Archive for the ‘Canine Diseases’ Category

Stem cells: A beneficial therapy or a waste of money?

May 8, 2011

 

Stem cell therapy (aka regenerative medicine) is becoming all the rage in veterinary medicine.  Initially used only to treat damaged horse parts (tendons, ligaments, and joints) the repertoire of stem cells has expanded to treating dogs, primarily for management of arthritis symptoms.  Even a few kitties are getting in on the act as regenerative medicine is investigated as a means of restoring health to their aged kidneys.

Here’s a rundown on the logistics of stem cell therapy. The process begins with the veterinarian harvesting fat or bone marrow samples from the affected individual.  These samples are then sent off to a specialized “stem cell company” for processing. Recently, one company, MediVet America, has provided the option for vets to propagate stem cells within their own hospital setting. Once harvested the stem cells are injected into the patient’s affected body part(s) and/or are administered intravenously.  Extra cells can also be “banked” for future use. And all of this for a price of $2,000 to $3,000, on average.

In theory, these stem cells have the potential to differentiate into bone, cartilage, and many soft tissue types.  Why do I emphasize, “in theory”? To date, there is no proof that the stem cells, once injected into the body, do actually become the cells we are hoping for.  Perhaps any observed benefit is a result of biochemical alterations of the cells already present rather than regeneration of new and improved cells. 

Not only is there a paucity of information about what actually happens to the cells after they are injected, there is a surprising lack of evidence-based data that supports any benefit of stem cell therapy.  In this regard, it appears that the stem cell therapy cart has pulled way ahead of the horse- unusual in the world of “western medicine” where veterinarians are typically reluctant to embrace a particular therapy without it having survived the scrutiny of evidence-based medicine.  Yet many western trained practitioners readily offer forth stem cell therapy to their clients based on anecdotal information (individual client impressions, vignettes told by other veterinarians, marketing materials from stem cell laboratories). 

According to a recent article in the Journal of the American Veterinary Medical Association (JAVMA), Dr. Robert Harman, CEO of Vet-Stem Inc reports that his company has processed stem cells from fat samples for approximately 8,000 patients.  Approximately half the patients are horses, the other half comprised of dogs and a few cats.  In the same article, Dr. Sean Owens, director of the Regenerative medicine Laboratory at the University of California- Davis School of Veterinary Medicine states, “We’ve moved forward so quickly that what we need to do now is put the science underneath.”

Dr. Brennan A. McKenzie is the president-elect of the Evidence-Based Veterinary Medicine Association. As stated in the same JAVMA article, “Dr. McKenzie thinks the use of stem cells is a promising avenue for therapy but that the evidence of efficacy and safety is inadequate to justify the expensive treatment in most cases.  He would prefer for clinics to offer stem cells as a truly experimental treatment in formal clinical trials.”

The North American Veterinary Regenerative Medicine Association has recently been organized with hopes of acting as a clearinghouse of information on the use of stem cells in veterinary medicine.  Their first official meeting will be in June with the intention of forming standing committees to address things such as clinical trials and regulatory affairs.

Given the paucity of research supporting stem cell therapy, is there any downside to opting for this form of therapy for your dog or horse?  While there is always risk associated with general anesthesia (usually required for harvesting fat or bone marrow samples as well as injecting the stem cells into the exactly appropriate spot), thusfar, there have been no reports of adverse effects caused by the stem cells themselves. If my own doggie had significant arthritis pain and nothing else in my medical arsenal (supplements, acupuncture, underwater treadmill therapy, nonsteroidal anti-inflammatory medications) made a difference, might I try stem cell therapy?  You betcha. Is there risk of expenditure of two to three grand without a return on investment?  You betcha.

Has one of your four-legged family members received stem cell therapy?  If so, I welcome your feedback.

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.

When to Say Yes to a Diagnostic Test

April 8, 2011
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.

