Health

A place of passing

“I’m never going back,” I have heard more than one pet owner say. They are talking about the office of their veterinarian, a person with whom they have built a relationship for years, someone they like and trust. But their pet died there, and the painful memories are too strong. So strong for some people that they go and find a new vet, even if they liked their old one just fine.

It’s one of the reasons I like having the option that I offer, of performing in-home euthanasia and pet hospice with Paws into Grace. Because I know more than anyone that as much as the client hated the office that one time, many pets hated it every time. That can be pretty upsetting for some families.

Which leads to the next concern, one I hadn’t thought of until a client voiced it to me. “I don’t want to go to the vet office, but I can’t euthanize my pet at home,” she said. “I can’t have that memory associated with my house.” So sometimes those clients end up decamping to a third party location, a park or a beach. And I respect that decision, though I would encourage those who feel that way to think on it a little while before making up their minds. Here’s why:

1. The precedent has been set in human hospice for staying at home.

The gold standard in human hospice, for those who have adequate support systems in place, is for people to pass at home whenever possible. That is by far the most comfortable place for a patient, in familiar surroundings. I was with my grandfather when he quietly died on a rented hospital bed in the living room he called his own for 40 years. He hated hospitals and I’m pretty sure had we put him in one, he would have haunted us all.

2. Moving an ill pet can be a challenge.

Pets who are very ill can be nauseated, painful, disoriented, and uncomfortable. This goes for people, too. How many times have we been down with the flu and known that we should probably go to the doctor but we feel too rotten to move? Same goes for pets. Add in mobility issues and it is just one more stress for owners, especially with very large pets or very upset cats- no matter the destination.

3. Your home is deafeningly, loudly, overwhelmingly a place of comfort.

This is the place Kekoa died:

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But unlike a vet office where I might only have a handful of memories, I see this place every day and I don’t look at it as the place my dog died. I look at it as my living room, the place we opened Christmas presents, the place Brody plops down while I’m writing. It also happens to be the place Kekoa chose to settle down and leave this earth, because she knew as well that this is a happy place.

And you know what? It still is. I am glad she chose our sun dappled living room. At home, when I administer a pet’s sedation, they choose where they want to be: outside, in the kitchen, in mom’s lap. People find comfort knowing their pet selected the place they are most at home.

home euthanasia pet hospice

I’ve only been in this house a year and it’s had more than its share of sadness. I am looking at the floor where Kekoa died while sitting on the couch where Apollo died. I actually drove him home from the specialty hospital as quickly as I could- after he got lots of pain meds, so he could curl up on my lap after everyone got a chance to say goodbye.

But right now, it’s the place my dog is chewing up a toy and my son is doing his homework. This is our home, where life happens. And I feel good about that.

Want more info or to know if anyone in your area provides this?

Not all veterinarians even know this service exists, and information can be hard to come by. Here are two national databases of veterinarians that offer this service:

The International Association of Animal Hospice and Palliative Care

Association for Pet Loss and Bereavement

Here in America’s Finest City of San Diego, you can of course reach me or my wonderful colleagues through Paws into Grace.

Filed: Blog, Cancer sucks, Daily Life, Euthanasia/Hospice, Featured Posts, Health, Musings, Picks of the Litter Tagged: , , ,

Awesome App Alert: Pet First Aid

You’re on a walk with your dog. He looks tired. You don’t know if he’s just tired from the walk or if he’s showing early signs of hyperthermia. What do you look for?

Unless you have a lot of experience with dogs or happen to have an emergency medicine textbook on you, you might not know. But thanks to increasingly cooler and better apps, you can get some immediate reassurance from your smartphone.

The latest must-have app for dog and cat owners just came out, and at $0.99 there’s no reason not to download it right now. The Pet First Aid app from the American Red Cross was developed in conjunction with the vets at Penn, and offers concise, easy to navigate info that you can access in seconds. It’s worth the price just for the 18 second CPR videos covering three sizes of dog and a separate one for cats. (There have been some awful CPR videos out there on YouTube, just sayin’.)

app

I just bought it and put it on all the smart apps in the house. The pictures (dog with bee sting!) and videos (bulldog in respiratory distress!) are ones you can use to educate yourself, or for the vets out there serves as a quick and easy resource to show clients in the exam room. And it has quizzes (thank goodness I passed all the ones I took, that would have been embarrassing.)

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Thanks Red Cross for another great- and affordable- resource!

Pet First Aid at itunes

Pet First Aid at Google Play

Filed: Blog, Cats, Daily Life, Dogs, Health Tagged: , , ,

The Secrets to Saving Money at the Vet

Hoo boy, that 20/20 piece sure stirred up some emotions, didn’t it? And it’s Thanksgiving, a week of gratitude, so I’m going to take a step back and say thank you to all the wonderful readers and colleagues who make writing this worthwhile. In honor of that, I’m going to take a moment and also share with you some of my own veterinary secrets. For the low low price of nothing, I want to explain to you what I believe, based on over a decade now in the field, is the best way to save money at the vet. No sarcasm here.

The best way to save money at the vet is….are you ready?

To spend more time at the vet. No, really.

