A story from the New York Times brings up a different twist to a quandary that many might have to face. If a senior dog needs surgery how much is too much to extend a pet’s life? The twist is that the dog didn’t belong to writer Roz Warren. It was Max, her son and his wife’s 13-year-old dog, who needed the gall bladder surgery costing $6,000—and it was Roz who offered to pay a third of it.
We didn’t want to let Max go. We wanted to try to save his life.
Was this crazy? “Would you pay $6,000 for a 70 percent chance of buying two extra years of life for an elderly dog?” I asked my dog-owning friends.
“In a heartbeat,” one said.
“No way,” another said. “When it’s time to go, it’s time to go. You grieve. Then you get another dog. Preferably from a shelter.”
Another friend admitted that when the vet told her a couple of years ago that her ailing Shih Tzu needed an expensive procedure to save his life, she had blurted: “Do whatever you have to do! I love this dog even more than I love my husband!”
“And I really do love my husband,” she told me sheepishly.
Luckily all went well with Max, even though the surgery found that his gall bladder had already ruptured, he recovered.
Even if he hadn’t made it through, knowing that we had done all we could for him would have been worth that price. More important, the whole experience has made me very hopeful about how Tom and Amy are likely to treat me when I’m old and frail.
That was a great gesture for a dog-grandmother to make. What do you think you would have done?
News: Guest Posts
Am I feeling frustrated and disappointed? You bet I am after reading an article titled, “Vets Slowly Move to 3-Year Vaccine Protocols” in the most recent edition of Veterinary Practice News. According to the article, approximately 60 percent of veterinarians continue to over-vaccinate their adult canine and feline patients by administering “core” vaccinations annually. This in spite of the fact that, for a decade now, it has been public knowledge that these vaccines provide a minimum of three year’s worth of protection.
Current canine and feline guidelines recommend that adult dogs be vaccinated against distemper, parvovirus and adenovirus, and adult cats against panleukopenia virus, herpesvirus and calicivirus no more than once every three years. Bear in mind, these are not rules or regulations (although I wish they were) they are simply guidelines. With the exception of rabies (mandated by state governments) veterinarians can vaccinate as often as they please.
The risks of over-vaccinating
Why some vets continue to over-vaccinate
The second explanation provided for over-vaccinating is that veterinarians don’t want to interrupt the revenue stream derived from annual inoculations. Despicable, in my book!
A possible third explanation is that some veterinarians remain unaware of current vaccination guidelines. If so, they must be living under a rock and begs the question, why would you want such an “outdated” individual caring for your pet’s health?
What you can do
- Stand your ground! If your vet insists on administrating core vaccinations to your adult pets every year, share a copy of current canine and feline guidelines. You may need to agree to disagree and/or find yourself a more progressive veterinarian. Remember, you are your pet’s medical advocate and you have the final say so!
- Bring your pets in for a yearly checkup, whether or not vaccinations are due. I cannot overstate the importance of an annual physical examination for pets of all ages. It’s a no brainer that the earlier diseases are detected, the better the outcome. The annual visit also provides a time to talk with your vet about nutrition, behavioral issues, parasite control, and anything else that warrants veterinary advice. Enough people bringing their pets in for annual wellness exams may convince more veterinarians to revise their vaccine protocols in accordance with current guidelines.
- Spread the word by sharing the information in this blog post with your pet loving friends and family members.
To learn more about vaccinations, I encourage you to read “The Vaccination Conundrum” in Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life.
How frequently are your adult pets receiving their core vaccinations?
Wellness: Health Care
Treatments to try at home
Paraphimosis is the inability to retract an extruded penis back into the preputial sheath, which is the skin that covers it. This can quickly turn into an emergency situation, as constriction of blood flow will lead to greater engorgement, necrosis (dying off of the tissue), and potential damage to the urethra.
More common causes of this condition can include chronic licking, sexual excitement, or foreign bodies getting up under the skin. However, there are more serious causes including neurological disease (such as a herniation of a disc in the spinal cord), penis fractures, or muscular issues. Paraphimosis also needs to be differentiated from priapism, which is a state of continuous erection, usually due to a neurological problem.