Price Shopping: To Be Avoided at All Costs

December 13, 2010

I recently exchanged emails with a woman who was feeling frustrated while searching for a new veterinarian.  Her search included some “fee shopping” and she was disgruntled to find that some vets had the nerve to mark up lab fees more than others.  She wrote to me to find out how she might gain access to the fees charged by commercial veterinary laboratories so she could figure out how much mark up each veterinarian applied. She mentioned that she’d found one vet she really liked, but she was “out of the running” because her office charged double the lab fees (exact same test) as two others she’d investigated.

Here’s how I responded.  I encouraged my email buddy to consider reasons why fees are not uniform from hospital to hospital. In some cases, laboratory testing is run “in house” requiring on site technician time and costs involved in maintaining equipment.  Certainly charges to the client for this should be higher. The expertise a veterinary specialist brings to interpreting laboratory test results may be greater than that of a general practitioner.  Shouldn’t a client pay more for this? Additionally, every clinic must pay its overhead to continue to provide good service, and the more “bells and whistles” the hospital has, the higher that overhead will be.  For example, if the hospital employs sophisticated equipment to monitor anesthesia, that’s a really good thing, right?  Chances are, the fees for surgery there will be higher in order to cover the costs of this advanced level of care.

I went on to explain that I truly discourage people from price shopping when it comes to veterinary care unless it is an absolutely necessity.  A sweet six-month-old Labrador is currently being treated at my hospital because she sustained a horrific thermal burn all along her back from a faulty heating pad used during her surgery at a low cost spay/neuter clinic. This has necessitated major reconstructive surgery over her back- a tremendous price to pay both in terms of money and what this poor dog is going through. By the end of our email thread my correspondent seemed convinced- she told me that she’d decided to use the vet she really liked in spite of more expensive lab tests. Hurray!

Now, I’m not completely naïve when it comes to how our current economy is influencing delivery of veterinary health care.  I realize that for many folks, price shopping has become a financial necessity.  When this is the case, I encourage the following:

-Do your best to avoid sacrificing quality of medical care.  The old cliché, “You get what you pay for,” is often true.  Be thorough in your investigation: don’t make up your mind based on brief over-the-telephone price quotes.  Visit the clinic, tour the facility, and meet the staff to feel confident this is a place you and your pet will feel comfortable.

-Watch for “hidden” fees.  Some clinics may offer an extremely reasonable quote for a surgical procedure, but then charge additional fees for the initial office visit or for post-surgical necessities like removing stitches.

-Keep in mind the potential for complications.  If a significant complication occurs due to substandard care (such as occurred with the Labrador mentioned above) you will end up spending a great deal more money treating it, not to mention associated emotional energy, than you would have spent at the better more expensive clinic to begin with.

When you chose your veterinarian, how did fees enter into your decision-making?  If so, how did things turn out? I’d love to hear about your experience.

Now here’s wishing you and your loved ones (including those who are furry or feathered) for a peaceful and healthy holiday season.   

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. 

Free holiday gift wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).

Reasonable Expectations VI: The Ability to Discuss Your Internet Research With Your Vet

December 7, 2010

This is the sixth part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through five can be found at http://www.speakingforspot.com/blog.  Please take your time with this one- I realize it is a lengthy post, but there is a great deal to say about this worthwhile topic!

When your beloved pet develops a medical issue, chances are you’ll be inclined to do some Internet research and then talk with your vet about what you’ve learned.  Know that having this discussion with your vet is a perfectly reasonable expectation as long as you are careful to avoid using valuable office visit time discussing “whackadoodle” notions gleaned from cyberspace.  Here are some pointers to help you find instructive, accurate, worthwhile Internet information while avoiding “online junk food”. By the way, although I’m a veterinarian teaching people how to better care for their furry and feathered family members, please know that this information also applies to your own health care.

So, let’s begin.  How can you determine whether or not a website is dishing out information that is worthy of your time? Here are some general guidelines:

1.  Ask your veterinarian for her website recommendations.  She might wish to refer you to a specific site that will supplement or reinforce the information she has provided.

