I Can’t Believe He Ate That!

Needle lodged within the intestinal tract © Cuyahoga Falls Veterinary Clinic

Dogs and cats eat some pretty darned crazy things! Sure, I can understand nabbing a loaf of bread from the kitchen counter or sneaking some “kitty roca” out of the litter box. But why on earth eat a sewing needle, panty hose, Lego pieces, or mama’s favorite diamond earrings? Just when I think I’ve seen it all, something new surprises me.

Dogs, more so than cats, tend to be “repeat offenders.” I recall one Labrador in particular who had six surgeries over the course of his lifetime to remove socks lodged within his intestinal tract (in spite of counseling his humans repeatedly on picking up their socks). As many surgeries as this dog had, we should have installed an abdominal zipper!

Not all cases of foreign body ingestion have such happy endings, particularly if the foreign object has perforated through the wall of the stomach or intestinal loop. This allows leakage of nonsterile gastrointestinal contents into the normally sterile abdominal cavity resulting in widespread inflammation known as peritonitis. With emergency surgery and post-operative intensive care, many of these patients survive, but it is certainly becomes a big deal, both for the patient and the pocketbook.

Esophageal foreign bodies are notoriously difficult to remove, particularly if they’ve been lodged for more than a day or two. (The esophagus is the muscular tube that transports food and liquids from the mouth down into the stomach.) Even if the foreign object is successfully removed, the resulting inflammation within the esophagus can result in the formation of a stricture (narrowing of the esophageal lumen) and chronic, severe swallowing difficulties.

Some dogs and cats are lucky. The foreign objects they eat pass freely without any ill effects. I see the not so lucky ones with objects that have become lodged within their gastrointestinal tracts. There are two means to retrieve a gastrointestinal foreign body, surgery and endoscopy. An endoscope is a long telescope device that can be passed through the oral cavity, down the esophagus and into the stomach and upper portion of the small intestine. The endoscope allows visualization of the inside lining of the bowel and its contents. A grabber type instrument can be deployed through a channel in the endoscope to grab the object and then pull it out through the mouth. Endoscopy requires general anesthesia, but it is often preferred over surgery because of its less invasive nature.

In order for endoscopy to be of benefit, the foreign body must be located within the esophagus, stomach, or the very upper part of the small intestine (this is as far as the endoscope can reach). Some objects (coins, needles, tennis ball fragments, cloth) are well suited to being removed endoscopically because they are more “grabbable.” Objects that have traveled further down the gastrointestinal tract (beyond reach of the endoscope) or are without “grabbable” surfaces (large rounded bones, balls) are better retrieved surgically.

What can you do to prevent your dog or cat from eating inappropriate things? First and foremost, “baby proof” your home and yard for your pet. Anything unsafe that your little snookums might want to “mouth” should be put away and out of reach. This is particularly important when caring for a puppy or kitten. Secondly, it pays to know your pet- some cats and dogs never grow out of the habit of putting strange things in their mouths. Some adult cats continue to graze on dental floss found in the bathroom garbage pail, and some adult dogs continue to scarf down panty hose and underwear. If you provide chew toys or bones to your dog, supervise carefully to be sure that he’s a nibbler rather than a “swallow it whole” kind of guy. The best defense against gastrointestinal foreign bodies is avoidance of the things your pet might be willing to swallow. In some extreme cases, I’ve encouraged folks to muzzle their dogs when outdoors unsupervised or on walks, so they can relax knowing that their dog cannot gobble something down in the blink of an eye.

Perhaps my most memorable foreign body retrieval was performed on an adult Saint Bernard. X-rays suggested something was lodged in her stomach, but I couldn’t be clear exactly what the foreign material was. I passed my endoscope down into the stomach and saw an intact hand. I thought, “Oh my goodness!” I looked around a bit more and spotted a foot, and then what looked like some human hair. My heart was racing until I finally removed what I could identify as the chewed up remains of a troll doll! Afterwards I chuckled remembering that the view I get through the endoscope is magnified significantly!

What crazy thing has your dog or cat eaten in the past? Did it pass on its own or was it necessary for your vet to come to the rescue?

