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News: Guest Posts
Great News on the Canine Cancer Front

In honor of November’s National Pet Cancer Awareness Month I would like to share some “hot off the press” wonderfully optimistic news with you. Dr. Nicola Mason from the University of Pennsylvania School of Veterinary Medicine has been researching a new way to treat osteosarcoma, an aggressive and fatal form of bone cancer that has an affinity for growing within the leg bones of large and giant- breed dogs.

Until now, treatment of osteosarcoma has consisted primarily of amputation (removal) of the affected leg with or without chemotherapy. In spite of such aggressive treatment, inevitably tiny clusters of cancer cells eventually grow into metastatic tumors that ultimately become life-ending. Approximately 60% of dogs die within one year of the diagnosis.

A new approach

Dr. Mason’s innovative approach to treating dogs with osteosarcoma involves “cancer immunotherapy” in which the patient’s own immune system is triggered to target and kill tumor cells. In order to use a dog’s immune system to treat osteosarcoma Dr. Mason devised a vaccine consisting of bacteria that have been modified to express a protein called Her2/neu. This protein is known as a “growth factor receptor” and is found on a variety of different cancer cells, including some canine osteosarcoma cells. You may have heard of Her2/neu before because it is commonly associated with breast cancer cells in women. The concept behind the vaccine is as follows: The bacteria stimulates the dog’s “immune system soldiers” to seek out and destroy the bacteria along with cells that express Her2/neu (osteosarcoma cells).

Outcomes to date

Thus far, Dr. Mason has treated 12 dogs with osteosarcoma following amputation and chemotherapy. The dogs received the vaccine once weekly for three weeks. Side effects of the vaccine were minimal. All that was observed was a mild, brief fever following vaccine administration.

The preliminary results have been immensely encouraging. The first vaccinated dog, Sasha has a survival time of 570 days thus far. Two other dogs vaccinated at the beginning of the study are alive and cancer free more than 500 days post diagnosis. Other dogs who were vaccinated more recently are still doing well. These are truly fantastic results.

What comes next?

Some dogs with osteosarcoma are not good candidates for amputation primarily because of neurological or musculoskeletal issues in their other limbs. Treatment options for these dogs are aimed at reducing the pain associated with the tumor. Dr. Mason plans to begin including some of these nonsurgical candidates in her osteosarcoma vaccine study.

Additionally, Dr. Mason is contemplating learning if what she has developed would be an effective means for prevention of osteosarcoma. Certain breeds (Rottweilers, Irish Wolfhounds, Great Danes, Saint Bernards, Doberman Pinschers, and Greyhounds, to name a few) are particularly predisposed to osteosarcoma. It will be fascinating to learn if the osteosarcoma vaccine will effectively prevent this horrific disease in high-risk individuals.

The research results gathered thus far represent a monumental success in cancer treatment and provide significant hope for a disease previously associated with a grim prognosis. Kudos to Dr. Mason for her stunning work! If your dog has osteosarcoma and you are interested in participating in Dr. Mason’s studies, contact her at 215-898-3996 or by e-mail at nmason@vet.upenn.edu.

If you would like to respond publicly, please visit Speaking for Spot. 
Best wishes,
Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog's Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog's Best Health.   There you will also find "Advocacy Aids"- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet's health. Speaking for Spot and Your Dog's Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.
 

Wellness: Health Care
Sundowning
For dogs with Alzheimer's confusion may reign as light falls

A slice of Oregon forest, a fragrant eight-foot noble pine, reigns over our living room in Southern California. I drape the boughs with a final string of lights—silly plastic teddy bears I’ve had for years—and step down from the ladder. It’s growing late on a Sunday afternoon. Our favorite Frank Sinatra carols are playing, scalloped potatoes are bubbling in the oven and the sun is going down over the Pacific Ocean. I’ve been looking forward to this: relaxing in front of the fire, the room lit only by the tree. I should have known better.

Recently, as the days shorten and the curtain of light falls earlier—at four o’clock, now three—Fromer, our 15-year-old Yorkie, goes bonkers! It’s as if the dark sets him off. Now he’s on the floor between my husband and myself, and his ballistic barking drowns out even the roar of the surf.

Five months ago he was diagnosed with terminal renal failure, and given two weeks to live. The vet said I should consider myself his hospice worker. (I don’t know about you, but a hospice worker to a dog was a new one for me.) I gave him subcutaneous fluids, fine-tuned his medications and administered pot roast aromatherapy. By October, my little hospice patient was skipping through the house. The vet cautioned me that Fromer still had renal disease; he was just “temporarily stabilized.”

So, our days were OK; the evenings were something else.

Like a young child squalling over a bogeyman only he can see, at night Fromer got spooked. On this December evening, I forego the pleasure of enjoying the room lit only by the Christmas tree, and switch on every light inside and out. He seems to calm down, but he is licking his paws so feverishly they will be raw if he keeps it up. His tommy- gun barking starts again. Night has turned him into Fromster-the-terrorist-terrier, an impossible-to-please elderly relative.

I poke at the embers to keep the fire from dying out, while Fromer totters off, whimpering in and out the dog door—flap! flap! out, flap! flap! in—the rest of the evening. Until we pack it in and head upstairs. Then he peters out.

When I originally mentioned these symptoms to Stephen Ettinger, our vet, I didn’t get much satisfaction. Dr. Ettinger is an internist, cardiologist and co-author of The Textbook of Veterinary Internal Medicine, said, “Maybe it’s neurological, or he’s cold, or it might be his eyesight.” He reminded me that Fromer’s eyes were failing, making it harder for him to see when the light goes. He didn’t offer any therapeutic help to deal with the situation.