A diagnosis of paraphimosis is generally based on simple observation of the penis extruded from the prepuce without any physiological reason. Paraphimosis accounts for approximately 7% of penile problems in the dog, and while not common, it can cause distress to pets (and their owners) and can have more serious consequences if left untreated or if it becomes a recurring issue.
Treatment is generally conservative in nature, and many of these interventions can first be tried at home. Here is what you can do if this condition if noted in your pet:
News: Guest Posts
He didn't run like a puppy; he flopped like a seal. His back hunched when he moved as if he was stalking stray sheep. Lucas was born with his front legs curved inward, hobbling his every step. In February, he arrived at Glen Highland Farm's Sweet Border Collie Rescue in Morris, New York, run by Lillie Goodrich and John Andersen. His new caretakers were smitten with him. But what good was their 175 - acre wooded, stream-filled sanctuary to a badly handicapped pup?
Worse, Lucas didn't seem to know he had any limitations. He tried to run and play as hard as any three month old pup; even though all of the bones in his elbows were displaced and separated, leaving him with no range of motion. His rescuers struggled to find solutions when veterinarians offered little hope. A canine cart? The “wheelchair” option led them to consider euthanasia. With his energy and powerful herding drive, Lucas might as well be imprisoned.
The traditional way of reconstructing limbs is to cut bone and utilize biomechanical devices, such as pins and screws, to hold the bone in place as it heals. In Lucas's case, a traditional approach could help, Dr. Hayashi says, but his deformity was so severe that “there is no ideal treatment.”
The chosen procedure would focus on stretching and adjusting the position of the muscles in order to reposition the bones. The method, which is inspired by a few veterinarians, including one from Cornell, doesn't replace other techniques, Dr. Hayashi says. “It's not very different from any other surgical procedures in principle,” he says. “It is a modification” of existing techniques used in other types of deformity. “Each case is different. Each deformity is different.”
Lucas's defect is “very rare,” the surgeon says. While the cause is unknown, genetics probably play a role.
In early March, Lucas underwent the operation at Cornell, where he is now in the first phase of physical therapy. Everything went well, but it's still too soon to gauge its success. “Lucas is still recovering and is fighting this tough battle, and he will probably need to go through more procedures,” Dr. Hayashi says.
His rescuers anxiously monitor his progress. “The process will be a slow one since he has never stood upright on his front legs and has no muscle development” for such movement, Lillie Goodrich says. “His attitude is terrific and he is truly loved by all the team in the hospital. This first two weeks is a vulnerable time when the therapy is critical. Then he returns to the farm for continued therapy up until age one.” The costs are extreme and caretaking is only half the job. His rescuers must also raise the funds for his recovery.
However, the future is looking a lot brighter for the once-unlucky puppy, who still has plenty of time to grow into his limbs. “His prognosis for a normal joint is poor,” Dr. Hayashi says. “His prognosis for a happy life is good.”
News: Guest Posts
Should food that has been genetically modified be labeled?
Last November, California became the first state to put the issue on the ballot. Proposition 37, the “Right to Know Genetically Engineered Food Act,” called for such disclosure on the labels of some raw and processed foods sold in stores. It also prohibited them from being advertised as “natural.” And it didn’t give dog chow a free pass.
Although the measure targeted human consumers, the California Sherman Food, Drug and Cosmetic Law applies to both human and animal foods. So any pet food with a detectable level of genetically engineered content would also have to note on its label, “Partially Produced with Genetic Engineering” or “May be Partially Produced with Genetic Engineering.”
That would mean a lot of new label text in the dog food aisle. Over 90 percent of the nation’s soybeans and 85 percent of its corn is genetically modified, according to 2010 data from the U.S. Department of Agriculture. These crops, modified to resist pests or withstand high doses of weed killer, are common in processed foods such as cereals and dog food.
But even with strong consumer support, the label law failed to pass. The organic industry and other advocates were outspent by biotech companies led by Monsanto—the world’s largest supplier of genetically modified seeds—and the food industry, including Big Dog Food. Nestle, owner of Purina PetCare Company and Mars, the maker of Nutro and Pedigree dog food, donated funds to help defeat it.
