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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.

Wellness: Health Care
Canine Orthodontics
Orthodontics—braces—are actually the most gentle way of dealing with a malocclusion.
Canine Orthodonics - Maxwell

Wilbur, a four-month-old Dachshund with a dash of Papillon or Chihuahua in the mix, was to be my first foster pup. A standout at the shelter, his irresistible face and personality sealed the deal. Once I got him home, I noticed that his lower jaw was considerably shorter than the upper one. Although he appeared to be almost chinless, it made his smile more pronounced. No big deal, I thought— he’s so adorable.

Two months later, I had him neutered, and when I picked him up, a handwritten note attached to his aftercare instructions suggested that he should be seen by an orthodontist immediately. My first response, like that of most people unfamiliar with this veterinary specialty, was one of disbelief. I thought perhaps it was some kind of joke. But no. According to my vet, Wilbur had a malocclusion that required treatment —the sooner the better.

Luckily, in nearby Pasadena, Calif., I found Jennifer Lynn, DVM, who has dedicated her practice exclusively to canine and feline dentistry for the past 15 years. Dr. Lynn explained Wilbur’s Type II, base-narrow malocclusion to me. His mandible (lower jaw) was much shorter than his maxilla (upper jaw), resulting in what most people refer to as an overbite. In growing pups, the jaws sometimes develop at different rates, but Wilbur’s situation was so extreme that there was no chance of the lower jaw ever catching up.

This was more than an issue of looks. His mandibular canines, which normally wing out in front of the maxillary canines, were not only behind them, but were linguoverted—that is, angled inward toward his tongue. Since his permanent teeth were still erupting, they hadn’t had time to do damage, but eventually, this misalignment could prevent him from closing his mouth, as well as injure his palate. The good news was that, treated early, the teeth could easily be shifted to give Wilbur a healthy, comfortable bite.

Why not just pull them? According to Dr. Lynn, canine teeth are important. Their roots are roughly double the length of their crowns, so removing them requires oral surgery and, sometimes, a bone graft. Lower canines make up a good portion of the chin, help hold the tongue in place and are used for grasping.

What about crown reductions? In cutting the crown, the tooth’s pulp is exposed. A small portion of the pulp is removed and the top of the tooth is shortened and reformed. Called a vital pulpotomy it’s not without potential complications, and needs to be monitored with annual dental X-rays.

Ball therapy is another option. Teeth can sometimes be moved into place in response to pressure generated by the dog chewing on an appropriately sized rubber ball for fifteen minutes three times a day. If, like Wilbur, the dog has no interest in anything that’s not stickor bone-shaped, then you don’t get to try that approach.

Orthodontics—braces—are actually the most gentle way of dealing with a malocclusion. Rather than surgically removing the teeth, they are carefully coaxed into position.

So, on to braces, and yes, they do come with rubber bands, or elastic chains, as they’re also called. With Wilbur under anesthesia, buttons were cemented to the lower canines and molars at the back of his mouth. Guided by composite extensions, pressure supplied by elastic chains attached to the buttons would gradually shift his teeth to the desired position.

Keeping the elastic chains intact proved to be the biggest challenge. Almost daily, Wilbur managed to dislodge one while chewing on found objects. I became an expert on reattaching them. Once, he managed to pop off a button, and had to be anesthetized so a new one could be put on. Thankfully, treatment is of short duration, two or three months on average. Wilbur didn’t require a retainer, though some dogs do. Once everything’s in place, it tends to stay that way because the dog’s normal bite acts as a natural retainer.

Others I spoke with have had equally positive experiences. Following the devastating loss of a beloved dog, and much searching, Brenda Lyum and her husband, Mark, of Simi Valley, Calif., brought home a Brittany Spaniel puppy, whom they named Abbey. During their first vet visit, the doctor took one look at Abbey’s mouth and commented that her severe overbite, a genetic defect, was reason to send her back to the breeder. But the Lyums were committed to caring for their new companion, and Brenda and Abbey made weekly visits to Dr. Lynn’s office, an hour-and-a-half drive each way.

During Abbey’s treatment, everyone, including those at the referring veterinarian’s office, marveled at the five-month-old puppy’s orthodontic appliances, which included a palatal expander with acrylic splints on both sides in addition to buttons, chains and composite extensions. They were amazed at what could be done. At a price not significantly different from the cost of extraction surgery, the Lyums were able to save Abbey’s teeth. Unlike rambunctious Wilbur, Abbey kept everything in place until her corrections were complete.

