Veterinary Medicine, Incorporated

Photo Credit: Flicker CC, sagesolar, upwardTwo giant corporate players have been making veterinary headlines as of late.  Mars, Incorporated, the candy maker (M&M’s, Snickers, Twix, etc.), pet food manufacturer (Royal Canin, Pedigree, Iams, Whiskas, etc.), and owner of Banfield Pet Hospital with its more than 900 locations has plans to acquire VCA Antech and its almost 800 veterinary hospitals. The purchase price is said to be $9.1 billion. Pending approval of federal regulators, this mega-deal is set to close before the end of 2017.

Corporatization of veterinary medicine is nothing new. It’s been going on for decades. The more recent trend is the consolidation of veterinary corporations. To date, the Mars-VCA deal is the largest such transaction on record.

Another relatively new trend is the consolidation of independent veterinary practices. The first large-scale merger happened in 2010 when 17 facilities joined together to create Companion Animal Practices, North America. This company grew to 56 locations before being acquired by VCA Antech. Mixed Animal Veterinary Associates North America (MAVANA) has been another successful merger in which 21 mixed animal and equine veterinary practices spread across 10 states joined forces. Dr. Scott Spaulding, founder of MAVANA stated,

It seemed to me there was an opportunity to put together some practices to develop a corporate structure to pull a lot of the business administration part out of the practice at the local level and put it at the corporate level. By pooling our resources, we can hire experts in those fields, and that’s what we’re in the process of doing right now with MAVANA.

The good

While it’s tempting to view large veterinary conglomerations and corporations as a Darth Vader character in a James Herriot story, they do have a bright side. Reinvestment of profits gleaned from improved business practices and economies of scale (a proportionate savings in costs created by an increased level of production) can provide bigger and better state of the art veterinary facilities and technology. This translates into improved diagnostic and treatment options.

Additionally, large veterinary corporations have the ability to gather data from their literally millions of patients and turn this information into meaningful research that can benefit animals wherever they receive veterinary care.

Lastly, without corporate buyout options, most veterinarians who own really large veterinary hospitals would not be able to come up with a financially feasible exit strategy for themselves. Few veterinarians have the capital required to make a multi-million dollar purchase.

The bad

Although an estimated 85-90 percent of veterinary clinics and hospitals within the United States remain independently owned, in some regions of the country, corporations own a disproportionately high percentage of veterinary facilities. For example, the San Francisco bay area supports a large number of veterinary specialty practices. VCA Antech (soon to be Mars) owns all but a couple of them. Such monopolies take choice out of the hands of the consumer.

VCA is a publicly traded company, meaning its business metrics and acquisition activities have been public knowledge. Such information can be useful in terms of the business of running a veterinary hospital. For example, private veterinary practice owners might derive reassurance that their financial “slow season” seems to match up with VCA’s “slow season.” All such public information will go underground once VCA’s approximately 800 hospitals are acquired by Mars.

The ugly

Having nonveterinarians call the shots can be worrisome in terms of the best interest of the patients. Banfield Pet Hospital and VCA have both been criticized for tying the hands of their veterinarians, requiring that they follow strict medical protocols rather than making decisions based on the needs of individual patients and clients. In fact, a recent Bloomberg Businessweek article featured a veterinarian accusing Banfield of pushing its employees to prioritize profit over the health and safety of the animals they are treating.

Reactions within the profession

Reactions to the Mars-VCA merger from those involved in the veterinary profession have been mixed. Dr. Eileen Jefferson is the owner of Ethical Veterinary, a mobile practice in Stone Ridge, New York. She is concerned that,

Veterinary medicine stands to be reduced to the financial interest of shareholders in a candy company, and at the expense of veterinarian-owned hospitals. Using a fast-paced, cookie-cutter retail model has the potential to undermine the science and ethics central to traditional veterinary practice. More than ever, animals are regarded as family members. As a veterinary practice owner, I see that clients are increasingly interested in time spent with the veterinarian, thoughtful education, continuity of care, and patient-tailored medical decisions. The trend toward corporate veterinary practice doesn’t seem to to match what clients are actively seeking for their animals.