By accident, I stumbled on a Newsweek article (Jan. 31, 2000), “Coping with Darkness,” revolutionary new approaches in providing care to people with Alzheimer’s. The article described how Alzheimer’s patients can become increasingly agitated at the end of the day, and how light is especially important to them in the late afternoon and early evening. Although Fromer hadn’t been diagnosed with Alzheimer’s—dogs also suffer from this disease—the early nights of winter had brought on a behavior in my dog that exactly matched the symptoms of some Alzheimer’s patients.

Now I had a name for what I’d been observing: sundowning. And a definition: According to Harvard Medical School, Department of Psychiatry, sundowning is a syndrome in Alzheimer’s patients of recurring confusion and increased agitation in the late afternoon or early evening. A sundowner is a patient who sundowns.

One antidote to sundowning is increasing the light to eliminate frightening shadows. Except increased illumination only helps patients with intact vision. That explains why flooding rooms with light did not soothe my geriatric friend.

This is now our second Christmas without Fromer. As I untangle those silly teddy bear lights, I remember those awful winter nights, and wonder what I might have done differently.

A half-dozen vets I have spoken with since then say they have never come across sundowning in veterinary literature. They offer replies similar to Allen M. Schoen’s, D.V.M., author of Kindred Spirits, “I am not familiar with the syndrome.”

Until I reach Nicholas Dodman, Director of the Behavior Clinic at Tufts University School of Veterinary Medicine. Dr. Dodman says, “I think you’ve struck on something.”

He explains that this behavior has sort of been recognized but under the global term of sleep disturbance, which is one-quarter of the diagnostic criteria for canine Alzheimer’s. “Did Fromer have canine Alzheimer’s?” asks Dodman. “I would say from what you’ve told me—I never examined him—almost certainly, yes. Since sundowning is a part of Alzheimer’s in people, why wouldn’t it be in dogs as well?”

Johnny Hoskins, a small-animal internal medicine consultant with a specialty in geriatrics and pediatrics, agrees. “I believe dogs go through similar changes as humans as they age.” Dr. Hoskins explains there are certain triggers in older animals when they start having behavioral–mental changes. “In your animal the trigger just happened to be when it was getting dark.”

Dodman says this is the first time he’s heard of this association with dogs and the day/ night junction. He thinks it’s helpful because it adds another layer of detail to nocturnal disturbance syndrome. “It makes it easier for people to recognize and it’s a very clear- cut sign: As light is fading, some dogs, not all dogs, because not all dogs do everything with any disease, but some dogs with canine Alzheimer’s may, when light falls, become even more confused, and upset, and that can lead to this hysterical behavior: barking, pacing, inconsolability. Sundowning. I think that’s a very nice addition to the canine Alzheimer’s syndrome, which previously was just painted as a late-night, throughout the night, problem.”

Dodman explains that vets don’t have a good handle in this area. “They know there are sleep disturbances. But what precisely are they? Vets think that means when the owner goes to sleep at night the dog wakes up and barks and paces. Sundowning makes it more subtle, and more akin to the human syndrome, and it sounds perfectly reasonable.”

Now that we have a definition and a basis for diagnosis, is there a treatment in the canine population? Dr. Hoskins cautions that since there are so many neurotransmitters in the brain, a dog owner should not expect that one single medication will handle all the behavioral-mental changes in his animal. It’s way too late for Monday morning quarterbacking with Fromer, but perhaps others who are currently caretaking an elderly dog will find that these medical suggestions (see sidebar) can make sundowning more understandable and less of a downer.

Dog's Life: Lifestyle
Dog Lifespans by State
Where are dogs living longest?

It is hard to decide which of the many wonderful qualities of dogs is the best one, but it’s easy for me to say what is the worst thing about dogs: They don’t live long enough. We all wish dogs lived longer and most of us are hungry for information about which factors may give us more time with our dogs. It’s possible that where our dogs live is one such factor.

A state-by-state analysis of dog lifespan shows Montana and South Dakota at the top with dogs living an average of 12.4 years. Other states with long-lived dogs include Oregon, Colorado and Florida where the dogs are typically living over 11 years. In contrast, Mississippi and Alabama have an average lifespan of just over 10 years.

These data come from Banfield Pet Hospital and only include those states in which they have facilities, which means that Wyoming, North Dakota, Maine, Vermont and West Virginia are not included. It also means that the data may only reflect the specific dogs seen in their practices rather than fully representing each state’s dogs.

However, there are a number of reasons that lifespans may vary from state to state. These include nutrition, exercise opportunities, rates of spaying and neutering and the types of disease prevalent in the area. The breeds and sizes of dogs that are most popular in those states may matter, too.

Wellness: Healthy Living
GI Involvement in Behaviorial Issues
Some Compulsive Disorders Point to the Gut
Dog looking away

Canine compulsive disorders (CCDs) take many forms and are generally considered to be behavioral issues. However, recent studies suggest that at least two of them—“excessive licking of surfaces” (ELS) and “fly-biting syndrome,” in which a dog appears to stare at something and suddenly snaps at it—may be related to underlying health issues. Both studies were conducted by researchers associated with the University of Montréal Veterinary Teaching Hospital.

The first set out to investigate surface-licking behaviors to see if there was a medical component: “The objectives of our prospective clinical study were to characterize ELS behavior in dogs and to examine the extent to which it may be a sign of an underlying gastrointestinal (GI) pathology as opposed to a primarily behavioral concern.”

Researchers looked at 19 dogs, 16 of whom exhibited this behavior daily. This group was compared with a control group of 10 healthy (i.e., non-ELS) dogs. Complete medical and behavioral histories were collected for all dogs. The medical evaluation revealed that 14 of the 19 ELS dogs had GI abnormalities; treatment of the underlying GI disorder resulted in significant improvement in a majority of dogs in the ELS group.

