Archive for the ‘Veterinary Care’ Category

Normal Abnormalities

May 23, 2011

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.

Advocacy Aids

May 16, 2011
 

Photo © Susannah Kay

I use the term Advocacy Aids to describe a set of health forms I’ve created to help you excel as your pet’s medical advocate. Where can you find them?  It’s easy.  Simply go to www.speakingforspot.com and look for “Resources” in the red horizontal main menu.  The first item in the Resources pull down menu is Advocacy Aids.  I invite you to download, print, copy, and use them to your heart’s content.  Feel free to share with others as well.  By the way, while you’re there  please check out my new website! 

The Advocacy Aids include: 

Health History Form:  This form provides an easy way to keep track of your pet’s vaccinations, test results, prior medical issues, surgical procedures, and adverse reactions to medications or vaccinations. 

Current Medications:  List all of your pet’s current medications (including supplements, flea and tick control products, and heartworm preventive).  Be sure to bring along a copy to every hospital visit. Your vet will be profoundly grateful and this paperwork will help you both catch any prescription errors. 

Current Health Issues:  This form helps keep track of all of your pet’s current medical issues.  It’s helpful to maintain a written list so none of the issues will be overlooked or forgotten. 

Medication and Treatment Schedule:  This template is wonderfully helpful if your pet requires medications/treatments multiple times daily and/or at different times of day.  I’ve provided you with the same template we use when treating animals in my hospital.  On my website you will find a sample template form that I’ve filled out (so you can see how it works) as well as a blank template for your use. 

Emergency Contact Information:  You will want to have ready access to this completed form in order to avoid spending time tracking down necessary information while in the midst of an emergency. Be sure to provide a copy to the person caring for your pets when you are away. 

Contingency Plan: Use this form when you are going out of town and may not be one hundred percent reachable.  The form lets your veterinarian know which trusted person you’ve designated to make medical decisions about your pet should you not be reachable.  Distribute a signed copy to your pet-sitter/boarding facility and your veterinarian. 

Veterinary Office Visit:  This form will help you keep track of the purpose of your visit as well as important questions to ask your veterinarian. 

For those of you with pets other than dogs, please forgive me as many of the forms contain the word, “dog”.  Feel free to cross this word out and substitute in any species you like!  After you’ve had a look at the Advocacy Aids, please let me know which ones you like and think you will use.  If you can think of other Advocacy Aids, please don’t be shy.  I would love to hear your ideas. 

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.

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.

Dogs and Mushrooms: A Potentially Lethal Mix

April 1, 2011

Donato © Diana Gerba

     

I remember the sad sinking feeling I experienced last August as I read an email from my friend Diana Gerba.  Seeing her email in my inbox initially prompted excitement- oh goodie, more photos and stories about Donato,  Diana’s adorable Bernese Mountain Dog. My excitement quickly morphed into utter disbelief as Diana described the death of her barely six-month-old pup caused by ingestion of a poisonous mushroom.      

Diana’s heart was broken.  As she wrote in her email,     

A special boy, Donato was a silver tipped puppy, a rarity in our breed. With his tail always wagging, he had boundless enthusiasm for life.  He was a happy little chap and was my joy.  He loved me and I him. We were a team ordained by the stars.      

      

Diana and Donato © Peter Nystrom

Every region of the country is different in terms of mushroom flora. Where I live in northern California, Amanita phalloides (aka Death Cap) is the most common poisonous species and grows year round particularly in soil surrounding oak trees.  Ingestion of a Death Cap mushroom causes liver failure (in people and in dogs)- makes sense given the liver’s function as the “garbage disposal” of the body. Symptoms typically include vomiting, diarrhea, lethargy, loss of appetite, delayed blood clotting, and neurological abnormalities.  Every year at my busy hospital, we see at least a handful of dogs with liver failure clearly caused by mushroom ingestion.  In spite our very best efforts, the individuals who survive mushroom poisoning are few and far between. Affected people can receive a liver transplant; no such technology available (yet) for dogs.      

