what we imagine to what we actually know. That would be a very good thing for us and for our co-pilots as well.
Wellness: Health Care
On the trail of canine cancer
In Dog Diseases Treated by Homeopathy (first published in 1863, before chemotherapy, radiation, biopsies and blood panels), author James Moore advised concerned dog owners on treating cancer: “An operation cannot remove the cancer, but it can remove the tumor, which causes much suffering; the knife is, therefore, merely palliative in its effect. Still, the disease, even then, is likely to return at a period more or less remote.”
Today, the diagnosis isn’t as bleak. Indeed, 50 percent of all canine cancers are curable if caught early enough. Moreover, the disease is mostly an aff liction of old age (tragically, some cancers strike dogs as young as two). It may seem like more dogs get cancer than ever before, but it’s presumably because they enjoy a longer life span, thanks to vaccinations against infectious diseases like parvovirus and distemper, and new treatments for congenital, degenerative and metabolic disorders.
“Cancer” is the broad term for a complex cluster of more than a hundred diseases. Although there are many causes, each type of cancer starts with alterations in genes that tell cells how to function, which triggers accelerated and uncontrolled cell growth. The defective signal may hide in abnormal genes inherited from parents, or germinate when normal genes are exposed to harmful environmental influences.
Some breeds are predisposed to certain types of cancer, and in those cases, a strong inherited genetic component is suspected. It is thought that a small number of genes account for cancer risk, but, although they are directly related to the development of individual cancers, rarely is a single gene the sole cause.
By the time people and dogs pass 70 and 10 years of age, respectively, about 50 percent will have been diagnosed with some type of cancer. The malady accounts for approximately 23 percent of all deaths in people. In dogs, cancer mortality varies across breeds, from under 10 percent to higher than 60 percent.
In general, small dogs weighing less than 20 pounds are at very low risk. (Small dogs have lower levels of IGF-1, a hormone that is related to bone and tissue growth. Researchers suspect this may be one reason they have a lower incidence of cancer.) For instance, the chance that a Chihuahua, Dachshund, Maltese, Miniature Pinscher or Pomeranian will get cancer is less than 10 percent. Breeds with the highest risk include the Bernese Mountain Dog, Bouvier des Flandres, Boxer, Bullmastiff and Golden Retriever (Fleming et al. 2011).
Goldens as Case Studies
Interestingly, cancer risk in Europeanbred Goldens appears to be significantly lower. A 2010 study put the mortality figure at 38.8 percent (Dobson 2012, Adams et al. 2010). Although much higher than average, the incidence is substantially lower than that found in North American Goldens.
Goldens in Europe and the U.S. may look similar, but there are enough DNA differences to separate the dogs into two distinct populations corresponding to their geographic regions. Gene pools on both continents are large, so breeding between the two populations is rare.
When studied in the lab, genomic differences suggest that risk for some types of cancer is related to recent genetic mutations in North American Golden Retrievers. And this could be good news: genetic differences between European and North American Golden Retrievers may be key to understanding the etiology of canine cancer overall.
Population, Popularity and Popular Sires
Registration agencies impose strict standards on pedigreed dogs, requiring that the ancestors of each dog be registered as well. This, combined with widespread use of popular sires, means that each breed is a closed population, with no gene flow. The “popular-sire” effect occurs when an animal with desirable attributes is bred repeatedly. Descendants share specific genetic mutations, both good and bad, and those mutations spread rapidly throughout the gene pool, where they may become permanently established, or fixed. (“Fixation” is a change in a gene pool in which at least two variants of a particular gene are reduced to only one.)
When the 1998 GRCA study confirmed that a high number of Goldens were dying of cancer, club members realized they had both a problem and an opportunity. The club’s nonprofit 501(c)(3) fundraising offshoot, the Golden Retriever Foundation (GRF), got off the ground about the same time the survey results were being analyzed.
It started by funding a few cancer studies, including some managed by Morris Animal Foundation (MAF), a nonprofit that invests in science to advance animal health worldwide. Eventually, GRF contributed $1 million and asked MAF to match it if both could agree on a project.
In the meantime, at a MAF canine cancer summit in Chicago, three goals were promulgated: build a tumor archive, fund more canine cancer studies and devise prevention strategies. In response to this collaborative effort, a team of scientists, epidemiologists, veterinary oncologists and surgeons, nutritionists, toxicologists, geneticists, breeders, and donors spent three-anda- half years designing the ideal study. Not an easy task.
Animal epidemiology studies (which deal with the incidence, distribution and possible control of diseases) are few in number, largely because they face so many obstacles. Among them are limited funding, participating private practices using non-standardized methods to record data, pedigrees that are difficult to confirm, and grieving owners who aren’t eager to authorize post-mortem tests. Some cancers are silent killers, so a sudden death may not be attributed to cancer. And, due to attrition, studies are difficult to adequately enroll and don’t last long enough to develop statistically significant patterns.
However, after almost four years of stops and starts, the Morris Animal Foundation Golden Retriever Lifetime Study, the first breed-specific, life-todeath research project of its kind, was launched on August 30, 2012.
Based on observations summarized in questionnaires, researchers hope to identify potentially modifiable risk factors that may account for the high incidence of cancer and other diseases in Golden Retrievers and, eventually, in all dogs. Funded and managed by MAF, the study will investigate the effects of genetics, nutrition and exposure to environmental factors.
Although other breeds are at higher risk for cancer, Golden Retrievers were chosen because their population exceeds that of most other breeds by a large margin: the larger the sample size, the more accurate the data. Additionally, because these versatile dogs perform multiple jobs—from assistance and search-and-rescue work to field, performance and companion tasks—they are subject to a broad range of environmental exposures.
Rodney Page, veterinary oncologist and director of Colorado State University’s Flint Animal Cancer Center and the project’s principal investigator, describes some of the factors underlying the study. “Within the estimates that we currently have, we know that 50 percent of canine cancers are curable with surgery and other treatments. Our study is addressing the ones you can’t cut out: the 15 percent of mast cell tumors that aren’t operable; lymphoma, a whole-body cancer; osteosarcoma and hemangiosarcoma, because they spread rapidly before they’re discovered. These four types of cancer cause approximately 80 percent of cancer deaths in Golden Retriever dogs.” These fatal cancers begin to increase in incidence around five to six years and peak about age nine or ten. However, they may also develop in dogs age two and younger.