The second study examined seven dogs with a history of daily fly-biting behavior. As the researchers noted, “Fly-biting dogs are generally referred to neurologists or behaviorists because the abnormalities are often interpreted as focal seizures or as obsessive-compulsive disorder (OCD).”

As in the ELS study, these dogs were given complete medical examinations and were filmed to determine if the behavior was perhaps more prevalent after eating. The video analyses revealed a significant finding: all of the dogs demonstrated head-raising and neck extension, which can be an indicator of esophageal discomfort, prior to fly-biting.

All of the dogs in this study were found to have a GI abnormality, and one was also diagnosed with Chiari malformation (a brain/skull disorder). The dogs were treated for their medical conditions, and four had complete resolutions of the fly-biting behavior. The authors of this study concluded, “The data indicate that fly-biting may be caused by an underlying medical disorder, GI disease being the most common.”

As Marty Goldstein, DVM, observed in a post related to this research, “These studies don’t mean that primary obsessive/compulsive behavioral issues don’t exist, because they do … [But] if you have a pet with obsessive/compulsive disorders, don’t jump to psychoactive medications before exploring the use of food-allergy testing, changes in diet, and digestive enzymes and probiotics that can repair a damaged GI tract.”

Dog's Life: Lifestyle
Dog’s Blood Saves Cat’s Life
Procedure necessary after ingesting rat poison

Rory the cat can claim that dogs are his best friend, too, or at least that one particular dog is. When Rory was in dire need of a blood transfusion, Macy the Labrador retriever was rushed to the vet to donate and that saved Rory’s life.

Rory the cat had consumed rat poison and his life was at risk. Due to bad luck, Rory had eaten the poison too late in the day on Friday for the lab to be able to determine the type of blood needed to ensure a match. The wrong type of blood could cause Rory to die, but the veterinarian treating Rory found out that there was a chance of saving Rory if he was given a transfusion of canine blood.

Rory’s guardian contacted Macy’s guardian, who is a good friend, and that’s how Macy came to be the life-saving blood donor. The procedure was not without risk. The canine blood could have killed Rory, but he certainly would have died without it. Cat’s antibodies don’t react to canine blood at first exposure, which is why the blood transfusion worked. The transfusion gave Rory enough time to replace the red blood cells he needed to recover. He’s doing well and Macy is just fine, too.

News: Letters
Toxic Treats
Buyer Beware

I just spent $400 for an ultrasound on my rescue Shepherd mix, whom we’ve had for five of his six years. Last year, we had baseline lab tests run and discovered that he had slightly elevated liver enzymes. This year, when the tests were rerun, they showed higher enzyme levels and mild chronic liver and renal failure.

The vet and I narrowed the cause down to one culprit: the chicken jerky treats we fed him every day. Although the treats are labeled “Made in America,” they are actually made in China and lab-tested in America. The vet said to immediately stop giving him these treats; he also said they’ve seen a large increase in medical issues (up to and including death) due to these made-in-China treats.

I would like stores to stop carrying all food products made in China, although I know this isn’t possible. But at the very least, because companies seem to hide the place of manufacture in very small print, warnings should be printed on packages that explain the risks of feeding these treats to our pets.

Had we not had a wellness-panel run, our beloved dog would have succumbed to liver and renal failure. I now wonder if the same product didn’t contribute to the deaths of our last two rescue dogs.

Wellness: Health Care
Preventing and Treating Canine Diabetes
An all-too-common malady demystified

The growing diabetes epidemic is not limited to people—diabetes mellitus is increasing among dogs as well. Researchers estimate that one in 200 dogs will develop the disease. Fortunately, treatment has made huge strides in recent years, and as a result, dogs with diabetes are living longer, healthier lives.

The mechanism of diabetes is relatively simple to describe. Just as cars use gas for fuel, body cells run on a sugar called glucose. The body obtains glucose by breaking down carbohydrates in the diet. Cells then extract glucose from the blood with the help of insulin, a hormone made by the pancreas in specialized cells called beta cells. (The pancreas, an organ situated behind the stomach, produces several hormones.) In diabetes mellitus, cells don’t take in enough glucose, which then builds up in the blood. As a result, cells starve and organs bathed in sugary blood are damaged. Diabetes is not curable, but it is treatable; a dog with diabetes may live many happy years after diagnosis.

Kinds of Diabetes
Humans are subject to essentially three kinds of diabetes. By far the most common is Type 2, followed by Type 1 and gestational diabetes. Type 2 diabetes has typically been a disease of middle and old age (though it is being seen increasingly in young people), and has two causes: The beta cells don’t make enough insulin, or muscle cells resist insulin’s help and don’t take in enough glucose (or both). As a result, blood glucose levels climb. Type 1 diabetes usually occurs when the immune system attacks and destroys the beta cells, cutting off insulin production; the reason for this attack is thought to be a combination of genetic predisposition plus exposure to a trigger (research into possible triggers is ongoing). Glucose then stays in the blood and, again, levels skyrocket. Roughly half of people who have Type 1 diabetes develop it by age 20. Gestational diabetes starts during pregnancy and is probably caused by hormonal changes.

You may have heard that dogs generally get Type 1 diabetes, but the reality is more complicated. Though there are no universally accepted definitions of dog diabetes, the United Kingdom’s Royal Veterinary College identifies two forms: insulin-deficiency diabetes (IDD) and insulin-resistance diabetes (IRD). Neither matches any kind of human diabetes exactly.

In IDD, a dog loses beta cells and no longer makes enough insulin to keep glucose levels under control. Causes include genetic defects, inflammation of the pancreas and immune attack (as in human Type 1 diabetes). In IRD, something prevents the dog’s insulin from functioning properly. That “something” may be “diestrus,” pregnancy, an endocrine disease, or treatment with steroids or progesterone-like hormones. Diestrus, the most common cause of IRD, is the approximately two months of high levels of progesterone (a female hormone) between periods of estrus (heat). Hormonally, diestrus resembles pregnancy, making this form of IRD similar to human gestational diabetes.