Preventive Care is where it’s At

If one wants to know some of the best ways to save money on medical care, we need look no further than the group that has gotten the cost/benefit analysis down to an exact science: the human medical profession. It’s taken a long time for the field to come away from the model of medical firefighting: wait until something gets bad- CANCER! KILL IT WITH RADIATION! and more towards preventive care: MAMMOGRAM ALL THE LADIES! Firefight when you have to, but how much better is it to catch things early? For us, of course, it’s lives on the line, but guess what? It’s better for the bottom line too. Win-win.

Interestingly, the three situations described in the 20/20 bit as potential money grabs by the veterinary profession are perfect illustrations of why preventive care is so very important. Had we seen the extent of Marty Becker’s 90 minute interview for the piece in context, this would have all been part of the piece, by the by.

1. Cancer

50% of dogs over the age of 10 will develop cancer. I see it every day. It stinks, and once it’s diagnosed  in advanced stages the treatment options are difficult and expensive. When your veterinarian finds a lump on a dog during a routine exam, for the love of everything, check it out! Trust me, I would make more money resecting it in a messy surgery a year from now when it’s huge as opposed to doing a little biopsy or fine needle aspirate here and now, but I don’t recommend that because I don’t want that to happen to your pet.

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Here’s just a few examples of things I have diagnosed on a check of a lump the owner was on the fence about doing anything about:

-melanoma

-lymphoma

-sarcoma

-mast cell tumor

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Kekoa had a sarcoma hiding under a lump of fatty tissue that, to my fingers, felt like a lipoma (benign fatty tumor.) It wasn’t.

Early detection saves lives.

2. Vaccines

People often go to those weekend vaccine clinics to save money instead of getting it done in the office. Then what happens? They hand you a pamphlet and you have to decipher which package, A, B, or C you want like it’s ordering your kid’s school photographs. It’s confusing. Often, you overbuy. It’s a lot of work to try and stay on top of these things, and I certainly don’t expect pet owners to be reading up on current best practices for vaccines each and every time the dog’s getting boarded and you need a Bordetella vaccine.

I take vaccines very seriously. I keep up on the latest AAHA guidelines- based on research, science, and the best our field has to offer in terms of what constitutes duration of immunity and core versus non-core vaccines. I use that to tailor a vaccination protocol for each pet who comes through the door. I can’t tell you what I recommend across the board because there is no such thing as ‘one size fits all’. I’ve done the full complement, I’ve done titers, I’ve written letters asking the county to exempt an elderly pet with a history of vaccine reactions from a rabies vaccine. This is what we do. If your veterinarian isn’t open to that conversation, I agree 100% that you may want to find someone else.

That being said, the majority of my patients do stay on schedule with vaccines, because once you’ve seen dogs dying of parvo while a little child weeps, you kind of get invested in doing all you can to prevent that.

Bottom line: It’s worth it to find a veterinarian you trust. We’re not unicorns, at least in my experience; we usually can be found hanging around.

Vaccines save lives.

3. Dentistry

Here’s the one that caused the most discussion. Our profession is in the middle of some real change in terms of recognizing the importance of dental care. Since I am not a boarded veterinary dentist, I defer to their vast reservoirs of knowledge and the evidence is clear: 85% of pets have periodontal disease by the age of 4. Most of it is invisible to the naked eye. Can you imagine if we waited until our teeth looked brown and grungy with recessed red gums before going to the dentist? There is real, actual value in getting professional care even if a mouth “looks” OK.

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The *best* way to keep your pets’ teeth healthy at home is incidentally also the cheapest: brush their teeth daily. The other best thing is to get regular, anesthetized dental cleanings to prevent disease from developing/worsening. If you choose not to anesthetize a healthy pet at 3 years old for routine maintenance, the end result is often a 12 year old with impaired organ function and a mouth full of horrifically painful teeth that need to be removed, at great expense. I can address the anesthesia component in another post, because it’s worth a discussion all its own, but suffice to say, anesthesia performed to excellent standards of care- that’s the key- while not risk-free, is actually very safe in healthy pets.

The three issues presented above are life-savers for pets. I am not saying this hyperbolically. Done early and with forethought, they are also money-savers, because they stave off much more significant, and expensive, disease down the road. There’s a reason my own insurance has a $0 co-pay for preventive care: it works. Same goes for our pets.

And happy Thanksgiving, everyone.

Filed: Blog, Daily Life, Health, Musings Tagged: , , , ,

Some Veterinarians Sell Unnecessary Online Memberships By Throwing Colleagues Under the Bus

Some Veterinarians Sell Unnecessary Shots, Tests to Make Extra Money, Says Former Vet

 

Did you see this bit on 20/20 this weekend? Ah, media. Titled “Veterinary Confessions,” the piece follows a couple of dogs through a series of veterinary visits where different vets offer different services based on their clinical experience, interspersed with the contrite admonitions of a former veterinarian who says that he was, before he relinquished his license (more on that later), the medical equivalent of a used car salesman.

Look, I’m not going to tell you that every vet in the world is equal and that everyone follows the same recommendations every time, but if you think that was the real point of this piece, you’ve been duped. Citizens of Oz, let me show you the Wizard.

“The vast majority of vets are ethical” and don’t recommend what’s not needed, says Dr. Andrew Jones, who then goes on to admit he regularly practiced the most unethical practice of recommending what wasn’t needed, just to make more money, hence confessing that he personally was worse than the vast majority of vets. Sounds like a legit guy to speak on behalf of the profession.