More than 2,050 veterinarians are providing health care for enrolled dogs. Annually, they conduct physical exams and report findings online; collect samples of blood, urine, feces, hair and toenail clippings and send them to participating laboratories; submit health information from additional heath visits; collect tumor tissue samples when applicable; and provide owners with information and guidance to help them make a choice about necropsy (an autopsy performed on an animal) after the dog dies.
Participating veterinarian Stephanie Ensley of Bentonville, Ark., who enrolled her own Golden in the program, elaborated on the study’s intent. “The information we’ll gather looks at areas of potential exposure by air, contact and feeding. Owners are expected to provide information as detailed as chemicals used in the home, yard and on the dog, and drinking water sources, to name just a few. When all this information is put together and analyzed, we’ll have an opportunity to find commonalities that may be related to cancer and other diseases. The more data available, the more opportunity to find a connection. On the flip side, we’ll also find commonalities in dogs who live to be 15 and over.”
Among the study’s other expected outcomes are insights into how dog-breeding practices and lifestyle choices might be modified to reduce the prevalence of myriad diseases, and the creation of a repository of biological samples that may be made available to researchers working to develop genetic tests.
As GRCA research facilitator and breeder Rhonda Hovan, who has been a Golden Retriever advocate for 45 years, notes, “Breeders play a special role in the success of the study because they can recruit multiple siblings who share the same genetic heritage. Data from littermates who experience different environmental factors and diets during their lifetimes may provide unique scientific insights that could make a significant impact on the long-term health of dogs.”
One immediate benefit is that veterinarians, dog owners and dogs won’t have to wait until the study is complete to see results that may help influence and improve veterinary medicine. The questionnaire responses are analyzed quarterly, so information is continually streaming into the study, and trends, once validated, will be published as they emerge.
Genetic testing to eliminate dogs from the breeding pool may not be the panacea it first appears. Dogs share more the 300 inherited diseases with humans, from narcolepsy and hemophilia to diabetes and lupus. It’s unlikely that all of these can be bred away from while still maintaining healthy genetic diversity. Reducing diversity increases risk for other diseases to surface in the future, especially in a breed like the Golden Retriever, one that has already experienced diversity loss caused by widespread use of popular sires.
In an article published in Golden Retriever News (Nov/Dec 2014), Hovan cautioned Golden Retriever breeders: “Keep in mind that when we remove a dog from breeding due to a failed health test or for any other reason, we are removing all of that dog’s genes from the gene pool, not just the genes associated with disease or unwanted traits …” She also observed that rigorously removing dogs affected with minor conditions has far more potential to damage future generations than occasionally and carefully breeding them. Breeding away from targeted conditions, she says, is part of an inescapable loop that presents subsequent generations with an elevated risk of having some other problem arise. “When conditions are targeted without good cause, there’s an all-too-real possibility that the ‘something else’ will be worse than whatever it is we tried to breed away from to begin with.”
Eliminating dogs based on genetic tests is not a sustainable way to control disease. A better approach, Hovan explained, is to “test and replace” as opposed to “test and eliminate.” For diseases with a recessive mode of inheritance, breeders can avoid risk by breeding carrier and affected dogs to normal dogs. That way, the genetic variety represented by the line can be maintained for as many generations as it takes to arrive at genetically normal offspring.
As Hovan went on to say, “To make good decisions as caretakers of our breed, we need to know what we’re working with. You can’t change what you don’t measure.” To this end, GRCA is working with a research team from University of California, Davis, to survey the breed’s genetic diversity across types and geographic location, collecting samples from the U.S. and Canada. Referencing this survey, Hovan added, “We want to approach this in a scientific manner. This study will help to clarify what we need to do and provide a road map so we can move forward.”
Could one solution be as straightforward as avoiding environmental triggers that trip biological switches and activate uncontrolled cell growth? Maybe. Researchers expect to collect enough biological samples to accurately define the incidence of each cancer being studied. When the study ends, researchers will also have a detailed life story of every enrolled dog. The hope is that in the long run, data will show relationships between cancers and exposures.
The population-based study is creating a baseline for future research in all sorts of health-related issues. According to Page, “The samples and data we are collecting now will be used by scientists in the future to answer their own questions about health and wellness issues in dogs. Studies will be encouraged that access these assets for analyses of everything from toxic exposures to microbial populations in the gut as they might influence health outcomes.”
Cohort studies like the Golden Retriever Lifetime Study are costly, susceptible to attrition and take a long time to produce statistically useful information. Their value depends on an organization’s capacity to stay in touch and engage all participants. DVM, PhD and CEO of Morris Animal Foundation David Haworth, who also enrolled his dog in the program, summarizes it most concisely: “A study like this can only happen through the active participation of an extended community of dog owners, dogs, veterinarians and study sponsors. I think I can say with absolute certainty that we have one of the most active groups of study subjects of any longitudinal health study ever initiated. After all, they are Golden Retrievers.”
Wellness: Health Care
Seven strategies to ease your dog's arthritis pain
The easy run becomes a stiff walk; the jump to a favorite chair is no longer possible; lying down is accompanied by a deep groan. As our dogs age, things that were once second nature become an effort. Today, thanks to advances in veterinary medicine and companion animal care, many dogs are living to a ripe old age. On the downside, that longevity also increases the odds that they’ll suffer from some form of degenerative joint disease (DJD), or osteoarthritis. There are several types of canine arthritis, but in this article, we’ll address the most common, the age-related degenerative form.
As dogs get older, the cartilage surfaces of their joints begin to thin, and cartilage cells die. When the cells die, they release enzymes that cause inflammation of the joint capsule and release of excessive joint fluid. Extra bony growths (osteophytes) can develop. With severe cartilage thinning, the normal joint space narrows and the bone beneath the cartilage deteriorates. All of these processes set in motion further changes in the normal functioning of the dog’s joint, and an ongoing spiral of pain, lameness, limb disuse/inactivity and muscle atrophy sets in. Many of these changes may be seen on X-rays.
On physical exam, veterinarians rely on a dog’s pain response to joint palpation, detection of crepitus (a crackling or grating sensation felt within the joint), observation of gait and the presence of muscle atrophy to diagnose osteoarthritis. Not all dogs—even those with significant DJD—vocalize when they’re in pain, but a dog whose muscles are atrophied and limbs are stiff, who requires assistance to rise, and does little more than teeter outside to go to the bathroom is without question suffering pain.
