Archive for the ‘Veterinary Office Visits’ Category

Black Friday Special – 2 for 1

November 19, 2011

 

Click on the picture to access the special 2 for 1 purchase link – http://www.speakingforspot.com/holiday2for1.html.

You can purchase single copies of Speaking for Spot via http://www.speakingforspot.com/purchase.html and designate your favorite participating non-profit group to receive $6 per copy.

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.

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

September 26, 2011

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best wishes for good health,

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

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

The Elephant in the Middle of the Exam Room

August 1, 2011

My dual career as an author and a practicing veterinarian provides me with a unique vantage point. Not only am I privy to the issues my veterinary colleagues are stewing about, I also receive a plethora of emails from my readers candidly venting about their experiences as consumers of veterinary medicine.  It’s rare that those on both sides of the exam room table are growling about the same issue, but these days this is certainly the case.

See if you can identify the elephant in the exam room based on the following data that has appeared in current veterinary news feeds along with quotes from recent correspondences with my readers:

– The number of pet visits to veterinary hospitals is dramatically decreasing (DVM Newsmagazine, June 2011), and a special session was held at this year’s conference of the American Veterinary Medical Association to explore ways to increase public awareness about the importance of annual checkups for pets.

– “In my opinion, most of the decline in veterinary visits is primarily due to the bad economy. If you are barely scraping by, you are certainly not going to the vet for a very pricey annual exam, especially if your pet seems fine.”

– While pet spending is up, the market isn’t growing fast enough to support the number of new veterinarians entering the veterinary profession. (DVM Newsmagazine, June 2011) Veterinarian supply is growing faster than pet owner demand. (The Bayer Veterinary Care Usage Study 2011)

– “Sadly there are some veterinarians who see hospitalization fees as a revenue stream and do not inform clients that no one will be supervising the pet they recommend be hospitalized. While one tends to like to think of their vet as a kind, caring person and many are, some are more business than heart.”

– Eighty-nine percent of current veterinary school graduates have student debt.  The average student loan debt of students graduating in 2010 from veterinary school was $133,873 (15% have debt in excess of $200,000) and the average starting salary was $48,674. (Veterinary Information Network News Service, January 4, 2011)

– “My question is why most vets feel the need to worry about money instead of worrying about taking care of the pets.”

– Although the number of households in the United States with cats is increasing, the number of feline visits to veterinary hospitals is decreasing. (Banfield Pet Hospital® State of Pet Health 2011 Report)

– “I’d love to take each of my cats in for dental cleaning on a regular basis and I have two cats that desperately need attention now. For me, it’s a matter of costs. Vets continue to increase their charges and there’s no break for multiple pets. Dental disease is a precursor for renal failure in cats and yet it’s so expensive for cleaning – yet alone extracting any teeth. Then blood work is usually advisable to be on the safe side. It’s a small fortune when you leave the vet’s office for ONE pet. Next you’ve got the cost associated with monthly flea control. You have to draw the line somewhere and hope for the best.”

– Fifty-four percent of cat owners and 47% of dog owners report that they would take their pet to the veterinary hospital more often if each visit were less expensive. (The Bayer Veterinary Care Usage Study 2011)

– “I am not saying veterinarians can’t charge a reasonable fee for their services, but most people can’t afford $300+ bills every time they step into a clinic, per pet, per year, and that is for the healthy ones who are coming in for regular yearly checkups and not for other medical concerns that require medications, further diagnostics, overnight stays, dental cleaning, blood work etc.”

– Fifty three percent of clients believe that veterinary clinic costs are usually much higher than expected. (The Bayer Veterinary Care Usage Study 2011)

– “I am sick and tired of the way veterinarians financially take advantage of people who are emotionally upset about their pets.”

– Twenty-four percent of pet owners believe that routine checkups are unnecessary and 36% believe that vaccinations are the main reason to take their overtly healthy pet in for an office visit. (The Bayer Veterinary Care Usage Study 2011)

– “We have a lot of price gouging going on here at local vets. A dental cleaning has gone from $75 to $300 and up at many places. A lot of the clinics are buying high tech equipment and passing overhead costs on us so they really shouldn’t complain when clients come for less visits.”

Have you identified the common thread amongst these comments and statistics?  No doubt in my mind that the “gripe du jour” is the “M word.”  Perhaps it is more accurate to say that the real issue is too little money.

This blog is not intended to create or perpetuate harsh judgments. Please hear me when I say that I know that not every veterinarian or every person who brings their pet to see the vet is thinking primarily about money.  Clearly, however, money matters are on the minds of many, in fact more so than I’ve witnessed throughout my thirty year career.   Never before have I observed colleagues declare bankruptcy.  Never before have I spent so much time in the exam room trying to help folks figure out how to do more with less.