Why is he a former vet, you may ask? Well, the excellent blog SkeptVet profiled him a couple of years ago, if you’re interested. Rather than stop his continued practice of talking smack about, well, pretty much any vet except for himself- he was great, you see, unlike the rest of us slobs- he voluntarily gave up his license to practice in Canada.

And what is the good Dr. Jones doing now? Championing the cause of the poor and underserved, fighting the good fight to educate consumers about the latest AAHA vaccination recommendations or raising money for all those people getting soaked by the rest of us unethical greedy vets?

Um, not quite. He has a website. On it, he offers a

 ”Free DVD”

which sounds nice and altruistic. Oh look, he’s pre-prepared for the website traffic he’ll get tomorrow:

Pet Health And Pet Care With Dr. Andrew Jones_ The Online Vet_s Pet Health DVD

 

So, if you continue to scroll down for 5 or 600 feet, you’ll see that yes! it’s FREE!

(save the $6 shipping and handling)

Hey man, sign me up! Only $6 for all this info! I’m going to CLICK!

Pet Health And Pet Care With Dr. Andrew Jones_ The Online Vet_s Pet Health DVD-1

Wait, what? In order to get the free $6 DVD I have to also sign up for the $10 monthly service in perpetuity? Isn’t that the Naughty Video Site approach?

So, in return for tossing me, and my friends, and the vet you hopefully like and trust, under the bus, the good doctor is already planning for the side bennie of all those new subscriptions (note the date on the website, and the date I’m posting this.) All in the name of altruism, you see. Behold the Wizard.

You know me, I don’t normally get this upset, but MAN, my hide’s a little chapped right now. Greedy vets? When’s the last time I’ve asked you for a credit card in order to peruse my website?

I will leave you with one last thought. In this piece, Dr. Jones called dental cleanings the “would you like fries with that” of veterinary medicine, a very often unnecessary bit of work. To illustrate the point, he used a little pit bull who was seen by several vets who said she was fine and didn’t need any dental work. Anesthetized dental cleanings, by the way, often allow you to do a closer examination than you can do on an awake pet and might let you discover something like

pibble

Yes, that’s the same dog.

But by all means, continue to compare me to a kid at McDonald’s. In the meantime, may want to get that looked at.

 

Filed: Blog, Features, Health, Musings, Picks of the Litter, Tails from the Vet Clinic Tagged: , , ,

Better With Pets

Hardened criminal. Swimsuit model. New media revolutionary. NPR host. Animator. What do they all have in common?

Their lives have been made better by having a pet. And we’re not talking oh, I have a cute cat and I sometimes feed it and it makes me chuckle, I’m talking about people whose lives have been profoundly affected by the animals in their lives.

I assume if you’re here reading this blog, you feel it too. Something about the bond between ourselves and our pets goes way beyond the mildly symbiotic relationship developed millennia ago when cavemen tossed scraps to the wolves on the outskirts of the clan; it is an uncomplicated, pure type of love, and those of us who are fortunate enough to have experienced it spend most of our lives trying to come up with ways to pay our animals back for what they give to us.

This Tuesday, I attended the Purina Better With Pets Summit in New York City. As it was the inaugural event, I didn’t know what to expect. No one did, really. 16 speakers in a Ted Talk-ish sort of format, 20 minutes each to share their stories of how pets have enriched their lives. It was, to put it mildly, fantastic.

Some speakers were enlightening, like Dr. Brian Hare from Dognition who is learning some amazing things about dog breeds and different measures of ‘intelligence’:

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Some were funny, like Alex Ohanian from reddit- who talked about how putting a cat on your head and taking a picture creates an experience that allows people to connect with all of humanity:

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Some moved us in entirely unexpected ways, like Black Label Dance Company’s exploration of a man’s relationship with his aging dogs:

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And some just reduced me to a slobbering mess of OMG-can’t-deal, like Judy Finnegan of Puppies for Parole. Missouri’s program has rescued over 2,000 dogs from euthanasia at high kill shelters, placed them with prisoners for 8-12 weeks, and ended up transforming the lives not only of the saved dogs, but the deeply hardened men who found, through these dogs, how to learn compassion.

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These are just a couple of samples, but the other previews are available here, including the inimitable Dr. Marty Becker ending us on a lovely note. When the full videos are up I’ll share again because there were some powerful messages in there that bear repeating, like Dr. Robin Downing’s assertion that reducing pain saves pets’ lives, and Dr. Arleigh Reynold’s touching discussion of moving to Alaska to live and breathe life with his dogs. Doesn’t that sound cool?

I left the event much more affected than I thought I would. As someone who has made my life’s work about animals, I forget that just because someone else hasn’t, doesn’t mean their pets aren’t just as important to them as mine are to me. I forget why I do what I do- not because I love pets, but because so many other people do as well, and I can provide something that helps make that even better. In our human world of strict social order, etiquette, and rules of conduct, pets are one of the rare things that can transcend that artifice and bring us all to the same level.

Group hug, everyone. Life really is better with pets.

better with pets

 

*disclaimer: Purina invited me to the Better with Pets Summit and generously covered my travel expenses. They did not pay me or require any posts about the Summit- all opinions and musings are entirely my own.