Risk Factors
Several factors raise a dog’s risk of developing diabetes. These include breed, age, gender, weight, diet, virus infections, an inflamed pancreas, chronic inflammation of the small bowel, Cushing’s disease (excess production of the hormone cortisol) and long-term use of progesterone-like drugs or steroid drugs.

•Breed. A study published in the Veterinary Journal in 2003 examined diabetes rates in thousands of American dogs and found that overall, mixed-breed dogs were more prone to diabetes than purebreds. Among purebreds, breeds varied greatly in their susceptibility.

•Age. Dogs most often develop diabetes during middle or old age.

•Gender. Female dogs and neutered male dogs are more likely than intact males to get diabetes.

•Weight. Obesity can make cells resistant to insulin, but it’s unclear whether it actually causes diabetes in dogs.

•Diet. A diet high in fat may contribute to pancreatitis (inflamed pancreas), a risk factor for diabetes.

Signs, Symptoms, Diagnosis
Diabetes can be a silent disease. Your veterinarian may discover your dog’s diabetes through routine bloodwork, but before that, you are likely to notice some of its symptoms: greater than normal hunger and/or thirst, weight loss, and frequent or copious urination (some dogs start having accidents in the house).

A blood test that measures your dog’s blood glucose level is the most common diagnostic tool, but a high glucose level does not always mean diabetes. Because other diseases sometimes raise these levels, your vet may run additional tests to rule out such causes.

Once your dog is diagnosed, her veterinarian will obtain a “serial blood glucose–concentration curve” by measuring her glucose level repeatedly over many hours. The results will help the vet choose an appropriate insulin, dose and dosing schedule.

After treatment starts, your dog will need to be routinely tested to see how well the protocol is working. Most commonly, either a fructosamine test or a glycated hemoglobin test, which reveal average control over the previous one to three weeks (fructosamine) or two to four months (glycated hemoglobin) is used. In contrast, the daily blood glucose measurement is a snapshot, an indication of your dog’s glucose level at one specific moment.

Treatment
In the long run, the label your vet gives your dog’s diabetes isn’t important. A good treatment plan is what matters. Treating diabetes is as much an art as a science. The goal of treatment is to keep blood glucose levels close to normal—roughly between 65 and 120 mg/dl—so that your dog feels good now and is less likely to develop diabetes-related problems later. The most common diabetic complication in dogs is cataracts (clouding of the lens of the eye); over time, dogs may also develop hardening of the arteries, kidney disease, retina disease or nerve disease. And because bacteria thrive on a high-sugar diet, dogs with diabetes are prone to gum, urinary, skin and other infections. Other components of treatment include proper diet, weight loss (if your dog is overweight), an exercise program and home testing of blood glucose levels.

•Insulin. With rare exceptions, dogs with diabetes need one to two daily insulin shots to survive; the insulin is injected just under the skin. Your vet may prescribe a human insulin, or possibly Vetsulin, which is a purified pig insulin; Vetsulin is the only insulin approved for use in dogs in the U.S. Insulins vary greatly in how quickly they start working, when their action peaks, how long they last and how much they cost. Your vet will take these factors into account when choosing the best type for your dog.

•Home monitoring. Weigh your diabetic dog regularly and watch for signs of excess hunger, excess thirst and excess urination, indicators that her glucose levels may be too high. Regular testing of your dog’s blood glucose level can reveal problems before they become emergencies. Glucose levels rise after meals, occasionally when your dog is sick, and when the insulin dose is too low or timed improperly; they drop during fasting, after exercise, and when the insulin dose is too high or timed improperly. Both too-high and too-low levels can be dangerous.

Testing also lets you know how well the treatment program is working.“It’s extremely important that a clear understanding be developed of the meaning of blood glucose monitoring,” says William D. Schall, DVM, professor in the Veterinary Medical Center at Michigan State University in East Lansing. When interpreting the results, consider when your dog last ate, how much exercise she has had recently, when she received an insulin dose, how large the dose was and any symptoms.

Testing involves pricking a hairless area with a lancet, collecting the blood drop that wells up and using a small device called a blood glucose meter to measure the concentration of glucose in the sample. Many dog owners use human blood glucose meters. However, these meters tend to read low for dogs. The AlphaTRAK meter is designed for dogs and cats and requires only a tiny blood sample. “Whichever glucose meter is used, the results should be compared at some point to the results obtained by the veterinarian’s laboratory by performing simultaneous samples,” says Louise Murray, DVM, DACVIM, director of medicine at the American Society for the Prevention of Cruelty to Animals in New York City.

When your dog is sick, the vet will also want you to test your dog’s urine for ketones (a poisonous byproduct of fat breakdown); you may need to do that on a regular basis as well.

•Diet. Researchers are still exploring what diet is best for dogs with diabetes. Most veterinarians recommend a diet low in fat and high in fiber. Fiber slows the entrance of glucose into the blood and may satisfy your dog’s appetite sooner, so she eats less and loses weight. Your veterinarian may recommend a prescription dog food designed for dogs with diabetes, or a homemade diet developed by a veterinary nutritionist. Some dogs may refuse to eat special diets; in that event, careful choices should be made when selecting a regular dog food. The one food Dr. Schall absolutely advises against for diabetic dogs is the semi-moist type that comes in packets. “They generally contain more refined carbohydrates than other dog foods,” he says.

•Exercise. Exercise not only may help reduce your dog’s weight, it also lowers blood glucose levels. Your dog should exercise every day for about the same length of time at about the same exertion level. Consistency is important—an unusually long or vigorous exercise session can cause blood glucose levels to drop dangerously low.

•Weight loss. If a dog is overweight, shedding some pounds can make the cells more sensitive to insulin, which means that glucose uptake is easier.

