Archive for the ‘Medicine Decision Making’ Category

Ovariectomy (OVE) Versus Ovariohysterectomy (OVH) Revisited

December 26, 2011
Licensed under a Creative Commons Attribution License.

Photo Credit: Roger H. Goun

If you’ve been reading my blogs for awhile now, you may remember two of my previous posts. While OVH surgery involves removal of the uterus and both ovaries, with OVE surgery just the ovaries are removed. Both are effective techniques for spaying (neutering) female dogs and cats. I am bringing this topic to your attention for a third time based on a recently published article within the Journal of the American Veterinary Medical Association.

The article is titled, “Ovariohysterectomy Versus Ovariectomy for Elective Sterilization of Female Dogs and Cats: Is Removal of the Uterus Necessary?” Let me get right to the article’s punch line by presenting the authors’ final paragraph:

We do not believe that there is any scientific evidence for the preferential teaching of ovariohysterectomy instead of ovariectomy by schools and colleges of veterinary medicine in the United States and Canada, and it is our view that ovariectomy provides an equally effective technique for elective sterilization of female dogs and cats with no recognized disadvantages. Potential advantages of ovariectomy include a smaller incision, better viewing of the ovarian pedicle, and possibly less risk of complications associated with surgical manipulation of the uterus.

The authors’ conclusion is based on a review of recent literature comparing these two surgical techniques. When I’ve previously recommended OVE as the spay surgery of choice, here are the two concerns that you, my readers have voiced:

  1. You are unable find a surgeon who will perform OVE surgery. Here is what I recommend. Call multiple veterinary hospitals in your community and ask if the vets on staff are willing to perform ovariectomies (if the receptionist is uncertain about what you are asking, you may wish to tactfully ask to speak with a veterinarian or technician). If nothing else, you will be raising awareness about this recommended alternative. Based on what you’ve told me, some of your vets have been willing to educate themselves and perform their very first OVE surgery in response to their client’s request, and the results have been fabulous. If one is adept at removing ovaries and uterus, removing just the ovaries is a “no brainer.” So, it is perfectly fine if your vet performs his or her very first OVE on your dog or cat (I would normally strongly advise against your pet being your vet’s “first” surgery or procedure of any kind). Board certified surgeons gladly perform OVE surgery and may do it the conventional way (incision made on the underside of the abdomen) or via laparoscopy (a method that employs scopes which are introduced into the abdominal cavity via small incisions). The only drawback to having a specialist do the work is that the price tag for the work will be considerably higher than the norm.
  2. You have voiced concern that if the uterus is not removed, your pet could develop pyometra, an accumulation of pus/infection within the uterus that necessitates its surgical removal. Please don’t buy into this ridiculous notion! Pyometra only occurs under the influence of progesterone, a hormone produced by the ovaries. Without the ovaries no progesterone is produced and there is no risk for development of pyometra. Period!

I want to emphasize that if you cannot find a surgeon who will perform OVE surgery on your dog or cat, no biggee! There is truly nothing wrong with removing the uterus. I only wish to create recognition for the fact that it is completely unnecessary to do so. Lastly, if you are contemplating spaying your older pet (her uterus has been around the block a few times), visual inspection of the uterus at the time of surgery is warranted. If the uterus appears abnormal, it should definitely be removed- the one situation where OVH rather than OVE makes perfect sense.

Has your pet recently been spayed? Which surgical procedure was performed?

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.

Murphy and Ruska

September 5, 2011

I refer to my last week at work as the “Murphy and Ruska Show” in honor of two delightful patients who arrived at my doorstep one day apart, each with a life-threatening disorder called pneumothorax. “Pneumo” means air and “thorax” refers to the chest cavity, so “pneumothorax” is air within the chest cavity.  If you’re scratching your head wondering, “Isn’t there supposed to be air in the chest cavity?” here’s what you need to know.  While the lungs are air-filled, the space surrounding the lungs, known as the pleural space, is normally devoid of air.  Pneumothorax refers to the accumulation of air with the pleural space. In order to understand how a pneumothorax causes difficulty breathing, it helps to think of the chest cavity as an empty barrel into which the lung lobes expand as they inflate (like balloons filling with air).  The lungs readily inflate with minimal effort because negative pressure (a vacuum effect) normally exists within the pleural space.  Fill the pleural space with air and the negative pressure is disrupted resulting in more effort required for lung expansion.  Make sense?

Murphy and Ruska were both observed by their families to experience an abrupt onset of labored breathing. Murphy also became subdued, a marked deviation from his normal wiggly-waggly Labrador self and he was unwilling to lie down.  Clever Murphy figured out that lying down makes labored breathing even more of a struggle.  In addition to working extra hard to breathe the normally ravenous Ruska refused her breakfast, a sure sign that this sweet Shepherd was off her game.

Normal Chest

The two most common causes of pneumothorax are penetrating chest cavity wounds that allow external air to enter the pleural space and leakage of air from the surface of a diseased or injured lung lobe.  Pneumothorax is readily diagnosed with a chest x-ray.  Have a look at the accompanying normal and abnormal x-ray images. In both views, the dogs are lying on their sides with their head end to the left and their tail end to the right.  You can see the spines at the top of the images.  Note the heart, the whitish round structure in the middle of the chest cavity. Air shows up black on an x-ray. Now notice how much more black (air) there is surrounding the heart in the pneumothorax image compared to the normal chest. Makes you want to become a radiologist, eh!