Happy holidays to you and your loved ones,

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
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
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.

Lick granulomas: An annoying little problem that is difficult to solve

If you’ve no idea what a lick granuloma is, count your blessings! What a nuisance they can be.  The official name for this disease is acral lick dermatitis.  “Acral” refers to an extremity (leg) and “dermatitis” means inflammation of the skin. The “lick” is thrown in because incessant licking behavior is what causes the problem.

Acral lick granulomas are skin sores that typically occur in large breed dogs (Doberman Pinchers and Labradors are notorious) and more males than females.  For reasons we truly don’t understand, affected dogs pick a spot towards the foot on one or more of their legs and begin licking…… and licking, and licking and licking.  The effect on the skin is no different than if you picked a spot on your arm and scratched at it round the clock.  The chronic self-inflicted irritation can result in thickening of the skin, increased pigmentation (skin appears darker than normal), an ulcerated surface with bleeding, and infection complete with pus, redness, and tenderness.  The average lick granuloma varies from dime-sized up to the size of a silver dollar.

Acral lick granulomas may be initiated by something that traumatizes or irritates the skin such as infection, allergy, or an embedded foreign body such as a thorn or splinter.  The dog overreacts lingually (no tongue in cheek here) and, over time, a lick granuloma appears.  It’s theorized that incessant licking may represent a self-soothing behavior (like thumb-sucking) associated with release of endorphins.  This theory is supported by the fact that, if one is savvy enough to interrupt the licking cycle at one site, many clever dogs redirect their attention to a new site on a different leg. Another possibility is that arthritis is present in the joint underlying the affected skin surface.  Licking is tantamount to a person massaging a sore joint.  Yet another theory is that boredom is the culprit. Truth be told, there are likely many different causes for lick granulomas.

The diagnosis of acral lick dermatitis is officially made via skin biopsy.  Your veterinarian may also recommend a skin scraping (material is scraped from the skin surface for evaluation under the microscope to rule out mange mites) and collection of samples for bacterial and fungal cultures.  Some veterinarians feel comfortable making the call based purely on history and visual inspection of the affected skin site.

Making the diagnosis is the easy part.  Stopping the licking is notoriously difficult.  In fact it can be a nightmare because many affected dogs simply will not be deterred from this obsessive behavior.  And even when one thinks the problem is licked (pun intended), a year or two down the road, the self-trauma cycle may begin all over again.

The ideal therapy for lick granulomas is identification and treatment of the underlying cause (foreign body, allergy, infection). If the cause cannot be determined (true for most dogs with lick granulomas) and eliminated, here are some therapeutic options.  Keep in mind, what works well for one dog may not work for another.

– Keep the site covered with a bandage.  You can use standard bandaging material or one of your own socks might be suitable.  Simply cut off the foot part and pull the tube section up over the affected area.  Secure in place with some tape.  If the lick granuloma is low enough on the leg, you can slip the dog’s foot into the toe of the sock.  A product called DogLeggs  may be worth a try as well.  If you are really, really, really lucky, your dog who is obsessed with applying his mouth parts to the spot you’ve covered will leave the bandage in place.  Warning!  It is extremely easy to put a bandage on that is too tight (a recipe for disaster).  Practice bandaging with a member of your veterinary team watching before trying it yourself at home.  Second warning!  Your dog may go one step beyond removing the bandage- he or she may eat the darned thing.  Close supervision is a must for the first day or two after accessorizing your dog with a bandage.  The last thing anyone wants is for a lick granuloma issue to morph into a gastrointestinal foreign body issue.

– Taste deterrents work for some dogs and there are a variety of products on the market (Bitter Apple is the classic).  If this is to stand a chance of breaking the cycle, application must be frequent and consistent.  Most dogs are so determined to lick that they will persevere in spite of the adverse taste reaction, and in all honesty, the looks on their faces after licking the nasty stuff time after time suggests that this “solution” may be less than humane.

– Elizabethan collars work well for some dogs.  Don’t forget to rearrange your house in advance so that nothing valuable is damaged as your dog learns to navigate his surroundings with a satellite dish around his neck.  (No, your television reception will not be enhanced.)