•Spaying. Spaying prevents female dogs from going through diestrus.

Day to Day With Your Diabetic Dog
Keeping a logbook can help you monitor your diabetic dog’s progress. Every day, record blood glucose test results; any ketone test results; changes in your dog’s appetite, weight, appearance, water intake, urination frequency or mood; and any treatment changes your veterinarian makes. A simple notebook, calendar or computer spreadsheet works well.
Among the things to watch for on a day-to-day basis are hyperglycemia, when blood glucose levels rise above the top end of the recommended normal level (ask your vet what this is for your dog; since perfect control isn’t always attainable with current methods, vets generally try to keep most dogs below 200 mg/dl), and hypoglycemia, when the level drops to 60 mg/dl or less.

Hyperglycemia can lead to ketoacidosis (harmful levels of ketones in the blood), which qualifies as an emergency, and you should call your vet right away. Symptoms include drinking lots of water, urinating frequently or copiously, loss of appetite, weakness, vomiting, lethargy, ketones in the urine, or—in the most serious situation—coma. Test strips are available to detect ketones in your dog’s urine, and you should report the presence of ketones to your veterinarian immediately, even if your dog has no other symptoms.

In hypoglycemia, a range of symptoms may be present, including restlessness, lethargy, confusion, weakness, wobbliness, lack of coordination, shivering, sweaty paws, seizures or coma. Test your dog’s blood glucose level if these symptoms appear. If it is below the recommended level, rub maple syrup, Karo syrup or tube cake frosting—high-sugar foods that are quickly absorbed into the bloodstream—on your dog’s gums and the inside of her cheek, then call your vet to report the episode and get further instructions.

***

Modern medicine has made caring for a diabetic dog quite doable and certainly worthwhile. Although daily care can seem burdensome at first, once you get used to it, it becomes a routine part of the day, like feeding her or taking her for walks. Owners do not need to worry that shots and blood tests will take over their lives. Nor do they need to fear that their dog will not be happy. According to Dr. Schall, almost all diabetic dogs can be treated at home and can enjoy a good life. A diagnosis of diabetes offers a challenge, but it’s a challenge that can be successfully met.

Dog's Life: Humane
Running the Numbers
Guest Editorial
UC Davis studies health conditions in Golden Retrievers

We humans are terrific at measuring and recordkeeping— we even know the length of Noah’s ark, in cubits (300) no less. Technology abets this trait, as computers dutifully crunch our numbers, ad, well, infinitum. As a species, however, we are not so good at appraising information to extract its meaning. Confronted with new data, we tend to overemphasize and generalize, often less than critically.

On that cautionary note, what are we dog people to make of a new University of California, Davis, study that examines relationships between early, late or no spay/neuter and several health conditions in Golden Retrievers? How do we apply its conclusions to the animals in our care?

The Davis docs found increased risk of several cancers, hip dysplasia and cranial cruciate ligament tears among sterilized Goldens; the incidence varied according to the sex and age-at-neuter of their subjects. As such, their findings add to a growing library of veterinary literature on the spay/neuter subject. However, the authors are careful to limit their conclusions, as should we.

First, the findings are breed-specific. Goldens, a highly inbred line, were chosen in part because of their susceptibility to cancers and joint issues. The gene pool was further limited by a study sample of dogs (759, to be precise) seen at the UC Davis clinic, in northern California.

Second, we need to remind ourselves that risk is not destiny, and that correlation is not causation. The study notes that the risk of one type of canine cancer quadrupled in late-neutered females, but also reveals that its incidence grew from 1.6 to 7.4 percent— meaning that about 93 percent of the subjects did not contract the disease.

The authors also indicate that they did not specifically consider obesity, another known factor in dysplasia and cancers. Neutered dogs do tend to be heavier, but we can manage that risk by controlling food intake and quality. We also need to recognize that other studies have noted countervailing positive health effects, as spay/neuter reduces or eliminates rates of other common diseases, such as mammary cancers and uterine infections.

Third, context is crucial. These data feed into the universe of things that are harmful to canines. We know, for example, that nationwide, some 50 percent of the animals in shelters don’t survive the experience. To the extent that intact canines contribute litters to the shelter population, that risk dwarfs exposure to accidents or disease. Shelter “save” rates are improving in many places, but we remain far from a no-kill equilibrium. Job One for canine partisans (including the veterinary community) remains the imperative to reduce that carnage.

After sheltering, risk-of-death varies widely by age and breed. A comprehensive University of Georgia study of vet-reported deaths (“Mortality in North American Dogs from 1984 to 2004,” published in 2011) identifies infections, trauma and birth defects as primary culprits in young dogs, with tumor-related diseases at various breed-specific rates, distantly followed by trauma and infections, which dominate the tally for the late-in-lifespan.

Finally, there are the behavioral and other risk implications of fertility, including management of ardent males and bitches in heat.

The Davis study is a significant contribution to our understanding of the unintended consequences of fertility management in a useful and popular breed. Reproductive organs contribute hormones for many reasons—it would be surprising if their removal were completely trivial. Alternatives to traditional spay/neuter do exist, but they are rarely performed. Injectable sterilizers and contraceptives are coming on the market (they, of course, will carry their own measurable side effects).

It’s important to recognize the limitations of the study: one breed, one gene pool, defined conditions and their rank among all the calamities that can befall our best friends. The study itself notes that spay/neuter is uncommon in Europe, which would appear to open up a range of comparative research possibilities and fertility management options.

We should add the Davis work to the burgeoning database. But until a lot more measurements have been taken from which broader conclusions may be drawn, the best advice is not general to all dogs, but individualized: choose your canine companions carefully and love and support them well, and completely. And recognize that we can’t measure or control for everything, yet—or ever.

