Goin’ to Carolina

While you are reading this, my husband and I are in the process of driving cross-country with our animals in tow. We’ve decided to follow our hearts on a new adventure and are leaving the warm slopes of northern California for the Blue Ridge Mountains of western North Carolina. The decision to move 3,000 miles certainly wasn’t made on the fly. My husband and I are big thinkers and planners, carefully weighing in on all the pros and cons over and over again. But, boy oh boy, this is a biggee and I vacillate between feeling super excited and scared to death!

Our friends, relatives, and colleagues (particularly those who have never been to western North Carolina) have all asked, “Why are you doing this?” The answer is really quite simple- our response is “Because we can.” Our three little chicks have left the nest and are doing their thing out in the world (Wyoming, Ohio and Germany). My hubby and I like to think of this major life change as our attempt to make our “third trimester” all that we want it to be. We are both avid horseback riders and we’ve longed to live on property abutting an extensive trail system. This means saddling and up and riding out with no horse trailering involved! Our new property abuts Dupont State Forest, a veritable mecca for horseback riding.

After figuring out where we wanted to live I checked out job prospects. The closest specialty hospital is Upstate Veterinary Specialists.  Now this part is too good to be true- not only did this hospital win the 2011 American Animal Hospital Association Specialty Hospital of the Year Award, the hospital owners want me to work with them! I will begin my new job in early December.

You won’t hear from me for another week or two. Not to worry, once settled I will resume my regular blogging habits, although you may begin to detect a bit of a southern accent!

Best wishes for good health,

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

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

When to Say Yes to a Diagnostic Test

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

© Susannah Kay

 

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

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

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

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

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

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

Best wishes for good health,         

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

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

Price Shopping: To Be Avoided at All Costs

I recently exchanged emails with a woman who was feeling frustrated while searching for a new veterinarian.  Her search included some “fee shopping” and she was disgruntled to find that some vets had the nerve to mark up lab fees more than others.  She wrote to me to find out how she might gain access to the fees charged by commercial veterinary laboratories so she could figure out how much mark up each veterinarian applied. She mentioned that she’d found one vet she really liked, but she was “out of the running” because her office charged double the lab fees (exact same test) as two others she’d investigated.

Here’s how I responded.  I encouraged my email buddy to consider reasons why fees are not uniform from hospital to hospital. In some cases, laboratory testing is run “in house” requiring on site technician time and costs involved in maintaining equipment.  Certainly charges to the client for this should be higher. The expertise a veterinary specialist brings to interpreting laboratory test results may be greater than that of a general practitioner.  Shouldn’t a client pay more for this? Additionally, every clinic must pay its overhead to continue to provide good service, and the more “bells and whistles” the hospital has, the higher that overhead will be.  For example, if the hospital employs sophisticated equipment to monitor anesthesia, that’s a really good thing, right?  Chances are, the fees for surgery there will be higher in order to cover the costs of this advanced level of care.

I went on to explain that I truly discourage people from price shopping when it comes to veterinary care unless it is an absolutely necessity.  A sweet six-month-old Labrador is currently being treated at my hospital because she sustained a horrific thermal burn all along her back from a faulty heating pad used during her surgery at a low cost spay/neuter clinic. This has necessitated major reconstructive surgery over her back- a tremendous price to pay both in terms of money and what this poor dog is going through. By the end of our email thread my correspondent seemed convinced- she told me that she’d decided to use the vet she really liked in spite of more expensive lab tests. Hurray!

Now, I’m not completely naïve when it comes to how our current economy is influencing delivery of veterinary health care.  I realize that for many folks, price shopping has become a financial necessity.  When this is the case, I encourage the following:

-Do your best to avoid sacrificing quality of medical care.  The old cliché, “You get what you pay for,” is often true.  Be thorough in your investigation: don’t make up your mind based on brief over-the-telephone price quotes.  Visit the clinic, tour the facility, and meet the staff to feel confident this is a place you and your pet will feel comfortable.

-Watch for “hidden” fees.  Some clinics may offer an extremely reasonable quote for a surgical procedure, but then charge additional fees for the initial office visit or for post-surgical necessities like removing stitches.