DJD isn’t the only reason for a decrease in a dog’s normal activity level, weakness or reluctance to move, so other conditions that could be causing or contributing to this change need to be ruled out. Among the entries on a lengthy list are infectious and metabolic illnesses, cardiac conditions, cancer (particularly bone cancer), anemia, and endocrine conditions such as hypothyroidism or Cushing’s disease. In an ideal world, all dogs would start life with genetically sound conformation and joints. For purebreds, the importance of responsible breeding and the use of OFA (Orthopedic Foundation for Animals) certification or other screening tests to evaluate hip and elbow conformation of prospective breeding animals cannot be overstated. Regardless of a dog’s origins, feeding her a high-quality diet throughout life and maintaining her at her optimal lean body weight are also crucial. If she’s overweight, a healthy weight reduction plan should be instituted immediately.
When it comes to relief, reaching for a single “big gun” pharmaceutical is rarely the most effective approach. Rather, best results are achieved by working with your vet to develop a plan tailored to help with your dog’s specific issues. An integrative, multimodal therapy regime can maximize your dog’s comfort and well-being as it minimizes the potential side effects of certain therapies, and is often more gentle to boot.Following are a few strategies that have been found to be beneficial.
Around the house: Provide well-padded bedding away from cold or damp drafts. (This will also help prevent the development of pressure-point calluses.) Carpeted or padded steps or a ramp to get on and off the bed or couch are advised. Nonskid flooring wherever surfaces are slippery is also very helpful. Outside, your dog may find a gently sloped ramp easier to negotiate than steps.
Body work: Many arthritic dogs appreciate muscle massages, which stimulate blood flow to atrophying muscles. Certified canine massage therapists are available in most areas of the country; many are willing to demonstrate techniques to owners. (Start your search here: members.iaamb.org/users) Warm compresses over sore joints can be soothing, but care must be used to avoid injury from excess heat.
Supplementation: Countless joint supplements are available to promote healthy cartilage and joint health. These contain varying combinations of glucosamine, chondroitin, MSM, green-lipped mussel and other chondroprotective substances. Many veterinarians and owners have found that a small number of these products seem to be helpful. We don’t yet know whether beginning supplementation at a young age benefits every dog. This decision is best made with your veterinarian, taking into consideration factors such as diet and genetics/conformation (e.g., has a dog been diagnosed early on with hip or other joint abnormalities?). The anti-inflammatory effects of omega-3 fatty acids (EPA, DHA) have also been documented to be of help in dogs with arthritis. These are included in some canine arthritis diets, but to be effective, higher levels via separate supplements may be needed.
Exercise: Maintaining mobility through reasonable exercise is important regardless of a dog’s age and the extent of her arthritis. (I’m convinced that what kept a certain red Dober-gal of mine going to 15-plus was her daily quarter-mile walk down the driveway, albeit at her own pace.) A dog with mild, early arthritis can and should get more exercise than an ancient pooch with severe cartilage erosion. Non-weight–bearing exercise— swimming, for example—is excellent if not contraindicated by other medical conditions. Look for a Certified Canine Rehabilitation Practitioner (CCRP) for help with designing an appropriate exercise program. (Visit canineequinerehab.com to see if there’s one in your area.)
Complementary therapy: Many arthritic dogs can be made more comfortable and more mobile by acupuncture. Alternative veterinary practitioners sometimes prescribe formulations of Chinese herbs to support the benefits of acupuncture. (Click on “Find an Acupuncturist” at aava.org.)
Laser: Class IV therapeutic laser is a newer form of treatment that stimulates blood flow to tissues and can greatly improve arthritic conditions.
Pharmaceuticals: When it comes to drugs, there are several options. Adequan injections have long been considered the gold standard for treating arthritis and other degenerative joint diseases in dogs. A potent chondroprotective agent, Adequan (polysulfated glycosaminoglycan, or PSGAG) provides the body with the building blocks of cartilage it needs to assist in repairing its own tissues. Unfortunately, it is often not employed because the initial treatment consists of six injections over three weeks, and it is somewhat expensive. However, rarely have I seen an arthritis patient it did not help, and in my own senior dogs, I get clear reminders if I forget one of their maintenance injections (every three to six weeks, depending on the dog). Adequan is largely without side effects; the main reported side effect is the potential for increased bleeding, but in 20 years of use in dozens of patients (including von Willebrand disease-affected dogs), I have never encountered this problem.
We can add an analgesic such as tramadol, a synthetic opioid. While not an anti-inflammatory, tramadol is a fairly potent pain medication, as well as being inexpensive and reasonably safe. Sedation and constipation are possible side effects, but in my experience, dogs tolerate tramadol wonderfully within the proper dose range. Gabapentin and amantadine also target the nervous system, altering the transmission and strength of pain signals.
We can elect to try a steroid for its anti-inflammatory effect. The caveat with steroids, of course, is that over time, they have a “breakdown” effect on body tissues, including joints. Also, if used for any length of time, they may contribute to the development of diabetes, medically caused Cushing’s disease, liver inflammation, immune suppression or other problems. In order to prevent gastric erosion or ulceration, vets will often prescribe medications such as histamine blockers (famotidine, cimetidine), proton-pump inhibitors (omeprazole) or gastrointestinal protectants (sucralfate). If ulcer symptoms develop, steroids should be discontinued. All this having been said, many ancient dogs with advanced arthritis can get four to eight weeks of benefit from a long-lasting steroid injection.
If none of the above provides sufficient relief, one of the veterinary NSAIDs (non-steroidal anti-inflammatory drugs) might be considered. Canine NSAIDs include Rimadyl, EtoGesic, Deramaxx, Previcox, Metacam and Feldene. While these drugs are highly effective at reducing inflammation and pain, they should not be casually dispensed. I use them on a very limited basis with exceeding caution.
Few drugs are without possible side effects. The potential side effects of veterinary NSAIDs are numerous; they can be severe, and even fatal; their development can be completely unpredictable; and most importantly, they can be irreversible. I hold the “above all, do no harm” portion of our oath close to heart at all times. Unpredictable, irreversible side effects are scary.
For dogs whose systems tolerate an NSAID well, they can be wonderful. However, more than a few dogs, including healthy non-geriatrics, have succumbed to irreversible organ-system failure from sometimes no more than a few days’ worth of NSAID therapy. I have also heard of fatalities from perforating gastric ulcers, seizures and other “adverse events.” The FDA has documented thousands of such deaths, which by their own estimation represent a fraction of total cases.
Blood work should be done before an NSAID is dispensed to confirm normal liver and kidney function, red blood cell count, and other parameters. These tests should be repeated at regular intervals to confirm that the NSAID is being tolerated. Ask your veterinarian for a copy of the pharmaceutical company’s Client Information Sheet; he or she should also advise you about symptoms to watch for, including, importantly, any increase in water consumption or urination. The medication should be stopped immediately if symptoms develop. NSAIDs must never be given with aspirin or any form of steroid; doing so can result in death.