     

To learn more about poisonous mushrooms visit the North American Mycological Association and Bay Area Mycological Society websites.  If you suspect your dog has ingested a mushroom get to your veterinary clinic or the closest emergency care facility immediately (choose whichever is most quickly accessible).  If possible, take along a sample of the mushroom so it can be professionally identified if need be.     

      

Fortunately, my friend Diana has managed to put a positive spin on the loss of her beloved Donato.  Not only does she have Tesoro, a new little Berner boy in her life, she has made it her personal mission to warn people about the potential hazards of mushroom toxicity in dogs.  She created the attached flyer (see above).  Feel free to download and post it wherever dog loving people congregate.  Diana sent a blast email out just a few days ago after finding a Death Cap mushroom in her yard.   Coincidentally, today I discovered several mushrooms on my property while beginning the task of weeding my garden. They’re gone now, but given our current weather pattern, I’m quite sure there will be more tomorrow.     

What can you do to prevent your dog from ingesting a poisonous mushroom?  Clear any mushrooms from your dog’s immediate surroundings, and be super vigilant on your walks, particularly if you have a pup (youngsters love to put anything and everything in their mouths) or an adult dog who is a known indiscriminate eater.  Learn more about which poisonous mushrooms grow in your area and what they look like.  And please remember, if you see your dog ingest a mushroom- get yourselves to a veterinary hospital as quickly as possible (even if it is after hours). Ingestion of even a nibble of a toxic mushroom is life threatening, and the sooner treatment is started the greater the likelihood of saving your best buddy.     

Are you aware of poisonous mushrooms in your neck of the woods?  If so, please share where you live (city and state) and the name of the mushroom if you happen to know it.     

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.      

Wacky Tales of Whacking Tails

February 24, 2011

How on earth could a wagging tail be a problem?  Have you ever been around a large, muscular, happy dog who upends flower vases and knocks over beverages on coffee tables with his long vigorously wagging tail?  People living with such dogs literally have to “tail-proof” their homes! Ever been repeatedly slapped across the thighs by one of these wagging whips, and the more you react to the pain the more the dog wags?  Ouch! 

Such vigorous tail wagging can also be problematic for the dog.  By repeatedly whacking his tail against a firm surface such as wall or a table, an open bleeding sore can develop on the tail tip.   The dog’s response is to lick and chew at the site resulting in more inflammation and bleeding. This tail tip trauma isn’t typically terribly painful for the dog so, of course the tail keeps right on wagging.  Only now it’s a live paintbrush spattering speckles of red at the walls, furniture, kitchen appliances, and even nearby humans!  The result is as graphic as a CSI crime scene. 

One might imagine this would be a simple problem to fix.  The fact of the matter is, a bleeding tail tip poses a significant medical challenge. In order to heal, the tail must be immobilized, but how in the heck can you make a dog quit wagging his tail?  You can’t.  And it’s almost impossible to keep a bandage secured on the tail tip.  Most dogs are happy to chew off (and ingest) their tail bandages, and there are no Elizabethan collars large enough to prevent the tongue from reaching the tail tip. I’ve seen other things tried such as temporarily bandaging the tail to the dog’s hind leg so he can’t wag, or 24-hour supervision until the tip heals (a certain way to create a tired and pissed off client).   Besides, even if the tail tip does heal, the dog is going to re-whack it and the bleeding will start all over again. 

So, what’s the solution?  Partial amputation of the tail is the treatment of choice.  The tail revision need not need be as short as a Rottweiler look. Rather, the length should resemble an Airedale or Vizsla tail; still some tail, but short enough to prevent the wagging tip from coming into contact with hard surfaces. As with any surgery, there are potential complications and it is important to discuss them with your veterinarian.  Yes, the look of the dog is forever changed, but the wag will continue as vigorously as ever without altering the color of your wallpaper. 

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 X: Saving the Best for Last!

February 18, 2011

This will be my tenth and final blog post describing reasonable expectations as they pertain to delivery of veterinary care (parts one through nine can be found at www.speakingforspot.com/blog).  This time, however, the tables will be turned- rather than describing what is reasonable for you to expect of your veterinarian, I am going to discuss what is reasonable for your veterinarian to expect of you!      