2.  Veterinary college websites invariably provide reliable information.  Search for them by entering “veterinary college” or “veterinary school” after the name of the disease or symptom you are researching.

3.  Web addresses ending in “.org,” “.edu,” and “.gov,” represent nonprofit organizations, educational institutions, and governmental agencies, respectively.  They will likely be sources of objective and accurate information.

4.  If your dog has a breed-specific disease, pay a visit to the site hosted by that specific breed’s national organization.

5.  Avoid business-sponsored websites that stand to make money when you believe and act on what they profess (especially if it involves purchasing something).

6.  Be ever so wary of anecdotal information.  It’s perfectly okay to indulge yourself with remarkable tales (how Max’s skin disease was miraculously cured by a single session of aromatherapy), but view what you are reading as fiction rather than fact. 

7.  I really love disease-specific online forums.  Check out those sponsored by Yahoo (http://groups.yahoo.com).  Not only do many of them provide a wealth of educational information, members can be a wonderful source of emotional support- always a good thing for those of us who share our homes and hearts with an animal.  If you are considering joining an online forum, I encourage you to look for a group that focuses on a specific disease (kidney failure, diabetes, etc), has lots of members, and has been around for several years.  For example, an excellent Yahoo group AddisonsDogs has 3,391 members and has been up and running for eight years.  A large group such as this typically has multiple moderators who screen participants, screen comments to keep things on topic, present more than one point of view (always a good thing), and provide greater round-the-clock availability for advice and support.  Look for presentation of cited references (clinical research that supports what is being recommended). Such groups should have a homepage that explains the focus of the group and provides the number of members and posts per month (the more the better).  They may have public archives of previous posts that can provide a wealth of information.

I happen to enjoy hearing about what my clients are learning online.  I sometimes come away with valuable new information, and I’m invariably amused by some of the extraordinary things they tell me- who knew that hip dysplasia is caused by global warming!  Surf to your heart’s content, but be forewarned, not all veterinarians feel as I do.  Some have a hard time not “rolling their eyes” or quickly interrupting the moment the conversation turns to Internet research.  What can you do to realize the expectation of discussing your online research in a way that is neither irritating to your vet nor intimidating for you?  Listed below are some secrets for success:

-I may be preaching to the choir, but I cannot overemphasize the importance of working with a vet who is happy and willing to participate in two-way, collaborative dialogue with you (please reference my earlier blog about relationship centered care- http://speakingforspot.com/blog/?p=1174). Your opinions, feelings, and questions are held in high regard and enough time is allowed during the office visit to hear them. A veterinarian who practices this “relationship centered” style of communication is far more likely to want to hear about your online research than the veterinarian who practices “paternalistic care” (far more interested in telling you what to do than hearing about your thoughts, questions, or concerns).  Remember, when it comes to veterinarian/client communication styles, you have a choice. It’s up to you to make the right choice!

-Let your vet know that you appreciate her willingness and patience in helping you understand how best to utilize what you’ve learned online.

-Wait for the appropriate time during the office visit to discuss what you’ve learned on line.  Allow your veterinarian to ask questions of you and examine your precious poopsie rather than “tackling” her with questions and discussion about your Internet research questions the moment she sets foot in the exam room.

-Be brief and “to the point” with your questions.  Remember, most office visits are scheduled for 15 to 20 minutes, max.

-Let your veterinarian know that you’ve learned how to be a discriminating surfer!  You know how to differentiate between valuable online resources and “cyber-fluff”. You ignore anecdotal vignettes and websites trying to sell their products in favor of credible information provided by veterinary college sites and forums that are hosted by well-educated moderators who provide cited research references that support their recommendations.

-When you begin conversation about your Internet research, I encourage you to choose your wording wisely. Communicate in a respectful fashion that invites conversation as opposed to “telling” your vet what you want to do.