My goal in presenting this information is to create some understanding about what’s going on in the minds of individuals on both sides of the exam room table.  Blame this money mess state of mind on the diseased economy, veterinary competition, or the expense of going to veterinary school.  Whatever the causes, there is an awful lot of emotion tangled up in the financial aspects of providing and receiving veterinary health care these days.

What are your thoughts? Let’s talk about it and in doing so we will be able to kick that big ole’ elephant out of the middle of the exam room!

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.

Does Your Veterinarian Hear Your Concerns?

July 18, 2011

Until a few years ago it was darned near impossible to find much in the way of useful research about communication between veterinarians and their clients.  Nowadays, several wonderful studies are surfacing.  It’s about time I say, and the results have been fascinating! The newest communication study appears in the June 15, 2011 issue of the Journal of the American Veterinary Medical Association and is titled, “Analysis of solicitation of client concerns in companion animal practice.”

The purpose of this study was to determine what percentage of veterinarians evaluated effectively solicited their clients’ concerns at the beginning of the office visit.  When veterinarians did solicit concerns, the client’s responses were referred to as their “opening statement”.  What we know from research pertaining to human physicians is that only 23% to 28% of patients are allowed to complete their opening statements.  On average, they are interrupted by their physicians within 12 to 23 seconds. Research has also documented that physicians often mistakenly assume that the first or only concern expressed by their patient is the main concern or only concern.

In addition to learning how many veterinarians effectively solicit client concerns, this study also determined if there is a difference in the way clients respond to open-ended versus closed-ended solicitations.  Open-ended questions such as “What brings you in today?” cannot readily be answered by a simple “yes” or “no”.  Rather, they require more expansive, thoughtful responses.  Closed-ended questions such as, “Has Peanut been vomiting?” can readily be answered by “yes” or “no” and may entice a client to focus on what they perceive the veterinarian thinks is important rather than what they are truly concerned about.

Here’s what this study’s researchers learned by reviewing 334 videotaped veterinarian-client office visits:

– Solicitations for client concerns were made in only 37% of the office visits.
– Of the office visits that included solicitations, 76% of the queries were open-ended and 24% were closed-ended.
– In response to open-ended solicitations 76% of clients expressed one or more concerns.  In response to closed-ended solicitations, 40% of clients expressed one or more concerns.
– Clients spoke more than twice as long in response to an open-ended solicitation compared to a closed-ended solicitation.
– Clients’ opening statements in response to the solicitation were interrupted by the veterinarian 55% of the time, on average after only 11 seconds!
– Following an interruption, clients returned to and completed their response only 28% of the time.
– Appointments in which the veterinarian did not solicit client concerns at the beginning the office visit were significantly more likely to have concerns raised at the end of the office visit.
– Open-ended solicitations were more likely to occur during “well pet visits” than visits initiated because of a medical issue.

Are you surprised by these results?  I’m a bit surprised by the numbers and, admittedly, as a veterinarian, I’m feeling a bit of professional embarrassment. This study underscores the fact that veterinarians could be doing a much better job soliciting and listening to their clients’ concerns.  By learning from studies such as these, there is so much potential for greater success, not only in terms of doing a better job for our patients (gaining an accurate assessment of all concerns is certainly in the best interest of the patient), but also in terms of our clients.  Actively listening to their concerns without interruption conveys empathy and what person worried about their best buddy’s health couldn’t use a good dose of that?

As a consumer of veterinary medicine, what is the take home message for you?  I hope this data will prompt you to be persistent in expressing all of your concerns to your veterinarian at the beginning of the office visit.  And, if interrupted, do your best to return to your original train of thought!

What is the take-home message for veterinarians?  It is clear that we could and should be doing a much better job consistently asking open-ended questions at the beginning of office visits and then actively listening, without interruption to hear what our clients have to say.  Perhaps before entering the exam room we might remind ourselves of the saying I’ve always loved, “Don’t just do something, stand there!”

 

Best wishes for good health,

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

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

Urinary Accidents

July 3, 2011

When your wonderful dog, who has always done his or her “business” outside, begins leaving puddles in the house, please do not default to the notion that this is a behavioral issue.  It is highly unlikely your dog is mad at you for sleeping in on Sunday mornings or jealous because you showed some affection to your neighbor’s dog.  Chances are, the inappropriate urination is a result of an underlying medical issue.