© Juli Dell'Era

Here are a dozen reasonable expectations.  By complying with as many as possible, not only will your vet and the hospital staff sing your praises, your efforts will directly benefit your pet’s health- and nothing is more important than that.       

  1. Arrive on time for your appointment. This means being present in the waiting room, not hanging out in the car finishing up your cell phone conversation or meandering with your dog outside the building (please read below about the importance of arriving with a full bladder, your dog’s that is). When you arrive late, not only will you and your pet be shortchanged on time spent with the vet, there’s a chance the staff will remain behind schedule for the rest of the day.  If you and your pet are new to the practice plan on arriving 10 to 15 minutes early to fill out necessary paperwork and be sure to bring all prior medical records including X-rays, ultrasound reports, and laboratory test results. (Old invoices are no substitute for the medical record). If you are tempted to arrive late because your vet consistently runs late, call ahead and chat with a front office staff member who will know if it’s “safe” to arrive after the scheduled appointment time. 
  2. If you suspect your pet has a contagious disease such as an upper respiratory infection, forewarn the staff.  For the sake of other patients in the waiting room, they may recommend that your little snookums remain in the car until it is time for the doc to see you.
  3. Unless instructed otherwise, do your best to bring your pet in with an empty stomach and a full bladder. This means taking the litter box away a couple hours ahead of time and foregoing the popular doggie p-mail spots outside the clinic.  Your vet may want a urine sample for testing and if procedures are recommended, better that breakfast was skipped.  Don’t worry, your dog or cat is unlikely to urinate on the hospital floor and if it does happen, guaranteed there’s a mop in every hospital!
  4. Please turn off your cell phone.  Not only is the ringing phone a distraction, answering it while in the midst of conversation with your vet conjures up adjectives I’d best not mention.
  5. Come prepared to provide a thorough history.  Believe it or not, your observations may provide more clues for a correct diagnosis than the actual physical examination.  In fact a solid history can make the difference between having to run one diagnostic test or five. Do some sleuthing around the home front to make sure there’s nothing unusual your dog or cat may have been exposed to. Your vet will want to know if you’ve observed any vomiting, abnormal stools, coughing, sneezing, decrease in stamina, or change in bladder or bowel habits.  If you don’t deal with “poop patrol” talk to the family member who does!
  6. Bring along all of your pet’s current medications (including supplements, flea control products, and heartworm preventive) so your vet can confirm that everything is as it should be.  At a minimum bring along a written list of what you are giving your pet including the name, strength and frequency of any medications- not just a visual description of the tablet. (Many medications come in the form of small, round blue pills!). Yes, the information is in the medical record, but, you’d be surprised by how often discrepancies are discovered.
  7. Know the name(s) of what you are feeding; in fact bring along a label just in case.  It’s remarkable how often clients can describe the appearance of the bag or wrapper “to a tee”, but for the life of them, cannot remember the name of the product. If the diet is homemade, bring along a copy of the recipe.
  8. Do your best to directly answer the questions asked by your veterinarian, without a lot of embellishment.  For example, if your vet asks if you have been filling the water bowl any more or less than usual, your answer should begin with “Yes,” “No,” or, “I don’t know.” “I give her only bottled water.” or “She absolutely adores water.” is not the answer your vet is looking for.
  9. If your pet is sick, try to have all the decision-makers present at the time of the office visit.  If this is difficult to arrange, the person present should take notes, and even consider audio-recording the conversation.  This is useful since details inevitably get lost in translation, especially when traveling from spouse to spouse!
  10. By all means, let the staff know if your pet is aggressive.  All animals are capable of unpredictable behavior.  A savvy veterinary staff can usually peg aggressive dogs and kitties within seconds of meeting them.  Occasionally one surprises us and bites or scratches- either a staff member or the client.  Everyone feels terrible but it’s made far worse when we learn that the client knew it could happen, but failed to warn us.
  11. Yes, I know it can be awkward, but I strongly encourage you to discuss your financial concerns before services are provided. When it comes to ways to pay your bill, there is no standard veterinary clinic menu, though most accept cash, credit/debit cards, and checks.  Do your homework to find out which ones apply to your facility. What receptionist hasn’t heard, “What do you mean, you don’t take Discover?” 
  12. Treat the entire staff well.  I get really peeved when I learn that a client, who has been sweet as can be with me, has been abrupt, condescending, or rude to one of my staff.  Keep in mind that everyone who works in the veterinary clinic plays an important role in keeping your pets healthy.   They all deserve to be treated with equal respect and without a doubt, the entire staff will know if this has not been the case. 