Good Dog: Behavior & Training
Tough Choices About End of Life
Deciding when to euthanize

Not everybody is at ease with the idea of euthanasia under any circumstances, and I understand that. Many people have moral conflicts with deciding to end the life of a pet, no matter what the reason. My perspective is that this is a highly individual decision but that I personally am comfortable with euthanizing my pets once their quality of life is so compromised or they are in such pain that keeping them alive feels like it’s more for my sake than for theirs. It’s my view that a peaceful death by euthanasia frees them from pain and misery, and is the final gift of love I am able to provide. I know many disagree, and I’m not suggesting that one way or another is right—I’m just describing my own personal take on this issue.

That doesn’t mean that I haven’t cried buckets and been inconsolable when I’ve euthanized a dog. It’s horrible beyond imagination, and I’ve never really recovered from it in any case. I always hope for any dog (or any person for that matter) to surrender peacefully to death while sleeping. When that doesn’t happen in time, facing the tough decision of when to euthanize is a challenge. Sometimes it’s obvious when it’s time because the dog has reached a point of literally being unable to move, being in constant and unmanageable pain, showing no joy at all or no recognition of anything or anyone.

In other cases, it’s not so clear, which is why a new tool that helps guardians and veterinarians decide when that moment has arrived may be useful. Researchers at Michigan State University developed a survey for probing into the specifics of a dog’s quality of life when undergoing chemotherapy for cancer. The idea is to develop an objective way to assess quality of life, which is such an important consideration when deciding whether to continue life-prolonging measures or to face the possibility that it is time to say good-bye.

Questions address a range of behavioral issues and observations before treatment, a retrospective on the dog’s behavior six months prior, and continued observations throughout their treatment at regular intervals. The questions address aspects of dog behavior including play, measures of happiness, and signs of disease. Both guardians and veterinarians have questions to answer based on their own observations. A small pilot study of 29 dogs found high levels of agreement from clinicians and guardians. Researchers plan to expand their original work to a study with hundreds of dogs and to other illnesses and medical issues as well.

Do you think an objective tool such as this might help you decide when to euthanize a dog, or do you feel comfortable with just “knowing” when that sad day has come?

Wellness: Food & Nutrition
Dog Food Watch: Recalls
What’s gotten into food safety?

We’re barely halfway into the year and already, there have been a flurry of pet food recalls. The sheer number of brands has been surprising, as have the names of the brands involved; we’ve seen recalls from some of the industry’s most respected companies. How and what we feed our dogs (and ourselves, for that matter) is such a fundamental issue that we’ve decided to do a series of articles on pet food safety, starting with a report on a few of the most recent recalls. We examine the reasons behind them, lessons learned and what we might expect in the future.

Until very recently, all recalls have been voluntary (a confusing term that can lead consumers to believe that a recall is optional), triggered for a variety of reasons: mislabeling, misbranding, the inclusion of potential allergens or adulterants, or contamination with a pathogen such as one of the varieties of salmonella. And some products are recalled simply because they were produced at the same factory during the same timeframe as the affected food.

So far, no pet food recall has been as widespread as the one in 2007, which involved the Menu melamine scandal. If Hurricane Katrina taught policymakers the importance of the human/ pet bond, the ’07 Menu Foods recall did the same for the focus on the safety of the food that we feed our pets. As William Hubbard, a former FDA official, notes, “I do think that this pet food thing has shown people … that something needs to be fixed. If this is not a wake-up call, then people are so asleep, they are catatonic.”

It took a while for Congress to fully awaken, but in 2010, the Food and Drug Administration (FDA) was given more power with the passage and then signing into law by President Obama of the Food Safety Modernization Act (FSMA). The act marks the most sweeping food-safety reform since the Great Depression.

This new act will soon be putting broader issues into the spotlight. For the first time, the FDA will be empowered to more aggressively regulate and enforce preventive measures. Recalls will no longer just be voluntary, but rather, can be mandatory. In our opinion, given this new regulatory power and the plethora of places from which pet food manufacturers source their ingredients, the number of recalls will surely rise. Closer attention and accountability are good for consumers and the animals we feed, and definitely something we need to be informed about.

RECALL CLASS OF 2013
Six years ago, in 2007, veterinarians began seeing a surprising number of companion animals—primarily dogs—with kidney problems; in September of that year, the American Veterinary Medical Association alerted the FDA that they had had reports of a Fanconi syndrome–like disease that appeared to be associated with the consumption of chicken jerky treats made in China. As a result, the FDA issued its first cautionary warning—not a recall—for those treats. In early January 2013, after the FDA had spent years investigating whether or not jerky treats from China were harming (and killing) pets, these treats were finally voluntarily recalled.

We have the New York State Department of Agriculture and Markets to thank for finding what might be the contributing factor: the department identified antibiotic residues not approved for poultry in the U.S. in the treats. This spurred Del Monte, the makers of Milo’s Kitchen Chicken Jerky Treats, and Nestle Purina, manufacturers of Waggin’ Train and Canyon Creek Ranch dog treats, as well as others, to finally initiate a nationwide removal of these products from store shelves.

Though the FDA continued to claim that “there is no evidence that raises health concerns, and that these results are highly unlikely to be related to the reports of illnesses,” the findings were enough to convince the slow-moving food industry that they needed to get the products out of circulation. The FDA, which still considers this to be an open investigation, notes that they “welcome additional information about New York’s testing methodology …” To date, the treats are thought to have contributed to the deaths of roughly 500 dogs and nine cats. If New York’s state inspectors had not found the illegal antibiotic residue, those treats would still be available. Chalk one up for the state team!