Pneumothorax

Murphy and Ruska were referred to me to figure out why they had leaky lung lobes.  The most common cause of pneumothorax is a blunt blow to the chest cavity (hit-by-car trauma is classic) forceful enough to tear a lung lobe and allow leakage of air into the pleural space. Ruska and Murphy were both closely supervised with no known trauma history.  Computed tomography (CT scanning) is my test of choice for solving the mystery of the leaky lung lobe. Murphy’s scan revealed multiple small blisters (aka, blebs or bullae) on his lung lobe surfaces.  Just as in people with this abnormality the blisters are thin-walled and capable of spontaneous rupture allowing air to leak into the pleural space. Fortunately, as was the case with Murphy, most lung blisters are self-sealing within a few days. Worse case scenario, a stubborn leaker can be surgically sealed. Murphy’s family has been forewarned that his multiple blebs will likely mean multiple penumothorax episodes.  They know what to be watching for and will return with Murphy any time, day or night, should his labored breathing recur. Murphy is now home, happy as can be with instructions to be a couch potato for the next two weeks with hopes of avoiding disruption of the body’s “bandaid” on his leaky lung blister.

Ruska’s CT scan documented a small walled off abscess on the surface of one lung lobe.  Given the time of year and where Ruska lives and plays, I’d be willing to bet my first born child that a foxtail plant awn is living within that abscess.  Fortunately, Ruska’s lung lobe leak resolved itself, and the pros and cons of surgically exploring the site versus long-term antibiotic therapy (foxtails shuttle bacteria wherever they migrate) were discussed and are still being considered.  I should be hearing back from Ruska’s mom sometime this week.  For now, this big girl is back home and, like her friend Murphy, she is doing her best to be a cooperative couch potato (easier for a Shepherd than a Lab!).

Our emergency room vets are used to seeing pneumothorax patients because hit-by-car trauma is so prevalent.  As a small animal internist I rarely see them, yet here were two within one week! (I suspect the third is on its way.)  Have you or a loved one (human or canine) experienced a pneumothorax?  Please 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.

A Primer on Leptospirosis

July 24, 2011

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

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

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

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

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

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

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

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

The Cost of Caring

June 20, 2011

The news would have us believe that the recession is over and unemployment is declining, but I’ve got to tell you, I’ve not yet seen even a glimmer of this in my professional life.  The majority of my clients remain hard pressed to pay for the diagnostic testing and care that would be ideal for their sick pets in spite of the fact that we lowered many of the fees at my hospital approximately one year ago.  Fortunately, for most of my patients, I can offer multiple medical options rather than just one.  For example, many folks these days choose the less expensive route of empirical therapy (providing treatment without certainty of what the underlying medical issue is) rather than performing diagnostic testing.  Within the limitations dictated by cost constraints, I try to do what’s best for my patient while also trying to assuage the guilt that most clients in this situation experience.  They love their pets dearly, but face the reality of having to settle for something that would not normally be their first choice.

When appropriate, I provide my client with a list of organizations that provide financial assistance for veterinary care costs.  Trust me, these wonderful organizations have been deluged by requests over the last few years.  Yet they still manage to pull through for some of my clients.  Many provide financial help for any type of veterinary care while others set specific criteria.  For example, they might provide assistance only for pets with cancer or only for service dogs.  None of them provide urgent funding- invariably there is an application process.  If you are interested in having a look at these wonderful organizations, I invite you to visit my website. Click on “Resources” found in the red horizontal main menu and then scroll down to “Financial Assistance for Veterinary Care.”  A sure sign of the times is that this is the most frequently visited page on my website!

For those of you with  young healthy animals (devoid of any preexisting medical conditions) I encourage you to consider purchasing a pet health insurance policy.  For an annual premium cost of $300-$400 you will have the peace of mind of knowing that you will be reimbursed approximately 80% of future out of pocket veterinary expenses.  The key is in choosing your insurance provider wisely.  Some reimburse exactly as you would hope while others come up with all kinds of crazy loopholes.  Visit my website for a list of questions to ask insurance providers that will help you separate the good guys from the bad.  Click on “Resources” found in the red horizontal main menu and scroll down to “Pet Health Insurance.”  My book Speaking for Spot provides a comprehensive resource for learning all you need to know about pet health insurance.

Have these tough economic times influenced how you provide medical care for your pets?  If you feel comfortable sharing your story, I welcome hearing it.  If you know of any organizations (not already on my list) that provide assistance for veterinary care, please give me a shout out.  I would love to include them.

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.