There, I’ve done it!  I’ve said what all vets long to tell their clients, and I sure as heck hope you’re not offended! Do you think these are reasonable expectations?  Are there others worthy of adding to the list?      

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.

Pet Nutrition Follow-up

February 10, 2011

If you could see me now dear readers, you would know that I am giving you a standing ovation! I anticipated my recent blog post about what to feed our pets might generate some heated discussion and bullying behavior. I thought I might have to be a cyberspace referee! I needn’t have worried- your comments, which can be viewed at http://www.speakingforspot.com/blog/?p=2048 were all so darned civilized! You reported how you feed your pets and what you’ve learned through your own experiences. No one was even remotely pushy! Better yet everyone agreed, as do I, that there is no single type of diet that is suitable for every dog or every cat. Hats off to you! I’m deeply appreciative.

Now, as promised, I will fill you in on my current philosophy about feeding our pets. I emphasize current philosophy because I am absolutely willing to change what I recommend pending the results of future research. While there is plenty of data telling us which nutrients and how much of them dogs and cats need to grow and maintain good health, there is a paucity of legitimate research comparing how those nutrients are delivered, particularly pertaining to raw versus processed foods.

Keep in mind I am not a primary care doctor (aka, family veterinarian). As a board certified small animal internist, the clients and patients I see are referred to me to address internal medicine issues. Invariably, my clients have already made diet decisions based on discussion with their family vets. My job is to determine if and when I should “rock the boat.” After raising three children and working with gazillions of devoted dog and cat lovers, I’ve learned that it is wise to choose my battles wisely. If a client is clearly devoted to a particular diet for his or her dog or cat, and I am convinced that their choice is causing no harm, I don’t go there. Here are some situations that will prompt me to recommend a diet change.

1. My patient is eating a diet that is not nutritionally balanced. Although this can happen with prepared foods, it most commonly occurs with homemade diets and well-meaning clients who don’t know that diets balanced for human consumption are not balanced for canine or feline consumption. If these clients wish to stick with home preparation, I recommend consultation with a board certified veterinary nutritionist and/or reliable references that provide recipes for balanced homemade diets.
2. My patient is eating a raw or processed food diet of dubious origin. If I am unfamiliar with the brand of food I encourage my client to share the package label with the family vet or me so we can provide a better sense of whether or not the food is of good quality and nutritionally balanced. For example, I am not keen on pet foods produced by the neighborhood health food store. How can such a business possibly have the financial resources and knowhow needed to create a quality pet food product that is nutritionally balanced?
3. My patient is eating a raw diet while receiving medication or fighting a disease that causes immune system dysfunction (i.e., their immune system is on the fritz). In this situation I recommend discontinuation of the raw diet. While there is no data (yet) comparing the incidence of raw diet-induced infections in healthy versus immunocompromised patients, there is data that clearly documents increased numbers of disease-causing types of bacteria in the feces of animals fed raw animal protein. Until proven otherwise, I am concerned that my immunocompromised patients are at higher risk for developing raw protein-induced infections. And this simply isn’t a chance I want to take. Please know that some veterinarians feel differently about this, and in fact, believe ingestion of raw meat will help bolster the immune system.
4. My patient has a medical issue that would best be served by a change in diet. For example, I will encourage diet transition for the patient with kidney failure who is eating a high protein diet, the diabetic kitty who is eating dry food only, or the obese patient with arthritis who is eating a high fat diet.