-Keep in mind the potential for complications.  If a significant complication occurs due to substandard care (such as occurred with the Labrador mentioned above) you will end up spending a great deal more money treating it, not to mention associated emotional energy, than you would have spent at the better more expensive clinic to begin with.

When you chose your veterinarian, how did fees enter into your decision-making?  If so, how did things turn out? I’d love to hear about your experience.

Now here’s wishing you and your loved ones (including those who are furry or feathered) for a peaceful and healthy holiday season.   

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

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

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

Avoiding Pancreatitis During the Holidays

I wrote the following for one of my favorite magazines, BARK (the inventors of “Dog is my co-pilot”).  With the holidays once again upon us, I thought I’d toss this information out into cyberspace as a timely reminder to avoid overindulging our dogs!

‘Tis the season for family gatherings, gift giving, and food galore.  Veterinarians know that this is also the season for canine pancreatitis (inflammation of the pancreas), a painful, potentially life-threatening condition most commonly caused by overindulgence in foods that are particularly rich or fatty. And what kitchen isn’t overflowing with such foods this time of year?

The pancreas is a thin, delicate-appearing, boomerang-shaped organ that resides in the abdominal cavity, tucked up against the stomach and small intestine. While the pancreas may be diminutive in appearance, its actions are mighty! It is the body’s source of insulin and enzymes necessary for food digestion. When pancreatitis is chronic or particularly severe, this little factory sometimes permanently closes down, resulting in diabetes mellitus (requires insulin shots) and/or exocrine pancreatic insufficiency (requires digestive enzyme replacement therapy). 

When a dog eats, enzymes are released from the pancreas into the small intestine, where they are activated for food digestion. Sometimes, for reasons we do not understand, these enzymes are activated within the pancreas itself, resulting in the inflammation of pancreatitis. In addition to rich or fatty foods, certain drugs, hormonal imbalances and inherited defects in fat metabolism can also cause pancreatitis. For some dogs, an underlying cause is never found. Classic pancreatitis symptoms include vomiting, abdominal pain, and decreased appetite and activity levels. 

Short of performing a pancreatic biopsy (an invasive and risky procedure), diagnosing pancreatitis can be challenging, because noninvasive tests are fraught with false-negative and false-positive results. Veterinarians must rely on a combination of the following: 

• A history of dietary indiscretion, vomiting and lethargy.

• Physical examination findings (particularly abdominal pain).

• Characteristic complete blood cell count (CBC) and blood chemistry abnormalities.

• A positive or elevated Spec cPL (canine pancreas-specific lipase) blood test.

• Characteristic abdominal ultrasound abnormalities. 

There is no cure for pancreatitis—much like a bruise, the inflammation must resolve on its own. This is best accomplished by allowing the pancreas to rest, which means giving nothing orally (not even water) to prevent digestive enzyme secretion. Treatment consists of hospitalization for the administration of intravenous fluids; injectable medication to control vomiting, pain and stomach acid secretion; and antibiotics to prevent secondary infection or abscess formation. Dogs should be monitored around the clock for the life-threatening complications that sometimes accompany pancreatitis, such as kidney failure, heart rhythm abnormalities, respiratory distress and bleeding disorders. Small amounts of water and a fat-free diet are typically offered once vomiting has stopped, abdominal pain has subsided, and there is blood test and/or ultrasound confirmation that the inflammation has calmed down. If your dog has pancreatitis, count on a minimum of two to three days of hospitalization, and be sure to ask who will be caring for your dog during the night. 

Long-term treatment for pancreatitis typically involves feeding a low-fat or fat-free diet. This may be a life-long recommendation, especially if your dog has been a “repeat offender.”  Most dogs fully recover with appropriate therapy; however, some succumb to the complications associated with this disease.