And please, do not give your dog over-the-counter pain medicines without consulting your veterinarian! Dogs have died tragic, unnecessary deaths from a variety of seemingly innocuous pills, including a healthy five-year-old dog whose owner gave her several days’ worth of Ibuprofen, which is toxic to canines (and, for that matter, felines too).
Let’s strive to support fit, structurally sound dogs; maintain them with excellent nutrition and age and breed appropriate exercise and at optimal body weights; and begin supplemental integrative therapies when they show symptoms of and are diagnosed with degenerative arthritis. Let’s work our way up to the “big guns” prudently and judiciously.
Here’s to long, happy and comfortable lives for all our dogs!
Wellness: Health Care
Abnormalities in stool color and consistency may indicate an underlying problem.
I’ll be the first to admit that I stand outside watching each and every performance of my dogs’ “poop show.” This isn’t just a weird sort of voyeurism—rather, it’s a good way to know what’s going on with a dog’s health. If you, too, like to see what’s coming off the production line, keep in mind that the number-one rule of thumb when considering canine elimination is reproducibility. Stools should generally have the same color, size and consistency each and every time.
Many things can cause variations in a dog’s stool. Some of the more common are dietary indiscretions (“garbage gut”) or a change in diet, stress (known as stress colitis), infectious disease, inflammatory conditions, or obstructive processes. Or it may be idiopathic (meaning, we just don’t know what causes it).
A couple of episodes of diarrhea generally don’t constitute an emergency. However, there are situations that do warrant an urgent evaluation. When your dog refuses food or water, vomits, or acts ill or “off,” a trip to the vet is indicated.
Your vet may ask you to bring in a stool sample for analysis. A tablespoon is generally plenty. Also, freshness counts; fecal samples less than an hour old give the best results. If you’re not able to collect one this quickly, get a morning sample, double (or triple!) bag it and keep it refrigerated until your dog’s appointment.
Testing usually starts with a screen for giardia and “O & P,” specifically looking for giardia protozoa as well as ova (eggs) and parasites. During this evaluation, the laboratory technician will also check for overgrowth of normal gastrointestinal (GI) bacteria, which we refer to as clostridial overgrowth. If your dog is acting ill, in addition to having diarrhea, other diagnostics such as blood work and radiographs may be indicated.
1. Streaks of bright red blood and/or mucus on the surface of a mostly normal, formed stool. This is generally caused by inflammation in the large intestine, where mucus is secreted to help protect the intestinal lining. While this does not necessarily indicate an emergency, it’s a good idea to keep a close eye out for further changes in your dog’s behavior and stool.
2. Soft-formed to liquid brown diarrhea, with or without streaks of blood. “Cow patty” and “soft-serve ice cream” are two frequent descriptors. As with the previous type, it is generally not life-threatening as long as there are no other signs of concern and it begins to improve within 24 to 48 hours. If your dog is acting normally otherwise— eating well, not vomiting, good attitude —a wait-and-see home approach may be tried (more on this to follow). Here again, red blood indicates inflammation and bleeding in the colon but does not necessarily mean that your pet is bleeding internally, as is often thought. This is a step up in concern from the previous condition, in the sense that the stool is now softer.
3. A large volume of bloody, watery, diarrhea. This one does require immediate evaluation by your veterinarian, especially with smaller dogs, as it can be an indicator of a common condition called hemorrhagic gastroenteritis, or HGE. (Read more about it here: thebark.com/hge) Tissue sloughing from the intestines gives it a distinctive appearance, and it’s often described as “raspberry jam” diarrhea.
4. Black, tarry stools. This generally indicates bleeding somewhere higher up in the GI tract, such as the stomach or small intestine, and also requires an urgent trip to the vet. A bleeding ulcer (oftentimes caused by steroid or NSAID use) or more generalized bleeding, such as from rat poison, heat stroke or an immune-mediated disease, can display as black, tarry stools. The appearance of the stool is due to the presence of digested blood, and can indicate that a large amount of blood is being lost. In these cases, I usually recommend blood work and an ultrasound to better assess the lining of the intestinal tract.
5. Yellow-orange or pasty, light stools. This may indicate the development of liver or biliary disease, or a too-rapid transit through the small intestine to the colon. A more thorough examination, including diagnostic tests, is in order.
6. Grey, greasy stools. A possible indicator of inadequate digestion and malabsorption of nutrients from the small intestine, this type of stool is typical of exocrine pancreatic insufficiency (EPI), also called maldigestion, a disease in which the pancreas no longer functions as it should. The pancreas is responsible for producing digestive enzymes, and without them, nutrients cannot be properly absorbed. Both German Shepherds and Rough-Coated Collies are commonly afflicted with EPI
7. Green stools. In the ER, I have seen dogs with green stool, and upon examination of the fecal contents, have discovered the cause to be undigested rat bait mixed in with normal stool. This condition also calls for an immediate trip to your veterinarian. Although relatively uncommon, rat poison can also cause both bright blood and dark, tarry stool, so—whether or not you think your dog could have had access to them—please let your veterinarian know if there is any possibility of exposure to rodenticides.
8. Worms. Most of the time, you will not actually see worms in the stool. We typically diagnose worms by looking for their eggs under the microscope; we can tell what type of parasite is present by the shape of the eggs. Occasionally, however, you may see white spaghetti-like shapes (typically, roundworms) in the stool, particularly with puppies. You may also see small flat worms on the outside of the stool or rectum, or “dried rice” in your dog’s sleeping areas. This typically indicates tapeworms, which can take over when fleas are allowed to flourish. Although seeing worms in the stool is not an emergency, an appointment with your vet is in order so you can get medication appropriate for the type of parasite present.
Wellness: Healthy Living
Gather up a high quality pair of trimmers and some styptic powder, such as Kwik-Stop or other product, to stop bleeding if you nick the quick.
You may want to sit on the floor with your dog in your lap, or have someone hold your dog on a table. Hold your dog’s paw firmly and push on the pads to extend the nail. Locate where the quick ends. With clear or light nails, it is easy to see the pink color where the quick ends. But with black nails you can look for a black dot on the underneath of the nail; that’s where the quick ends.
Trim the nail below the quick on a 45- degree angle, with the cutting end of the nail clipper toward the end of the nail. Make several small nips with the clippers instead of one large one.
In some cases, if the nails are brittle, the cut may tend to splinter the nail. In these cases, file the nail in a sweeping motion starting from the back of the nail and following the curve to the tip.