 

Filed: Blog, Features, Health, Musings, Videos Tagged: , ,

Three things to know about the jerky illnesses

Let’s imagine, for a moment, that there is a serial killer loose in your town. One by one, he picks little kids off from the local playground, and it’s horrible and awful. The police are working around the clock, but the killer remains elusive.

But he only ever chooses his victims from that one playground.

You wouldn’t take your kids there, right? Even if *most* of the kids who play there end up ok, even if the police chief says, well, it might be OK now? Why take that chance, when there are plenty of safe alternatives?

That’s kind of how I feel about this jerky thing. From the latest FDA update:

The agency has repeatedly issued alerts to consumers about reports it has received concerning jerky pet treat-related illnesses involving 3,600 dogs and 10 cats in the U.S. since 2007. Approximately 580 of those pets have died.

Since 2007, guys. Keep in mind that the FDA is usually all over dog foods when there is potential human illness involved as well, but the wheels turn a little more slowly when there is no indication people are also getting sick. Regardless, I’m glad they are becoming involved- and the level in which they are asking for veterinarians and consumers to participate is much higher than I’ve seen before- but there’s no indication when we might have some answers.

jerky

There’s really only three things I’m reminding people of here:

1. It’s not just chicken

Everyone keeps focusing on chicken jerky as the culprit, but some sickened dogs have eaten duck, fruit, or sweet potato jerkies as well. Most of the treats have come from China (they aren’t saying it outright in the fact sheet, but we can read between the lines here.)

2. The symptoms are diffuse

Not every dog has the same symptoms. Some have GI signs, some have liver issues, others have renal disease. There may be one cause but it is possible we are dealing with multiple contaminants, drugs, or toxins. Which is really frightening.

3. This is 100% entirely preventable

Now that we know it’s a problem, there’s an easy solution. Don’t feed jerky treats from China. They are not a necessary part of anyone’s daily nutrition. It won’t find the culprit, but it will keep your pet safe until they do. Here are some alternatives:

  • Make your own. No special equipment required.
  • Use fresh alternatives like baby carrots or apples
  • Become obsessive about label-reading. Even some products that appear to be from the US or distributed from the US have ingredients made in China. If you’re not sure, don’t buy it.

I made this video almost two years ago, and we STILL don’t know what is going on with those jerky treats.

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Do you know anyone whose pet was sickened from jerky?

Filed: Blog, Cooking, Daily Life, Health Tagged: , , ,

Poke, pay, push off

I used to work in a clinic that offered twice a week vaccine clinics. During those times, we would waive our customary exam fee (at the time it was $45), as long as the client was coming in solely for vaccines and had no health questions.

We did this to provide a service to those clients who would go to the weekend vaccine clinic at the pet store instead of coming to us. I know how those weekend clinics work. They are much like the flu clinic I took my kids to last week. You go, you get your shots, you leave. If you ask about your kid’s ear infections you’d be given a blank stare as they ushered you out the door. Poke, pay, push off.

And you know, it works as long as that is truly all you need. But you would be shocked, or maybe you wouldn’t, I don’t know, at how many times that was not at all the only thing clients need. Especially in the vet clinic. I love questions! That is what I am here for, to educate nervous new pet owners and also say, hey, look at this tooth or this mass or this ear. To say, hey, I see Rover is 14 and has never had bloodwork and you said his appetite is low; perhaps we should postpone these vaccines and make sure he’s OK. But all of that stuff? That’s an office exam. And we have 15 people in the lobby waiting for a bordetella vaccine.

I hated those vaccine clinics with a passion, because at least once a clinic I would get a client who said, “no concerns! Just rabies!” to the technician, waited until I came into the room, and asked me for an allergy consult. And I would either do it because I felt a professional obligation, even though it meant everyone else outside had to wait, or risk being called a (insert choice insult here.)

With the exception of rabies vaccine, our local feed store carries all the other regular canine vaccines. Yes, it’s less than coming to me. Anyone can learn how to give a shot to a dog in about 5 minutes, that’s not the hard part. When you come to me for an exam and vaccines, you are paying for all the other intangibles, captured here so nicely by a colleague with better graphic design skills than me:

Exam.and.vaccs

I understand why people go to those clinics- it’s inexpensive and it’s convenient. It is not, however, a replacement for an office call. Give us a chance. You might be pleasantly surprised at what our staff can do for you, and most importantly, your pet.

Filed: Blog, Daily Life, Health, Picks of the Litter Tagged: ,

How to talk to your vet about death

I’m getting Apollo’s ashes back this week. I still haven’t quite processed it yet, because his death lacked that months long painful preparation/ agonizing over a pet in the process of dying: The Infinite Hovering of the Big Hanging Clock. He woke up Wednesday morning, meowed for his food like always, and was dead 12 hours later.

Whenever you learn of a terminal diagnosis, that invisible countdown clock that all living beings share suddenly appears. And we know that it’s winding down, sooner rather than later, but we don’t know quite how long it will take. No matter how long it takes it always feels like no time at all, while also taking forever. In Kekoa’s case, 2 long months. In Apollo’s case, one unending afternoon.  That hovering space between a good life and a good death is a painful, lonely place when you’re a loving pet owner trying to decide what is best for your pet.

It is, however, part of living with a pet, right? We know it happens, and with as much precision as science allows how a body winds down, so why aren’t we doing a better job of working through it?

