Archive for January, 2011

Reasonable Expectations IX: Discussion With Your Vet About What Your Dog or Cat Should Be Eating

January 28, 2011

This is the ninth part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through eight can be found at www.speakingforspot.com/blog.

 

I’ll be straight with you- I’ve been procrastinating writing this blog for a long time. Every time I think about it, I get a queasy feeling in my stomach.  It’s not because I don’t think it’s reasonable for you to discuss your pet’s nutrition with your veterinarian.  It’s super easy for your vet to advise you when to transition from puppy/kitten formulas to adult foods, and if your pet is too fat or too thin and what to do about it. It’s the question of what to feed your beloved four-legged family member that has prevented me from getting excited about sinking my teeth into this blog (pun intended).  For many veterinarians, myself included, this has become a complicated issue and, in some cases, a no-win situation. Consider the following factors and you’ll understand my “dis-ease” with this topic.  When it comes to pet nutrition many people, veterinarians included, hold tenaciously to one or more of the following convictions:

• Processed pet foods (kibble and canned foods) are the best way to ensure balanced nutrition.
• Processed pet foods are the devil incarnate.
• Home-cooked diets are the best way to feed a pet.
• Home-cooked diets are not nutritionally balanced.
• Raw diets promote the best health.
• Raw diets have the potential to transmit serious infectious diseases not only to the pet, but also to the human handling the food and the feces.
• Dogs and cats should eat the same foods every day.
• Dogs and cats should eat a variety of foods.

Now here’s the icing on the cake.  Most veterinarians, myself included, are not nutritionists.  Yes, we understand the benefits of altering diet content to treat disease (a low protein diet is best for kidney failure, novel protein diets may benefit animals with food allergies, avoid salty foods for patients with heart failure), but show us the label from a can of Aunt Hattie’s Healthy Hound Hash (I hope and pray there really is no such product!) that has miraculously enhanced your dog’s vim and vigor, and we won’t be able to tell you with 100% certainty that Aunt Hattie is making a good product. An AAFCO (Association of American Feed Control Officials) seal of approval on the label is reassuring, but not all manufacturers of well balanced diets have gone through the AAFCO approval process.  And there are those who believe that AAFCO labeling is meaningless in terms of assuring good quality. We can enlist help from a board certified veterinary nutritionist to review the label, but this can be an expensive and cumbersome process. To make matters more complicated there is a constant and steady stream of new pet food manufacturers all vying for your pet’s grocery money.

Now can you understand why even thinking about this blog gives me a headache?  Truth be told, I believe I’ve seen examples of the good and the bad that can accompany every genre of pet food.  Dogs and cats have been eating processed foods for decades, yet we all recall the 2007 melamine pet food recall. Do you remember how shocked we were to learn that so many different brands of processed foods were manufactured in the same location?  I’ve seen damage caused by raw diets- infectious diseases and gastrointestinal bone foreign bodies.  I’ve also observed profound improvement in patients’ symptoms in response to the introduction of raw food (when I certainly couldn’t figure out how to make the symptoms disappear by other means).  I’ve seen pathologic bone fractures because of unbalanced homemade diets.  Likewise, I’ve met animals who appeared overtly healthy in spite of eating nothing but an unbalanced homemade diet for years.

So, what’s the answer here? What is a veterinarian supposed to say when their clients ask, “What should I be feeding my dog?” and “What should I be feeding my cat?” As tends to be my style, this blog has gone on a bit too long (you supposedly lose your ability to concentrate after 400-500 words).  So let’s do this- let me know how you think a veterinarian should answer the question of what to feed your pet and I will post a follow-up blog letting you know how I work with this complicated question.  I can’t wait to hear what you have to say!

Best wishes, 

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook  

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

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Graffiti

January 21, 2011

At long last, here is a blog post that will appeal to those of you who love cats (although dog lovers will likely enjoy it as well).  You have been such loyal fans in spite of the fact that I know you’ve felt slighted.  We all hoped there would be a Talking for Tabby published on the heels of Speaking for Spot.  No such luck!  The publishers I’ve spoken with feel that medically oriented cat books don’t sell well.  Here’s the good news – the medical advocacy principles presented in Speaking for Spot  and my blog apply across species lines (including humans).

 

So, for all you cat lovers, this blog’s for you!  I heard a recent story on the radio about a gentleman known as the “graffiti guy.”  Every morning, he heads out into his neighborhood armed with a bucket of paint, rollers, and brushes.  His goal is to cover up the graffiti applied the night before throughout his inner city neighborhood.  Apparently, there is considerable concern for the safety of the “graffiti guy.”  It’s possible that the gangbangers whose graffiti he is erasing might seek retribution against the individual “defacing” their artwork. 