The Pet Food Institute and Pet Industry Joint Advisory Council argued that the label requirements would increase costs for farmers, manufacturers and consumers alike. Heated editorials appeared on Petfoodindustry.com.
“Putting scary sounding labels on pet food packaging will likely mislead consumers and impact their purchasing choices,” states a “No on 37” Campaign flyer.
In one ad by the campaign, a befuddled-looking man held up a slab of meat and a pet food canister. The line read, “So dog food would need a label but my steak wouldn’t?” The ad aimed at exemptions in the law that might confuse consumers; in this case, that processed beef dog food would be labeled but beef from animals fed genetically engineered crops wouldn’t.
Label supporters say that, given the prevalence of genetically modified ingredients and the scale of the industrial supply chain, a label that covers many of these foods is a good start (for example, dog food with beef which may contain bioengineered ingredients, such as vegetable oils).
Some dog owners already consider mainstream pet food, with its uniform nubs of dry kibble or wet mush, mere canine junk food; fast, convenient, and nutritionally questionable. But are those genetically modified morsels unhealthy in other ways?
The science is inconclusive. A genetically engineered food is a plant or meat product that has had its DNA altered by the insertion of genes from other plants, animals, viruses, or bacteria. The traditional means—plant breeding—allows desired traits to be cultivated, or unwanted effects to be eliminated, over time. Gene-splicing also shortcuts the long process of adaptation and evolution that occurs between food and consumers,
The FDA has ruled that these foods are “substantially equivalent to conventionally produced foods,” and does not safety test them. Unless they contain a known allergen, there is only a voluntary consultation process with developers, who conduct their own testing. But scientists say that the potential for creating new allergens and toxicants in bioengineered foods is there. At the same time, corporate patent rights over seeds limit independent researchers’ ability to study them.
California’s failed initiative calls labels “a critical method for tracking the potential health effects of eating genetically engineered foods.” Dog owners may agree. How would anyone know if genetically altered foods are triggering disease in dogs? Shouldn’t vets know what the pets they attend to are eating?
One thing is clear: it isn’t over. Several states are now working on proposals for their own label laws.
Editor's note: Starting in 2018 Whole Foods will be labeling GMO foods. And even Wal-Mart has been looking at labeling as well.
Wellness: Health Care
A broken toe nail can be a painful and potentially expensive injury for our furry friends, and it is something that I often see in the ER. A common scenario is a pet suddenly begins to limp while out playing, and upon closer inspection, an injured nail is seen. Some nails have just a minor crack with some bleeding, while other injuries put a toenail at a 90-degree angle (ouch!). Because they can be painful or have bleeding, a cracked or broken nail may be best treated by a veterinarian. With that being said, it may not necessarily require an urgent trip to the emergency room. A broken nail may be something you can care for at home, or, depending on the degree of injury, it may be reasonable to wait to see your regular veterinarian in the morning.
So, what to do if your pet is suddenly favoring a paw and/or you see bleeding? First, get a good look at the paw—including in between the toes and webbing—to see if it is a cut, foxtail or other foreign object, insect stinger, or (you guessed it) possibly a broken nail. When doing so, be sure to look closely at the nail bed, as I have seen cracks and injuries in the nail that were actually hidden underneath the fur line, where the base of the nail goes into the toe. There are 3 general “types” of nail injuries: one where the nail has been completely broken off and is bleeding, one where the nail is cracked or broken but is loosely attached, and one where the nail is cracked or broken but remains firmly attached.
Usually, the best case scenario is when the nail is fully broken off and some bleeding is noted. In these cases, bleeding is usually mild but can be worrisome if it continues. These are the easiest types of injuries to treat at home as you generally only need to apply pressure with a gauze or clean cloth to the nail to stop the bleeding. The key is to hold pressure for at least 5 to 10 minutes with no “peeking to see” if the bleeding has stopped before this time is up. It is important to keep your pet calm during this time, as excitement increases blood pressure and works against a good clot forming. If bleeding continues despite applied pressure, you can apply styptic powder (such as Kwik Stop) and resume applying pressure for another 5 minutes or so. If you do not have styptic powder at home, sometimes a little baking soda can do the trick. If the bleeding continues despite these measures, then I would go to the ER rather than wait.