It’s the way doctors- MDs and DVMs alike- are trained: here is how you cure. Here is how you preserve, prevent, delay, at all costs and to the last breath, we go down fighting. Play as long as you want, but the house always wins, in the end.

What are we fighting for again?

My grandfather wanted to die for at least a year before he actually did. He was very clear about this. He was done, his wife was gone, he had no interest in this world any more. I understood this. I respected it. The last day of his life, he lost consciousness and was rushed to the ER (which he never would have agreed to when conscious.) When he woke up, the doctors said they couldn’t find anything wrong with him so they were going to have him stick around for a while and be observed. He was so annoyed at this that, by what I can only assume is sheer force of will, he said, “NO!” and died. Sometimes, it’s ok to not want to fight.

Sometimes we want to, and we should fight. And in that regard, veterinary medicine has a dizzying array of weapons at its disposal, chemo and surgeons and radiation therapy. Here’s the truth from the trenches, though: most people don’t go that far. Good owners, loving owners, many people stop far short of doing everything, for a variety of excellent reasons. When looking at the inevitable certainty of death, the pendulum is swinging away from quantity of life to quality of life. Instead of preserving life at all costs, we preserve good life as long as possible, and then we accept the end. I like this. I am glad more vets are open to this approach.

koa

I will support whatever decision you make

When I took Apollo to the specialty hospital after finding him down in the back end, I was almost certain of his diagnosis. Once I had confirmation from one other vet, I was 100% set that letting him go was the proper option. That is an educated decision based on my history with saddle thrombus and my personal beliefs, but if I were a non-vet client, I’d have been overwhelmed.

Apollo’s clock stood at 00:00:01. I knew this. I had no desire to fight for two extra minutes. The specialty hospital, doing what specialty hospitals do, assumed I was more of the “let’s throw the whole arsenal at him” camp because that is what most people who seek out a specialist want to do. I don’t blame them for that, but I did have to clarify “Nope, that’s not what I want.” As soon as the cardiologist confirmed my suspicions and also told me Apollo’s heart was enlarged, I knew all I needed to know.

I have worked with some exceptional veterinarians in my time; a couple who stand out to me tonight are an oncology resident in vet school and the cardiologist I met this month with Apollo.

They lay things out, clearly and precisely. “Your pet has this. Our options for treatment are A (everything), B (somethings), or C (nothing/palliative care.) The survival rates are this. I will support whatever decision you make.” Even though most vets really do feel this way, I wish we did a better job of letting clients know this, that A-B-C does not stand for ‘great owner- OK owner- awful owner.’

It’s actually a terrible choice of words;  ’doing nothing’  often really means “choosing not to pursue therapy and instead focusing on minimizing suffering.” That’s something. That’s huge. And clients shouldn’t feel guilty asking for that.

The Hospice Vet

If your pet has a terminal diagnosis, you have options. My friend Edie has written eloquently about her recent experience with a hospice veterinarian, and it outlines an experience I hope more people become aware of: The preparation visit. We do a great job of outlining a treatment plan for life, for managing kidney failure and cancer and liver disease, but when it comes to outlining a plan for death? Not so much. I have done these visits as part of my current work and it does so much to reduce the fear and anxiety of the unknown surrounding death.

Even if you don’t specifically use the services of a hospice veterinarian, most veterinarians can help you come up with a long-term plan if you ask for them to help. A hospice plan will help you determine several things:

  1. What to expect as your pet’s disease progresses.
  2. What quality of life means to you and your pet, which may be different than it is for someone else.
  3. What very specific occurrences are your signal that it is time.
  4. What tools are at your disposal for managing pain and keeping your pet comfortable.

Knowledge is power. Knowledge is peace. To all of you facing a tough decision, I wish you all three.

Filed: Blog, Daily Life, Health, Musings Tagged: , , , ,

The strange twisted story of canine circovirus

You have probably been hearing a lot about canine circovirus. So have I. You may have heard some conflicting things about this virus. So have I. Because I love you all and I want you to know what I know, I’ve spent the day trying to make sense of the information that’s out there. Here’s what I know so far and why I’m not recommending mass panic at this time.

Part 1: It’s the food

Here’s how the story evolved, as far as I can piece together.

1. In mid-August, P&G pet foods issues a voluntary recall of certain lots of dry food manufactured at an East Coast plant over a 10 day period because of the possibility of Salmonella.

2. Last week, The Pet Spot, a pet kennel in Ohio, learns that several dogs who had been at the facility in the last few weeks had become sickened with a severe hemorrhagic gastroenteritis/ vasculitis type disease. Three of those dogs died.

3. The kennel owner, trying to figure out what was going on, noted that his kennel’s stock food is Iams. He makes a “hey, we may want to look into this” sort of statement which gets digested, churned up in the bowels of social media and local media, and becomes

OMG EUKANUBA IS KILLING DOGS AGAIN (CHAOS/PITCHFORKS)

mob

The only problem is, it wasn’t. By this time, P&G- which coincidentally is headquartered in Ohio- hears this story and of course they would like to know what happened to those dogs. I spoke with Jason Taylor over at P&G, who among many duties has the awesomely fun job of managing pet food recalls when and if they occur, to ask what happened next.