After hearing this story, I began thinking about these gangbangers and what motivates them to post graffiti.  For the most part they are adolescent males (heavily under the influence of testosterone) who spray paint in order to mark their territory.  As a veterinarian, this all feels so familiar!  Think about it- a client comes in, pulling her hair out because her adolescent male kitty (heavily under the influence of testosterone) is spraying all over the house to mark his territory. Only he’s not spraying paint, he’s spraying urine!  The good news for my client is that I have a surefire way to fix the problem. A simple “snip-snip” surgery (aka castration) and voila, the spraying stops.  Now let your imagination run wild.  Are you thinking what I’m thinking?!

Best wishes, 

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook  

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

Dog Auctions

January 12, 2011

I wish I were a fiction writer and the details within this blog were simply a product of my imagination.  Unfortunately dog auctions are a painful and despicable fact of life. As much as I dislike crafting blogs that are “downers” I’ve recognized the importance of educating as many people as I can about animal-related issues that undermine our humanity.  Dog auctions certainly fit the bill.  

 

In case you are unfamiliar with dog auctions let me fill you in.  Envision rooms filled floor to ceiling with crates and cages each housing dogs whose sole purpose in life is to make puppies.  Every dog in the room is identified by the number on the auction tag hanging round his or her neck. There are purebreds of multiple varieties although some might not be recognizable as such given their lack of health care and horrifically overgrown hair coats. And, of course, there are plenty of “designer hybrids” the mutts that are purposefully planned because they are “all the rage” and their litters will garner thousands of dollars.  One would think these rooms filled with dogs would be chaotic and noisy.  In fact the quiet is eerie; these are dogs with broken spirits- too scared to vocally protest and too disassociated from their miserable existences to invite attention from the humans peering into their cages. 

 

Six auctions are held every year in Farmerstown, Ohio.  In fact the next one is later this week on January 15th.  If you happen to live near Farmerstown, I encourage you to attend.  You will be surrounded by puppy mill proprietors who have come to socialize, discuss their trade, and buy and sell “livestock”. There will also be some representatives from breed rescue organizations, hoping to place some winning bids that will alter the dismal fate of as many dogs as is affordable.  Don’t take a camera with you- it will be confiscated.  You see, these are rather covert affairs- journalists and photographers are not allowed.  The photographic images accompanying this blog were obtained via an undercover operation.  At the upcoming Ohio auction 463 dogs are slated to be auctioned.  The dogs bringing the highest prices will be those with proven fertility records; already pregnant bitches are highly valued.  Details about each dog’s breeding behavior and previous litter sizes are provided, but information about basic temperament or breed-specific inherited diseases within the family tree will be   unavailable. 

  

 

 
If you attend an auction in Ohio, be sure to look for and meet Mary O’Connor-Shaver.  You will find her at the peaceful protest that is a visible presence on each and every auction day.  In my mind Mary is a hero, working tirelessly to convince Ohio legislators to ban dog auctions from her state.  I hope you will visit her website www.BanOhioDogAuctions.com.  Mary has been a huge source of information and inspiration for me.  

What can you do to help eradicate dog auctions and put an end to puppy mills?  Here are some suggestions:

1. Boycott puppy mills.  This means never ever purchasing a puppy from a pet store or from an on line source (site and sight unseen).  Visit your local shelter (a surprising number of purebred dogs wind up there) and contact local breed-specific rescue organizations.  If you decide to purchase a puppy from a breeder please take the time to read my article titled “A Dozen Simple Ways To Be Certain You Are Working With a Reputable Breeder” (http://speakingforspot.com/blog/?p=749).
2. If you live in a state that sanctions dog auctions (Ohio, Kansas, Oklahoma, Nebraska, Arkansas, Iowa, Wisconsin, Missouri) write your legislators and appeal to them to stop this madness.  And if there are efforts within your state to create legislation banning dog auctions, please pitch in.  This might involve organizing rallies, writing letters, and gathering signatures of support.
3. If you don’t reside in a state that sanctions dog auctions, write letters to the governors and legislators of the eight states that do.  Let them know you will no longer support their state in terms of travel and commerce until their dog auctions cease to exist.
4. Let your veterinarian know how you feel about dog auctions and puppy mills, and encourage him or her to take a public stance against them.  Goodness knows, they see first hand the horrific health issues and accompanying heartbreak produced by puppy mills.
5. If you are a teacher, educate your students about puppy mills and dog auctions.  Teach them about responsible ways to adopt a dog.  I firmly believe that educating children about these issues is the key success.
6. Please share this blog with anyone and everyone you know who loves a dog, and encourage them to take action. 

