Archive for the ‘Medical Advocacy’ Category

Looking back on 2010

December 30, 2010

Dr. V. at Pawcurious has initiated a “blog hop” recruiting her fellow pet bloggers to compile their lists of the best of 2010.  This Dr. V. is so darned nice, adorable, and funny, that I would be hard-pressed to ever decline her invitation.  So, I’ve chosen for you what I consider to be my favorite blogs from 2010.  If you think I left one out that should have made the top ten, by all means let me know.  Now, here’s a look back at 2010!

A Rottweiler Reunion

This was such a sweet story originating with two wonderfully sweet and very pregnant Rottweilers who were abandoned at my hospital.  This is a story with a wonderfully happy ending.

What is a Veterinary Specialist?

I’m always surprised by how many people don’t know that veterinary specialists exist.  This is my way of getting the word out.

Speaking for Spot Gives Back

The Speaking for Spot Gives Back Program has been wonderfully successful allowing animal-centered nonprofit organizations to benefit from sales of Speaking for Spot.  I couldn’t be more pleased.

Gastric Torsion: A Horribly Unhealthy Kind of Twist

I’ve always loved explaining this strange disease to my clients, so why not explain it to my blog audience as well!

What Not to Name Your Dog

This was a fun blog to write and based on my readers’ responses, a good reminder to me to not be so darned serious all the time!

Reasonable Expectations

My main soapbox is medical advocacy which translates into trying to convince people about what they are entitled to when it comes to medical care.  My series on “Reasonable Expectations” does exactly that.  So far there are 7 blog posts within this series and there will certainly be a few more.  The very last one (will likely show up in February) may surprise you!

A Dozen Simple Ways to Be Certain You Are Working With a Reputable Breeder

How can the “average Joe” feel confident they are purchasing a healthy purebred puppy and not supporting puppy mills in the process?  The purpose of this blog post was to teach exactly that! 

Puppy Mills: People and Their Puppies Pay the Ultimate Price

Here I am on my anti-puppy mill soapbox!  

My Puppy Mill Education

And more on my anti-puppy mill soapbox!  When will this insanity against animals ever end?

Vaccinations for Your Dog: A Complex Issue

It’s critical to be your best friend’s medical advocate when it comes to vaccinations.  This blog is my attempt to teach people how.

Best wishes for a happy new year.   

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.

Reasonable Expectations VII: Discussion and Open-Mindedness About Your Dog’s Vaccinations

December 27, 2010

This is the seventh part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through six can be found at www.speakingforspot.com/blog

As invaluable as vaccinations are for protecting canine health, determining which vaccines are appropriate and how frequently they should be administered are no longer simple decisions. Gone are the days of behaving like  “Stepford wives” simply because you’ve received a vaccine reminder postcard or email. Vaccinations are no different than any other medical procedure.  They should not be administered without individualized discussion with your veterinarian and consideration of the potential risks and benefits. Please know that having such a discussion with your veterinarian is a perfectly reasonable expectation, and your input is an invaluable part of the vaccine decision-making process.

Consider the following:

• There are currently more than a dozen canine vaccinations to choose from! Back in the days when I was just a pup there were only five, and decision-making regarding vaccine selection for an individual dog was far less complicated.
• Over the past decade we’ve learned that, for some vaccines, the duration of protection is far longer than previously recognized.  In the past we vaccinated against distemper, parvovirus, and rabies annually.  We now know that these vaccinations, when given to adult dogs, provide protection for a minimum of three years and, in some cases protection is life-long.
• The duration and degree of immune protection triggered by a vaccine is variable, not only based on vaccine manufacturer, but from dog to dog as well.
• Other than for rabies (state mandated), vaccination protocols are anything but standardized. There are no set rules veterinarians must follow when determining which vaccines to give and how often they are administered. Unfortunately, some vets continue to vaccinate for distemper and parvovirus annually even though we know that these adult vaccines provide protection for a minimum of three years.  Some vets give multiple inoculations at once, others administer just one at a time.
• Increasingly clear-cut documentation shows that vaccines have the potential to cause many side effects.  While vaccine reactions/complications are still considered to be infrequent, they can be life threatening.