Go slowly, take breaks between each paw., and don’t forget the dewclaws. If you accidentally cut the quick, wipe off the blood and apply Kwik-Stop or styptic powder to stop the bleeding. It is not serious and will heal in a very short time.
Some important tips:
Wellness: Health Care
An examination of coming to terms with our worst fears
The way we loved her—my husband and I —ended in a fierce custody battle when we divorced, both of us threatening the other with lawyers and lawsuits. Which, of course, was ridiculous, since animals, as we found out, are not family but property. Which made Riva Jones technically mine, since I’d adopted her before the marriage. But as we all know, in matters of the heart, “technically” and “legally” are muddled, and a dog qualifies as a matter of the heart.
When we fought, Riva would come over and rest her head on my knee while she looked up at me, her eyes saying, Please be happy. She, like most dogs, was family, not property. And that’s why I agreed to share custody of her. My ex loved her the way I loved her, and no matter what kind of meanness I could muster for him at the loss of our relationship, I could not take Riva away from him, nor could I take him away from Riva. So after we broke up, we traded weeks. He lived across the highway and it was easy enough. We saw her through two major surgeries, costing us $7,000; she saw us through new partners, engagements, broken engagements and a marriage. She loved us just the same. She accepted her two-household life. She loved the girlfriends of my ex (even though I told her not to), and she loved my new husband.
After three years of the weekly dog swap, my ex announced that he was moving three hours away. I figured I’d just keep Riva full-time, but he figured otherwise, and fought for her. Motivated by the leftover guilt of leaving him or the fact that she loved him too, I agreed—we would do the dog swap once a month. For three more years, we met on the side of highways, at rest stops, in the dark corners of gas stations.
It seemed like we were trading contraband— who would have guessed that we had pulled over to trade off a German Shepherd? My new husband resented waiting in the gas station parking lot or on the side of the road. I do not know what the girlfriend thought. But Riva always seemed happy to get into one car or the other, never complaining, never even looking back. I wish I had just a little bit of that kind of acceptance, that sort of living in the moment, the attitude that says: “Okay, this is what we’re doing now. Fun!”
At 12, Riva started cutting trail on backcountry ski trips so she could keep up. The last time I took her skiing, she ran down the skin trail instead of following behind us, diving in and out of the fresh snow like a porpoise. When she disappeared, I shouted for her for an hour, afraid she’d fallen in a tree well. She had taken the easy way down and was waiting for us at the car; she sat, smiling, as if to say, That took you a long time.
I took Riva on her last summer hike when she was 14, which, in retrospect, was ambitious, though even our vet had called her the “Wonderdog.” My plan was to hike the two miles to Meiss Meadow from Carson Pass and then back again. It was hot, she was tired and her back end kept giving out. I sat in the shade with her, stroked her head and told her it was okay. I am sure that my ex and Riva took a similar hike—one that was a little too much.
By 15, Riva was blind and deaf. She became incontinent and was horrified when she realized what she had done. I tried my best to tell her it was all right. Nobody was mad at her. No one had ever been mad at her. We tried everything, including installing a doggy door and layering plastic over the floor of one room, with pieces of old carpet on top so she wouldn’t slip. That lasted until she pooped, stepped in it and smeared it all over the carpet pieces and the plastic. Then, the dog whose bed had been right next to mine for 15 years had to sleep in the garage.
My ex got a new job, one that required travel, so the last six months of her life, Riva stayed exclusively with me. I resented my ex on the days I had to clean the house, my shoes and her fur. I resented it when she had to sleep in the garage. I resented it every time I had to help her up and down the stairs, every time I had to go outside and stop her from barking at imaginary things, which prompted the neighbors to call animal control, even the police. Once during that time, I needed a break and called my ex; he said he could not take her. My husband said, “Riva is here to teach you something. It’s her last gift.”
I made a list of all the things I loved and how many of them I could do without and still want to live. Perhaps I could go without skiing and hiking and running, but not reading, not spending time with family and friends. I came up with a number: 30 percent. If I could still do 30 percent of the things I loved, I would want to live.
I made a list for Riva. She could no longer chase chipmunks or swim, but she could eat treats and relax in the sun. From what I could tell, she was at exactly 30 percent. That’s when I started googling “When to put your dog down.” During this period, my friend Sandra came over. When she saw Riva, she said, “You have to put that dog down.” She was not being mean. Sandra is unflappable, and she is not one to couch her opinions in euphemism. She has an aging Pit Bull, Luna, who goes everywhere with her; they even went out together last Halloween, both dressed as witches. Sandra said, “When it’s Luna’s time, I want you to tell me.” I should also say that in addition to old age, Riva had Cushing’s disease, and her spine was a column of stones. Her belly was bloated and her fur matted with old age. Her milky eyes probably no longer looked intelligent, but I had not noticed. At one point that evening, Riva had fallen on the slate floor (recently installed because of her incontinence) and cried, and I picked her up. This, from the dog who never complained. Sandra said, “Put that dog down. You can’t let a dog lose her dignity.” I knew Sandra was right, that she was only trying to encourage me to do the humane thing, but of course I could think only this: That is coming from a woman who dresses her Pit Bull in a witch costume.
I asked my husband what he thought, and he said, “It’s your decision to make. And you have to do it alone. Riva would want that from you. She expects it.”
But I called my ex, and we decided together that we would put Riva down in one week’s time. He would come to the house. The vet would come to the house. I put in for a day off work. But still, I kept searching online for something that would make things easier, something that would tell me when it was time. Again, I googled “when to put your dog down” and landed upon lists and surveys, which I took for Riva Jones, checking whether or not she ate or wagged her tail when I got home (the answer to both of those, by the way, was “yes” until the very end).
All week, I fed Riva steak and chicken and rice. I doubled her pain medication. I spent as much time with her as I could, and she improved. The weather had warmed, so she was sleeping on the deck, happy in the spring Sierra air. Some days, she could walk a half-mile up the trail behind my house. My ex came over, and we ended up sitting on the deck, sharing a bottle of chardonnay with Riva at our feet. We caught up on our friends, but talked very little about Riva. I wondered why he didn’t spend the time on the ground with her, but figured that we all deal with these things in our own way; maybe he didn’t really want to admit she was going, could not bear to say good-bye.
He came again the next day, the day before the appointment, and we took her walking. She made it about a half mile. We saw a bear, and she seemed happy to be among the wakening wildlife. We didn’t talk about the appointment, which was how things had always been between us. But after he left, I cancelled it. I told him we’d wait and see, take it day by day. My ex went home.