DOMESTIC PRODUCTS TAKE A HIT
Over the past few years, consumers have learned to look for “Made in the U.S.” to guide their food purchases. So it was a surprise when a U.S. manufacturer of jerky and other “animal-parts” treats like bully sticks and pig ears issued a large-scale recall. This time, salmonella —a group of bacteria responsible for most cases of human food poisoning— was the culprit. Again, inspectors from a state department of agriculture, this time in Denver, Colo., were responsible for identifying the problem. In September 2012, during a routine check of the Kasel Associated Industries processing plant, inspectors found evidence of salmonella contamination. The firm issued three recall notices that year, one in September and two in October.

In February of this year, Kasel had the dubious distinction of being the first pet food manufacturer to possibly face a first-ever FDA/FSMA mandatory recall notice, a threat based on inspections by an FDA team that found a number of infractions: “All of the finished pet treat product samples and 48 out of 87 environmental samples collected during the inspection tested positive for salmonella. More than 10 different species of salmonella were found in the firm’s products and manufacturing facility, indicating multiple sources of contamination.” The jerky treats were sold through a number of big-box retailers, including Target, Petco, Sam’s Club and Costco.

Other jerky products made in Kasel’s Denver plant were drawn into the recall as well. Bixbi, an up-and-coming independent brand from Boulder, had batches of their products swept up, and Nutri-Vet, a more established brand, was also named, although it was noted that none of these products had tested positive for bacteria. (I contacted the owners of Bixbi and Kasel, who responded to my questions; I also placed numerous calls to Nutri-Vet, who didn’t reply.)

Treats aren’t the only products in which salmonella has been found, however. Natura, a premium holistic brand now owned by Procter & Gamble, had its first recall experience this year after one of their dry-food products tested positive for salmonella by Michigan inspectors. When I spoke in late March to Jason Taylor, a P&G spokesperson, he said the company was still in the process of trying to recreate the production situation at the time the contamination happened; they were, however, sure that it had occurred during a post-extrusion step. “We have an extrusion [cooking] process that is scientifically proven to kill pathogens … So it probably happened either at the dryer or packaging line.” According to Taylor, the company has a complex manufacturing process in place to ensure that their products are contamination- free. Their microbial-mitigation process, which has more than 100 steps, addresses each step the food goes through, from raw material through packaging.

Taylor said that the company was fairly confident that the problem was limited to products manufactured during the two-week period beginning December 17, 2012, and ending January 2, 2013. Since then, we learned that they extended the recall for products manufactured up through March 24, 2013— making this a larger-scale recall.

RAW FOOD PRODUCTS UNDER THE MICROSCOPE
Pet-food safety advocates wondered if the FDA was exerting more muscle on domestic manufacturers to make up for their foot-dragging on Chinese jerky. Then the recalls moved into the raw-food realm. The first, also in February, involved Honest Kitchen’s recall of limited lots of Verve®, Zeal® and Thrive® products. Honest Kitchen has a transparent, consumer-friendly approach to their food sourcing, and in their recall notice, founder and CEO Lucy Postins noted that “the Company is taking this action after learning that one of its raw ingredients suppliers has recalled a batch of human-grade parsley that may contain salmonella.” The parsley— which had come with a certificate of analysis from the supplier attesting that it was pathogen-free—had been used in the production of five lots of finished products.

While most of Honest Kitchen’s rawfood sources are in North America, they also get some produce from Europe and exotic fruits from Asia. Surprisingly, they get their parsley from Egypt. Yearround availability of organic and/or human-grade ingredients at a reasonable price is one of the challenges faced by smaller food manufacturers like Honest Kitchen, and is the reason for this wide-ranging sourcing.

Since this incident, Honest Kitchen has switched to another parsley supplier (also in Egypt) and added a new step to their processing of dried herbs and leafy greens, treating them with a gentle steam sterilization to protect against microbial pathogens.

More raw food companies were hit with recalls in March, when the Minnesota State Department of Agriculture found salmonella, first in Steve’s Real Food Turducken patties, and a week later in a two-pound tube of Bravo! Chicken Blend raw frozen food diet the agency had purchased from a local pet store.* I talked with veterinarian Heidi Kassenborg, director of Dairy and Food Inspections for Minnesota, to get a better idea about her state’s pathogen inspection process.

Many have observed that while salmonella is the most prevalent foodborne pathogen, few dogs actually become ill from it, and I asked her why the FDA and her agency have such a strong concern about its presence in pet food. She explained that they are charged with finding adulterants in food, and “in food items, salmonella is considered to be an adulterant.” As for the USDA’s salmonella-tolerance level for raw poultry (now at 7.5 percent, down from 20 percent in 1996), she confirmed that “in raw food, like poultry and beef, it is not considered to be an adulterant.” Basically, there is no tolerance for adulterants in finished food items, and even raw diet is considered a “food item.”

Kassenborg explained the high concern about pet food, saying that since pet food is handled by humans, they are exposed to any pathogens that may be in it; these pathogens can also be excreted in the pet’s stool. Given that salmonella can cause serious and sometimes fatal infections in young children, the frail or elderly, and those with weakened immune systems, this is indeed a compelling reason for concern.

She went on to say that there would be increased surveillance now that raw diet has tested positive for pathogens. “Once things are found in one food type, they start looking at it and testing more. We have an obligation to find out if it is a widespread problem. And if so, is there a way to produce it better without it becoming contaminated?”

Doug Lueders, supervisor of Minnesota’s Commercial Feed Regulatory Program and the person responsible for its product-sampling plan, concurs. “If we have a category that has had few [contaminants] or none, we may switch our emphasis to one where we have had a problem. I think we will raise the percentage [of resources] that we have devoted to raw in the past; that, however, will be at the expense of something else.”

