A Primer on Leptospirosis

Of all the vaccination questions I receive, the most common one is from folks questioning whether or not to vaccinate their dogs for Leptospirosis.  And I am so pleased they are asking- I love when people recognize that simply handing their dog over for “the works” in response to a vaccination reminder card (or these days, perhaps an email reminder) simply doesn’t make sense.

Unlike canine distemper and parvovirus- infectious bad guys that are ubiquitous in the environment and against which all dogs should receive vaccine protection- not all dogs come into contact with Leptospirosis.  Exposure is truly dependent on where you and your dog live and his or her extracurricular activities- in medical jargon this is referred to as “biolifestyle”.  Leptospirosis organisms are bacteria that thrive in warmer, wetter climates.  Wild animals (particularly deer and rodents) and some domesticated animals (cows, sheep, pigs) can be Leptospirosis carriers. Although infected, they manage to maintain good health while shedding Leptospirosis organisms in their urine.  Dogs can develop the disease by coming into contact with the infected urine or urine contaminated soil, water, food, or bedding.  So, if your dog’s biolifestyle includes roaming on rural property or drinking from creeks, streams, lakes, or rivers the potential for exposure to Leptospirosis is far greater than if your pup is a couch potato and your yard is devoid of trespassing wildlife.

Not all dogs become sick when exposed to Leptospirosis, but for those that do, the results can be devastating.  Symptoms associated with kidney failure (lethargy, vomiting, diarrhea, loss of appetite) are most common.  The liver and lungs are also targets for this disease.  Your veterinarian will suspect Leptospirosis based on the history your provide, abnormal kidney and/or liver enzymes on blood testing, and specific blood and/or urine testing for Leptospirosis.

Successful treatment ideally consists of aggressive round the clock intravenous fluids and antibiotics. If the kidneys become so inflamed that urine production diminishes, temporary dialysis may be recommended.  Infected dogs should be housed in an isolation ward to protect other hospitalized patients and personnel are advised to wear protective garb (gloves, gown, goggles) as Leptospirosis is considered a zoonotic disease (humans can become infected via contact with infected urine). Yes, such therapy is expensive- far more costly than the price of a vaccination- and in spite of everyone’s best efforts, some dogs do succumb to Leptospirosis.

The Leptospirosis vaccine provides adequate protection for one year and, in theory, the risk of adverse reactions is no different than reported with other vaccinations.  However, some vets feel strongly that the Lepto vaccine is more likely to produce transient “post-vaccine blues” than are other vaccinations.

Is the Leptospirosis vaccination appropriate for your dog?  Talk to your vet to find out whether or not the disease has been reported in your neck of the woods.  Next consider your doggie’s biolifestyle.  Does your pup live in a pristinely kept environment or does he go camping and hiking with you? If your pup lives in an environment with no standing water or exposure to wildlife, the risks of vaccinating clearly outweigh the benefits.  If you and your best buddy love to hike and camp together, vaccinating may be a no-brainer.  As I routinely advise whenever discussing vaccines: Administration of vaccinations is no different than any other medical procedure- they should not be administered without individualized discussion and consideration of the potential risks and benefits.

Have you considered vaccinating your dog for Leptospirosis?  If so, whereabouts do you live and how did you (will you) decide whether to say “yea or nay” to the vaccine?

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.

Does Your Veterinarian Hear Your Concerns?

Until a few years ago it was darned near impossible to find much in the way of useful research about communication between veterinarians and their clients.  Nowadays, several wonderful studies are surfacing.  It’s about time I say, and the results have been fascinating! The newest communication study appears in the June 15, 2011 issue of the Journal of the American Veterinary Medical Association and is titled, “Analysis of solicitation of client concerns in companion animal practice.”

The purpose of this study was to determine what percentage of veterinarians evaluated effectively solicited their clients’ concerns at the beginning of the office visit.  When veterinarians did solicit concerns, the client’s responses were referred to as their “opening statement”.  What we know from research pertaining to human physicians is that only 23% to 28% of patients are allowed to complete their opening statements.  On average, they are interrupted by their physicians within 12 to 23 seconds. Research has also documented that physicians often mistakenly assume that the first or only concern expressed by their patient is the main concern or only concern.

In addition to learning how many veterinarians effectively solicit client concerns, this study also determined if there is a difference in the way clients respond to open-ended versus closed-ended solicitations.  Open-ended questions such as “What brings you in today?” cannot readily be answered by a simple “yes” or “no”.  Rather, they require more expansive, thoughtful responses.  Closed-ended questions such as, “Has Peanut been vomiting?” can readily be answered by “yes” or “no” and may entice a client to focus on what they perceive the veterinarian thinks is important rather than what they are truly concerned about.

Here’s what this study’s researchers learned by reviewing 334 videotaped veterinarian-client office visits:

– Solicitations for client concerns were made in only 37% of the office visits.
– Of the office visits that included solicitations, 76% of the queries were open-ended and 24% were closed-ended.
– In response to open-ended solicitations 76% of clients expressed one or more concerns.  In response to closed-ended solicitations, 40% of clients expressed one or more concerns.
– Clients spoke more than twice as long in response to an open-ended solicitation compared to a closed-ended solicitation.
– Clients’ opening statements in response to the solicitation were interrupted by the veterinarian 55% of the time, on average after only 11 seconds!
– Following an interruption, clients returned to and completed their response only 28% of the time.
– Appointments in which the veterinarian did not solicit client concerns at the beginning the office visit were significantly more likely to have concerns raised at the end of the office visit.
– Open-ended solicitations were more likely to occur during “well pet visits” than visits initiated because of a medical issue.