In the Internet, we have an extraordinary tool at our fingertips. I encourage you to be selective when choosing which websites you intend to take seriously and which ones you wish to visit for a good chuckle.  Approach conversations with your vet about your Internet research thoughtfully and tactfully.  These strategies are bound to facilitate constructive conversation and create a win-win-win situation- for you, your veterinarian and your beloved best buddy! 

Have you had conversation with your vet about your Internet research?  If so, how did it go?

Now here’s wishing you and your four-legged family members abundant 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 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. 

Free holiday gift wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).

Avoiding Pancreatitis During the Holidays

November 22, 2010

I wrote the following for one of my favorite magazines, BARK (the inventors of “Dog is my co-pilot”).  With the holidays once again upon us, I thought I’d toss this information out into cyberspace as a timely reminder to avoid overindulging our dogs!

‘Tis the season for family gatherings, gift giving, and food galore.  Veterinarians know that this is also the season for canine pancreatitis (inflammation of the pancreas), a painful, potentially life-threatening condition most commonly caused by overindulgence in foods that are particularly rich or fatty. And what kitchen isn’t overflowing with such foods this time of year?

The pancreas is a thin, delicate-appearing, boomerang-shaped organ that resides in the abdominal cavity, tucked up against the stomach and small intestine. While the pancreas may be diminutive in appearance, its actions are mighty! It is the body’s source of insulin and enzymes necessary for food digestion. When pancreatitis is chronic or particularly severe, this little factory sometimes permanently closes down, resulting in diabetes mellitus (requires insulin shots) and/or exocrine pancreatic insufficiency (requires digestive enzyme replacement therapy). 

When a dog eats, enzymes are released from the pancreas into the small intestine, where they are activated for food digestion. Sometimes, for reasons we do not understand, these enzymes are activated within the pancreas itself, resulting in the inflammation of pancreatitis. In addition to rich or fatty foods, certain drugs, hormonal imbalances and inherited defects in fat metabolism can also cause pancreatitis. For some dogs, an underlying cause is never found. Classic pancreatitis symptoms include vomiting, abdominal pain, and decreased appetite and activity levels. 

Short of performing a pancreatic biopsy (an invasive and risky procedure), diagnosing pancreatitis can be challenging, because noninvasive tests are fraught with false-negative and false-positive results. Veterinarians must rely on a combination of the following: 

• A history of dietary indiscretion, vomiting and lethargy.

• Physical examination findings (particularly abdominal pain).

• Characteristic complete blood cell count (CBC) and blood chemistry abnormalities.

• A positive or elevated Spec cPL (canine pancreas-specific lipase) blood test.

• Characteristic abdominal ultrasound abnormalities. 

There is no cure for pancreatitis—much like a bruise, the inflammation must resolve on its own. This is best accomplished by allowing the pancreas to rest, which means giving nothing orally (not even water) to prevent digestive enzyme secretion. Treatment consists of hospitalization for the administration of intravenous fluids; injectable medication to control vomiting, pain and stomach acid secretion; and antibiotics to prevent secondary infection or abscess formation. Dogs should be monitored around the clock for the life-threatening complications that sometimes accompany pancreatitis, such as kidney failure, heart rhythm abnormalities, respiratory distress and bleeding disorders. Small amounts of water and a fat-free diet are typically offered once vomiting has stopped, abdominal pain has subsided, and there is blood test and/or ultrasound confirmation that the inflammation has calmed down. If your dog has pancreatitis, count on a minimum of two to three days of hospitalization, and be sure to ask who will be caring for your dog during the night. 

Long-term treatment for pancreatitis typically involves feeding a low-fat or fat-free diet. This may be a life-long recommendation, especially if your dog has been a “repeat offender.”  Most dogs fully recover with appropriate therapy; however, some succumb to the complications associated with this disease.