If you do happen to find a nail that is very loose and dangling, then you can attempt to remove it at home. It is important to have someone help restrain your pet safely while you gently try to remove the nearly broken off nail with a quick pull motion. Caution: only attempt removal if the nail is very loose! Think “loose wiggly tooth” like when you were a kid. Also, be careful during your inspection or attempt to remove a loose nail as this can cause a sudden and unpleasant pain sensation in which some dogs may nip or bite in surprise. If bleeding is noted following the removal, you can then use some gauze and light pressure, and/or Kwik Stop, as previously discussed.
Lastly, there is the type of broken nail that would ideally be treated by a veterinarian. These are nails that are cracked, continually painful, may be bleeding, and are still firmly attached. Treatment for these stubborn injured nails is typically some form of sedation with pain medication followed by cutting off the damaged nail just above the level of the crack. Sedation is needed because you are cutting through the very thick part of the nail with a live blood vessel and nerve, which is very painful. This is usually followed by styptic powder application and a bandage that is left in place for about 24 hours. The bandage promotes a day of rest so that a solid clot forms and the minor wound does not continue to bleed if it gets bumped on something. Although these types of injuries require professional care, it is something that can wait to be seen the following day if you are unable to get an immediate appointment with your veterinarian (unless your dog seems excessively painful, then I would not wait).
Whatever the type of nail injury, dogs are very good at keeping the area clean all on their own with licking, and antibiotics are not needed. A little licking is OK, and it is what a dog would do “in the wild” to keep it clean. With that being said, some of our babies get a little obsessed, and their good intentions can actually make the area more irritated by their constant worrying at it. Because of this, you should continue to monitor the area for any signs of redness, increased swelling, cloudy discharge, or increasing discomfort. The development of these complications is rare in my experience, but if noted, then an e-collar, pain medications and possibly some antibiotics may be indicated. No matter what kind of damage has occurred to the nail, it will generally regrow normally in all but a few situations. Sometimes the nail will regrow with a slight curve or different pigment, but usually returns to its normal appearance over several months - kind of like when us humans lose a nail.
As always, it is best to seek veterinary care if you are uncertain about the severity of any injury, but hopefully this may save you an unnecessary trip to the ER if this happens to your dog during a weekend while you are out having fun!
Smiling in Seattle
The design sensibility at Urban Animal, a veterinary office that opened last year in Seattle, is part Airstream and part 1978 Ford truck—both of which practice founder Cherri Trusheim, DVM, owns.
Located in an old medical building in what is arguably the city’s hippest neighborhood, the warm modern space features funky vinyl chairs and second-hand medical cabinets, paint-by-number dog portraits, an enormous vintage print of a cabin in the mountains (the Irish Setter pointing in the grass was added by an artist friend later), and, in the corner, a photobooth.
Yep, a photobooth, and not one of those unsatisfying digital numbers. This booth uses film and dispenses slightly wet prints in four minutes (for $4). It’s here for clients and patients to amuse themselves and perhaps take some of the stress out of a visit, but non-clients are also welcome to pop in for snapshots.
The photobooth isn’t the only unconventional thing about Urban Animal. Dr. Trusheim, who’s worked as a relief vet and at an emergency hospital, has a different plan. In addition to its all-walk-in, open-weekends schedule, Urban Animal has a strong commitment to keeping care affordable, an approach that might include not pushing for the most extreme and costly interventions. In an industry with spiraling costs, these ideas are as surprising as, well, a photobooth in a vet’s office.
Wellness: Health Care
Excessive levels of steroids in the body leading to disease
Hyperadrenocorticism, known as Cushing's disease, is a hormone imbalance that results from excessive cortisol in the bloodstream over a long period of time. Cortisol is produced and stored in the adrenal glands, which are two little glands that “sit” on top of the kidneys and is what is released in times of stress, preparing for a “flight or fight” response. However, if this system goes awry, and a dog's body is exposed to this hormone for a majority of the time instead of just in times of stress, it can become chronically debilitating.