What you can do:

As your dog’s savvy medical advocate, what can you do to be sure that he or she is neither under or overvaccinated? Here are some guidelines for making wise vaccine choices for your best buddy:

1.  Educate yourself about available canine vaccinations and the diseases they are capable of preventing (in some cases treating the disease, should it arise, might be preferable to the risks and expense associated with vaccination). Learn about duration of vaccine protection and potential side effects.  Read the chapter called “The Vaccination Conundrum” in Speaking for Spot. It provides detailed discussion about all aspects of canine vaccinations including the diseases they prevent, adverse vaccination reactions, and the topic of vaccine serology (blood testing that helps determine if your dog is truly in need of vaccine booster). The American Animal Hospital Association’s “Canine Vaccine Guidelines” is also an excellent source of information (http://secure.aahanet.org/eweb/dynamicpage.aspx?site=resources&webcode=CanineVaccineGuidelines).
2.  Talk with your veterinarian to figure out which diseases your dog has potential exposure to.  A miniature poodle who rarely leaves his Manhattan penthouse likely has no exposure to Lyme disease (spread by ticks); however a Lab that goes camping and duck hunting may have significant exposure.
3.  Alert your veterinarian to any symptoms or medical issues your dog is experiencing.  It is almost always best to avoid vaccinating a sick dog — better to let his immune system concentrate on getting rid of a current illness rather than creating a vaccine “distraction.” If your dog has a history of autoimmune (immune-mediated) disease, it may be advisable to alter his vaccine protocol or even forego ongoing vaccinations — be sure to discuss this with your vet.
4.  Let your vet know if your dog has had vaccine side effects in the past. If the reaction was quite serious, she may recommend that you forego future vaccinations, necessitating an official letter to your local government agency excusing your pup from rabies• related requirements.
5.  Talk to your veterinarian about vaccine serology.  This involves testing a blood sample from your dog to determine if adequate vaccine protection still exists (remember, vaccine protection for the core diseases lasts a minimum of three years).  While such testing isn’t perfect, in general if the blood test indicates active and adequate protection, there is currently no need for a vaccine booster. Serology may make more sense than simply vaccinating at set intervals.
6.  Talk to your veterinarian about the potential side effects of proposed vaccinations, what you should be watching for, and whether or not there are any restrictions for your dog in the days immediately following vaccination.

What happens if your veterinarian declines vaccine discussion and simply wants to vaccinate based on what he or she thinks is appropriate?  Time to find yourself a new veterinarian who is progressive enough to have a working relationship with people who choose to be a stellar medical advocates for their dogs!  Is your vet willing to have open-minded discussion with you about your dog’s vaccinations?

Best wishes for a happy new year.   

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.

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).

A Short Sabbatical

November 13, 2010

After four years of procrastination, I’m finally gonna do it!  I’m heading into the operating room, only I won’t be the one holding the scalpel blade.  A team of surgeons aim to fix a nagging back issue I’ve been annoyed by for far too long. Fret not, the prognosis is very good and I aim to be busy word processing again in no time!  In the meantime, some of my esteemed co-bloggers will provide guest posts that I know you will enjoy.  While in the midst of my post-operative narcotic haze, I won’t be emailing blogs as I normally do. Rather, I hope you will join me on Facebook (http://www.facebook.com/speakingforspot) so you will be notified of new blogs as they are posted.  

And now for some shameless self-promotion!  I emphatically urge you to place Speaking for Spot at the very top of your holiday gift list for all of your dog loving friends, relatives, groomers, trainers, pet sitters, and dog park compatriots. And while you’re at it, don’t forget your veterinary hospital staff!  

Here are five reasons to give the “Gift of Spot” this year:  

  • Free Christmas gift-wrap included (an adorable double-sided wrap with bright Christmas doggie décor on one side and red and white dog bones on the other).
  • Free Chanukah gift-wrap included; sorry, no adorable canine theme (go ahead, you try to find dogs and Chanukah on the same wrapping paper!).
  • Four dollars from each book purchased will be sent to the participating animal-centered nonprofit organization you designate at the time of purchase.
  • Your gift will be personally signed by yours truly!
  • Your gift will provide an invaluable lifelong resource that is sure to enhance the life of a dog! 