Nicky 

How can you prevent pancreatitis during this food-oriented time of year? You can avoid feeding holiday leftovers altogether (this would cause canine mutiny in my household) or you can heed the following recommendations. New foods should be fed sparingly and only if well tolerated by your dog’s gastrointestinal tract and waistline.  Keep in mind that whether offered a teaspoon or a tablespoon of something delicious, most dogs will gulp it down in the same amount of time and reap the same psychological benefit. Don’t offer tidbits from the table while you are eating. This is a set up for bad behavior. Offer the treat only after you’ve left the table. If you shouldn’t be eating the food yourself (emphasis on shouldn’t), please don’t feed it to your dog! By all means, give your precious poopsie a bit of turkey breast, but without the turkey skin or fat-laden mashed potatoes and creamy gravy. Go ahead and offer your sweet snookums a bite of brisket, but please —no potato latkes or sour cream! Bear in mind that most dogs are so darned excited about getting a treat, they don’t care what it is, only that they’re getting it!

Some people dream of sugar plum fairies, a white Christmas or a stress-free family gathering. I’m dreaming of a holiday season in which not a single dog develops pancreatitis!

Wishing you and your four-legged family members a joyful and healthy holidays season.

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. 

Free Christmas or Chanukah guft wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).

Axel

July 25, 2010

Rarely do dogs show their true colors during a veterinary hospital visit.  Outgoing dogs may become timid, gentle dogs sometimes growl or nip, and normally obedient dogs frequently feign deafness (one of the reasons I rarely request anything from my patients before offering them a treat-being tolerant of me and what I’m doing with them is a trick in and of itself). This out of character behavior is why it’s always so fun for me to catch a glimpse of my patients’ genuine personalities when in their “own element.”  Never has this been truer than with Axel, a five-year-old Belgian Malinois.  Not only is Axel a beloved family member, he is also an employee of the Sonoma County Sheriff’s Department.  He and his best buddy Sheriff Adrian Mancilla have been partners for approximately two years.  I first met Axel approximately nine months ago when he was a 50 pound dog living in what should have been a 65 pound body. Adrian reported that, although Axel’s appetite and enthusiasm seemed normal, he had been vomiting a few times weekly.  Diagnostic tests revealed that the cause of Axel’s vomiting and dramatic weight loss was inflammatory bowel disease, a syndrome in which noncancerous inflammatory cells infiltrate the lining of the intestines. 

© Susannah Kay 2010

Fortunately Axel has responded beautifully to a combination of medication and a novel protein diet.  He’s regained his missing 15 pounds and is back in full force on the force!  I recently had the thrill of witnessing this first hand while attending a competition for law enforcement dogs from all over California.  The first leg of the competition was basic obedience, followed by a rather daunting agility course including elements such as ten-foot vertical fence. Axel was a superstar and endeared himself to the spectators when, upon being released from the last agility element, he literally jumped into Adrian’s arms for a bear hug- his reward for a job well done!  

The “box search” was the third phase of the competition. Multiple closed containers resembling large trash dumpsters were scattered around a field. Only one contained a person sitting silently.  The challenge for the dog was to use his nose to identify the occupied box and then alert his partner in the shortest time possible.  Most of the dogs cruised the field checking out multiple containers before honing in on the correct one.  Not Axel- he apparently picked up the scent before Adrian released him and made a beeline (with the winning time) to the occupied box.    

© Susannah Kay 2010

The “protection phase” of the competition was the grand finale.  The dogs were required to pursue and subdue several “agitators.”  In the process, they were challenged to ignore a “dummy agitator,” jump through a screen of spraying water while in pursuit, and voluntarily release their hold on one agitator in order to subdue a second agitator (who happened to be attacking the dog’s partner).  Only a few dogs were successful with all three challenges and, you guessed it- Axel was one of them. 

© Susannah Kay 2010

Not only did Axel win the box search and protection phase of the competition, he won the entire competition’s top dog honors, known as the Maverick Award.  I feel enormously proud for Adrian and Axel. What a team- they share an indescribable bond whether on and off duty.  I felt privileged to watch them compete, and it was so thrilling to watch my patient doing exactly what his body and personality were designed to do- something I could never have fully imagined in the confines of my hospital exam room. 

p.s. Something only a veterinarian would notice- Axel was the only neutered dog in the competition, yet he was the top performer.  Hmm, food for thought…………… 

How does your dog’s behavior in a veterinary hospital setting compare to his behavior in his own surroundings?