According to Taylor, despite the fact that the kennel owner did not have the lot codes of the food he was using, P&G was able to ascertain the lot numbers based on order history and shipping details, determining that the food being fed at the kennel was not part of the recall, and in fact was not even manufactured at the same factory.

But since they were there anyway with a group of microbiologists and toxicity experts and a small business owner who was under a lot of pressure to figure out what was going on, they figured they would add their resources to the investigation, crawling around with cotton swabs and all that science-y stuff and send it off to see if there was any identifiable pathogen in the environment. There was none. The facility was cleared to re-open.

Still with me?

Part 2: It’s circovirus

4. By now, the state veterinarian, the local veterinary community, and the Ohio State veterinary hospital are involved. People put their heads together. Someone says, “hey, I remember reading about a dog in California that died this April with similar symptoms; he had circovirus, which is weird and unusual because it’s normally a pig disease. We should test for that too.” The news, already paying attention after losing the whole pet food angle, is still interested. Under the tender editorial guidance of a click-happy news site, “we are investigating this possibility” becomes:

OMG A SCARY NEW VIRUS WILL KILL YOUR DOG

because if there’s one thing the spell check challenged online journalism teams at local newspapers like to do, it’s to drive traffic with leads like “It’s a scary new disease, that can kill your dog” then follow up with some man-on-the street interviews with statements such as “It can like, kill your dog, and that’s like bad for them.”

hazmat4

Uh oh.

As anyone who has read any sort of newspaper or watched any news channel in the last decade will attest to, journalism has become less about accurate reporting and more about fast reporting. It’s the nature of the beast these days, but it’s why everything needs to be taken with a grain or bushel of salt because guess what?

According to a UC Davis professor who tested samples from three of the affected dogs, only one tested positive for circovirus. You may not have heard that yet because Ohio can’t test for circovirus; samples got sent to California and despite what CSI tells us, results are not instantaneous. It took this long for the official results to come in, which is about 4 days too slow for a news cycle that is moving on to the next disaster at midnight.

Part 3: It’s…a case in progress

So what do we know about circovirus and dogs, exactly? Not much. What caused these illnesses? Not sure.

  • Correlation does not imply causation. In the above referenced piece, Dr. Pesavento points to an academic article published in April that  talks about the dog in California, then went looking for the presence of circovirus in other dogs. To sum up, it was found in some dogs with diarrhea. It was also found in some healthy dogs. Most of the sick dogs were co-infected with some other pathogen as well. Clear as mud.

So again, what do we know about circovirus in dogs? That it exists. It may or may not cause disease. That is all the scientists are willing to say at the moment. Wordier summary is in the Ohio Department of Agriculture press release.

That is soooo anticlimactic and unsexy and un-newsworthy, and as a person who likes exciting news as much as the next person I wish I had something more earth-shattering to report. But at the end of the day I am also a person that likes TL:DR summaries, so to put it all in one handy image:

circotagion

Part 4: So now we torch the dog park, right?

I in no way want to minimize what happened to those affected dogs, who suffered from a rapid onset, devastating illness. It is entirely possible that circovirus will be identified as the cause, and in that case we can revisit this issue and talk more. I as much as anyone else hope the patient scientists who make this their life’s work will be rewarded for their diligence with a definitive cause. As of now, there is none. We live such stressful lives as it is, I like to wait until I’m forced to panic so I don’t spend my entire life wedged in the corner covered in Saran Wrap. While we wait to determine if this is necessary, here’s what you can do:

1. Remember the number of reported cases stands at ‘miniscule’. If you’re worrying about circovirus while your dog is running around a year late on his parvo booster, I would recommend re-focusing your attention, at least for the time being. That being said:

2. Call the vet immediately if your dog shows any signs of this disease. If your dog has bloody diarrhea, you should be at the vet ASAP anyway; this advice has not changed since before this virus emerged. The affected pets became rapidly, severely ill: rapid treatment was essential to positive outcome.

3. Avoid high risk environments. Consider the fact that all of the reported cases happened in dogs that had recently been to kennels or doggie daycares. High concentration of dogs in one place means higher likelihood of disease spread.  I actually don’t recommend carte blanche avoiding these environments, but if you are really concerned or if your dog has a less than hardy immune system, dogs survive just fine without those facilities.

Filed: Blog, Dogs, Health, Picks of the Litter Tagged: , , , , ,

World’s Most Adorable Degenerate Produce

A grape. So benign. Frozen, so delicious. Dehydrated, so raisin-y. And in large quantities in dogs, the unassuming grape goes Breaking Bad and becomes a killer. Da da duuuuum…. so let’s talk toxic foods for a minute.

When my friend Lili Chin over at Doggie Drawings asked if I would look over a poster she was designing of toxic foods for canines, I was so excited, because her drawings rock and I couldn’t wait to see how she interpreted “bulb of garlic.” The idea was to create a simple, cute piece about toxic foods for dogs, and she wanted my thoughts.

As soon as I looked at the list, I realized this would be a challenge, because toxicity is not always linear. Sometimes a dog eats a bag of grapes and is fine and other times a dog eats one bite of pork fried rice and dies of pancreatitis. Sometimes only portions of a fruit are toxic and other parts are fine. Sometimes there are at least three variables that must be calculated before you know if a food was ingested at a toxic amount (chocolate, for example.)