Please visit www.speakingforspot.com/purchase.html to do your holiday shopping!  

Thank you for your readership. I extend my heartfelt best wishes to you and your loved ones (including those who are furry or feathered) for a peaceful and healthy holiday season.   

Dr. Nancy Kay
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

Stop That Scratching!

April 22, 2010

If the sounds of a canine or feline “scratchfest” is interrupting your slumber, or you’re snarling, “Stop scratching!” several times a day, chances are you have an allergic pet on your hands. Just as with human hay fever, most dog and cat allergies are the result of an exaggerated immune system response to allergens in the environment such as plant pollens, tree pollens, and mold spores.  The scientific name for this inherited allergic condition is atopy or atopic dermatitis. Terriers of any type are notorious atopy sufferers along with Dalmatians, Lhasa Apsos, Shar-peis, Bulldogs, and Labrador Retrievers. 

Whereas people are prone to runny nose and eyes, dogs and cats with atopy develop itchy skin, often accompanied by skin and ear infections. Symptoms are initially mild and seasonal, but tend to progress year by year in terms of severity and duration.  Fortunately, there are many options for treating atopy including medicated shampoos, antihistamines, fatty acid supplements, and drugs that alter the immune system’s overzealous behavior (cyclosporine, cortisone).  Just as for people, desensitization injections can be administered after specific testing is done to determine which allergens are provoking the immune response. Elimination of exposure to the allergens may also be an option (a good excuse to move to Hawaii!). 

Some dogs and cats develop allergies to their food.  This can result in year round itchy skin, ear infections, and/or gastrointestinal symptoms (vomiting, diarrhea, gassiness).  If a food allergy is suspected, your veterinarian will recommend an “elimination food trial.”  This requires strict adherence (including elimination of your pet’s favorite treats) to feeding a novel protein diet for six to eight weeks. There are many such diets to choose from these days that contain duck, rabbit, venison, salmon, and even kangaroo! If the chronic symptoms disappear in response to the diet change, voila, the diagnosis of food allergy has been made. One must then hope that, over time, the animal doesn’t develop an allergy to the new diet! 

Lastly, some dogs and cats develop an allergy to fleas, more specifically, to the flea’s saliva.  Whereas many fleas are required to cause most animals to scratch like crazy, for those with a flea allergy, just one bite is all it takes to set off an intensely itchy reaction that can last for days. The best treatment for this allergy is stringent flea control, or relocation to Colorado; fleas don’t survive in high altitude locations! 

‘Tis the season for fleas and seasonal atopy.  Do you have an itchy dog or cat on your hands?  If so, what will your strategy be to soothe your pet’s itch and preserve your sanity? 

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.

Stop That Scratching!

April 22, 2010

If the sounds of a canine or feline “scratchfest” is interrupting your slumber, or you’re snarling, “Stop scratching!” several times a day, chances are you have an allergic pet on your hands. Just as with human hay fever, most dog and cat allergies are the result of an exaggerated immune system response to allergens in the environment such as plant pollens, tree pollens, and mold spores.  The scientific name for this inherited allergic condition is atopy or atopic dermatitis. Terriers of any type are notorious atopy sufferers along with Dalmatians, Lhasa Apsos, Shar-peis, Bulldogs, and Labrador Retrievers. 

Whereas people are prone to runny nose and eyes, dogs and cats with atopy develop itchy skin, often accompanied by skin and ear infections. Symptoms are initially mild and seasonal, but tend to progress year by year in terms of severity and duration.  Fortunately, there are many options for treating atopy including medicated shampoos, antihistamines, fatty acid supplements, and drugs that alter the immune system’s overzealous behavior (cyclosporine, cortisone).  Just as for people, desensitization injections can be administered after specific testing is done to determine which allergens are provoking the immune response. Elimination of exposure to the allergens may also be an option (a good excuse to move to Hawaii!). 