Dr. JP Gonzalez-Torres, a general dentist (for humans), was surprised to find that Piper, his 10-month-old female Wire Fox Terrier, could be treated for a malocclusion resulting from a retained primary, or persistent deciduous tooth. When his veterinarian recommended that he take Piper to Dr. Lynn, Dr. Gonzalez-Torres was intrigued. “As a dentist, I got really excited about the idea of a pet orthodontist. I didn’t know they existed. We were able to correct the issue in a relatively short period of time. Piper did great throughout treatment. For those who question it, the price can be steep, but the end result is amazing. If you can correct a dental issue that could affect the life of your pet, wouldn’t you do it?”

Board-certified veterinary dentists Dr. Anson Tsugawa and Dr. Kristin Walker, who specialize in oral surgery for trauma, fractures and conditions such as oral cancer at Dog and Cat Dentist, Inc. in Los Angeles, believe that every dog is entitled to a comfortable bite. On occasion, however, they have had to explain that veterinary orthodontic techniques are performed only to improve function, for comfort and to eliminate traumatic damage to the mouth, not for cosmetic reasons. In fact, the AKC does not allow dogs who’ve had “work” done on their inherited dentition to compete in confirmation trials.

Because older animals may take longer to treat, dogs should be evaluated as early as possible to prevent or correct dental problems. To avoid complications, multiple visits are required as treatment progresses, so proximity to the dentist is important. For those who must travel long distances and would appreciate fewer appointments, Dr. Tsugawa says some dogs can be fitted with an appliance that their guardian can tighten with a little wrench. Or sometimes, a mold of the dog’s teeth is sent to PetAlign, a New York company that fabricates a series of five or six progressive aligners that can be changed at home. Since each dog’s mouth is unique, a dental specialist or boardcertified veterinary dentist is the best judge of how to proceed.

While Wilbur’s treatment was successful, my fostering was not; he became a permanent part of the family the moment he first scampered through our door. And on our walks, his captivating smile continues to charm and start conversations with every person we meet.

Wellness: Health Care
Arthritis in Senior Dogs
What can be done?

As our pets age, you may begin to notice subtle changes in their movement, such as having a little difficulty going up or down the stairs, or seemingly slow to rise from a comfortable laying position.  These can be early signs of arthritis, and early intervention is critical to slowing progression of the disease.  I am currently experiencing this “slow down” with my 11 year old Dobie, and I thought it would be good to share some suggestions that you, too, can consider if you have a pet that is living with some degree of arthritis.

Like any lifestyle change, one of the most important things to do first is to ensure that there are no other causes for the changes you are seeing in your pet. An intermittent and subtle slow down can be caused by many things, such as a low thyroid level or even a slowly bleeding tumor on the spleen. X-rays, a urine sample and blood work are important to ensure the overall health of your pet before starting any treatment plan.   

Today, there are a number of effective pain medications that are available to our pets, and a multi-modal approach to pain management is the best way to go.  By using pain medications that address various pain pathways, you get more complete and synergistic pain management while actually using lower doses of medications.  A cornerstone of arthritis management is a non-steroidal anti inflammatory, or NSAID. This provides excellent pain management in the early stages of arthritis, and then as the disease progresses, additional “layers” of pain management can be “added on.” These medications include such options as gabapentin, tramadol, and amantadine, with each one working to enhance the other.

Adequan is another medication that has been used in pets with degenerative joint disease or traumatic events such as a torn cruciate ligament. It works to help slow down the rate of decay of cartilage as well as stimulate new collagen and hyaluronic acid, a lubricant in joints. This is an injectable product that can be taught to be given at home underneath the skin and is initially given twice weekly for three to four weeks and then, once monthly. By the fifth or sixth injection, most pet parents usually see a more comfortable and agile pet.

Supplements such as glucosamine, chondroitin and omega-3 fish oils are good additions to managing arthritis changes. These supplements provide your pet's joints with building materials to help rebuild their cartilage and decrease the inflammation in the joints. Supplements are not an overnight fix, and they generally take at least six weeks before improvements can be seen. Products can be purchased over-the-counter and do not need to be labeled specifically for pets.  However, not all nutrapharmaceutical products are FDA regulated, and there is quite a bit of discussion with regards to bioavailability between various brands; this is a case where cheaper is not always better and I would recommend purchasing only high quality and trusted brands.  Your veterinarian can make recommendations for you. The standard dose for glucosamine/chondroitin is approximately 10 mg per pound of body weight once a day, for which you can round up or down to make tablet division or multiplying easiest.  For example, a 20-pound dog could take half of a 500 mg tablet daily (250 mg), even though its “recommended” dose is 200 mg. Also, when you are considering fish oil, you want to be sure to base it on the omega-3 concentration of EPA. The dose is 20 mg EPA for every pound of body weight once daily, and for example, our 20-pound dog would need 400 mg EPA daily.