My youngest child attends college in Athens, Ohio.  During a recent Parents Weekend visit my husband, daughter and I checked out Petland, the pet store in Athens. We found no fewer than three dozen utterly adorable purebred and designer hybrid puppies- undoubtedly puppy mill progeny.  There were plenty of customers in the store that day interacting with the pups and contemplating adoption. I chatted with the store manager about the Boxer pup on display and asked to see the paperwork documenting if Boxer cardiomyopathy existed in the pup’s family tree.  Boxer cardiomyopathy is an inherited heart condition that prematurely ends the lives of afflicted dogs.  She responded by saying, “No, we don’t have that paperwork but no problem because Petland guarantees full refunds on any dogs that develop symptoms caused by an inherited disease.” No problem for Petland that is…….. 

What are you willing to do to help stop this madness? 

Best wishes, 

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook  

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

Reasonable Expectations VIII: Written Cost Estimates

January 8, 2011

This is the eighth part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through seven can be found at www.speakingforspot.com/blog.

You’ve just taken your best buddy to see your veterinarian because he’s been vomiting for three days and is now beginning to refuse his food. Your vet performs a thorough physical examination with all normal findings, so she recommends blood tests along with X-rays of your dog’s belly.  If these tests don’t provide a diagnosis, she tells you that the next recommended step would be abdominal ultrasound.  Of course you want to proceed with this testing because your dog is a beloved family member and you want him to get better, but do you know how much the recommended diagnostics will cost?  Will you be charged $300, $800,  $1,300? Unless your dog is a “repeat offender” how in the world could you possibly know? Three hundred dollars might be completely within your budget; whereas $1,300 might mean coming up short on your mortgage payment.

Whether you are independently wealthy, barely making ends meet, or somewhere in between, know that it is perfectly reasonable to request a written cost estimate from your veterinarian before services are provided.  Why must you be responsible for asking- shouldn’t your vet automatically offer forth a written cost estimate?  Much to my chagrin, I must tell you that only the minority of vets voluntarily provide written estimates. This was documented by veterinarian/researcher, Dr. Jason Coe and his colleagues. Their research appeared in 2009 within the Journal of the American Veterinary Medical Association.  The article titled, “Prevalence and Nature of Cost Discussions During Clinical Appointments in Companion Animal Practice” documented the following:

• Actual cost is addressed in only 29% of veterinary appointments.
• When cost is discussed, 33% of the time it is the client and not the veterinarian who initiates the discussion.
• Talk related to cost information constitutes a mere 4.3% of the total dialogue time.
• Written cost estimates are discussed during 14% of appointments.
• Written cost estimates are actually prepared and delivered to the client in only 8% of appointments.

Dr. Coe’s research certainly supports the notion that veterinarians are squeamish when it comes to discussing fees for their service.  I must admit it is certainly one of the least favorite parts of my job.  Nonetheless, I consistently provide written cost estimates, particularly if I’ve recommended something other than a single treatment or test, in order to avoid communication snafus and clients who are disgruntled when it comes time to pay their bill. 

Why is a written estimate preferable to a verbal estimate? Written estimates require time and focus. Guaranteed such estimates are far more likely to be accurate than those prepared by the vet using mental math while “on the fly”.  Additionally written estimates avoid uncomfortable conversations such as, “You told me it would be $100, not $300……..” and, “But you never told me you were going to do that……”.   So, please don’t encourage your vet to simply give you a “ballpark estimate” or an estimate “off the top of his or her head.”   I avoid providing such guesstimates at all costs (no pun intended).  Try as I might, I invariably lowball such estimates because of my innate desire to make the cost for my client as reasonable as possible.  And when this happens I end up cutting corners (not a good thing for the patient) and/or having to make uncomfortable phone calls advising clients of added expenses (and I definitely get called into the principal’s office).

It is completely reasonable to receive a written cost estimate before services are provided, but keep in mind, you may need to be the one who initiates this process!  With written estimates everybody wins- communication is so much clearer and there are no surprises when it comes time to collect fees.  Additionally, a written cost estimate provides an itemization for you of everything that is planned for your pooch. Have you received estimates from your veterinarian?  If so have they been delivered verbally or in writing?

Best wishes,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

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

A Different Way to Spay

January 2, 2011

This blog presents an idea that will be new for many of you and may be new for your veterinarians as well.  I thought presenting a novel idea would be a great way to kick of the new year! 