Well house-trained dogs would rather urinate anywhere other than inside their own home.  Several types of medical issues are capable of disrupting normal house-training.  Bladder infections, stones, and tumors create an urgency to urinate even when the bladder contains only a small amount of urine.  Prostate gland disease (more common in boys who have not been neutered) can disrupt normal urinary habits.  Increased water intake may overwhelm a dog’s normal eight to ten-hour bladder capacity.  Common causes of increased thirst include a variety of hormonal imbalances, kidney failure, and liver disease.  Commonly prescribed medications such as prednisone (a form of cortisone) and furosemide (a diuretic or “water pill”) typically cause increased thirst.

Some dogs develop urinary incontinence (involuntary urine leakage).  This is more common in females and is usually a result of relaxation of the muscular sphincter that normally prevents urine from flowing down the urethra- the tube that carries urine from the bladder to the outside world.  The urine leakage may be constant, but more commonly it occurs as the bladder distends during the night while the dog is soundly sleeping. In most cases, urinary incontinence can be successfully managed by correcting the underlying cause and/or treating with medications that “tighten up” the urethral sphincter.

If your dog has a break in house-training, please don’t respond with a reprimand.  Far better to schedule a consultation with your veterinarian.

Has your well house-trained dog ever urinated in the house?  Were you and your vet able to determine the cause?

Best wishes for good health,

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

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

Trends in Veterinary Medicine

June 26, 2011

Just as human docs are seeing more patients with diabetes, so too are veterinarians.  A first-of-its-kind study conducted by Banfield Pet Hospital (a corporation with more than 770 veterinary hospitals) documents rises in the incidence of diabetes, dental disease, flea infestations, ear infections, and intestinal parasites.  Banfield collected their data from a whopping 2.1 million dogs and 450,000 cats seen during 2010, and then released it as a document called “State of Pet Health 2011 Report.” The entirety of this report is available via the Banfield website.

 

Here are some highlights from this study:

-Dental disease was the most common medical condition reported. In fact, 78 percent of dogs and 68 percent of cats over three years of age had some form of dental disease.  The top five dog breeds most likely to develop periodontal disease included the Toy Poodle, Yorkshire Terrier, Maltese, Pomeranian, and Shetland Sheepdog (it’s a given that small breed dogs have a higher incidence of dental disease than medium and large breed dogs).

-Otitis externa (infection or inflammation of the external ear canal) was the second most common disease, found in 15.8 percent of dogs and 7.4 percent of cats.

-There has been a 32 percent increase in canine diabetes and a 16 percent increase in feline diabetes compared to data collected in 2006.

-Obesity ranked in the top five diagnoses for dogs and in the top three diagnoses for cats.  This may, in part, explain why the prevalence of diabetes is increasing.

-The incidence of flea infestation has increased 16 percent in dogs and 12 percent in cats; rather surprising given the fact that flea control products have been steadily evolving.

-One of the top three diseases found in dogs examined in Banfield hospitals located within the Southern United States was heartworm disease (detected in 6.7 percent of dogs examined).

-Cats in 2010 more frequently test positive for roundworms, hookworms and whipworms (all intestinal parasites) compared to cats evaluated in 2006. Canine hookworms and whipworms have also increased during this same time period.

-Small breed dogs are gaining in popularity.  Chihuahuas represented a whopping 8 percent of Banfield’s patient population.  This represents a 116 percent increase when comparing data between 2000 and 2010.  Labrador Retrievers remained the most common dog breed among Banfield patients, but their numbers decreased by 20 percent between 2000 and 2010.

-The number of feline vet clinic visits is declining.  In 2006 Banfield veterinarians examined 5.3 dogs for every feline visit.  The current ratio is 6.6 dogs for every one kitty.

Dr. Jeffrey Klausner is the chief medical officer for Banfield.  He expresses concern about the rise in some of the preventable diseases mentioned above and he states, “I just can’t help but wonder if there is a correlation between the increase and prevalence of these diseases and the decreasing visits to veterinarians.”

The stated purpose of the Banfield study is to help the veterinary profession gain a better understanding of the state of pet health in the United States, especially in light of many recent reports indicating a decline in veterinary visits.  Dr. Klausner hopes that the Banfield analysis will help veterinarians develop strategies to improve patient care.  The decline in vet clinic visits may correlate with the relatively newer knowledge that core vaccinations (rabies, distemper, parvovirus) need not be given annually.  It appears that some folks view vaccines to be the primary reason for vet clinic visits and ignore the importance of an annual physical examination. Several studies are currently underway to try to understand why feline veterinary clinic visits have declined so dramatically.

Kudos to Banfield Pet Hospital for orchestrating this monumental study.  What a great way to give back to the profession.  The Banfield data underscores the importance of annual visits to the vet (whether or not vaccinations are due) and discussion of preventive health care.  When did you and your pet last visit your vet for an annual physical examination?  Did you discuss dental disease, flea control, or weight management for your pet?

Best wishes for good health,

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

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

Normal Abnormalities

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.

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.