– Medications can be applied to the site that are antinflammatory in nature and/or help rebuild healthy tissue.  These typically must be accompanied by a method for keeping tongue away from skin so the medication has a fighting chance.

– Acupuncture and/or chiropractic treatments are thought to work for some dogs.

– Laser therapy at the site is successful with some lick granulomas.

– See if keeping your dog super-busy for a week or two breaks the cycle.  The hope is to alleviate boredom and/or create a dog that is too tired to lick.  Try increased play/exercise, a large Kong toy filled with peanut butter, doggie day care while you are away from home, or adoption of a playmate (careful here- sometimes the stress of a new animal in the household amplifies licking behavior).

– Behavior modification medications work for some incessant lickers, but should be tried when other efforts have failed.  Categories of medications that can be tried include tricyclic antidepressants, serotonin-inhibiting drugs, and endorphin blockers.

It’s a given that the more treatment options there are for a particular disease, the less we know about how best to treat it!  Lick granulomas are a classic example.  If your dog is afflicted, I strongly encourage you to enlist help from your veterinarian.  If, together you try two or three things without success, please consider consultation with a board certified dermatologist.  To find one in your neighborhood visit the American College of Veterinary Dermatology website.

Although a lick granuloma looks like a small problem, it can be downright difficult to cure.  If your dog’s lick granuloma remains small and clear of infection, and if the sound of licking is not keeping you awake at night, simply living with the problem is a reasonable choice to consider.

Has your dog had a lick granuloma?  If so, please tell us what you tried, what worked well, and what didn’t.

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.

It’s foxtail season, again!

Photo © Margaret Birkhaeuser

 The emergency room docs I work with are  busy pulling foxtails out of eyes, ears, noses, and throats as well as from in between toes.  Such activity reminds me that it is once again time to blog about these pesky bristly plant awns that grow in abundance where I live in California.  In fact they are reported in most every state west of the Mississippi.  For more information about foxtails and the ways they wreak havoc, please read the blog I wrote right about this time last year.  

This year I’d like to tell you about a new way to prevent foxtails from finding their way into their favorite canine orifices (eyes, ears, nose, and mouth). Check out the OutFox Field Guard™ (www.outfoxfieldguard.com), the brainchild of a clever woman named Margaret Birkhaeuser. I suspect her invention was born as a result of multiple foxtail related trips to the veterinary hospital.  Have a look at Margaret’s site and you will see dogs modeling their mesh bonnets along with a video demonstrating the ease of attaching and detaching the device from a dog’s collar.  Believe it or not, dogs can drink and even carry toys in their mouths while wearing them!  A few of my clients who have purchased the product are completely sold on their investment.  

Photo © Margaret Birkhaeuser

If your dog has been a foxtail repeat offender I strongly encourage you to consider the OutFox Field Guard™.  Not only is it a great insurance policy to protect your dog’s health, think about the money you’ll save by eliminating trips to the vet clinic during foxtail season.  

Photo © Margaret Birkhaeuser

Has your dog been a repeat offender?  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, 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.

Normal Abnormalities

A “normal abnormality” is the term I use to describe something that is worthy of note within my patient’s medical record, yet is an anticipated abnormality (given the animal’s age, breed, or circumstances) that is highly unlikely to ever become a significant health issue.  I liken such abnormalities to the brown “liver spots” many people develop on their skin in response to sun exposure and aging.  Here are some examples of commonly encountered “normal abnormalities”:

Lenticular sclerosis:  This is an age-related change that occurs within the lenses of the eyes (dogs and cats). The pupil of the eye is normally black because the lens which is located just behind the pupil is crystal clear.  With age comes some rearrangement of lens fibers resulting in a grayish/whitish rather than normal black appearing pupil. This change is referred to as lenticular sclerosis.  People who notice this are usually concerned that their pet is developing cataracts. Whereas cataracts are opaque and interfere with light transmission to the retina, lenticular sclerosis causes no functional visual impairment. How can you know if your pet’s graying pupils represent cataracts or lenticular sclerosis?  Ask your veterinarian to have a look.