Now, here’s wishing you and your four-legged best friend a most enjoyable and safe summer! 

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
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
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
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, or your favorite online book seller.

Gastric Torsion: A Horribly Unhealthy Kind of Twist

July 1, 2010
Torsion, gastric torsion, gastric dilatation-volvulus, GDV; these are terms you never want to hear applied to your dog.  They all mean the exact same thing- your dog’s stomach is distended with gas and has twisted on itself, and emergency surgery offers the only hope for saving his life.  Here’s a visual aid to help you understand what happens when a dog develops gastric torsion.  Picture a fanny pack in your mind.   The pouch of the fanny pack represents your dog’s stomach.  One strap of the fanny pack is the esophagus that transports food from your dog’s mouth down into his stomach.  The other strap is the upper small intestine (duodenum) that transports food out of the stomach.  Now hold one strap of the fanny pack in each hand and twirl the pouch until it twists on itself causing the straps to crimp.  This is what happens when gastric torsion occurs- the stomach twists on itself, cutting off normal blood flow to the stomach and surrounding structures.  Additionally, gas and fluid continue to accumulate within the stomach and cannot flow out via the crimped esophagus or duodenum, so the stomach progressively distends. A dog in this situation quickly lapses into a state of shock and surgical “decompression” or untwisting of the stomach is the only way out of this nightmare.  Time is of the essence- the longer the stomach remains twisted, the greater the likelihood of irreversible devitalization (death) of the stomach tissue.

Image Credit: HoundFancy, 2001

 

Initial symptoms of gastric torsion include a bloated appearance through the midsection (the ribs look like they are expanding outward), drooling, nonproductive retching/vomiting, restlessness, weakness, shallow breathing, rapid heart rate (if it can be felt through the chest wall), and pale gum color.  If you observe such symptoms, quickly make some phone calls to find the closest veterinary hospital capable of performing immediate surgery on your best friend.  The sooner surgery can be performed the greater the likelihood of a successful outcome.  Irreparable damage to the stomach tissue is often the deal breaker if the torsion is not corrected quickly.  At the time of surgery, not only is the stomach derotated, it is tacked (attached with stitches) to the inside of the abdominal wall to prevent a repeat spinning performance.  Additionally if the spleen or portions of the stomach wall appear devitalized (deprived of normal blood flow for too long) they will be removed.  If surgery is successful, the dog typically has a minimum two to three day post-operative stay in the hospital for round the clock monitoring for post-operative complications.   

Truth be told, we really don’t know much about what causes gastric torsion.  Clearly, there is a breed/conformation association- large deep-chested breeds such as Great Danes, Irish Setters, Standard Poodles, Irish Wolfhounds, Boxers, Dobermans, Weimaraners, and Rottweilers are particularly predisposed.  Affected males definitely outnumber females. One study documented that elevating the food bowl actually predisposes to gastric torsion.  Other studies have indicated that the following factors may also be part of the recipe that results in gastric dilatation-volvulus: eating only one meal per day, eating rapidly, eating dry foods that list oils or fats among the first four label ingredients, exercising in close association to mealtime, being underweight, and being of an “anxious” rather than “happy” personality type.  The only known way to prevent gastric torsion from occurring is by performing a prophylactic (preventive) gastropexy procedure (sutures are used to tack the stomach wall to the inside lining of the abdominal cavity).  This does not prevent the bloating (stomach distending with gas), but does prevent the life threatening twisting part of this miserable disease process.   