I firmly believe that most of our dogs and cats can thrive on a variety of different foods/diets as long as they contain high quality ingredients and are nutritionally balanced based on life stage (puppies/kittens, adults, and seniors all have different requirements). Whether you choose to feed a homemade diet or prepared raw or processed food is a personal choice; just as shopping for yourself at Whole Foods versus Safeway (the main grocery store chain in northern California) is a personal choice. Whichever style of diet you choose for your pets, your goal is to ensure you are feeding a high quality, balanced product. Here are some suggestions to help you hone in on some good choices amongst the literally hundreds of products at the pet food grocery store!

• Shop at your local independent pet food store. Yes, the prices may be higher (quality pet food is expensive), but the sales people you encounter are far more likely to be knowledgeable than those working at the big box stores. Additionally, pet store shelf space is limited so the brands of food stocked there will be those the staff truly believes in.
• Learn what to be looking for when you read the food label. The best resource I’ve found for teaching this is The Whole Dog Journal. Your dog and I strongly encourage you to get a subscription as soon as possible (http://www.whole-dog-journal.com) ! Editor, Nancy Kerns provides her readers with plenty of practical wisdom about canine nutrition. In fact the February 2011 issue contains a fabulous article called, “Choices, Choices- On What Criteria Do you Base Your Dog’s Food Selection?” Be forewarned, there is some nepotism going on at WDJ- you will find at least one picture of Nancy’s dog Otto in every single issue! Now, if only Nancy would begin working on The Whole Cat Journal!
• The American Animal Hospital Association Nutritional Assessment Guidelines for Dogs and Cats can be found at http://www.aahanet.org/resources/NutritionalGuidelines.aspx. There is a lot of valuable information here. By the way, at the top of the page you will see that a major pet food manufacturer provided some funding for these guidelines to be made available in French, Japanese, and Spanish. Please don’t let this deter your learning.
• Talk to your veterinarian, let him or her know what you’ve learned, and discuss your pet food preferences.

As always, I welcome your comments!

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.

Videotaping for Your Vet

February 1, 2011

Rarely am I bothered by client misbehavior, but when a client answers their cell phone while we are in the midst of discussion, I admit to feeling a bit peeved. So why in the world would I invite my clients to whip out their cell phones during the course of an office visit? Because I want to see video of my patients’ symptoms! Unless you are like me- still using a cell phone that my daughter considers prehistoric- your cell phone allows you to have instant access to shooting video. And if I can watch videotape of your pet’s confusing symptom or odd behavior, I’m more likely to figure out the underlying issue, more so than with just your verbal description (no offense intended). And when I have a better sense of the underlying issue, I can more expediently, and often less expensively, guide you towards rational diagnostics and/or therapy.

Unless the odd behavior or new symptom is occurring round the clock, the likelihood of it happening in my exam room is slim to none. You’d be surprised what symptoms fully resolve when animals are under the influence of adrenaline. So, if your dog or cat is doing something bizarre that you think will be difficult to accurately describe to your vet, I encourage you to grab your cell phone and shoot a video (feel free to include some Jacques Cousteau narration if you like). By all means, nix the video if you sense you are observing something that is life threatening, and get to the nearest veterinary hospital ASAP.

Here’s a classic example of how videotaping a medical problem can be wonderfully helpful. A common symptom in dogs is referred to as “reverse sneezing.” It occurs when a dog feels a tickling sensation in the back of their throat. It is somewhat equivalent to a person clearing their throat. However, when dogs reverse sneeze, the symptoms appear ridiculously overly dramatic. They assume a stiff posture with head and neck rigidly extended forward. This is accompanied by forceful, noisy inhalation and exhalation that can last for several seconds, even minutes. Check out the example of reverse sneezing in the video below.

For the uninitiated, reverse sneezing is a scary thing to watch- clients commonly report that they think their dog is having an “asthma attack.” Show your vet a video of reverse sneezing and he or she will be able to recommend what to do about it as well as provide plenty of reassurance that, no matter how dramatic the symptoms appear, they are not causing any oxygen deprivation. As much as video is helpful in this situation, I must admit I will miss watching my clients trying to imitate reverse sneezing (oops- I just revealed one of this veterinarian’s dirty little secrets)!