Sebaceous adenomas:  These small, warty appearing skin growths commonly develop in older dogs.  Sebaceous adenomas result from blockage of ducts that normally carry sebum to the skin surface. Smaller dogs are particularly prone- Miniature and Toy Poodles reign supreme when it comes to this age-related change.  Sebaceous adenomas are completely benign and rarely need to be removed unless they are growing or changing significantly (some dogs bite or scratch at these skin growth resulting in bleeding or infection). Removal of sebaceous adenomas may also be warranted if they manage to get in the way of grooming clippers.  Always point out any new lumps or bumps to your veterinarian including those you suspect are sebaceous adenomas.

Lipomas:  These benign fatty tumors develop under the skin in mature dogs (rare in kitties).  They can occur anywhere, but their favorite places to grow are the armpit, the inguinal region (the crease between the upper thigh and the belly wall), and along the body wall.  They are completely benign and need to be removed only if they are growing rapidly or, because of their location, have the potential to impede normal limb motion.  How can you know if a lump you’ve just discovered is a lipoma?  Schedule a visit with your veterinarian.  She will collect some cells using a small needle for evaluation under the microscope. If all that is present are fat cells, the diagnosis is a lipoma.  Every once in awhile these tumors become infiltrative sending tendrils of growth down into deeper tissues.  If your vet feels that your dog’s lipoma falls into this category, surgical removal will be recommended.

Stress induced changes:  No one likes going to the doctor, and our pets are no exception.  Squeezing your kitty into a cat carrier, the car ride, a lively waiting room scene, having a thermometer inserted you know where, the sights, the smells- all of these things can cause stress for your dog or cat!  And when the body is stressed, the body compensates by producing a number of normal physiologic changes such as increases in heart rate, blood pressure, body temperature, and blood sugar measurement.  Your veterinarian will have various tricks up her sleeve to determine whether such changes represent “normal abnormalities” or are indicators of underlying disease.

Should such “normal abnormalities” be ignored?  Not at all.  They should be noted in your pet’s medical record.  Additionally, “watchful waiting” will be recommended because every once in awhile, these abnormalities can morph into something that is deserving of more attention.  For example, a sebaceous adenoma can become infected, a dog with lenticular sclerosis can develop cataracts, and a growing armpit lipoma can begin to hinder normal motion of the front leg. While you are doing your “watchful waiting” count your blessings because, of all the abnormalities you or your veterinarian can find, a “normal abnormality” is the very best kind!

Does your dog or cat have a “normal abnormality”?  Do tell.

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

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.

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

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).

Canine arthritis: Symptoms and treatment options for arthritis in dogs

While I’m busy recovering from some back surgery, you have the good fortune of reading posts from some of my favorite doggie bloggers!  Today’s post comes from Dr. Lorie Huston who blogs regularly at Examiner.com.   Please make her feel welcome by posting your wonderful comments.  Be back soon! 

Best wishes,

Dr. Nancy Kay

Canine arthritis is a common and painful disease for affected dogs.

Canine arthritis is also commonly referred to as degenerative joint disease. Arthritis in dogs can have many causes. It may be:

• caused by a congenital deformity in the affected joint, as in hip dysplasia or elbow dysplasia
• caused by a previous injury
• caused by aging and the resultant “wear and tear” on the affected joint
• caused by infectious agents, such as Lyme disease
• caused by autoimmune disorders

Symptoms of canine arthritis

Whatever the cause of arthritis, degenerative joint disease in dogs causes pain in the affected joint. Arthritis may affect any joint in the body, including hips, knees, elbows, shoulders, and spines. Arthritis may involve many joints or may affect only one joint.

Symptoms commonly seen with arthritis are related to pain in the affected joint and may include:

• an abnormal gait (i.e. limping or carrying the painful leg)
• stiffness
• difficulty going up and down stairs or climbing into cars, onto furniture, etc.
• difficulty finding a comfortable way to rest or lie
• difficulty rising from a sleeping or seated position
• lack of appetite
• irritability

Treatment of arthritis in dogs

Treatment of arthritis in dogs may involve many different tactics. The immediate objective in treating arthritis is to decrease the pain associated with arthritis, which is often done through the use of pain relief medications. However, there are many other things which may also be recommended to improve the joint health of dogs suffering from arthritis.