Some dogs and cats develop allergies to their food.  This can result in year round itchy skin, ear infections, and/or gastrointestinal symptoms (vomiting, diarrhea, gassiness).  If a food allergy is suspected, your veterinarian will recommend an “elimination food trial.”  This requires strict adherence (including elimination of your pet’s favorite treats) to feeding a novel protein diet for six to eight weeks. There are many such diets to choose from these days that contain duck, rabbit, venison, salmon, and even kangaroo! If the chronic symptoms disappear in response to the diet change, voila, the diagnosis of food allergy has been made. One must then hope that, over time, the animal doesn’t develop an allergy to the new diet! 

Lastly, some dogs and cats develop an allergy to fleas, more specifically, to the flea’s saliva.  Whereas many fleas are required to cause most animals to scratch like crazy, for those with a flea allergy, just one bite is all it takes to set off an intensely itchy reaction that can last for days. The best treatment for this allergy is stringent flea control, or relocation to Colorado; fleas don’t survive in high altitude locations! 

‘Tis the season for fleas and seasonal atopy.  Do you have an itchy dog or cat on your hands?  If so, what will your strategy be to soothe your pet’s itch and preserve your sanity? 

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.

What is a Veterinary Specialist?

March 21, 2010

I participate in a list serve for veterinarians who specialize in internal medicine. The list serve “topic de jour” concerns veterinarians who are general practitioners (also known as family veterinarians), yet bill themselves as “specialists” in specific venues such as surgery, dentistry, or cardiology.  The responses have been strongly disapproving, and here is the reason why:  The American Veterinary Medical Association dictates that the term “specialist” be reserved only for veterinarians who have completed all of the requirements to become a “diplomate” within a specialty organization. What must a veterinarian do to become an official specialist/diplomate? Trust me, it is a long and arduous process! After graduating from veterinary school, wannabee specialists must complete a minimum three-year internship and residency training program, author publications in peer reviewed journals, and pass some insanely rigorous examinations specific to the specialty they are pursuing.  (Note that the requirements differ for those who become specialists in complementary/alternative medicine fields of veterinary medicine such as homeopathy, acupuncture, chiropractic, and Chinese herbs.) If one is successful in completing this rigorous and extensive training they achieve “board certification” status and are deemed to be “specialists” or “diplomates” within their chosen specialty.  This is much like the process physicians go through to become specialists.

The world of veterinary specialists has grown by leaps and bounds.  Much like Starbucks®, if there’s not already a group of specialists in your community, there likely will be soon!  Veterinary specialists are found in university teaching hospitals and in some private practices.  They often “cohabitate,” sharing specialty staffing, equipment and laboratory services with specialists in different areas of expertise.  When this is the case, you, the lucky client, end up with access to multiple specialists under one roof.  Not only is this convenient, it also focuses a lot of brainpower and experience on your pet- group discussions about patients (medical rounds) typically occur daily in such specialty hospital settings.

When might you need the services of a veterinary specialist? Just as your family physician refers patients to specialists, your family veterinarian should be considering referral in the following three situations:

  1. A second opinion is desired by you or your veterinarian.  Yes, you definitely have the right to request a second opinion.  I know it can be tough telling your vet you would like a second opinion, but as your beloved pet’s medical advocate, you are obligated to do so just as soon a your “gut” starts suggesting that a second opinion makes sense. I encourage you to read the chapter called, “A Second Opinion is Always Okay” in Speaking for Spot- it will provide you with plenty of helpful coaching about how to tactfully broach the subject with your veterinarian! Hopefully your vet has established relationships with local specialists- the kind she would trust to take good care of her own dog should the need arise. Not all family veterinarians are keen on “letting go” of their patients, so self-referral might be your only way to seek out the help of a specialist.
  2. Help is needed to figure out what is wrong with your pet. Specialists have advanced diagnostic tools (ultrasound, endoscopy, CT imaging, MRI scans, etc.) and have developed the skills to use them. Additionally, because of their extensive experience with challenging cases, specialists often have the ability to hone in on a diagnosis in the most direct and expedient manner.
  3. Your vet doesn’t specialize in the disease your pet has or the therapy he needs.  Just as with our own health issues, treatment is ideally managed by someone who works with that particular disease issue day in, and day out, and regularly pursues continuing education pertaining to that disease.

