Back at the Keyboard

© Diane Gerba

Following a brief medical leave of absence I’m thankfully back at the keyboard.  I’d like to draw your attention to a PetConnection blog post I wrote in which I discuss a study that examined the causes of death in more than 70,000 purebred dogs (82 breeds represented).  While some of the data presented was rather predictable (at least for those of us who have worked with the particular breeds studied), some of the findings were surprising and fascinating.  I invite you to check it out- the blog is called “Breed Profiling: What Does it Mean for Your Dog’s Health.” If you are curious to know what the study had to say about your favorite breed, feel free to ask.  I’ll let you know if it was included in the study.

 

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, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

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

People Plan and God Laughs

This is what my grandmother and then my mother always used to tell me, and I never liked it, not one little bit.  It is not a great quote to deliver to a control-oriented person like me. As adults we pretty much figure out that while we cannot necessarily control the adverse events that affect our lives we can control (or at least attempt to control) how we respond to adversity.   

Coco ©Dunja Oertel

Case in point, after some obscenities and a lot of venting to my wonderful husband, I’ve acquiesced to having a second surgery because of a complication resulting from back surgery I had in November.  While I was away from the keyboard then, you got to enjoy some guest bloggers.  This surgery provides less lead-time so I’ve not recruited anyone to fill in. (I shouldn’t be gone for more than a few weeks, unless God laughs, that is!).  If you’re hungry to read I thoroughly recommend the following sites to whet your whistle:  Kathie please make all of the following live links   

– PetConnection Blog (a team of writers, myself included)   

– Fully Vetted by Dr. Patty Khuly   

– Daily BARK (a team of writers)   

– About.Com, Veterinary Medicine by Janet Tobiassen Crosby   

– Pawcurious by Dr. V.   

 By the way, if you are looking for the perfect Mother’s Day gift for a woman who happens to be crazy about dogs, please check out the Speaking for Spot Gives Back Program.  When you purchase your copy of Speaking for Spot (complimentary gift wrap included), the animal-centered nonprofit organization you select will receive $6.00 from the purchase price.  Check it out, and if you don’t see your favorite nonprofit organization on the list, encourage them to contact me.  The program provides easy money, and goodness knows they could probably use it!   

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.

Age is Just a Number

When my clients make decisions on behalf of their senior dogs and cats, they routinely factor in their pet’s age.  I often hear statements such as, “I would pursue a diagnosis if only she weren’t so old.” and “I would treat him if only he were younger.”  When my clients voice such “senior objections” I gently encourage them to consider the situation a bit more objectively by considering their pet’s functional age rather than their chronological age.  For example, it might be far safer for me to anesthetize the vigorous, playful thirteen-year-old Labrador with normal liver and kidney function I evaluated on Monday compared to the debilitated eleven-year-old Labrador with impaired kidney function I examined on Tuesday. Functionally speaking, the thirteen-year-old is, by far, the younger of the two.  When making decisions, savvy medical advocates evaluate the whole package- spryness, organ function, overall comfort, joie de vivre- rather than considering age alone.  Just because a dog or cat is, by definition, a senior citizen doesn’t mean their body is functioning like that of a senior citizen.

I thoroughly enjoyed explaining this point on NPR’s popular show, Fresh Air With Terry Gross. “Terry, you and I could both be 80 year old women in need of knee replacement surgery.  You might be a terrific candidate for surgery, whereas I might be a horrible candidate!”

When making medical decisions, my clients frequently ask about their pet’s life expectancy. Life expectancies for cats and dogs of varying breeds are nothing more than averages.  This means some individuals will never reach “average” and others will far exceed it. 

Here’s the bottom line. If you have a happy, lively, interactive, and agile senior dog or cat on your hands, throw those age-related numbers and averages out the window.  Rather, I encourage you to observe your pet’s overall quality of life, share some nose-to-nose time with your best buddy, look deep into those beautiful eyes, and make important medical decisions based on what’s truly important rather than simply a number.  Have you ever needed to be a medical advocate for a senior pet?  If so, please share your story.

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.

When to Say Yes to a Diagnostic Test

As veterinarians we have access to so many incredible diagnostic tests. They help us uncover medical issues in our patients that, in the past, we could only guess about. How can you know whether or not to say, “Yes” to your vet when she or he recommends a diagnostic test, whether advanced or more basic? Here are my suggestions:  

© Susannah Kay

 

Begin by talking with your veterinarian about all the potential risks and benefits and pros and cons associated with the recommended testing. What will be involved for your dog or cat (sedation, general anesthesia, time spent in the hospital) and what will be involved for you (time, expense)? Most importantly, before making a decision about whether or not to proceed with recommended testing, be sure to ask yourself the following two questions:   

1. Will the results of the testing have the potential to change what I do next?
2. Will the results of the testing have the potential to provide me with some necessary peace of mind?   

If your answer to one or both questions is, “Yes” then it is certainly reasonable to consider proceeding with the diagnostic testing. However, if your answer to both questions is, “No” the testing is impossible to justify. Not only will it be a waste of your money, why on earth subject your dog or cat to a needless test? Remember, satisfying your veterinarian’s curiosity is definitely not a reason to proceed with any recommended testing!   