Weight control is important for arthritic dogs

For those arthritic dogs which are overweight or obese, weight control should be a top priority. Besides adding additional weight to diseased joints leading to increased pain, fat as a tissue is increasingly being recognized as a secretory organ which produces substances which may in themselves contribute to causing pain. By reducing the weight of an arthritic dog, if appropriate, joint-related pain may become easier to manage.

Pain control for arthritic dogs

There are numerous pain control medications available for dogs with arthritis, including numerous NSAIDS (such as Rimadyl, Etogesic, Deramaxx, Metacam, Previcox and others) as well as medications such as tramadol, gabapentin and amantadine.

Cortisone or steroid products, such as prednisone, prednisolone or dexamethasone, are sometimes used to control the pain associated with arthritis under certain circumstances as well. These medications do have side effects and should be used as directed by the veterinarian. NSAIDs are contra-indicated when these products are being administered.

Nutraceuticals and other medications which may improve joint health

Various dietary supplements have been identified which may help to improve the health of affected joints, thereby easing the symptoms of arthritis. These supplements, also known as nutriceuticals, include:

• glucosamine
• chondroitin
• omega-3 fatty acids
• Methyl-sulfonyl-methane (MSM)

Pet owners should use caution in choosing nutriceuticals for their pets, however and should deal only with reputable drug manufacturers. Nutriceuticals are not regulated as most other pharmaceutical medications are in the United States and there have been many instances of labelling discrepancies with some of these medications.

Adequan is another medication which is often used to help improve the health of an arthritic joint. Adequan is an injectable medication which contains a protective cartilage component known as polysulfated glycosaminoglycan. Adequan has been used with success in relieving pain for some dogs with arthritis and other forms of degenerative joint disease.

Alternative medicine options for relief of arthritis pain in dogs

Acupuncture is being used more commonly to relieve the pain associated with arthritis in dogs and may an alternative in some communities where the services are readily available.

Physical rehabilitation is also becoming more widely used to control chronic pain such as that seen with arthritis as well. Physical therapy may range from modalities such as laser therapy or hydrotherapy to range-of-motion exercises which loosen and strengthen injured muscles, tendons and joints.

Adult stem cell therapy in treating canine arthritis

Stem cell therapy is another treatment option which is showing promise in the treatment of canine arthritis. Adult stem cell therapy has been used for several years as a treatment for muscle, joint and tendon injuries in horses and has more recently become available as a treatment option for dogs with similar injuries or diseases.

Multi-modal treatment approach to treating canine arthritis

In most cases of joint pain and arthritis in dogs, a multi-modal approach which incorporates one or more of the available treatment modalities is advisable. Weight loss for those dogs which are overweight is essential and may in itself provide some pain relief. Nutriceuticals may be used to help improve joint health and provide long-term pain relief. In the shorter term, pain medications or other options, such as acupuncture, may provide more immediate relief from pain. Physical therapy may also be indicated to help keep otherwise unsued muscles strong and healthy.

Dr. Lorie Huston

http://www.examiner.com/pet-health-in-national/canine-arthritis-symptoms-and-treatment-options-for-arthritis-dogs

Lorie Huston currently works as a small animal veterinarian in Providence, dealing primarily with dogs and cats. She has been practicing veterinary medicine since 1986. Lorie is a member of the American Veterinary Medical Association, the Rhode Island Veterinary Medical Association and the Veterinary Information Network. She also does a large amount of work for the Volunteer Services for Animals, a non-profit local group dedicated to helping pet owners and their pets. Lorie has been writing online since 2001. She has published numerous articles to various E-zines and newsletters, as well as providing news material to PRWeb. Currently, she is also writing for Ehow.com and Suite101.com.

_____________________________________________________

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

Avoiding Pancreatitis During the Holidays

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.

 

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).

Gastric Torsion: A Horribly Unhealthy Kind of Twist

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.