There is a reason this poster does not have in-depth detail about toxicity doses, etc. Determining toxic likelihood on a case-by-case basis is exactly what veterinarians are for, so if you swear up and down onions have made your dog’s life better don’t email me complaining, talk to your vet and go forward in peace. Consider this a lighthearted PSA that you can do with what you will.

At the end of the day, the world will always be improved by more of Lili’s drawings. Macadamias packing heat will NEVER go out of style.

toxiclili

Source: Lili Chin, DoggieDrawings.net

What this is: a cute graphic with limited specifics intended to share knowledge about foods that might cause a problem for your dog, so that you can discuss it with your veterinarian if you are concerned.

What this is not: An exhaustive treatise with toxic dose approximations, a prediction of your dog’s demise if he eats a piece of cheese, an academic piece in a peer reviewed journal, a substitute for your vet’s opinion.

It’s a poster, and a really cute one at that. Lili has them available for download here as well.  Hope you like the hooligan chocolate bar as much as me!

Filed: Blog, Daily Life, Dogs, Health, Lifestyle, Picks of the Litter Tagged: , ,

Do dogs get headaches?

Humans For Sure Get Headaches

A week ago, I decided I was going to stop drinking caffeine. Now if you know me at all, you know I adore coffee, more than almost anything else in life. If you cut my arm, skinny vanilla latte would pour out. The decision to give up my biggest vice was not an easy one by any means, but at the end of the day, health trumps pleasure, and I figured there’s always decaf.

I did what everyone tells you not to do, and just stopped cold turkey. Big mistake, everyone.

8 am: I felt a little sluggish, but not too off. This is totally manageable.

10 am: I felt really sluggish, like I was about to fall off the kitchen barstool; a sober drunk. I am still mostly coherent, though, so I figure I can continue to tough it out. My children look on in confusion.

noon: I felt a little twinge in the back of my temple, just a tiny blip of a possible headache. I take 2 Advil. Ah yes, the infamous caffeine headache. It’s not too bad, though.

3 pm: An small but bloodthirsty miniature barbarian horde has invaded my head. They have taken microscopic pickaxes to my sinuses and are attempting to harvest my eyeballs through the back of my orbits. Paralyzed by exhaustion, I am unable to tell anyone of my predicament as I am systematically destroyed.

Here they come.

Here they come.

5 pm: My husband finds me slumped on the bed in the fetal position, moving centimeter by centimeter in slow motion because every time a wave of movement jolts the marauding horde in my cranium, they get angry again. He has no way to tell that this is what is going on; as far as he knows, I have the flu, or allergies, or I ate some bad Greek yogurt. In a feathery voice, I whisper: “Make me a cup of coffee, if you would.”

I admit defeat, and give the barbarians their drugs.

7 pm: Feel fine.

If you are not someone who experiences headaches, you have my complete and utter envy. While my caffeine withdrawal headache was nasty (I have since elected for a more subtle weaning-off process), I used to suffer migraines as well and those would pretty much put you out of commission in a blinding stroke of agony, nausea, and an unending mantra: please let me go unconscious please let me go unconscious. And despite the misery and despair you are experiencing, to the outside you simply look like someone who doesn’t feel that great.

But what about dogs?

At 11 pm, recovered but now fully awake from my late night caffeine jolt, I started thinking about dogs and headaches. As veterinarians, we aren’t really trained in the idea that dogs get headaches, so therefore they don’t exist. Well, pain in the head is not a disease, it’s a clinical sign of a disease process, such as dehydration, brain tumors, or any number of other problem that both dogs and humans do get, so it’s not unreasonable to think they might get head pain as well. They get other kinds of pain, after all. But objectively speaking, we have no idea whether or not a dog gets a headache because there’s no way for them to describe it as such.

I suspect they do get them. Have you ever seen a dog with a hangover? I have, sadly, in the ER. It’s not funny, it’s actually very sad that someone would knowingly intoxicate an animal, but the morning after they really do look like every college kid on a Sunday morning. Whatever it is they are feeling, it’s not super awesome.

At my first job, I worked with an old timer who always criticized how long it took my pets to wake up from anesthesia. “Look how quickly mine wake up!” he’d crow proudly. 20 minutes after a spay they were up and pacing. Mine were usually out for at least an hour or two. Eventually I decided to take a look at the differences in technique, and the main difference was this: I gave a lot more pain medications. My pain protocol back then was an eye-roller to many, but is now standard in many hospitals. My patients weren’t taking too long to recover, they were sleeping because their pain was being managed appropriately and they were comfortable.

If you could tell the cat to please stop playing the bongoes over there, that would be great.

If you could please stop playing the bongoes over there, that would be great.

If you talk to your typical veterinary anesthesiologist or oncologist, many of them will tell you that most people- vets included- tend to underestimate the amount of pain a pet experiences, assuming if a pet is not howling in pain they are OK. The more we learn, the more we are realizing the effect of pain on health, and how much more we can do to alleviate it. We are getting better about that as a profession, and I’m glad to see more and more vets adopting aggressive pain management protocols for everything from cancer to arthritis, but at the end of the day we can’t really manage a symptom we don’t know exists.

So to answer the question: Do dogs get headaches? I hope not, but I suspect they might. Poor dogs. Good thing Brody’s not hooked on caffeine.