Would you like to participate in a study to learn more about why dogs develop gastric torsion?  If your dog has ever bloated (distention of the stomach without rotation) or has experienced gastric torsion, I encourage you to take this survey http://www.surveymonkey.com/s/WS2VKFP.  It is being conducted by Dr. Cynthia Otto from the University of Pennsylvania School of Veterinary Medicine in collaboration with researcher, author and lecturer, Dr. Carmen Battaglia. A summary of the results and findings will be posted at www.breedingbetterdogs.com in November, 2010.  If you and your dog did have direct experience with a gastric torsion, I sure as heck hope yours was a happy ending.   

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
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
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
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, or your favorite online book seller.

Diarrhea Disclosures

April 2, 2010

A conversation earlier this week with one of my clients prompted this blog.  Jeanette, my client, and I debated whether or not her elderly and adorable shepherd mix named Jack had diarrhea.  I felt that Jack’s once daily, unformed bowel movement qualified as diarrhea (sorry if I am grossing you out here).  Jeanette’s thinking was that the term diarrhea should be reserved only for situations with increased frequency and urgency.  This got me to thinking about how many times I might be receiving inaccurate feedback to my standard question, “Have you observed any diarrhea?” I remember going round and round with one client who repeatedly answered “No” to this question.  When we discovered that, yes, her cat truly did have chronic diarrhea, she defended her responses by saying that it was her husband who always cleaned the litterbox (in truth, she had never “observed” any diarrhea!).

So, folks, here’s the scoop (no pun intended).  When a veterinarian asks if your dog or cat has been having diarrhea, please disclose any and all information about how his or her bowel movements appear abnormal.  Believe it or not, your description of stool appearance, number of bowel movements per day, urgency, and the presence or absence of blood, mucous, straining, and gassiness can provide your veterinarian with a wealth of useful information including whether the diarrhea is originating from the small (upper) or large (lower) intestine.

Boy oh boy is your veterinarian gonna get an earful next time he or she asks about your pet’s bowel movements! Please note, I purposefully refrained from including a photo with this blog.

Best wishes to you and your four-legged family members for abundant good health, 

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
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
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
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, or your favorite online book seller.

Breed Profiling

March 13, 2010

Racial profiling is considered taboo, and for good reason.  Breed profiling, however, is fair game for those of us in the veterinary profession! We breed profile on a daily basis particularly pertaining to health issues.  Name just about any breed of dog or cat and I can provide you with a laundry list of potentially inherited diseases.  Patty Khuly, VMD (the “VMD” means her veterinary degree is from the University of Pennsylvania) has created a wonderfully comprehensive list of canine breed related diseases (the feline list is in the works).  I encourage you to check it out at www.embracepetinsurance.com/PetHealth/default.aspx. Not only does she list the most common maladies for each dog breed, she rates the risk for disease inheritance (low, medium, or high), describes each disease, and provides the approximate (emphasis on approximate) cost to diagnose and treat each disease. Hats off to Dr. Khuly for creating such a useful tool!  And if all of this weren’t enough, Dr. Khuly also manages to find the time to pen a witty and informative daily blog (www.petmd.com/blogs/fullyvetted).    

So how might Dr. Khuly’s information about breed-specific diseases be useful for you?  Certainly, if you are thinking about adopting a purebred pup, what you learn might sway your opinion about a particular breed.  If you already have your heart set on a specific breed, the disease-specific information will empower you to ask the right questions of the breeder to learn if the litter’s dam, sire, grandparents, and aunts and uncles have been affected.  A word of warning: don’t dare rely on the proverbial, “None of my dogs have ever had that problem.”  A conscientious breeder will offer forth official paperwork rather than verbal reassurances. Finally, if you already share your heart and home with a particular breed or think you know what breeds have gone into the “making of your mutt” being informed about the diseases that may arise will allow you to better be on the lookout for early symptoms. Timely detection and intervention can favorably affect the long-term outcome.     