Another area of extreme importance is your pet’s body weight.  I have to admit, I am a little guilty of letting this area slip and my boy and I recently went through a five-pound weight reduction program (I couldn’t let him “suffer” alone). How can you tell if your pet is a little too chubby? You should be able to easily feel your pet's ribs and backbone beneath the skin; if you cannot, then your pet may be overweight. Excessive weight is an added burden for already compromised joints, and you may be amazed how much better your dog will feel simply by shedding a few pounds. I can already see a difference in the way Bauer prances around.

Continued activity is also important—the old adage, “if you don’t use it, you lose it,” holds true for our pets, too. Working to keep up your pet’s muscle mass through activity can help provide stability and flexibility to joints.  Low-impact exercise is best, such as long walks and swimming, and both are highly encouraged.  

There are also newer concepts of arthritis management. One such treatment is known as Stem Cell Therapy. This is a procedure in which adult stem cells are injected into the arthritic joints, or into damaged ligaments and tendons, to aid in healing and repair. While continued studies are still needed, there are many reports of pets responding well and this therapy holds promise.  Joint replacement is a surgical therapy and has been proven to be very successful. As an example, 95% of canine patients with hip replacement can return to normal function. There has also been the development of dedicated rehabilitation centers for pets, which are becoming more widely available as the demand for options grows. Trained professionals can offer additional treatments such as hydrotherapy, acupuncture, chiropractic, massage, physical therapy, cold laser therapy, and pulsed signal therapy. Complementary treatments can offer your pet a complete approach to management of its arthritis, and many of these singular modalities, such as acupuncture, are often offered by veterinarians in general practice. These newer approaches to arthritis management are areas that I can discuss in greater detail in another blog, if there is any interest.  Let me know!

 

 

 

 

 

 

 

Wellness: Healthy Living
Time to Beware of Foxtails
Tips on keeping your dogs safe
Foxtails and Dogs

It’s the season, in California and in other states, when foxtails are starting to rear their “ugly” and dangerous seed-heads. These days after our morning walk, and before I load the dogs into the car, I do a complete check-up on them. I need to comb Lola, because she has a shaggy, wired coat, and her high-leaping, coursing style of recreation, attracts burrs, seeds, and unfortunately the worst of them all, foxtails. Checking each toe, paw pads, nose, ears, eyes—I also pat around the other two short hair dogs, attention that they really enjoy. Here are two wellness articles from our two vet bloggers, Shea Cox and Nancy Kay, that will tell you everything you might need to know about keeping your dog safe from these flora pests. There was also a good article in Gun Dog magazine back in 2010. What that piece shows is that foxtails are spreading to other areas of the country.

P.S. A couple days after posting this blog, Charlie, my little Terrier, got one up his nose. Poor guy, he sneezed like mad, and then stopped. Some people believe that the stopping means a dog has expelled the foxtail through sneezing, but unfortunately that is not usually the case. Only means that the darn thing has moved further up the nasal passage. It is always wise to have a vet check it out.

Wellness: Health Care
Bromethalin: not all blue-green rodenticides are the same

In 2008, the Environmental Protection Agency announced that it planned to restrict sales of certain rodenticides containing second-generation anticoagulants (such as brodifacoum and bromadiolone) to pest control professionals and agricultural supply stores only. Rodenticide manufacturers came up to speed with compliance in 2011, and  in doing so, began using bromethalin more and more instead of anticoagulants in their products. 

While the change was designed to make rodenticides safer for our children, pets and wildlife, there has also been some devastating consequences. Unlike anticoagulant rodenticides, bromethalin does not have an antidote, and there are still many people and veterinarians that are not aware of its toxicity. There has been an uptick in the number of cases treated since these regulations have been put in to place, and this toxicity is once again being highlighted in veterinary publications in hopes of raising awareness.  

If a dog had ingested a rodenticide in the recent past, it was very likely a D-Con-like product. Anticoagulant toxicities are relatively easy and cheap to treat if caught early as  there is a 2-5 day lag time before bleeding actually happens. This type of exposure can also be diagnosed with a simple blood test, known as a PT test, which checks the clotting time of the blood and confirms exposure if it was not witnessed.

This is not, however, the case with bromethalin.  Bromethalin is a neurotoxin which affects the cells in the brain by causing a rapid influx of sodium particles into its cells.  When this happens, body water follows the sodium particles and leads to swelling in the central nervous system. The symptoms come on much faster and neurological signs can be seen within as little as 2 hours of ingestion. These signs can include depression, a “drunken” gait, rigid limbs, seizures and coma. Because there is no antidote, treatment is aimed at decontamination, intensive, and expensive hospitalization for support of the body and treatment of clinical signs if they develop.