In the end, it really would be my decision to make. Among the survey questions on the “Should you put your dog down” test was Did you make euthanasia appointments and cancel them? I now checked “yes.” Riva was now at 50/50, the point at which, according to the survey, one should “put the dog down.” But did it count? Did I make a mistake when I made the appointment in the first place? So I waited.
I am here to tell you there will be an answer to your question, “When should I put my dog down?” but the answer cannot be found on an Internet survey.
There is only this: On a Thursday morning in April, you will wake up and your dog will be throwing up. By the time you leave, she will seem fine. But still, you ask your dog sitter, who is also a vet tech, to check on her during the day. You will run a poetry slam in the evening and will not be home until late. When you call your husband after work and before the event, he will say your dog seems fine. You will ask him what the dog sitter’s note said—she always leaves detailed descriptions of what goes on.
“No note,” he will say.
“She always leaves a note. Find it. Tell me what it says.”
“I didn’t see a note.”
“Look on the counter,” you will insist.
“No note,” he will answer.
You will leave it alone, knowing something is wrong, but you are in charge of an event, so you will choose to believe that your husband is telling you the truth.
He isn’t. He knows you have to go to the event. The note says your dog has been throwing up. But your husband checks on her and she seems to have improved, so he doesn’t say anything.
When you get home, you will find your dog on the porch, dry heaving. Though it will not have snowed for months, on this night, it will be snowing. You will find your dog outside, trying to throw up over the deck. She will know better, even then, to make a mess outside. She will be shivering, and tiny frozen flakes will be caught in her fur.
You will coax her inside, start the fire and ask her to lie on her bed. She will be dry heaving, and every once in a while, yellow bile will come up. She will froth at the mouth, and you will wipe the fur around her face with a towel.
So here’s when you know: when it’s too late. Which is what you tried to avoid with your googling late into the night. You will apologize to her over and over, telling her how sorry you are for not having the doctor come to the house and put her down.
But you could have not done that. You needed it to get to this.
You will call your vet, and because you live in a small mountain town, the office is closed. You will be directed to the vet hospital in the nearest big city, more than an hour from your house. You will call the hospital, and the woman on the other end of the line will encourage you to bring your dog in. “Her stomach could be flipped, and this is extremely painful,” the voice will say. You don’t believe this, but it will make you cry harder. “But she probably won’t make the drive,” the vet tech will say.
You will ask, “Why would I force my dog into a long car ride she probably won’t make?”
“You should bring her in,” the voice on the other end will answer. You will hand the phone to your husband, and he will talk to the vet tech in the other room. You cannot, in fact, do this alone.
When your husband hangs up and comes back into the living room, you will ask if you are going to drive your dog to the big-city vet. He will say no. You will say, “Call Sandra. Ask for her gun.”
He will say, “What? I am not calling Sandra. It’s after midnight.”
“Call Sandra and ask for her gun.”
“I can’t do that.”
“You have to. Just get her gun.”
This is when you know it is time to put your dog down: when you have never shot a gun in your life, and you’re willing to illegally fire a bullet from your unflappable friend’s pink .22 into your dog’s brain.
Your husband will call your friend Sandra, and after she figures out who’s calling her so late at night and asking for her gun, she will say no way. She will tell you it is illegal to shoot a handgun in your town. Unflappable though she is, she will not let you shoot your own dog.
So you will pull your dog’s bed, with her on it, over to the couch, and you will sleep next to her on the couch. She will dry heave for a while but then fall asleep, mercifully, until 7 am. For the last time, you will sleep beside her.
Your husband will leave for a meeting. It will seem, for a minute, that your dog has stopped dry heaving, frothing at the mouth.
But she hasn’t.
You will call your local vet, and the receptionist will say the vet cannot come to the house, but you can bring your dog to the office any time. Your eyes will have that sandpapery feel. You won’t know why, but you will feel the need to shower while your poor dog is suffering in the other room. Maybe you just want to make sure. Maybe you will get out of the shower and she will have stopped dry heaving, and she will be better!
So you will dry off and get dressed and you will realize you can’t wait for your husband to be done with his meeting. It is time.
You will lift your old dog from her bed and carry her down the stairs. She will not resist you. You will put her on the grass, and she will sniff around and go to the bathroom, and this last act of normal doggy behavior will nearly bring you to your knees.
You will call her, your voice cracking. She will see the hand motions you now use since she can no longer hear you, and she will look into the car as if she might try to jump into it. Before she can try, you will lift her into the car, and put her on her bed. She will smile, knowing she is going somewhere.
You will call your ex, telling him you are on your way to the vet … that it is time. You will call your friend Eve, who has three dogs, because you figure she might offer you some words of wisdom, and she does. She tells you to have them do it in the car. She will tell you that is how she has had all her dogs put down.
When you walk into your vet’s front office, everyone will know why you are there. The front office staff will tell you they will help you carry her in. You look around at all the other pet owners with their animals who will have to watch this. Your vet will agree to come out to the car. You are thankful for your friend who told you to have it done that way. You will go out to the car, open the back and sit with your dog in the morning sun.
The front office person will come out with paperwork. He will ask if you want your dog’s paw print. You will imagine them sticking the dead paw into a mold and quickly say no. Then you realize that your ex might want said paw print, so you call him.
“Do you want her paw print?” you say when he picks up.
“You know, they make a plaster imprint of her paw.” Then you add, “But they do it after she’s dead.”
Your ex will agree that the $79.95 paw print isn’t needed.
“But you are doing the private cremation, right?”
“Yeah,” you will answer.
“Call me. Later.”
You agree that you will.
You also agree to the more expensive “private cremation,” even though a former student has offered to dig a hole in your yard.
Here’s what you need to know if you are afraid of the actual procedure. Don’t be. You will not believe how easy the dying is. Afterward, you will wonder why we can’t let our humans go in this way, with compassion and kindness and love.
Here’s what happens: The vet tech will tell you that your dog will be given something to calm her down, make her “loopy.” You will ask if you can have some. “Only if you want to puke,” your vet will say. “It makes dogs feel great, not so much with humans.” Your dog will very quickly stop dry heaving and foaming at the mouth. She will lay her head down and seem to be in a very happy place. You will pet her and talk to her and do your best not to cry because you do not want to upset her. Then the vet will say she is giving the second injection. You will keep your hand on your dog’s chest, feel her heart slow and then stop.
“We’ll be right back,” your vet will tell you. “Take a few minutes.”