 

How can you prevent pancreatitis during this food-oriented time of year? You can avoid feeding holiday leftovers altogether (this would cause canine mutiny in my household) or you can heed the following recommendations. New foods should be fed sparingly and only if well tolerated by your dog’s gastrointestinal tract and waistline.  Keep in mind that whether offered a teaspoon or a tablespoon of something delicious, most dogs will gulp it down in the same amount of time and reap the same psychological benefit. Don’t offer tidbits from the table while you are eating. This is a set up for bad behavior. Offer the treat only after you’ve left the table. If you shouldn’t be eating the food yourself (emphasis on shouldn’t), please don’t feed it to your dog! By all means, give your precious poopsie a bit of turkey breast, but without the turkey skin or fat-laden mashed potatoes and creamy gravy. Go ahead and offer your sweet snookums a bite of brisket, but please —no potato latkes or sour cream! Bear in mind that most dogs are so darned excited about getting a treat, they don’t care what it is, only that they’re getting it!

Some people dream of sugar plum fairies, a white Christmas or a stress-free family gathering. I’m dreaming of a holiday season in which not a single dog develops pancreatitis!

Wishing you and your four-legged family members a joyful and healthy holidays season.

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

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

Free Christmas or Chanukah guft wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).

How to trust an ER vet you just met

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

Best wishes,

Dr. Nancy Kay

“I’m sorry, ma’am, your pet is going to need surgery”. 

These are words any pet owner dreads hearing, especially on an emergency basis. For a pet owner, a trip to the veterinary ER can be a terrifying and frustrating experience; almost always unplanned… certainly unwelcome…usually expensive. 

Part of the stress of an ER visit comes from having to entrust your pets care, and very possibly their life, to someone you have just met. This is a little bit like embarking on a perilous sea voyage with a captain you know nothing about. It can be a very scary and unsettling prospect.

How can you come through this stressful experience intact? How can you maximize the chance of your pet having a successful outcome and minimize your stress level? 

Hopefully I can give you some pointers so this journey across the stormy seas of veterinary emergency care doesn’t end up on the rocks.

 

The first thing to know is this: Vets are not the enemy. They are in that ER in the dark of night because they want to help your pet get better.  Sure, there are dishonest veterinarians just like there are dishonest hairdressers and dishonest orchestra conductors, but the vast majority of animal docs are there because of a sincere desire to help.

I think the easiest way to find a path to trust in these circumstances is to plan ahead, so you are armed and empowered with some information before the crisis hits.  Emergencies don’t often give you the benefit of warning, but if you can pre-screen your veterinary ER options you will be ahead of the game.

I recommend contacting your trusted family veterinarian to find out where they send patients after hours.  Consider calling or visiting the ER before an emergency happens to get a feel for how they run their ship. Do they make you feel welcome? Secure? Is the hospital clean and well equipped? If so, then you will likely feel more trusting when a true emergency takes place.

During the emergency visit itself, try and get a feel for your doctor. Do they seem rushed and unfocused, or do they take the time to answer your questions? Do they seem confident, overconfident or insecure? In order to earn your trust, they should be willing and able to answer your questions to your satisfaction. Part of the responsibility falls on you, however, to limit your questions to the important ones and avoid repetition. (We want you to be informed, but time is a precious commodity in the ER). Bring a notebook and write down the questions as you think of them along with the answers.  It can be very difficult to remember all of the pertinent details when you are stressed and emotional.  And remember not to take your stress out on the doctor or staff.  Keep in mind that they are there to help you through this difficult situation. 

When it comes to making treatment decisions, the important words here are ‘options’ and ‘advice’. A good doctor will give you realistic options for care (from the basic to the cutting edge) and advise you as to the risks and benefits of each as you plot a course. Their job is to help you come to a decision you are comfortable with that also meets the medical needs of your pet. 

If the diagnostic and treatment options do not feel right to you, ask if there are any other options to explore.  In many cases (but not all) there are plans A, B and C (and even sometimes D). 

It is a tall order to be asked to trust your beloved pet’s life and health to someone you just met, but with just a little luck and a little knowledge, you can chart a course for a good outcome.