I am sure many people are thinking, “Who would keep this stuff around when you have pets?!” I often have the same thought, but you would be surprised by the number of dogs we treat for this toxicity.

Here is the take home message: 

  • Severity of signs are dose-dependent, and if the poisoning is discovered within 30 minutes to an hour of ingestion, you should attempt to induce vomiting at home* if you are not close to a veterinarian; this will lessen the amount in the body, and therefore lessen the severity of signs
  • Despite how little was ingested, always assume worst case scenario: your pet should be hospitalized on IV fluids for at least 24 hours, during which time multiple doses of charcoal will be given as well as treating for any brain swelling that develops
  • Always bring in any packaging to your veterinarian to help facilitate rapid treatment
  • The lowest average lethal dose of bromethalin for dogs is 2.38 mg/kg, meaning a 10 pound dog could die from ingesting 5 small cubes of bait- not an uncommon feat
  • If at all possible, avoid the use of any rodenticide if you have pets or children

 

* If you need to induce vomiting at home, you can administer 1 ml of hydrogen peroxide per 1 pound of body weight with a maximum of 45 ml being given. For example, a 10 pound dog would need 10 ml of hydrogen peroxide and 80 pound dog should get no more than 45 ml. Trying this at home is not without risk and there are words of caution to consider: ONLY attempt to induce vomiting if your pet is very alert and if you are further than 1 hour away from your veterinarian.  Also, do not "force" the peroxide in—your pet needs to swallow the peroxide, and because it tastes bad, there is a risk of your pet aspirating the peroxide into the lungs if they are resisting and it is being forced.  Another concern is the potential for aspiration during the vomiting process. Aspiration of peroxide during administration or through the process of vomiting leads to additional problems such as pneumonia. Another note: don't waste time waiting to see if your dog will vomit... gently give the peroxide, grab a blanket to cover your car seat, and begin driving immediately to your vet. 

 

 

 

 

 

Wellness: Health Care
Hops Can Be Lethal to Dogs

Home-brewing is a trend that is becoming more and more popular, and unfortunately, so is the occurrence of hops toxicity in dogs. Hops is the plant used in the process of brewing beer, and both the 'raw' or spent hops are toxic. True flowers or dried hops plugs tend to be more toxic than hops pellets (pellets have less residue), while wild hops have been found to be non-toxic. The diagnosis is generally made based on history of having home-brewing supplies as well as seeing hops in vomit.

The mechanism of toxicity is unknown, but may be related to essential oils, resins, phenolic compounds, or nitrogenous constituents within the plant. Many of the substances in hops are degraded or aerosolized during the brewing process, so the exact relationship between substance and toxicity remains unknown.

Clinical signs of toxicity can include agitation, panting, excitement, flatulence, rapid heart rate followed by life-threatening elevations in body temperature. Death has been reported in as little as 6 hours without appropriate treatment. I have seen rectal temperatures greater than 108 F, and these temperatures can be very difficult to control. The high end of normal of a dog’s temperature is 102.5 F, and any temperature above 106 F can lead to an “unwinding” of the body’s proteins as well as permanent brain injury, depending upon the length of time that the elevation in body temperature persists.   

Treatment consists of aggressive decontamination measures including induction of vomiting, gastric lavage (“washing out” the stomach under anesthesia), administration of charcoal, and enemas. Active cooling by any means available is extremely important. There are also specific medications that can be given in the hospital to help control the clinical signs.

Prognosis for survival is generally guarded to poor, and unfortunately, many deaths have been reported. We have had 2 cases of hops toxicity this past year in the ER, and thankfully, both survived with aggressive treatment.

Any breed of dog may be affected, but breeds that are predisposed to malignant hyperthermia (extreme elevation of body temperature for an unknown reason) tend to be more susceptible.  These breeds include Greyhounds, Labrador Retrievers, Saint Bernards, Pointers, Dobermans, Border Collies, English Springer Spaniels, and northern breeds.   

If you suspect your dog has been exposed to hops, seek veterinary care immediately! This is not something that can be managed at home. Quickly take a rectal temperature, and if it is found to be greater than 105 F, begin active cooling measures—such as dousing your pets body with cool water and wrapping icepacks in towels and placing them over its body—in addition to running the air conditioning in car while on your way to your veterinarian or local emergency clinic. This measure could help save your pets life and give him or her the best chance for survival.

 

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