Archive for February, 2011

Wacky Tales of Whacking Tails

February 24, 2011

How on earth could a wagging tail be a problem?  Have you ever been around a large, muscular, happy dog who upends flower vases and knocks over beverages on coffee tables with his long vigorously wagging tail?  People living with such dogs literally have to “tail-proof” their homes! Ever been repeatedly slapped across the thighs by one of these wagging whips, and the more you react to the pain the more the dog wags?  Ouch! 

Such vigorous tail wagging can also be problematic for the dog.  By repeatedly whacking his tail against a firm surface such as wall or a table, an open bleeding sore can develop on the tail tip.   The dog’s response is to lick and chew at the site resulting in more inflammation and bleeding. This tail tip trauma isn’t typically terribly painful for the dog so, of course the tail keeps right on wagging.  Only now it’s a live paintbrush spattering speckles of red at the walls, furniture, kitchen appliances, and even nearby humans!  The result is as graphic as a CSI crime scene. 

One might imagine this would be a simple problem to fix.  The fact of the matter is, a bleeding tail tip poses a significant medical challenge. In order to heal, the tail must be immobilized, but how in the heck can you make a dog quit wagging his tail?  You can’t.  And it’s almost impossible to keep a bandage secured on the tail tip.  Most dogs are happy to chew off (and ingest) their tail bandages, and there are no Elizabethan collars large enough to prevent the tongue from reaching the tail tip. I’ve seen other things tried such as temporarily bandaging the tail to the dog’s hind leg so he can’t wag, or 24-hour supervision until the tip heals (a certain way to create a tired and pissed off client).   Besides, even if the tail tip does heal, the dog is going to re-whack it and the bleeding will start all over again. 

So, what’s the solution?  Partial amputation of the tail is the treatment of choice.  The tail revision need not need be as short as a Rottweiler look. Rather, the length should resemble an Airedale or Vizsla tail; still some tail, but short enough to prevent the wagging tip from coming into contact with hard surfaces. As with any surgery, there are potential complications and it is important to discuss them with your veterinarian.  Yes, the look of the dog is forever changed, but the wag will continue as vigorously as ever without altering the color of your wallpaper. 

Best wishes for good health,

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 Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. 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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Reasonable Expectations X: Saving the Best for Last!

February 18, 2011

This will be my tenth and final blog post describing reasonable expectations as they pertain to delivery of veterinary care (parts one through nine can be found at www.speakingforspot.com/blog).  This time, however, the tables will be turned- rather than describing what is reasonable for you to expect of your veterinarian, I am going to discuss what is reasonable for your veterinarian to expect of you!      

© Juli Dell'Era

Here are a dozen reasonable expectations.  By complying with as many as possible, not only will your vet and the hospital staff sing your praises, your efforts will directly benefit your pet’s health- and nothing is more important than that.       

  1. Arrive on time for your appointment. This means being present in the waiting room, not hanging out in the car finishing up your cell phone conversation or meandering with your dog outside the building (please read below about the importance of arriving with a full bladder, your dog’s that is). When you arrive late, not only will you and your pet be shortchanged on time spent with the vet, there’s a chance the staff will remain behind schedule for the rest of the day.  If you and your pet are new to the practice plan on arriving 10 to 15 minutes early to fill out necessary paperwork and be sure to bring all prior medical records including X-rays, ultrasound reports, and laboratory test results. (Old invoices are no substitute for the medical record). If you are tempted to arrive late because your vet consistently runs late, call ahead and chat with a front office staff member who will know if it’s “safe” to arrive after the scheduled appointment time. 
  2. If you suspect your pet has a contagious disease such as an upper respiratory infection, forewarn the staff.  For the sake of other patients in the waiting room, they may recommend that your little snookums remain in the car until it is time for the doc to see you.
  3. Unless instructed otherwise, do your best to bring your pet in with an empty stomach and a full bladder. This means taking the litter box away a couple hours ahead of time and foregoing the popular doggie p-mail spots outside the clinic.  Your vet may want a urine sample for testing and if procedures are recommended, better that breakfast was skipped.  Don’t worry, your dog or cat is unlikely to urinate on the hospital floor and if it does happen, guaranteed there’s a mop in every hospital!
  4. Please turn off your cell phone.  Not only is the ringing phone a distraction, answering it while in the midst of conversation with your vet conjures up adjectives I’d best not mention.
  5. Come prepared to provide a thorough history.  Believe it or not, your observations may provide more clues for a correct diagnosis than the actual physical examination.  In fact a solid history can make the difference between having to run one diagnostic test or five. Do some sleuthing around the home front to make sure there’s nothing unusual your dog or cat may have been exposed to. Your vet will want to know if you’ve observed any vomiting, abnormal stools, coughing, sneezing, decrease in stamina, or change in bladder or bowel habits.  If you don’t deal with “poop patrol” talk to the family member who does!
  6. Bring along all of your pet’s current medications (including supplements, flea control products, and heartworm preventive) so your vet can confirm that everything is as it should be.  At a minimum bring along a written list of what you are giving your pet including the name, strength and frequency of any medications- not just a visual description of the tablet. (Many medications come in the form of small, round blue pills!). Yes, the information is in the medical record, but, you’d be surprised by how often discrepancies are discovered.
  7. Know the name(s) of what you are feeding; in fact bring along a label just in case.  It’s remarkable how often clients can describe the appearance of the bag or wrapper “to a tee”, but for the life of them, cannot remember the name of the product. If the diet is homemade, bring along a copy of the recipe.
  8. Do your best to directly answer the questions asked by your veterinarian, without a lot of embellishment.  For example, if your vet asks if you have been filling the water bowl any more or less than usual, your answer should begin with “Yes,” “No,” or, “I don’t know.” “I give her only bottled water.” or “She absolutely adores water.” is not the answer your vet is looking for.
  9. If your pet is sick, try to have all the decision-makers present at the time of the office visit.  If this is difficult to arrange, the person present should take notes, and even consider audio-recording the conversation.  This is useful since details inevitably get lost in translation, especially when traveling from spouse to spouse!
  10. By all means, let the staff know if your pet is aggressive.  All animals are capable of unpredictable behavior.  A savvy veterinary staff can usually peg aggressive dogs and kitties within seconds of meeting them.  Occasionally one surprises us and bites or scratches- either a staff member or the client.  Everyone feels terrible but it’s made far worse when we learn that the client knew it could happen, but failed to warn us.
  11. Yes, I know it can be awkward, but I strongly encourage you to discuss your financial concerns before services are provided. When it comes to ways to pay your bill, there is no standard veterinary clinic menu, though most accept cash, credit/debit cards, and checks.  Do your homework to find out which ones apply to your facility. What receptionist hasn’t heard, “What do you mean, you don’t take Discover?” 
  12. Treat the entire staff well.  I get really peeved when I learn that a client, who has been sweet as can be with me, has been abrupt, condescending, or rude to one of my staff.  Keep in mind that everyone who works in the veterinary clinic plays an important role in keeping your pets healthy.   They all deserve to be treated with equal respect and without a doubt, the entire staff will know if this has not been the case. 