Resource allocation is a real issue. Other states have registered positive hits on items like jerky and kibble, so even though there might not be direct interstate coordination of efforts, Lueders says, since “Michigan found salmonella in one brand of pet food, it probably doesn’t serve much practical purpose for us to look at the same brand ourselves. There is an old adage that says an absence of evidence is not evidence of absence, so we wouldn’t continue to test the same pet food for salmonella in hopes of finding more salmonella, or hoping to find that it is clean …”

THE PRICE OF SAFETY
What impact does this have on consumers and the pet food industry— in particular, the raw-diet industry? For an answer to that question, I turned to Melinda Miller, president of North American Raw Petfood Association (NARPA), a trade organization. She acknowledges that positive findings— which she says are likely to increase once the FSMA legislation is fully implemented—have an impact on NARPA members; she also notes that the leading raw-diet manufacturers subject their processes to more vigilance and testing than occurs in any other pet-food sector.

Prior to processing a food in their facilities, suppliers must certify that the food is pathogen-free. Throughout the manufacturing process, pathogens are tested for and eradicated. A few NARPA members use what is known as highpressure processing or high-pressure pasteurization (HPP), which disrupts a pathogen’s cell walls. Miller says that this very expensive system is considered by the general food industry to be stateof- the-art in controlling pathogens.

Companies like Bravo! also batchtest and follow a test-and-hold system, meaning that finished products are not shipped from their plants until negative pathogen reports are in hand. A Bravo! spokesperson described the company’s process: “Most established companies in raw diet own their own facilities. We [at Bravo] come out of the meat business and our facility is a USDA facility for human food, so we have standards we have to keep up. We have a USDA inspector who checks the plant daily to make sure that [things are] being done by the books [and] we have a HACCP [Hazard Analysis Critical Control Points] plan in place. What consumers should be looking for are companies who use ‘test and release’ and batch testing, and have HACCP plans.” He also noted that the company’s website will soon have a function that will allow consumers to enter an item number and “best used by” date and receive test results for E. coli, Listeria and salmonella.

This type of high-level testing increases the cost of the final product; as Miller observes, “you can’t add a whole level of pathogen controls and not have a resulting increase in cost to consumers.”

THE BOTTOM LINE
No business undertakes a recall lightly — it’s the last thing any food manufacturer wants to do. Not only are recalls costly, they have the potential to harm a brand’s image.

But while smaller brands can be devastated by such events, companies who have worked hard and long to develop a loyal customer base can, most likely, recover from them, as can internationally distributed brands such as Natura.

I don’t believe that most of these pet food companies and manufacturers acted recklessly. But after a recall, it shouldn’t be business as usual. Measures need to be taken to identify where the contamination came into the system, and pathogen controls need to be improved. Changes need to be made—for some businesses, that may mean switching manufacturers, raw-material suppliers, warehouses or distributors, or even instructing pet stores on proper handling and storage techniques for their products.

It’s also critically important that they pay attention to how customers are notified (and receive compensation or refunds). For example, I commend Honest Kitchen for quickly alerting its customers via email, social media and website notices. Retaining the trust of customers requires companies to be transparent, forthcoming and ready to make production and sourcing modifications, as they and a few other companies have done.

Realistically speaking, it’s unlikely that the food system can be made 100 percent safe. Nonetheless, we need to know we can trust that those who make the food we feed our companion animals are held to the same standards as those who supply the food we eat ourselves.

Over the years, we’ve become well aware of the concept of food sourcing. In addition to knowing exactly what goes into the food we feed our dogs and cats, we also need to know where it comes from. How the finished products are processed, packaged and distributed is also vitally important. As P&G’s Taylor observed, pathogen elimination is challenging when working with large quantities of raw meat and poultry.

Do some food processors take shortcuts to save money? For some, that might be the case, as evidenced by the huge 2012 recall involving a Diamond co-processing plant in Gaston, S.C. , which ultimately affected 17 brands representing more than 30,000 tons of dry dog and cat food. Because a rare strain of Salmonella infantis was found in some product samples, all brands, ranging from high-end Wellness to Costco’s brand, Kirkland, were recalled. According to the Centers for Disease Control and Prevention, at least 49 people in 20 states and two in Canada who came in contact with pet food made at this facility are confirmed to have been affected. When the FDA inspected the plant, they found numerous problems with the contamination-containment processes, including the use of cardboard and duct tape on some of the equipment. How they got away with this—how they managed to fly under the radar of the companies for which they were making food—is anyone’s guess.

Yet another problem that cries out for better monitoring involves actually getting recalled products off store shelves. A reporter for a Colorado television station found bags of the tainted Chinese jerky in stores such as Safeway, K-Mart and Albertsons almost a month after it had been recalled. I learned about this from attorney Jennifer Reba Edwards of the Animal Law Center in Wheat Ridge, Colo. As Edwards points out, “The bigger problem is [that] once recalled, the products are still getting to the end user. Retailers are not pulling the products from the shelf and you can buy them online; that is almost a bigger problem than the recall itself—preventing it [from] being available to the end user.” Who is responsible for this step? Who should be held accountable? This is definitely a problem to track and one that consumers need to be aware of.

Within the dog community, the issue of salmonella is controversial; some question its potential to harm dogs. However, I don’t believe this is debatable. There are too many instances in which people have been damaged by cross-contamination or mishandling in the home of food intended for pets. The FDA considers it to be an adulterant in both human and animal foods, as well they should. More to the point, as Jennifer Edwards says, “I’m pregnant; I would really be upset if I were to be exposed to salmonella. It goes beyond protecting our animals—we have to protect our people as well.”

If ever there was a reason to look at the big picture, this is it. We have only one food supply, and it should be safe for both humans and animals. This is, and ought to be, the standard that foodsafety regulators, the food industry and we—the consumers—need to meet.

*A Bravo! company spokesperson told me that the product that tested positive had been tested by a third-party inspector before leaving the plant and had a negative-contamination finding. In an unusual step, the FDA allowed that point to be included in their recall statement.

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