Know your dog or cat. Know what is normal behavior and what is off. And if you suspect something is wrong, trust your instincts, and get them to a vet. Subtle signs can mean big things going on.

 

Filed: Ask Dr. V, Blog, Dogs, Health, Musings Tagged: , ,

Fear Me: Fear Free Practice and You

My resting blood pressure, I assure you, is completely normal. I have to state this fact again and again every time I wind up at the doctor’s office, when the nurse places the cuff and then pulls it off with a thoughtful wrinkle in her forehead. “It’s not normally 200/140!” I plead, hoping she doesn’t direct me to the closest ER. “I just get this way when I’m in the doctor’s office.” She nods, and we get on with our day. I have no idea why it happens, but apparently it’s A Thing. I blame it on the scale. I hate going to the doctor and avoid it as often as possible.

Sound familiar?

trip-to-the-vet-every-single-time

It happens at the vet, too. “The cat’s temperature is 103.8,” the tech will say, shrugging. “I think. She was trying to bite me most of the time, so I didn’t get a heart rate.” White coat syndrome in pets can be so significant that some behavior experts counsel the veterinarian to leave the coat in the back room, so as to trick the pet into thinking you aren’t the dreaded vet. We accept this as a reality of practice, our years of blood sweat and tears in service of our love of animals being reduced to this: told, on a daily basis, “Ha ha! My dog hates you.”

“Fear is the most damaging thing a social species can experience.”

I was talking to Dr. Marty Becker the other day (I know, right? I am so excited to actually say that I am a person who talked to Marty Becker the other day) and he was sharing a conversation he had with Dr. Karen Overall about the effect of stress hormones on physical health. It’s not some theoretical thing; fear causes permanent change to the brain. It is damaging in a profound and terrible way.

I think of my mother, who had such horrible experiences at the dentist as a child that she refused to go back for years until the advent of sedation dentistry. I think of my own memories of childbirth and hospitals and how simply seeing the maternity ward from the side of the freeway gets my heart pumping. Fear is an awful feeling. And what we do to pets in the hospital can only be described in many cases as a terror inducing, fear of death experience. Slapping a cat on a cold exam table, sticking needles in their neck like a predator sinking their teeth into prey, staring at them through the bars of the cage. It can take them days or weeks to recover from the stress of a hospitalization, and as soon as they get put in the carrier for a follow up, it starts all over again. No wonder cat visits to the vet are so infrequent. And we are supposed to be their health champions.

As vets, we often blame clients for not caring enough about their pets. “Don’t you know,” we ask sagely, “how important these visits are?” And we shake our heads at the pet owners, blaming them for not having their priorities straight, for not wanting to spend the money on visits. We have done this for years, without ever looking at ourselves and wondering what part of the blame we shoulder ourselves for making the vet hospital pretty much the worst environment possible for pets. “Shelters are so stressful and sad,” we say, ignoring the PTSD we are inducing in the cat with a urinary catheter in the back who has nowhere to escape the prying eyes of the Husky across the room.

When I really started to think about it, I was mortified.

It doesn’t have to be this way.

Some people get it. I worked with a technician who loved cats, like, in a self professed ‘cat lady’ sort of way. She was always sneaking into exam rooms to place a microwaved towel under a cat, or sprinkling catnip in their cage, making little hidey boxes out of recycled cardboard. It was tolerated. It should have been celebrated.

A lot of people in the profession, like that technician, are intuitively doing what they can to make things easier on pets. After hearing Dr. Margie Scherk lecture on this topic years ago,  I started keeping a yoga mat in the back for cats to sit on, on the table. Dr. Becker is taking it one step further: he wants vets to re-envision practice from the ground up, to change them from a vet-friendly hospital to a pet-friendly one. He calls it “Fear Free Practice,” and I love it.

When I was in school, veterinary behavior as a specialty was just getting off the ground. It was scoffed at. It’s not ‘real medicine’ was the prevailing attitude. They were wrong. It is, in my opinion, our biggest oversight as a profession. We blame backyard breeders and lack of affordable spay/neuter for pet overpopulation while neglecting to address behavior issues that eventually result in a pet being relinquished. We make the clinic so unpleasant people would rather let their pet suffer in pain at home than come see us and miss the chance for interventions that can save a life.  The consequences: less visits, more health issues, more behavior issues we never got the chance to address.

The veterinary community needs to do a better job, from start to finish, of addressing and incorporating behavior into practice.

Fear Free Practice: Real Life Implications

Anyone who has spoken to me in the past year or two knows I am passionate about encouraging our profession to take a more active role in maintaining a pet’s healthy role in the family. To me, preserving that relationship is just as important as maintaining a good weight. It is vital. As is, I think, this concept of fear-free practice.

While Dr. Becker and other like minded vets work on our colleagues, I encourage you to advocate for your pet’s mental well being at the clinic. Bring a mat or towel. Spray them with Feliway. Ask the vet to give your dog some of his favorite treats before jumping into the exam, or if they can take the heart rate while the cat stays in your lap. Making a visit less stressful doesn’t have to involve rebuilding the clinic from the ground up; it can start with these little steps. It’s a philosophy more than a set of prescriptives.

Has fear kept you and your pet from the vet? Had a vet that went out of their way to make you comfortable by embracing a fear free approach?

Filed: Be The Change, Blog, Health, Musings, Picks of the Litter Tagged: ,
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