There, I’ve done it!  I’ve said what all vets long to tell their clients, and I sure as heck hope you’re not offended! Do you think these are reasonable expectations?  Are there others worthy of adding to the list?      

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 Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook      

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. 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.

Pet Nutrition Follow-up

February 10, 2011

If you could see me now dear readers, you would know that I am giving you a standing ovation! I anticipated my recent blog post about what to feed our pets might generate some heated discussion and bullying behavior. I thought I might have to be a cyberspace referee! I needn’t have worried- your comments, which can be viewed at http://www.speakingforspot.com/blog/?p=2048 were all so darned civilized! You reported how you feed your pets and what you’ve learned through your own experiences. No one was even remotely pushy! Better yet everyone agreed, as do I, that there is no single type of diet that is suitable for every dog or every cat. Hats off to you! I’m deeply appreciative.

Now, as promised, I will fill you in on my current philosophy about feeding our pets. I emphasize current philosophy because I am absolutely willing to change what I recommend pending the results of future research. While there is plenty of data telling us which nutrients and how much of them dogs and cats need to grow and maintain good health, there is a paucity of legitimate research comparing how those nutrients are delivered, particularly pertaining to raw versus processed foods.

Keep in mind I am not a primary care doctor (aka, family veterinarian). As a board certified small animal internist, the clients and patients I see are referred to me to address internal medicine issues. Invariably, my clients have already made diet decisions based on discussion with their family vets. My job is to determine if and when I should “rock the boat.” After raising three children and working with gazillions of devoted dog and cat lovers, I’ve learned that it is wise to choose my battles wisely. If a client is clearly devoted to a particular diet for his or her dog or cat, and I am convinced that their choice is causing no harm, I don’t go there. Here are some situations that will prompt me to recommend a diet change.

1. My patient is eating a diet that is not nutritionally balanced. Although this can happen with prepared foods, it most commonly occurs with homemade diets and well-meaning clients who don’t know that diets balanced for human consumption are not balanced for canine or feline consumption. If these clients wish to stick with home preparation, I recommend consultation with a board certified veterinary nutritionist and/or reliable references that provide recipes for balanced homemade diets.
2. My patient is eating a raw or processed food diet of dubious origin. If I am unfamiliar with the brand of food I encourage my client to share the package label with the family vet or me so we can provide a better sense of whether or not the food is of good quality and nutritionally balanced. For example, I am not keen on pet foods produced by the neighborhood health food store. How can such a business possibly have the financial resources and knowhow needed to create a quality pet food product that is nutritionally balanced?
3. My patient is eating a raw diet while receiving medication or fighting a disease that causes immune system dysfunction (i.e., their immune system is on the fritz). In this situation I recommend discontinuation of the raw diet. While there is no data (yet) comparing the incidence of raw diet-induced infections in healthy versus immunocompromised patients, there is data that clearly documents increased numbers of disease-causing types of bacteria in the feces of animals fed raw animal protein. Until proven otherwise, I am concerned that my immunocompromised patients are at higher risk for developing raw protein-induced infections. And this simply isn’t a chance I want to take. Please know that some veterinarians feel differently about this, and in fact, believe ingestion of raw meat will help bolster the immune system.
4. My patient has a medical issue that would best be served by a change in diet. For example, I will encourage diet transition for the patient with kidney failure who is eating a high protein diet, the diabetic kitty who is eating dry food only, or the obese patient with arthritis who is eating a high fat diet.