That is when you will bury your face in the fur of your dead dog and you will wail. The vet and vet tech will come back with a little stretcher, they will lift your dog onto it and cover her with a fuzzy ducky blanket that seems at once sentimental and silly, but heartbreaking, really.
The next day, you will relay your story to your running partner, and when you get to the ducky blanket, your voice will crack. You will have to stop talking. Your friend will say, “That isn’t heartbreaking. It’s soulbreaking.”
And so it was.
As with most dogs, Riva Jones taught me how to be a better creature in the world. How to live in the moment, to go with the flow. How to be a friend. How to live and, finally, how to let go.
Even though I wanted to prevent her from suffering even one single minute, I couldn’t. The last 20 hours or so were uncomfortable, really uncomfortable. But I have to believe Riva could see that I did the best I could. Would it have been more humane to put her down a week earlier, when I had made the first appointment? Probably. But as it is, I sometimes wonder if I should have brought her into the vet that morning, had the doctor check her. Maybe she’d be alive today! Those are the irrational thoughts that go along with the here-one-day-gone-the-next nature of death. I even worried that Riva would “wake up” in the vet’s office, scared, wondering where I was.
Everyone says your dog will tell you when it’s time. That you will know. That only makes sense in retrospect. You did it, so it was very much the right time. My ex didn’t send me a check for half the euthanasia or cremation, but he did call me to tell me he would be up to spread the ashes. When I told my husband, he responded, “Tell him no cash, no ash.”
I went back and forth about what to do. Finally, I opened the wooden box (a private cremation comes with a lovely cedar container) and we dished two heaping ladlesful of Riva into another baggie. As I did with my father’s ashes, I sifted through Riva’s remains, hoping for what, I’m not sure. Some feeling that it was her. But as with my father, it was gray bone fragment, and I could make no connection between it and the living being.
When I went to meet my ex with the ash and Riva’s collar, he asked me if I wanted to go with him. I felt like I needed an ending to my story, an ending, in many ways, to my relationship with my ex. We had kept in close contact because of Riva, but that would be over now. I then realized that the day he sat on the deck with me, drinking chardonnay, he was there not so much to say good-bye to Riva as to say good-bye to me.
We hiked up the hill behind the house we once shared. Since her death, he had gotten a dog paw tattooed on his forearm, and underneath, Riva’s name. I refrained from telling him, even in my usual passive-aggressive way, how ridiculous I found that. I saw that even though we both lost the same dog, we both had our own journey with it. When we reached the top, the valley unfolding into the lake, my ex opened the baggie and let the wind take the ash. It swirled around, scattering on the dirt below us. He then drove a metal cross into the ground with a mallet and wrapped Riva’s collar around it. We both sat there for a long time, looking out across the lake.
A woman with a dog came up the trail, and said, “Great spot, huh?” We allowed that it was.
“My husband proposed to me right there,” she called.
“Right where you’re sitting.”
She walked off with her dog, and I said, “Should we tell her?” We both laughed for a long time and then agreed it was time to head back down. When we reached my car, my ex gave me a check for half the vet bill without being asked. And then, finally, we said good-bye.
Wellness: Health Care
Take a Deep Breath
Somewhere in northern California, a tiny dog is still prancing around on four paws thanks to hyperbaric oxygen therapy (HBOT). Unbeknownst to the dog’s owner, a piece of string had become wrapped around his paw, hidden in the dog’s dense fur. As circulation in the paw slowed down, skin and tissue began to slough off. By the time the owner realized what was happening, the paw was in such bad shape that the little dog’s vet, understandably, recommended amputation. The owner, however, wanted to try to save it. After a strict regimen of cleaning and dressing changes failed to promote significant improvement, the dog was referred for HBOT treatment.
Deep-sea and scuba divers have long used HBOT to combat the bends, and in the medical arena, it has been employed for more than 50 years to help people recover from serious infections and hard-to-heal wounds, among other ailments.
Now, this technology is being utilized to help companion animals and horses with conditions as varied as head and spinal-cord trauma, intervertebral disc disease, wounds and burns, infections, and inflammatory conditions.
The general theory behind HBOT is that it promotes healing by raising oxygen levels in the blood, allowing oxygen to diffuse into tissues at distances three to four times further than usual. Gary Richter, MS, DVM, medical director of Holistic Veterinary Care and Rehabilitation Center, Oakland, Calif., is among those who use HBOT in their practices. According to Dr. Richter, “When there’s inflammation, damaged tissues or injury, lack of oxygen is very commonly the limiting factor. By increasing the amount of oxygen delivered to tissues, we are stimulating these patients’ own healing abilities—immune systems, stem cells—to begin the healing process where other types of conventional medicine might not be able to achieve that goal.” (The dog with the damaged paw was treated at Dr. Richter’s clinic.)
Typically, HBOT treatments last about an hour and are given one to two times daily. A patient is placed in a hyperbaric chamber and breathes 100 percent oxygen at 1.5 to 3 times normal atmospheric pressure. The total number of treatments required depends upon the condition and how the patient responds. Being enclosed in the chamber doesn’t seem to distress the dogs or cats who use it; many reportedly go to sleep during treatment. Dr. Richter thinks that for the patient, it’s mainly boring; “as far as the animal’s concerned, nothing’s happening.” The cost and protocol are the same no matter how large or small the patient.
The therapy has essentially no side effects, although Dr. Richter says that it’s also important to select HBOT candidates appropriately. Dogs or cats with some types of respiratory problems or who are predisposed to specific types of seizures need to be evaluated before undergoing the therapy.
And sometimes, says Dr. Richter, the therapy may have positive side effects. Take, for example, the case of a cat with inflammatory bowel disease (IBD) so severe that she required a surgically implanted feeding tube. The surgical site became infected with Methicillin-resistant Staphylococcus aureus (MRSA), a bacterium responsible for several difficult-to-treat infections. HBOT was used to help the site heal and resolve the MRSA, but as a side effect, her IBD improved to the point that she no longer required intensive medical monitoring.
Despite being approved for use in humans for an array of medical conditions, HBOT is not without its skeptics, who say that the lack of clinical trial data supporting its claims puts it into the realm of experimental. However, based on the human experience, it would seem that HBOT has the potential to become another valuable tool in the veterinary health-care toolbox.
Wellness: Health Care
Periodontal disease, the most common disease occurring in dogs and cats, is defined as plaque-induced inflammatory pathology of any part of the tissues that hold the tooth in the mouth. >Plaque is a soft biofilm that contains bacteria and toxins. It accumulates on the surface of teeth within hours after dental cleaning; if it mineralizes, tartar (calculus) forms.