MAVANA founder, Dr. Scott Spaulding, views the VCA-Mars merger as potentially positive for the veterinary profession. Based on his experience as a practice management consultant and member of the AVMA Veterinary Economics Strategy Committee, he recognizes that one of the largest financial hurdles most practices deal with is the lack of capital. Pertaining to the the acquisition of VCA, Dr. Spaulding stated,

It’s a capital-intensive business. We have to have facilities and a large enough staff. We also invest heavily in surgical facilities and the latest diagnostic technologies. With $9.1 billion coming into the veterinary industry, I think that is definitely needed by veterinary medicine and that it will have a tremendous long-term impact.

In response to the VCA-Mars transaction, the American Veterinary Medical Association (AVMA) issued forth the following uber-politically correct statement:

We support every veterinarian engaged in veterinary medicine, no matter where they practice. In addition, regardless of practice ownership, the interests of the patient, client, and public require that all decisions that affect diagnosis and treatment of patients are made by veterinarians in the context of a veterinarian-client-patient-relationship, and veterinarians must have the authority to exercise professional judgment in making clinical decisions.

How do you weigh in on this topic?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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 and Your Dog’s Best Health.   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 and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

Alaska’s New Divorce Law: Pets Are More Than Property

Photo Credit: Flicker CC, Davidegorla, HugMy interest is always piqued by news of changes in laws that view animals as family members rather than personal property. Case in point is a newly amended law in Alaska (Amendment HB 147) that requires consideration of the best interest of companion animals who are caught up in the tangle of divorce. In the past, the animals would have been placed with whomever was deemed to be the more “rightful owner.”

The Animal Legal Defense Fund (ALDF) has called Amendment HB 147, “groundbreaking and unique.” A recent ALDF blog post stated, “Even though judges throughout the U.S. can already choose, in their discretion, to consider an animal’s best interests, no other state legislature has required judges to do so when adjudicating property distribution upon the dissolution of a marriage.”

Will other states follow suit?

Alaska’s Amendment HB 147 has set a precedent in the United States in terms of divorce law. It remains to be seen whether or not other states will follow suit. Few laws currently exist within the United States that recognize the best interests of animals within the court system. Alaska’s decision represents significant progress. State Representative Liz Vasquez, a sponsor of HB 147 stated,  “Pets are truly members of our families. We care for them as more than just property. As such, the courts should grant them more consideration. It’s only natural.”

A case in Texas

There have been a handful of court cases in recent years that have challenged the long-standing legal precedent that animals are to be regarded as personal property. One notable example involved Texans Kathryn and Jeremy Medlen. Their lawsuit stemmed from the wrongful euthanasia of their dog Avery by a Fort Worth animal shelter. Avery had been picked up as a stray and was to be held until the Medlens could retrieve him. Shelter workers erroneously placed Avery on the “euthanasia list.” The Medlens sued and attempted to recover “sentimental” and “intrinsic” damages for the loss of their dog. Ultimately, the Texas Supreme Court denied the Medlen’s claim declaring that pets are nothing more than personal property.

The court, however, did sympathize with the Medlen’s grief by acknowledging that, “Texans love their dogs. Throughout the Lone Star State, canine companions are treated- and treasured- not as mere personal property but as beloved friends and confidants, even family members.”

However, the Supreme Court justices felt that this sentiment should not negate a more than a century old precedent that bars emotional damage claims for the death of a pet. As Supreme Court Justice Don Willet wrote, “The Medlens seek emotion-based damages for the death of ‘man’s best friend’ when the law denies such damages for the death of a human best friend. For all their noble and praiseworthy qualities, dogs are not human beings, and the Texas common-law tort system should not prioritize human-animal relationships over intimate human-human relationships, particularly familial ones.”

How do veterinary organizations weigh in?

Professional veterinary organizations typically voice opposition to viewing pets as more than personal property. Here is their reasoning. Currently, veterinary malpractice insurance premiums are extremely affordable. If and when pets become more than personal property and their owners can sue for emotional damages, the cost of veterinary malpractice coverage will skyrocket, perhaps rivaling those of human medical doctors. This would dramatically drive up the cost of veterinary care.

In the Medlen lawsuit, both the Texas Veterinary Medical Association and the American Veterinary Medical Association filed legal briefs requesting that the existing law viewing pets as property be upheld.  About this case, Texas Veterinary Medical Association president, Dr. Jed Ford stated, “The court upheld a legal precedent that has served the people and animals of Texas well for over 100 years. While animals play important roles in our lives, it was critical that the court maintain its position that noneconomic damages are unavailable for the loss of an animal. To have ruled otherwise would have had a dramatic negative impact on the practice of veterinary medicine in Texas and animal care in general.”