Dr. Tony Johnson

www.PetConnection.com

Dr. Tony Johnson received his veterinary degree from Washington State University in 1996 and obtained board certification in the specialty of emergency medicine and critical care in 2003. He completed a residency program in Portland, Oregon prior to becoming an emergency specialist. He is currently a clinical assistant professor at Purdue University School of Veterinary Medicine and a consultant and editor for the Veterinary Information Network. He has lectured for several international veterinary conferences and is an active blogger for http://www.PetConnection.com. He is also the recipient of the 2010 Small Animal Speaker of the Year award from the Western Veterinary Conference.   

He used to live in a converted one-room schoolhouse in the middle of a cornfield, but has since taken up occupancy in a normal house in a normal neighborhood with very little corn.  He has a young son named Connor (which is Gaelic for ‘dog lover’) and a beautiful wife named Gretchen, who is also a veterinary emergency and critical care specialist.  

Their animal family consists of: The Cats:Cupid – formerly shot with an arrow, now a feline meatloaf and Crispy – formerly set on fire, now rules the basement with a furry iron fist.       

The Dogs: Rocco – missing a leg from a Buick-induced nerve injury and    NYSE – former hoodlum-owned Pit Bull, now a creampuff.           

The Lower Vertebrates:Fontina –  a cockatiel found in a parking lot  and he has lost count of how many fish they have, although it really isn’t that many, he  just isn’t all that good at counting. 

In his spare time Tony enjoys sleeping, eating and breathing with occasional forays into woodworking, cooking and reading and writing (but not arithmetic).

_____________________________________________________

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

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

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

Gastric Torsion: A Horribly Unhealthy Kind of Twist

Torsion, gastric torsion, gastric dilatation-volvulus, GDV; these are terms you never want to hear applied to your dog.  They all mean the exact same thing- your dog’s stomach is distended with gas and has twisted on itself, and emergency surgery offers the only hope for saving his life.  Here’s a visual aid to help you understand what happens when a dog develops gastric torsion.  Picture a fanny pack in your mind.   The pouch of the fanny pack represents your dog’s stomach.  One strap of the fanny pack is the esophagus that transports food from your dog’s mouth down into his stomach.  The other strap is the upper small intestine (duodenum) that transports food out of the stomach.  Now hold one strap of the fanny pack in each hand and twirl the pouch until it twists on itself causing the straps to crimp.  This is what happens when gastric torsion occurs- the stomach twists on itself, cutting off normal blood flow to the stomach and surrounding structures.  Additionally, gas and fluid continue to accumulate within the stomach and cannot flow out via the crimped esophagus or duodenum, so the stomach progressively distends. A dog in this situation quickly lapses into a state of shock and surgical “decompression” or untwisting of the stomach is the only way out of this nightmare.  Time is of the essence- the longer the stomach remains twisted, the greater the likelihood of irreversible devitalization (death) of the stomach tissue.

Image Credit: HoundFancy, 2001

 

Initial symptoms of gastric torsion include a bloated appearance through the midsection (the ribs look like they are expanding outward), drooling, nonproductive retching/vomiting, restlessness, weakness, shallow breathing, rapid heart rate (if it can be felt through the chest wall), and pale gum color.  If you observe such symptoms, quickly make some phone calls to find the closest veterinary hospital capable of performing immediate surgery on your best friend.  The sooner surgery can be performed the greater the likelihood of a successful outcome.  Irreparable damage to the stomach tissue is often the deal breaker if the torsion is not corrected quickly.  At the time of surgery, not only is the stomach derotated, it is tacked (attached with stitches) to the inside of the abdominal wall to prevent a repeat spinning performance.  Additionally if the spleen or portions of the stomach wall appear devitalized (deprived of normal blood flow for too long) they will be removed.  If surgery is successful, the dog typically has a minimum two to three day post-operative stay in the hospital for round the clock monitoring for post-operative complications.   