Here are a couple of real life examples excerpted from my practice life that illustrate how the answers to these two questions help in the decision-making process. Shasta is a sweet as can be twelve-year-old Golden Retriever mix, brought to see me because of vomiting and anorexia (food refusal). When I noninvasively looked inside her belly with ultrasound I found multiple masses within the liver, stomach, and spleen. As I told Shasta’s mom I was 99% certain I’d identified cancer involving multiple organs. Surgical removal would not be an option (disease too widespread) and the only option for potentially helping Shasta would be chemotherapy, that is, if the cancer were of the type that is responsive to chemotherapy. We discussed performing an ultrasound guided biopsy to “name the enemy” and know whether or not chemotherapy might be of some benefit. Shasta’s mom was clear that, depending on the tumor type, she would wish to give chemotherapy a try. She opted for the biopsy procedure (the biopsy results are pending at the time of this writing). In this case Shasta’s medical advocate opted for diagnostic testing because the results had the potential to change what would happen next.   

Here’s a second example- this time it’s Pixel, an eight-year-old mid-sized mutt who presented for coughing. X-rays of his chest revealed multiple lung masses, and I told Pixel’s family that I could be 90% certain that they were malignant growths. I left the 10% door open to the slim possibility of an unusual infectious disease. We discussed further diagnostics including a computed tomography (CT) scan of the chest cavity and aspirate or biopsy of a mass in order to “name the enemy”. With that information we could know whether or not we might be able to provide effective treatment for Pixel. His family members felt certain that if Pixel had cancer they would not wish to treat it. Additionally, 90% certainty that their boy had cancer was good enough for them. Pixel’s people had all the peace of mind they needed and the results of the testing would be highly unlikely to change what they would do in terms of treating their little boy. Pixel went home on a cough suppressant and pain medication and is doing reasonably well for the time being.   

Have you ever found yourself in a decision-making dilemma concerning diagnostic tests for your pets? If so, would answers to the two questions above have helped you make your choice?  

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.

Dogs and Mushrooms: A Potentially Lethal Mix

Donato © Diana Gerba

     

I remember the sad sinking feeling I experienced last August as I read an email from my friend Diana Gerba.  Seeing her email in my inbox initially prompted excitement- oh goodie, more photos and stories about Donato,  Diana’s adorable Bernese Mountain Dog. My excitement quickly morphed into utter disbelief as Diana described the death of her barely six-month-old pup caused by ingestion of a poisonous mushroom.      

Diana’s heart was broken.  As she wrote in her email,     

A special boy, Donato was a silver tipped puppy, a rarity in our breed. With his tail always wagging, he had boundless enthusiasm for life.  He was a happy little chap and was my joy.  He loved me and I him. We were a team ordained by the stars.      

      

Diana and Donato © Peter Nystrom

Every region of the country is different in terms of mushroom flora. Where I live in northern California, Amanita phalloides (aka Death Cap) is the most common poisonous species and grows year round particularly in soil surrounding oak trees.  Ingestion of a Death Cap mushroom causes liver failure (in people and in dogs)- makes sense given the liver’s function as the “garbage disposal” of the body. Symptoms typically include vomiting, diarrhea, lethargy, loss of appetite, delayed blood clotting, and neurological abnormalities.  Every year at my busy hospital, we see at least a handful of dogs with liver failure clearly caused by mushroom ingestion.  In spite our very best efforts, the individuals who survive mushroom poisoning are few and far between. Affected people can receive a liver transplant; no such technology available (yet) for dogs.      

     

To learn more about poisonous mushrooms visit the North American Mycological Association and Bay Area Mycological Society websites.  If you suspect your dog has ingested a mushroom get to your veterinary clinic or the closest emergency care facility immediately (choose whichever is most quickly accessible).  If possible, take along a sample of the mushroom so it can be professionally identified if need be.     

      

Fortunately, my friend Diana has managed to put a positive spin on the loss of her beloved Donato.  Not only does she have Tesoro, a new little Berner boy in her life, she has made it her personal mission to warn people about the potential hazards of mushroom toxicity in dogs.  She created the attached flyer (see above).  Feel free to download and post it wherever dog loving people congregate.  Diana sent a blast email out just a few days ago after finding a Death Cap mushroom in her yard.   Coincidentally, today I discovered several mushrooms on my property while beginning the task of weeding my garden. They’re gone now, but given our current weather pattern, I’m quite sure there will be more tomorrow.     

What can you do to prevent your dog from ingesting a poisonous mushroom?  Clear any mushrooms from your dog’s immediate surroundings, and be super vigilant on your walks, particularly if you have a pup (youngsters love to put anything and everything in their mouths) or an adult dog who is a known indiscriminate eater.  Learn more about which poisonous mushrooms grow in your area and what they look like.  And please remember, if you see your dog ingest a mushroom- get yourselves to a veterinary hospital as quickly as possible (even if it is after hours). Ingestion of even a nibble of a toxic mushroom is life threatening, and the sooner treatment is started the greater the likelihood of saving your best buddy.     

Are you aware of poisonous mushrooms in your neck of the woods?  If so, please share where you live (city and state) and the name of the mushroom if you happen to know it.     

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.