Official White House Photo

Now, just for kicks, let’s check Dr. Khuly’s list of inherited diseases pertaining to Bobama (the name I’ve affectionately bestowed upon the newest dog in the White House).  According to the list, Portuguese Water Dogs are at medium risk for hip dysplasia (instability of the hip joints that results in arthritis), and at high risk for Addison’s disease (a hormonal imbalance) and follicular dysplasia (a hair follicle issue resulting in abnormal hair growth).  President Obama might be interested to know that one of his predecessors in the White House had Addison’s disease- none other than the late John F. Kennedy!  I wish Bobama a lifetime of good health, not only for the sake of the first family, but for the sake of the White House veterinarian as well!   

Best wishes to you and your four-legged family members for abundant good health,   

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
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
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
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, or your favorite online book seller.

Fish Oil (Omega-3 Fatty Acids): a Proven Treatment for Canine Arthritis

January 30, 2010

 I had the good fortune of receiving my veterinary school training at Cornell University.  Part of what made this education so fabulous was that the senior faculty spent a great deal of “face time” with their students.  I have fond memories of a seasoned clinician patiently holding a Dachshund for me while teaching this novice how to collect a blood sample from the jugular vein.  Another taught this city slicker how to collect a milk sample for mastitis testing from the teat of a cow.   A major “take home point” my classmates and I received from these icons in veterinary medicine was, “First, do no harm.”  In other words, before subjecting our patients to diagnostic testing or treatment, we should strive to be as confident as possible that the potential for benefit was far greater than the potential for harm.  “First do no harm” has always been my mantra and is the main reason I try to rely on “evidence based medicine” (facts substantiated by research) rather than anecdotal information to support what I do. 

Unfortunately, there is a paucity of evidence based medicine pertaining to the use of many commonly used supplements, nutraceuticals, and herbs for dogs and cats.  This is the reason a big smile appeared on my face when I opened a recent edition of the Journal of the American Veterinary Medical Association.  It contained two studies on the effects of omega-3 fatty acids (fish oil) for the treatment of osteoarthritis (also known as arthritis or degenerative joint disease) in dogs.  The study designs were excellent in that many dogs were included, there was a control group (some dogs received a placebo rather than the fatty acids), and the observers were “blinded”- neither the veterinarians nor the dogs’ families knew if the dogs were receiving the fatty acids or the placebo.  

Fish Oil (Omega-3 Fatty Acids)Here’s what the studies showed.  Compared to the placebo group, the dogs receiving omega-3 fatty acids had a significantly improved ability to rise from a resting position and play by six weeks after beginning supplementation, and improved ability to walk by 12 weeks.  Additionally, compared to the control group, dogs receiving the fish oil had improved weight bearing on the affected limbs as assessed by force-plate analysis (an extremely humane testing method).  No significant adverse side effects from the fish oil supplementation were reported. 

If you’ve spent any significant amount of time with dogs (especially large dogs), guaranteed you’ve known at least a few with arthritis.  It is estimated to affect up to twenty percent of dogs over one year of age. Dogs with arthritis resemble people with arthritis- they are often stiff and slow to rise when they first get up in the morning, as well as after vigorous exercise.  There are many ways to treat this common canine malady including nonsteroidal anti-inflammatory medications (the equivalent of ibuprofen for humans), acupuncture, rehabilitation therapy, and supplements that increase the production of normal joint fluid.  The effectiveness of all of these modalities, including fish oil, will vary from individual to individual.  The beauty of fish oil is that, likely the only potential significant risk is for you- your dog may develop fish breath! 

I love the fact that veterinarians now have evidence based support for recommending fish oil as a treatment for their canine patients with arthritis, and in doing so, they can abide by the mantra of, “First do no harm.”  If you suspect your dog has arthritis (if you have a large breed dog over eight years of age, chances are that you do), talk with your veterinarian about the pros and cons of all the treatment options.  And the next time you are dining on fish, don’t be surprised if your dog’s nose appears right beside your dinner plate.  Chances are, your dog clearly recognizes the benefits of fish oil supplementation!  Now, pass the salmon please. 

Wishing you and your four-legged family members abundant good health.

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine 

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, or your favorite online book seller. 

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