There are 3 main ways that a dog can get Cushing's Disease. The first way is from a tumor forming on the pituitary gland, and is known as Pituitary-dependent hyperadrenocorticism (PDH). These tumors are generally small and non-cancerous, although rarely a cancerous tumor can occur. The pituitary gland is located in the brain and is the “master gland” of the body. One of its jobs is to detect when cortisol levels are declining, and in response, secrete a stimulating substance, called ACTH, that kicks the adrenal gland into gear causing it to secrete more cortisol. When the body reaches normal levels of cortisol, the pituitary gland stops this message from being sent, and production is halted. In the case of PDH, a tumor causes the pituitary gland to go into overdrive, telling the adrenals to produce excessive amounts of cortisol, despite there already being too much in the body. This is the most common form of Cushing's and accounts for about 85% of dogs with disease.
Adrenal gland tumors are the next common cause, account for approximately 15% of dogs affected. This is a situation where a tumor is on the adrenal gland instead of the pituitary, and puts the gland into overdrive. The adrenals begin making excessive steroids all on their own, no longer “listening” to the pituitary when it tells the adrenals to shut off. These tumors are generally larger in size (usually detectable on ultrasound) and both cancerous and non-cancerous tumors are possible. Another problem that can happen with this type of tumor is that the pituitary “sees” that there is enough cortisol in the body, and subsequently stops producing ACTH. As a result, the other adrenal gland (the one without the tumor) becomes shrunken due to nonuse.
The last major cause is what is known as Iatrogenic Cushing's and is the result of the long-term use of steroids, or medications containing steroids. This is not from any inherent disease in the pet's system, but from the effects of the hormones given over the long term. Over time, the pituitary gland perceives that the body is getting enough steroids (thinking it is being produced from the adrenal glands-not knowing it is coming from medications) and quits sending its signal to produce more. In turn, the adrenal glands stop doing their job and also begin to shrink, temporarily loosing their ability to release cortisone on their own should their body require it to do so. This inability to produce steroids naturally in the body can last for several months following the stopping of medication. This is why your veterinarian will instruct tapering doses of steroids instead of an abrupt stop: this gives these important glands time to recover and begin working on their own again.
There are a multitude of clinical signs that can be seen, and as always, can mimic many other disease processes. Signs are generally gradual, and because of this, they are often attributed to “normal aging” and disregarded. The most common signs that are easily observed in pets by their owners are increased drinking and urination, increased appetite (a good reminder that eating well is not always a sign of normal health), a “pot-bellied” appearance, thin skin and sparse hair coat, blackheads and/or darkening of the skin, and loss of muscle mass or muscle weakness. Aside from these symptoms described, advanced or untreated Cushing's disease can also put a dog at risk for the development of bladder stones, diabetes and blood clots to the lungs.
If you notice any of these signs in your pet, a veterinary exam is in order. Your veterinarian can begin the process of testing for the disease, ensuring your pet is appropriately treated. If your veterinarian has reason to suspect Cushing's (based on history, physical exam and initial blood work), it will then be necessary to perform confirming blood tests and ideally, an ultrasound. This is not an easy diagnosis to make, and it requires several specific tests to positively identify not only the presence of Cushing's, but whether the problem is in the pet's pituitary or adrenal glands, as there is a different treatment for each form of disease.
The expected course of disease depends on which type of Cushing's is present, as well as response to treatment. PDH generally carries a good prognosis, and survival time for a dog treated with appropriate therapy is 2 years, with at least 10% of dogs surviving 4 years (this is better than it sounds, as dogs are generally diagnosed at an older age, usually 10-12 years old). Dogs with non-cancerous adrenal gland tumors usually have a good to excellent prognosis; those with cancerous tumors that have not spread can have a fair to good prognosis, making early detection important.
Other tips and sidenotes:
Wellness: Health Care
Dog? Check. Buccal swab? Check. Apply the latter to the former, inside of cheek. Rub for 10 seconds. Voilà. DNA collected.
Until fairly recently, the garden-variety dog owner could only wonder if potential problems lurked in her dog’s DNA. Now, however, it’s possible to know—maybe not everything, but at least the possibilities. Which can be kind of comforting, since it allows you to focus your anxiety where it might be more useful.