How can you tell if a particular veterinarian is truly a specialist?  Simply examine the initials following his or her name. See the list of specialties and their corresponding initials below. For example, if you look at the initials following my signature (ACVIM), you can tell that I am a specialist in The American College of Veterinary Internal Medicine. To learn more about any of these areas of specialization, pay a visit to the websites.  Those listed below are within the United States, but you will find comparable organizations in many other countries or continents.

Have you ever taken your pet to a veterinary specialist?  Have you ever wanted to do so, but had trouble getting “buy in” from your family veterinarian?  If so, please share your experience.  I’d love to hear from you.

Diplomate, ACVIM Internal medicine (acvim.org)
Diplomate, ACVIM, Cardiology Cardiology (acvim.org)
Diplomate, ACVIM, Oncology Oncology (acvim.org)
Diplomate, ACVIM, Neurology Neurology (acvim.org)
Diplomate, ACVS Surgery  (acvs.org)
Diplomate, ACVD Dermatology (acvd.org)
Diplomate, ACVR Radiology (acvr.org)
Diplomate, ACVO Ophthalmology (acvo.org)
Diplomate, AVECC Emergency and critical care (acvecc.org)
Diplomate, ACVA Anesthesiology (acva.org)
Diplomate DACVB Behavior (dacvb.org)
Diplomate, ACVN Nutrition (acvn.org)
Diplomate, AVDC Dentistry (avdc.org)
Diplomate, ACT Theriogenology (theriogenology.org)
CVA Veterinary acupuncture (Ivas.org)
TCVM Chinese veterinary medicine (tcvm.com)
AVH Homeopathy (drpitcairn.com) or (theavh.org)
ACVA Chiropractic (animalchiropractic.org)
CCRP Canine rehabilitation (caninerehabinstitute.com)

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

Nancy Kay, DVM
Diplomate, ACVIM
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.

An Herbal Addendum and Vital Information About Vitamins

March 1, 2010

My most recent blog focused on potential pitfalls associated with treating our pets with medicinal herbs.  As so commonly happens, I received wonderful feedback, and one comment in particular, I would like to share with you.  Dr. Susan Wynn, a much-admired veterinary colleague offered this sage advice, “I think your conclusion is appropriate – if you’re interested in herbs, talk to your vet.  I think you need to go one further, though, since most veterinarians know little about herbs – find a veterinarian who has a special interest in herbal medicine.  Not only are they more aware of interactions and toxicity, recent research and clinical experience, they also take great care to source their products from American companies, some of them organic, that employ knowledgeable formulators. About the PDR recommendation – that will not be as helpful as it is for people only.  Please see Veterinary Herbal Medicine (Elsevier, 2007).  Disclaimer – I’m the first author on it – but it was written to collect the most comprehensive available information on herbs and their use in domestic animals.  There are thousands of references, detailed information on over 100 herbs including known toxicity and interactions, species specific cautions, traditional ethnoveterinary uses and scientific support.”  

Just as many people are giving their herbs to their pets without veterinary supervision, so too are they providing them with supplemental vitamins.  I wish I could tell you that vitamins are perfectly safe to give.  Alas such is not the case and here is why.    Vitamins come in two basic varieties; they are either water soluble or fat soluble. Vitamins B and C are water soluble meaning that any excess in the body is readily eliminated from the body within the urine.  I certainly take an abundance of vitamin C when I feel a cold coming on (thanks to Linus Pauling) with no worries of an overdose.  Not true for vitamins A, D, E, and K.  These are fat soluble vitamins, meaning amounts above and beyond what the body needs cannot be readily eliminated. Rather, the excess is retained within the body’s fat stores which can result in hypervitaminosis (symptoms caused by a vitamin overdose).  For example, too much vitamin A can cause horrendous bony abnormalities and too much vitamin D can wreak havoc on normal calcium metabolism resulting in muscle tremors, gastrointestinal issues, and even kidney failure. 

What’s the bottom line?  As tempting as it is to believe that over the counter herbs and vitamins are safe for any and all living beings, take the time to discuss these products with a trusted veterinarian before you provide them to your beloved pets.

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.