Here are some examples of other behaviors/symptoms that should prompt you to grab your cell phone and shoot some video (if you can think of others, please let me know):

1. Weakness
2. Trembling
3. Incoordination
4. Falling down/collapse
5. Episodes of pain
6. Symptoms associated with passing urine or stool
7. Making odd noises (in this situation audio taping is a must along with video)
8. Coughing (again, adding audio is great)
9. Labored breathing
10. Limping/lameness
11. Odd behavior

Have you ever shared video with your vet? If so, did it prove to be beneficial in making decisions about how to proceed?

Best wishes,

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 VIII: Written Cost Estimates

January 8, 2011

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

You’ve just taken your best buddy to see your veterinarian because he’s been vomiting for three days and is now beginning to refuse his food. Your vet performs a thorough physical examination with all normal findings, so she recommends blood tests along with X-rays of your dog’s belly.  If these tests don’t provide a diagnosis, she tells you that the next recommended step would be abdominal ultrasound.  Of course you want to proceed with this testing because your dog is a beloved family member and you want him to get better, but do you know how much the recommended diagnostics will cost?  Will you be charged $300, $800,  $1,300? Unless your dog is a “repeat offender” how in the world could you possibly know? Three hundred dollars might be completely within your budget; whereas $1,300 might mean coming up short on your mortgage payment.

Whether you are independently wealthy, barely making ends meet, or somewhere in between, know that it is perfectly reasonable to request a written cost estimate from your veterinarian before services are provided.  Why must you be responsible for asking- shouldn’t your vet automatically offer forth a written cost estimate?  Much to my chagrin, I must tell you that only the minority of vets voluntarily provide written estimates. This was documented by veterinarian/researcher, Dr. Jason Coe and his colleagues. Their research appeared in 2009 within the Journal of the American Veterinary Medical Association.  The article titled, “Prevalence and Nature of Cost Discussions During Clinical Appointments in Companion Animal Practice” documented the following:

• Actual cost is addressed in only 29% of veterinary appointments.
• When cost is discussed, 33% of the time it is the client and not the veterinarian who initiates the discussion.
• Talk related to cost information constitutes a mere 4.3% of the total dialogue time.
• Written cost estimates are discussed during 14% of appointments.
• Written cost estimates are actually prepared and delivered to the client in only 8% of appointments.

Dr. Coe’s research certainly supports the notion that veterinarians are squeamish when it comes to discussing fees for their service.  I must admit it is certainly one of the least favorite parts of my job.  Nonetheless, I consistently provide written cost estimates, particularly if I’ve recommended something other than a single treatment or test, in order to avoid communication snafus and clients who are disgruntled when it comes time to pay their bill. 

Why is a written estimate preferable to a verbal estimate? Written estimates require time and focus. Guaranteed such estimates are far more likely to be accurate than those prepared by the vet using mental math while “on the fly”.  Additionally written estimates avoid uncomfortable conversations such as, “You told me it would be $100, not $300……..” and, “But you never told me you were going to do that……”.   So, please don’t encourage your vet to simply give you a “ballpark estimate” or an estimate “off the top of his or her head.”   I avoid providing such guesstimates at all costs (no pun intended).  Try as I might, I invariably lowball such estimates because of my innate desire to make the cost for my client as reasonable as possible.  And when this happens I end up cutting corners (not a good thing for the patient) and/or having to make uncomfortable phone calls advising clients of added expenses (and I definitely get called into the principal’s office).

It is completely reasonable to receive a written cost estimate before services are provided, but keep in mind, you may need to be the one who initiates this process!  With written estimates everybody wins- communication is so much clearer and there are no surprises when it comes time to collect fees.  Additionally, a written cost estimate provides an itemization for you of everything that is planned for your pooch. Have you received estimates from your veterinarian?  If so have they been delivered verbally or in writing?

Best wishes,

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.