Truth be told, we really don’t know much about what causes gastric torsion.  Clearly, there is a breed/conformation association- large deep-chested breeds such as Great Danes, Irish Setters, Standard Poodles, Irish Wolfhounds, Boxers, Dobermans, Weimaraners, and Rottweilers are particularly predisposed.  Affected males definitely outnumber females. One study documented that elevating the food bowl actually predisposes to gastric torsion.  Other studies have indicated that the following factors may also be part of the recipe that results in gastric dilatation-volvulus: eating only one meal per day, eating rapidly, eating dry foods that list oils or fats among the first four label ingredients, exercising in close association to mealtime, being underweight, and being of an “anxious” rather than “happy” personality type.  The only known way to prevent gastric torsion from occurring is by performing a prophylactic (preventive) gastropexy procedure (sutures are used to tack the stomach wall to the inside lining of the abdominal cavity).  This does not prevent the bloating (stomach distending with gas), but does prevent the life threatening twisting part of this miserable disease process.   

Would you like to participate in a study to learn more about why dogs develop gastric torsion?  If your dog has ever bloated (distention of the stomach without rotation) or has experienced gastric torsion, I encourage you to take this survey http://www.surveymonkey.com/s/WS2VKFP.  It is being conducted by Dr. Cynthia Otto from the University of Pennsylvania School of Veterinary Medicine in collaboration with researcher, author and lecturer, Dr. Carmen Battaglia. A summary of the results and findings will be posted at www.breedingbetterdogs.com in November, 2010.  If you and your dog did have direct experience with a gastric torsion, I sure as heck hope yours was a happy ending.   

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook    

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

Morris Animal Foundation 2010 K9 Cancer Walk

I am gearing up for Morris Animal Foundation’s 2nd annual K9 Cancer Walk to be held in Elk Grove, California (www.curecaninecancer.org/) on Saturday, April 24th.  Just as was the case last year, I will be a speaker at this fabulous event along with Dr. Michael Kent, a staff oncologist at the UC Davis veterinary school.  The actual walk will begin at 10:00 am and the speakers program will be at 11:30 am.

Care to join me there?  If you cannot participate in person, I hope you will consider joining my virtual Speaking for Spot Team (http://maf.convio.net/site/TR/Events/CCC?team_id=1260&pg=team&fr_id=1040).   And if you are able to attend, please come introduce yourself to me.  I would love to meet you!

Here is the blog I posted one year ago after the very first K9 Cancer Walk.

Walking to Cure Canine Cancer

This past Saturday, I saw four three-legged dogs- each one having lost a limb as part of their treatment for bone cancer.  I met another sweetie pie with a shaved patch over one side of his chest.  His mom told me this was the site where her pup’s chest cavity was drained of fluid produced by a cancer growing at the base of his heart.  Yet another dog I encountered had an orange-sized tumor on the bridge of his nose. 

Believe it or not, I met none of these dogs in a veterinary hospital setting; rather, we were all gathered in Elk Grove, California, the site of the very first Morris Animal Foundation Walk to Cure Canine Cancer. Morris Animal Foundation has launched an unprecedented $30 million fundraising effort with the following goals in mind:

1.  Provide new treatments for dogs currently suffering from cancer
2.  Establish a high-quality tumor sample bank that can be used by cancer researchers
3.  Develop prevention strategies so that cancer might one day be eliminated or, at the very least, drastically reduced in incidence and severity
4.  Train new researchers who will work towards discovering preventions, treatments and cures

An important part of the fundraising effort will be in the form of “Walks to Cure Canine Cancer.”  The Elk Grove Walk raised $17,945!  I had the honor of speaking at this fabulous first-of-its-kind event-what a thrill to be part of it all!  More than 300 dogs and their humans gathered together in the fight against canine cancer.

As unfathomable as it sounds, cancer will be the cause of death in one out of every four of our beloved canine companions.  There’s so much we don’t yet know about what causes canine cancer and how best to treat it.  I’m thrilled with the Morris Animal Foundation plans.  They are an incredibly ethical and effective organization, and I am expecting great things. To learn more about the Morris Animal Canine Cancer Campaign, please visit www.curecaninecancer.org/. I encourage you to participate in any way you can.

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

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook 

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

What is a Veterinary Specialist?

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

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

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

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

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

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

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

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

Nancy Kay, DVM
Diplomate, ACVIM
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook

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