Medicinal Herbs: Not to Be Taken (or Given) Lightly

February 23, 2010

As a small animal internist, the majority of my patients are referred by their family veterinarians.  By the time I first examine them, they are usually receiving a laundry list of conventional medications (antibiotics, nonsteroidal antiinflammatories, etc.) and/or complementary medications (herbs, homeopathic remedies).   I’ve always scrutinized the conventional medications on the list because their potential side effects and the ways they might impact my diagnostic and therapeutic planning.  I’ve tended to pay far less attention to the complementary medications because of my impression that these medicinals are unlikely to cause significant harm or interact unfavorably with other things I might prescribe. Well, there will be no more of this “ignorant bliss” for me! Not after reading, “A Review of the Potential Forensic Significance of Traditional Herbal Medicines” from the Journal of Forensic Science (January, 2010).  The author, Roger Byard, M.D. undertook a review of herbal medicines based on their increasing popularity (there has been a steady 10% increase in spending on botanical remedies in the United States) and the fact that access to such products is largely unrestricted- they can be purchased without prescription. Keep in mind that herbs are manufactured and sold without any FDA approval process.

Here are some of Dr. Byard’s comments and findings:

-An analysis of 251 Asian herbal products from stores in California identified arsenic in 36, mercury in 35, and lead in 24. There have been reports of lead poisoning and mercury poisoning in people caused by such contamination.
-Less expensive herbs are sometimes intentionally used to replace those that are more costly. A case is referenced in which an herb designed to promote weight loss was replaced with another. The unfortunate result for the patient was kidney failure.
-Accidental substitution can occur if plants are incorrectly identified or if the name is misinterpreted. Apparently, some traditional herbal preparations have multiple names. To make matters even more confusing, some herbal preparations that are different from one another go by the same name.
– Failure to process fresh herbs correctly can have serious consequences. Processing is designed to clean and preserve the desired material while removing or reducing any unwanted toxic components. The example provided was aconite root, a plant that must be soaked in water and boiled to reduce toxicity. Failure to do this can result in heart rhythm abnormalities and/or heart failure.
-Some herb manufacturers purposefully adulterate their products with drugs presumably to increase their efficacy. Yet no mention of this is made on the packaging. Examples of hidden products found in herbal preparations have included conventional medications to treat pain, inflammation, seizures, heart failure, and asthma.
-Herbal medicines can interact with conventional drugs and other herbs to cause undesirable side effects. For example, St. John’s Wort can decrease the blood level of some medications by impacting how they are metabolized within the liver.
-The American Society of Anesthesiologists has recommended discontinuation of herbal medicines at least two weeks prior to surgery because of their potential for causing complications. Although only eight herbs were identified as being potentially dangerous, they accounted for 50% of all single herb preparations of those sold within the United States. For example, Ginkgo has the potential to increase the risk of hemorrhage and Valerian can exacerbate the sedative effects of anesthetic agents.

Although Dr. Byard’s review is based on findings in human medicine, I have to believe that the general points he makes likely apply to veterinary medicine as well. His review has certainly served as a wake up call for me. If you use herbs, for your pets or yourself, perhaps this information will prompt you to think about things a bit differently as well. What is a practical approach for avoiding the potential pitfalls associated with herbal medications? I encourage you to consider doing the following:

  1. If you are giving herbs to your pet based on your own initiative, schedule an appointment with your vet to discuss and verify that what you are doing is reasonable and safe.
  2. Have a look at the blog I posted in July, 2009 (http://speakingforspot.com/blog/?p=407) called, “The Lowdown on Nutritional Supplements.” It will teach you how to use the ACCLAIM system to evaluate the quality of herbal products.
  3. Pick up a copy of the Physician’s Desk Reference (PDR) for Nonprescription Drugs, Dietary Supplements, and Herbs. It provides information about the indications, contraindications, and warnings for all commonly used herbs. This PDR is readily available via major online book vendors. I will certainly be using my own copy a whole lot more than ever before!

I hope I have not created fear or anxiety by presenting this information. Rather, my goal is to help you become the very best medical advocate possible. Now, like me, you know that herbal medications should not be taken (or given) lightly. If you provide herbs to your pet(s), I would love to hear from you. Please let me know which one(s) you are giving and whether you or your veterinarian initiated this treatment.

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. 

 

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