How do you weigh in on the legal view that pets are no more than property?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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 and Your Dog’s Best Health.   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 and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

X-ray, Ultrasound, MRI and CT: Which Imaging Study is the Best Choice for Your Pet?

Photo Credit: Liverpoolhls, x-ray, Flicker CC licenseWhy has your veterinarian recommended an MRI scan rather than a plain ole’ x-ray of your dog’s back? Why a CT scan rather than an ultrasound of your kitty? Nowadays, when it comes to diagnostic imaging, there are a number of options to choose from. Each of them caters differently to visualizing abnormalities. Knowing the merits and limitations of each imaging option allows your veterinarian to recommend the best choice for your dog or cat.

Radiographs (X-rays)

Of all commonly used imaging modalities, radiographs have been around the longest. High-energy radiation is passed through the body to create a radiographic image. In the past, images were transcribed onto x-ray film. Nowadays, most veterinarians use digital sensors to capture the images. Digital radiographs are preferred because, not only can the images can be enhanced, there’s no need to mess with the nasty chemicals necessary to develop x-ray film.

Radiographic images are great for looking at bones, particularly when wanting to identify fractures or arthritic changes. Chest x-rays can detect pneumonia, enlarged lymph nodes, tumors that are relatively sizeable, and heart enlargement. Radiographs of the abdomen can be useful for finding prostate gland enlargement, most bladder stones, enlargement of the liver or spleen, abnormal gas patterns within the bowel, and some gastrointestinal foreign bodies (those that contain mineral or metal). It’s quite common for veterinarians to choose radiographs as a first diagnostic imaging test. If they don’t reveal an abnormality, a different type of imaging study may be recommended.

In some states, California being one of them, it is required that only the animal be in the room when radiographs are taken so as to avoid repetitive human radiation exposure. Depending on the finesse of the x-ray technician in using gentle restraint devices as well as the malleability of the patient, sedation may be necessary. In states where such radiation exposure laws don’t exist, a technician or two wearing lead-lined gloves and aprons typically restrain the fully awake patient in position when the x-ray is taken.

Ultrasound

Ultrasound resembles sonar in that sound waves are emitted to retrieve information. In the case of ultrasound, the sound waves are emitted from a hand held device and information about how they pass through or are blocked by the various tissues they encounter is converted into electrical signals that are then interpreted by a computer and transformed into an image. Ultrasound is a wonderful modality for evaluating abdominal organs such as the spleen, gall bladder, liver, and kidneys. It’s also great for evaluating the heart (referred to as an echocardiogram).

Unlike x-rays that provide silhouette images of structures, ultrasound allows a look inside various organs. For this reason, ultrasound is a commonly used diagnostic tool. Where ultrasound is limited is in evaluating bony abnormalities or things within the chest cavity other than the heart. This is because sound waves are blocked by air (the lungs are filled with air) and bone.

Unless an animal is quite anxious, wiggly, or fractious, ultrasound can be usually be performed with nothing more than gentle restraint. Hair gets in the way of creating a good ultrasound image, so the study site must be shaved. Not to worry, the hair coat will grow back good as new in approximately three months time (a small price to pay for valuable information).

Computerized tomography (CT)

CT imaging is a moving x-ray machine. The x-ray and recording device rotate around the patient. The recording device sends data to a computer that compiles an image. Like a loaf of bread, the image contains multiple slices. The data is then constructed so that the person interpreting the CT scan can view the images one slice at a time or compiled into the whole loaf.

A CT scan is a good choice when an abnormality is detected that an x-ray cannot find. For example, small growths within the bone or lungs that are too subtle to be seen on an x-ray will appear crisp and clear on on a CT scan. Given that the CT machine tends to be noisy and scary and the animal must lie perfectly still for several minutes, general anesthesia is invariably required.

Magnetic Resonance Imaging (MRI)

MRI imaging uses magnetic field and high frequency radio waves to create an image. The beauty of the MRI scan is twofold. First, it creates greater soft tissue (as opposed to bone) detail than any of the other imaging studies. Secondly, it does so without any radiation exposure for the patient. MRI is an ideal choice when evaluating soft tissue structures such as muscles, tendons, ligaments, solid organs (liver, spleen, kidneys), and the spinal cord.