Taking a fresh look at the things we take for granted can be wonderfully enlightening.  Sometimes, the little light bulb overhead begins to sizzle and sparkle, illuminating a new and better way of doing things.  Consider this example- when some savvy veterinarians took a fresh look at performing spays, a surgery we’ve been doing the exact same way for decades, guess what happened!  They came up with a revised technique that accomplishes all of the objectives of the spay surgery with fewer complications!  How cool is that!

Spay is the term used for neutering a female dog.  As I was taught in veterinary school, the medical jargon for spaying is ovariohysterectomy (OVH). “Ovario” refers to ovaries, “hyster” refers to uterus, and “ectomy” means removal of.  In other words, spaying the traditional way involves surgical removal of the uterus and both ovaries.  The objectives of the spay surgery are to render the dog infertile, eliminate the mess and behavioral issues associated with a female dog in heat, and prevent diseases that may afflict the uterus and ovaries later in life.  Thanks to some innovative veterinarians, what we now know is that ovariectomy (OVE)- removal of just the ovaries sans uterus accomplishes these objectives just as effectively as does the OVH.  And, here’s the icing on the cake- removal of the ovaries alone results in fewer complications when compared to removal of the ovaries and uterus combined.

Here’s a simple short course in canine female reproductive anatomy and physiology that will help explain why leaving the uterus behind makes sense. The shape of the uterus resembles the capital letter “Y”.  The body of the uterus is the stem and the two uterine horns represent the top bars of the “Y”.  An ovary is connected to the free end of each uterine horn by a delicate structure called a fallopian tube (transports the egg from the ovary into the uterus).  While the uterus has only one purpose (housing developing fetuses), the ovaries are multitaskers.  They are the source of eggs of course and, in conjunction with hormones released by the pituitary gland, ovarian hormones dictate when the female comes into heat and becomes receptive to the male, when she goes out of heat, when she ovulates, and when her uterus is amenable to relaxing and stretching to house developing fetuses.  After the ovaries and the hormones they produce have been removed from the body the uterus remains inert. The dog no longer shows symptoms of heat, nor can she conceive. Additionally, any chance of developing ovarian cystic disease or cancer is eliminated.

What happens when we leave the uterus behind- is it not subject to becoming diseased later in life?  Here’s the good news- the incidence of uterine disease in dogs whose ovaries have been removed is exceptionally low.  Pyometra (pus within the uterus), is the most common uterine disorder in unspayed dogs, and typically necessitates emergency surgery to remove the uterus.  Without the influence of progesterone, a hormone produced by the ovaries, pyometra does not naturally occur. The incidence of uterine cancer is extremely low in dogs (0.4% of all canine tumors)- hardly a worry, and studies have shown that the frequency of adult onset urinary incontinence (urine leakage) is the same whether or not the uterus is removed during the spay procedure. 

If you are not already convinced that the “new spay is the better way”, consider the following complications that can be mitigated or avoided all together when the uterus remains unscathed:

– Compared to an OVH, an OVE requires less time in the operating room.  This translates into decreased likelihood of anesthetic complications.
– Removal of the uterus requires that the surgeon perform more difficult ligations (tying off of large blood vessels and surrounding tissues with suture material before making cuts to release the organs from the body).  A uterine body ligation that isn’t tied quite tightly enough can result in excessive bleeding into the abdominal cavity and may necessitate blood transfusions and/or a second surgery to stop the bleeding.
– The ureters (thin delicate tubes that transport urine from each kidney to the bladder) run adjacent to the body of the uterus.  If a surgeon is not being extremely careful, it is possible to ligate and obstruct a ureter in the course of removing the uterus.  This devastating complication requires a second corrective surgery, however damage to the affected ureter and adjoining kidney may be irreversible. 
– Removal of the uterus occasionally results in the development of a “stump granuloma”- a localized inflammatory process that develops within the small portion of uterus that is left behind.  When this occurs a second “clean up surgery” is typically required. 
– We know that the degree of post-operative patient discomfort correlates with the degree of surgical trauma.  No question, of the two surgical options the OVH creates more trauma.

European veterinarians have been performing OVE’s rather than OVH’s for years.  In fact, the bulk of the research supporting the benefits of leaving the uterus behind has been conducted in Europe.  Slowly, veterinarians in the United States are catching on, and some veterinary schools are now preferentially teaching OVE rather than OVH techniques to their students.  What should you do if you are planning to have your dog spayed?  Talk with your veterinarian about this article and provide a copy for him or her to read.  Perhaps OVE surgery is already their first choice.  If not, perhaps your vet will be willing to take a fresh look at performing this old fashioned surgery.

Wishing you many blessings for the new year,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

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