I firmly believe that most of our dogs and cats can thrive on a variety of different foods/diets as long as they contain high quality ingredients and are nutritionally balanced based on life stage (puppies/kittens, adults, and seniors all have different requirements). Whether you choose to feed a homemade diet or prepared raw or processed food is a personal choice; just as shopping for yourself at Whole Foods versus Safeway (the main grocery store chain in northern California) is a personal choice. Whichever style of diet you choose for your pets, your goal is to ensure you are feeding a high quality, balanced product. Here are some suggestions to help you hone in on some good choices amongst the literally hundreds of products at the pet food grocery store!

• Shop at your local independent pet food store. Yes, the prices may be higher (quality pet food is expensive), but the sales people you encounter are far more likely to be knowledgeable than those working at the big box stores. Additionally, pet store shelf space is limited so the brands of food stocked there will be those the staff truly believes in.
• Learn what to be looking for when you read the food label. The best resource I’ve found for teaching this is The Whole Dog Journal. Your dog and I strongly encourage you to get a subscription as soon as possible (http://www.whole-dog-journal.com) ! Editor, Nancy Kerns provides her readers with plenty of practical wisdom about canine nutrition. In fact the February 2011 issue contains a fabulous article called, “Choices, Choices- On What Criteria Do you Base Your Dog’s Food Selection?” Be forewarned, there is some nepotism going on at WDJ- you will find at least one picture of Nancy’s dog Otto in every single issue! Now, if only Nancy would begin working on The Whole Cat Journal!
• The American Animal Hospital Association Nutritional Assessment Guidelines for Dogs and Cats can be found at http://www.aahanet.org/resources/NutritionalGuidelines.aspx. There is a lot of valuable information here. By the way, at the top of the page you will see that a major pet food manufacturer provided some funding for these guidelines to be made available in French, Japanese, and Spanish. Please don’t let this deter your learning.
• Talk to your veterinarian, let him or her know what you’ve learned, and discuss your pet food preferences.

As always, I welcome your comments!

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.

Videotaping for Your Vet

February 1, 2011

Rarely am I bothered by client misbehavior, but when a client answers their cell phone while we are in the midst of discussion, I admit to feeling a bit peeved. So why in the world would I invite my clients to whip out their cell phones during the course of an office visit? Because I want to see video of my patients’ symptoms! Unless you are like me- still using a cell phone that my daughter considers prehistoric- your cell phone allows you to have instant access to shooting video. And if I can watch videotape of your pet’s confusing symptom or odd behavior, I’m more likely to figure out the underlying issue, more so than with just your verbal description (no offense intended). And when I have a better sense of the underlying issue, I can more expediently, and often less expensively, guide you towards rational diagnostics and/or therapy.

Unless the odd behavior or new symptom is occurring round the clock, the likelihood of it happening in my exam room is slim to none. You’d be surprised what symptoms fully resolve when animals are under the influence of adrenaline. So, if your dog or cat is doing something bizarre that you think will be difficult to accurately describe to your vet, I encourage you to grab your cell phone and shoot a video (feel free to include some Jacques Cousteau narration if you like). By all means, nix the video if you sense you are observing something that is life threatening, and get to the nearest veterinary hospital ASAP.

Here’s a classic example of how videotaping a medical problem can be wonderfully helpful. A common symptom in dogs is referred to as “reverse sneezing.” It occurs when a dog feels a tickling sensation in the back of their throat. It is somewhat equivalent to a person clearing their throat. However, when dogs reverse sneeze, the symptoms appear ridiculously overly dramatic. They assume a stiff posture with head and neck rigidly extended forward. This is accompanied by forceful, noisy inhalation and exhalation that can last for several seconds, even minutes. Check out the example of reverse sneezing in the video below.

For the uninitiated, reverse sneezing is a scary thing to watch- clients commonly report that they think their dog is having an “asthma attack.” Show your vet a video of reverse sneezing and he or she will be able to recommend what to do about it as well as provide plenty of reassurance that, no matter how dramatic the symptoms appear, they are not causing any oxygen deprivation. As much as video is helpful in this situation, I must admit I will miss watching my clients trying to imitate reverse sneezing (oops- I just revealed one of this veterinarian’s dirty little secrets)!

Here are some examples of other behaviors/symptoms that should prompt you to grab your cell phone and shoot some video (if you can think of others, please let me know):

1. Weakness
2. Trembling
3. Incoordination
4. Falling down/collapse
5. Episodes of pain
6. Symptoms associated with passing urine or stool
7. Making odd noises (in this situation audio taping is a must along with video)
8. Coughing (again, adding audio is great)
9. Labored breathing
10. Limping/lameness
11. Odd behavior

Have you ever shared video with your vet? If so, did it prove to be beneficial in making decisions about how to proceed?

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.