As dogs age, they display a number of signs similar to those experienced by aging humans, among them, loss of muscle tone and strength. And, like humans, those symptoms can be chalked up to simple aging. For the prone-to-worry among us, they can also be signs of something more dire, such as degenerative myelopathy, or DM (see Nick Trout’s column in the Spring 2013 issue for more on that).
For answers, we turn to our vets, and increasingly, to science. The Orthopedic Foundation for Animals offers much, much more than insights into a dog’s predilection for, say, dysplasia or subluxations. This nonprofit, which was incorporated in 1966 and began with the mission of evaluating and genetic counseling for those whose dogs were at risk of hip dysplasia, has evolved its objective: “To improve the health and well being of companion animals through a reduction in the incidence of genetic disease.” (They’re also including other companion animals these days, cats, for instance.)
So, when I started noticing hesitations and missteps in my large-breed, 14-year-old dog’s gait, I wasted no time. Going to the OFA website, I was able to request the DNA test for DM, pay for it online and have the kit sent to me. Once I received it, it was comparatively easy to do the cheek swab required (it would’ve been easier with just the tiniest bit more cooperation from the dog in question, but then, that would’ve been out of character). Some DNA tests require a blood draw, which needs to be done at a vet clinic, but many are equally reliable via cheek swab, which pretty much anyone can do at home.
The instructions were simple, as was the return. Within in days, I had a response from the University of Missouri’s Animal Molecular Genetics Lab, where the DNA was evaluated. I was glad to see that the test came back N/N, or no genetic markers for DM. But even if the results had been different, I would have at least known, and knowing is always better. Having this test done also meant I could provide my vet with one more piece of information that he could factor in to his diagnostic consideration.
Another benefit is that by having this sort of evaluation done, you—via your dog—are contributing to the larger body of knowledge on genetic diseases. The samples and associated information about the dog become part of a DNA repository, which may in the future provide answers to some of dogs’ more vexing health issues.
Wellness: Health Care
Q&A with Denis Marcellin-Little, DEDV
Denis Marcellin-Little is an orthopedic surgeon at the College of Veterinary Medicine at North Carolina State University. Over the last seven years, he has been pioneering a remarkable intervention for dogs with missing legs, giving them prosthetic limbs that are permanently attached to their bodies. In the procedure, known as transdermal osseointegration, Marcellin-Little implants one end of a titanium rod into whatever remains of a dog’s leg, attaching the metal directly to the bone. The other end of the metal implant attaches to an artificial foot. So far, he’s outfitted six dogs and two cats with these bionic limbs, and he’s currently preparing three more canines for the procedure. We caught up with Marcellin-Little to ask him what it takes to build a pooch a brand new leg.
Bark: How did you get interested in osseointegration?
B: What kinds of injuries or ailments have your osseointegration patients had?
B: We know each case is a little different, but what’s the general procedure like? When a dog gets one of these implants, what happens?
The patient will get a CT scan, a good orthopedic exam, maybe some radiographs. And then we get to work. We make implants that are customized to the patient—what we call “freeform implants”—that are designed to merge with the bone. The next time we see the patient, we will be ready to do the surgery. By then, we have rehearsed that surgery, we know the implant is a perfect fit on the bone. And then we will do our surgery. We prepare the tissues, then we place the implant on the bone, and then we reconstruct the soft tissues.
B: How do you attach the implant?
B: After the dog heals, you attach some sort of external foot to the prosthesis?
B: Some dogs get socket prostheses, which just slip on over their stumps. What’s the advantage of an osseointegrated prosthesis?
B: How do you think the procedure and approach will improve as time goes on?
One challenge would be to design a foot that is very ergonomic: it’s easy to put on and [take] off, it’s very stable when it’s on, it’s light, it’s strong, it’s wear-resistant, it has good traction. We could imagine that these things could become more sophisticated over time.
I foresee that the process will become more standardized; I also think that it will become more rapid. And, of course, we will know more about it. Right now, we don’t know much—it’s just one case here, four cases there. As you can imagine, the field can be greatly improved. I think it’s going to play a big role in medicine. I spend a lot of time and energy for a few patients that have very big problems, thinking that it will trickle down to other patients in the future. I would like people to know that there are options if a dog is missing a foot or two—or maybe three or four.
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