The challenges of combining Eastern and Western medicine for your pets

June 6, 2011

Choosing a veterinarian who practices Western medicine (conventional medicine/allopathy) or one who practices Eastern medicine (alternative/complementary medicine) is fairly straightforward.  Successfully combining the best of both medical worlds however can be challenging.  Speaking for Spot fan, Carolyn recently sent me an email based on her experiences:

Hello Dr. Nancy! My question has to do with both holistic and conventional medicine for our dogs. I try to do everything as “green and natural” as possible for my dog: home-made food & treats, non-toxic cleaning products, natural materials in beds and toys … you get the idea. I think supplements and holistic treatments have their place and often are very valuable in maintaining health and even in treating illness. That said, I believe conventional veterinary medicine is valuable too. My conventional vet is great … but she does roll her eyes when I discuss a holistic approach. So how does one balance both therapy options for their dog? Are there any vets who practice both holistic and conventional veterinary medicine, that have a more diverse toolbox so to speak? I sort of feel that I have a foot in both camps and I’m not sure my dog is well served by one approach over the other.

Here’s how I responded to Carolyn. By the way Maggie, the insanely adorable cotton ball flying over the hedge in the accompanying photo is Carolyn’s lucky companion.

Hi Carolyn. How nice to hear from you. Please give Maggie a treat from me! You are correct.  It can be difficult to find a veterinarian who practices Western medicine and supports referral for complementary medicine, and vice versa.  Truthfully, it is difficult for a veterinarian to be extremely well versed in both disciplines (hard enough staying truly proficient in just one of them).  There are a few veterinarians who do a great job with both, but they are few and far between.  Western medicine is the discipline predominantly taught in veterinary schools throughout the United States.  Proficiency in complementary modalities including Chinese herbs, homeopathy, and acupuncture requires additional training and certification.

What can you do to avoid having your veterinarian roll his or her eyes at you? As you know, I am a big believer in picking and choosing your veterinarians wisely. Certainly, open-mindedness is an important trait in any doctor, whether providing service for us or for our beloved pets.  The “ideal vet” is happy to have you work with other veterinarians so that your pets receive the care that is best for your peace of mind.  Just as most of us have a number of doctors for our health needs, it’s perfectly acceptable for your pets to have different doctors for their different health care needs.  Here is an example. The surgical specialists I work with frequently treat dogs suffering from severe arthritis pain.  In addition to prescribing a nonsteroidal antiinflammatory medication and joint care supplements the surgeon may refer their patient to a rehabilitation therapy specialist for workouts on the underwater treadmill.  Clients are also offered the option of consulting with a veterinarian who specializes in acupuncture. The key to success is that all three specialists are open-minded, communicate with one another, and share a common goal- namely what is best for the patient. Can such a winning combination be found in every community? No, unfortunately not, but you won’t know until you look.  What should you do if your veterinarian feigns hurt feelings or rolls her eyes?  Stay true to your goals.  You know what is best for your pet.  Besides, which is more important, your vet’s feelings or your pet’s health?

Have you been successful at combining Eastern and Western medical approaches for your pets?  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.

 

 

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

May 8, 2011

 

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

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

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

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

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

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

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

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

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

Best wishes for good health,             

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

When the Doctor Becomes the Patient: Not Always a Pretty Picture

May 2, 2011

While in the midst of my post-surgery “down time” I’ve been chuckling a bit about what my own physicians have endured as a result of my medical background.  How commonly is a surgeon interrogated about what type of suture pattern and material he intends to use? How often does an anesthesiologist need to provide a detailed pharmacologic rundown of the anti-emetic (anti-vomiting) drugs that will be used to keep the patient with a queasy stomach from puking post-operatively? 

© Steve Horton

I remember one particular appointment with my family physician a few years back.  When we discussed the reason for the visit I began with, “I think I have cancer!”  I explained that I’d been losing weight even though I’d been eating normally.  After all, a diagnostic workup on a middle-aged dog or cat losing weight in the “midst of plenty” often results in the diagnosis of cancer.   My physician worked hard to hide a grin as he explained that, given my age, sex, and overall vigor, other diagnoses were far more likely. Thankfully, he was right, and the next time I saw him he asked for permission to share this “amusing patient story” with some medical students he was training.  

Sometimes, the medical knowledge I have can be a detriment to my own peace of mind.  As the story above illustrates, I’m always keenly aware of the worst-case scenario (tough on a person who is a natural born worrier). Would I trade being a veterinarian for any other profession?  Not in a million years.  Not only do I love what I do, I love that my medical background (along with a bit of chutzpah) allows me to be a stellar medical advocate for myself.  And if you’ve read much of what I’ve written in the past, you know that I am all about medical advocacy! 

Do you work within the medical profession?  If so, how has this been helpful or detrimental when interacting with your health care professionals (including your veterinarian)? 

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.

Back at the Keyboard

April 26, 2011

© Diane Gerba

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

 

Best wishes for good health,            

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Age is Just a Number

April 14, 2011

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

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

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

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

Best wishes for good health,         

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook         

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

When to Say Yes to a Diagnostic Test

April 8, 2011
As veterinarians we have access to so many incredible diagnostic tests. They help us uncover medical issues in our patients that, in the past, we could only guess about. How can you know whether or not to say, “Yes” to your vet when she or he recommends a diagnostic test, whether advanced or more basic? Here are my suggestions:  

© Susannah Kay

 

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

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

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

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

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

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

Best wishes for good health,         

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook         

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.