>Gingivitis is the reversible form of periodontal disease, affecting only gingiva (the gums). As inflammation continues, the gum detaches from the tooth, creating a pocket. Toxins from plaque bacteria and enzymes from inflammatory cells cause further destruction of periodontal tissues.
>Periodontitis is the more severe form of periodontal disease. It results in attachment loss, gingival recession and loss of alveolar bone, which loosen the tooth and put it at risk of falling out. In multi-rooted teeth, the furcation between two roots becomes exposed. Bacteria, toxins and inflammatory mediators may also be released into the bloodstream, allowing them to travel throughout the body and cause harm to important organ systems.
Your pet should generally have an annual oral examination performed by a veterinary health care professional. The amount of dental deposits (plaque and tartar) and the condition of the gingiva (color, texture, shape) will dictate the need for placing your pet under anesthesia to have dental scaling and periodontal therapy performed.
Although anesthesia will never be 100 percent risk-free, modern anesthetic and patient-evaluation techniques minimize the risks, and millions of dentistry and oral surgery procedures are safely performed each year.
(Anesthesia-free dentistry by untrained individuals is inappropriate for several reasons, including insufficient cleaning of inaccessible tooth surfaces, oral discomfort and serious pain.)
An effective home oral hygiene program consists of daily tooth brushing and use of various oral health care products (e.g., rinses/gels, chew toys, dental treats). When oral hygiene is less than optimal, plaque can mineralize within two to three days, forming tartar that resists being easily brushed off. All you need is a soft-bristled and appropriately sized toothbrush, veterinary toothpaste, some patience and one minute each day.
Certain toys and treats can be used in combination with daily tooth brushing, oral health care products, yearly dental check-ups, and dental cleaning and periodontal therapy. Toys and treats should not be too hard, as very hard materials can fracture teeth; rocks and large ice cubes should also be avoided. Tennis balls are popular toys for many dogs; however, they are very abrasive and will rapidly wear down the teeth.
Wellness: Health Care
Your dog is sluggish, withdrawn and avoids his food bowl—is it inflammatory bowel disease?
See those beautiful lilacand plum-colored hills, dotted with darker stones on what looks like pathways? And the slopes that dive into valleys lined with translucent pebbles? But wait. These aren’t lavender-f lowered furrows. They’re a close-up view of the intestines in cross-section. The purple polka dots are inflammatory cells, out of place and infiltrating the tissues. This is inflammatory bowel disease, or IBD, as seen under a microscope.
These histological views, thin slices of stained tissue, are collected via endoscopic or surgical biopsy. They might be small but they reveal a lot, particularly about the kinds of inflammatory cells that are cramming the villi and crypts—the steep hills and valleys— of the GI tract. Crowds of lymphocytes, plasma cells, eosinophils, macrophages and/or neutrophils cause the bowel to thicken, and hinder its motility. They also block the gut’s ability to absorb nutrients, properly manufacture mucus to line the tract and originate hormonal signals.
What causes the GI tract to host the wrong type of cells? It’s not completely clear. Broadly speaking, the immune system overreacts, perhaps to diet, parasites or bacteria. The visiting immune cells then send signals, called cytokines, which create more inf lammation. The end result is an altered intestinal architecture and a host of symptoms: weight loss, diarrhea, vomiting, mucus and/or blood in the stool. The particular symptoms depend on where the inflammation lives, which can be anywhere from the stomach to the rectum.
Diagnosis begins with blood work, which may show protein loss, anemia, dehydration, altered B12/cobalamin and folate levels, elevated liver enzymes, and sometimes pancreatitis. For a definitive identification, a GI biopsy is the gold standard, but when possible surgical risk or cost is a factor, an abdominal ultrasound can provide a presumptive diagnosis; thickened bowel loops usually indicate IBD. (In rare cases, they may also indicate a cancer such as lymphoma; it can be difficult to suss out the subtleties between it and IBD on ultrasound. It’s important to be sure that lymphoma’s not in play because starting prednisone—a common steroid used to treat IBD—without ruling out lymphoma can make an accurate diagnosis difficult later and can create future chemotherapy resistance.)
Medical Treatment Options
Dogs who do not respond completely to diet change may be placed on steroids, antibiotics and, sometimes, stronger immunosuppressive drugs like cyclosporine or azathioprine. Each medication comes with its own list of possible side effects, so the goal is to try to taper the medication to the lowest effective dose. To cover all bases of possible inflammatory triggers, many veterinarians will also deworm dogs with suspected IBD.
Traditional Chinese Veterinary Medicine (TCVM) is another excellent tool. TCVM includes acupuncture, Chinese herbs, food therapy and tui na (a form of therapeutic massage). Rather than treating a dog for a list of symptoms, TCVM creates a picture of his health based on patterns. From indicators such as the dog’s tongue color and coating, pulse strength and character, time of day of the signs, personality, and preferences for cold or warm places, a TCVM vet develops an individualized treatment plan.
These specifics matter. Herbal formulas for chronic early-morning diarrhea are different than those used to treat acute bloody diarrhea. Formulas for acute diarrhea may only be used for a week, but herbs for chronic GI issues are usually given for one to three months. It’s important to use highquality, domestically manufactured formulas from suppliers like Jing Tang Herbal to guarantee low toxicity and uniformity. Herbs are medicine, with possible side effects and interactions, so it’s best to have a TCVM vet prescribe the correct formula for your dog.
Combining acupuncture and Chinese herbs is another powerful way to assist in the resolution of both acute and chronic GI issues. Acupuncture points are located in areas where nerve endings, blood vessels, mast cells and lymphatics are concentrated, and activating those points helps to strengthen the immune system, lower inflammation, increase circulation and reduce pain. Studies have documented that point stimulation also releases neurotransmitters such as beta-endorphin and serotonin.
A TCVM vet will choose a series of points to relieve pain, vomiting and poor appetite, as well as to address heat in GI tract (blood) or a yang deficiency (warm-seeking). Thin, single-use, sterile needles are placed at specific sites, and are left in place from one to 30 minutes. The number of needles used depends on the dog’s age, personality and level of disease. Most dogs relax, yawn and even fall asleep after about 10 minutes. As with any chronic disease, it takes time to steer recovery in the right direction. For acupuncture, a good place to start is three to five treatments spaced at 10- to 14-day intervals.
When all goes well, combining Western and Eastern medical treatments results in weight gain, eagerness to eat and a reduction in GI pain. Not to mention the return of those wonderful, broad doggie smiles and whole-body tail wags.
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