Are you surprised by these results?  I’m a bit surprised by the numbers and, admittedly, as a veterinarian, I’m feeling a bit of professional embarrassment. This study underscores the fact that veterinarians could be doing a much better job soliciting and listening to their clients’ concerns.  By learning from studies such as these, there is so much potential for greater success, not only in terms of doing a better job for our patients (gaining an accurate assessment of all concerns is certainly in the best interest of the patient), but also in terms of our clients.  Actively listening to their concerns without interruption conveys empathy and what person worried about their best buddy’s health couldn’t use a good dose of that?

As a consumer of veterinary medicine, what is the take home message for you?  I hope this data will prompt you to be persistent in expressing all of your concerns to your veterinarian at the beginning of the office visit.  And, if interrupted, do your best to return to your original train of thought!

What is the take-home message for veterinarians?  It is clear that we could and should be doing a much better job consistently asking open-ended questions at the beginning of office visits and then actively listening, without interruption to hear what our clients have to say.  Perhaps before entering the exam room we might remind ourselves of the saying I’ve always loved, “Don’t just do something, stand there!”

 

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.

Who Was Dr. Leo Bustad?

I first heard of Dr. Leo K Bustad in association with the Bustad Companion Animal Veterinarian of the Year Award.  Since 1986 this award has been bestowed upon veterinarians whose work exemplifies and promotes the human animal bond. When I first learned of the award I remember thinking, how fabulous to honor this important professional achievement rather than the academic/research accomplishments more commonly recognized within the profession.  Some of the veterinarians I most admire have been recipients of this award including my friends Drs. Jane Shaw, Alice Villalobos, and Marty Becker.

Fast-forward to 2011 and here I am pinching myself since learning a few months ago that I am the incredibly fortunate recipient of the 2011 Bustad Companion Animal of the Year Award! I feel honored beyond belief.

So who was the man who served as the inspiration for this award?  Dr. Leo Bustad was a veterinarian who also happened to be an outstanding educator, scientist and humanitarian. While dean of the veterinary school at Washington State University, he co-founded the People-Pet Partnership, the first university based community service program focusing on the human-animal bond. In 1981, the Partnership morphed into the Delta Society, an organization that continues to thrive and co-sponsors the Bustad Award along with the American Veterinary Medical Association and Hill’s Pet Nutrition.

The stated mission of the Delta Society is, “To help lead the world in advancing human health and well-being through positive interactions with animals.”  Dr. Bustad served as the first president of the Delta Society, a position he held until 1990.

As a veterinarian, Dr. Bustad’s interest ventured far beyond the healing of animals.  He devoted his professional life to the healing of humans through their relationships with animals. A great deal has been written in recent years about the human-animal bond. Perhaps the best description comes from Dr. Bustad himself. In 1985 he wrote, “On the basis of experiences by many people and institutions in Australia, Europe, New Zealand and North America, companion animals must be recognized as vital to the physical, psychological and social well-being of people and as agents of therapy in a great number of conditions and situations. Almost everyone could benefit by contact with warm “fuzzies” (unless we are allergic), and our companion animals offer us security, succor, esteem, understanding, forgiveness, fun and laughter and, most importantly, abundant and unconditional love. Furthermore, they make no judgments, and we can be ourselves with them. They also need our help and make us feel important.”

Dr. Leo Bustad passed away on September 19, 1998. He was 78 years old.  On July 16th, 2011 at the American Veterinary Medical Association conference, I will be deeply honored to accept the award memorializing Dr. Bustad’s heartfelt professional endeavors and pioneering accomplishments.

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.

Urinary Accidents

When your wonderful dog, who has always done his or her “business” outside, begins leaving puddles in the house, please do not default to the notion that this is a behavioral issue.  It is highly unlikely your dog is mad at you for sleeping in on Sunday mornings or jealous because you showed some affection to your neighbor’s dog.  Chances are, the inappropriate urination is a result of an underlying medical issue.

Well house-trained dogs would rather urinate anywhere other than inside their own home.  Several types of medical issues are capable of disrupting normal house-training.  Bladder infections, stones, and tumors create an urgency to urinate even when the bladder contains only a small amount of urine.  Prostate gland disease (more common in boys who have not been neutered) can disrupt normal urinary habits.  Increased water intake may overwhelm a dog’s normal eight to ten-hour bladder capacity.  Common causes of increased thirst include a variety of hormonal imbalances, kidney failure, and liver disease.  Commonly prescribed medications such as prednisone (a form of cortisone) and furosemide (a diuretic or “water pill”) typically cause increased thirst.

Some dogs develop urinary incontinence (involuntary urine leakage).  This is more common in females and is usually a result of relaxation of the muscular sphincter that normally prevents urine from flowing down the urethra- the tube that carries urine from the bladder to the outside world.  The urine leakage may be constant, but more commonly it occurs as the bladder distends during the night while the dog is soundly sleeping. In most cases, urinary incontinence can be successfully managed by correcting the underlying cause and/or treating with medications that “tighten up” the urethral sphincter.

If your dog has a break in house-training, please don’t respond with a reprimand.  Far better to schedule a consultation with your veterinarian.

Has your well house-trained dog ever urinated in the house?  Were you and your vet able to determine the cause?

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.