As with CT scanning, MRI imaging requires general anesthesia so that the animal will lie completely still in a very noisy machine over the course of 30 minutes to an hour.

Have any of these imaging studies been used for your pet? If so, what was discovered?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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 and Your Dog’s Best Health.   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 and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

 

Ovary-Sparing Spay Surgery (OSS)

Photo Credit: Flicker CC, Smerikal, BeautifulMy last blog focused on the boys, specifically canine vasectomy, a surgical technique for sterilizing male dogs without removal of their reproductive organs (testicles). Now, it’s time to talk about the girls! The corollary surgery in female dogs is called ovary-sparing spay (OSS).

What exactly is ovary-sparing spay surgery?

The canine spay surgery traditionally performed in the United States is called ovariohysterectomy in which both ovaries (ovario) and the uterus (hyster) are removed. OSS surgery is simply a hysterectomy- only the uterus is removed and, as the name implies, the ovaries are spared. The hysterectomized dog is sterile, but her ability to produce reproductive hormones remains intact.

Why consider OSS?

There are a few different reasons why people might opt for OSS surgery:

  • They want a sterilized dog, but believe in the importance of maintaining normal reproductive hormones status. Over the past decade or so, we’ve learned considerably more about some deleterious effects of traditional spay surgery particularly when performed before one year of age. The studies to date have mostly been breed-specific (Rottweilers, Labrador Retrievers, Golden Retrievers, Vizslas, and German Shepherds). In these studies, removal of the reproductive organs increased the risk for development of behavioral problems, orthopedic diseases, urinary incontinence, and various types of cancers. At this point, we really don’t know if this information can be extrapolated to other breeds.
  • They want their sterilized dog to achieve “normal” or “breed typical” stature and conformation. Conventional spaying, particularly at a young age, tends to create a somewhat different physical appearance.
  • They want to eliminate the risk of pyometra (see below), but don’t want the loss of normal reproductive hormone production.

Not for everyone or every dog

While OSS makes perfect sense for some people and some dogs, there are a number of important factors to consider:

  • A dog who has had OSS surgery will continue to have heat cycles complete with a swollen vulva, behavioral changes, and an invitation to all the unneutered male dogs in the neighborhood. The good news is that the amount of vulvar discharge associated with the heat cycle should be significantly diminished.
  • Dogs who have had OSS surgery will be subject to developing mammary (breast) cancer, one of the most common malignancies in female dogs. Removal of the ovaries, particularly before the first heat cycle occurs, protects against this disease.
  • When the ovaries are spared, it’s super important that the uterus, including the cervix, is removed in its entirety. Most veterinarians do not have experience removing the uterus this “aggressively”. Leaving even a remnant behind can result in pyometra (pus within the uterus). This “stump pyometra” can make for a very sick dog, and treatment typically requires surgery. Correctly performed, OSS surgery prevents pyometra from ever occurring. If you opt for OSS surgery, pick your surgeon wisely. Consider working with a veterinarian who specializes in surgery.
  • Although she will be receptive to male dogs when she’s in heat, the female who has had OSS surgery should not be bred. Given that her cervix will have been removed, from an anatomical point of view she may not be able to accommodate the male dog.
  • Just like dogs who have not been spayed, dogs who have undergone OSS surgery may exhibit symptoms of pseudopregnacy, also known as false pregnancy. This is a truly interesting phenomenon in which reproductive hormones trick the dog into thinking she’s pregnant even though she’s not. So, at right around 60 days following her heat cycle, the pseudopregnant dog begins behaving just as she might if she were getting ready to give birth. She might exhibit behaviors such as nesting, aggression, panting, pacing, whining, and not eating. She may even begin producing milk. While none of these are symptoms that typically need to be treated, they can create a nuisance that lasts for quite awhile.

Would you ever consider OSS surgery for your dog?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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 and Your Dog’s Best Health.   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 and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

Canine Vasectomies

Do you know that vasectomy surgery can be performed on dogs? Indeed this is true, Photo Credit: Nguyen Hoangnam, cute, Flicker CC licenseand, as we learn more and more about the impacts of traditional canine neutering (castration), vasectomy surgery is becoming increasingly popular.

What exactly is a vasectomy?

Whether performed on a human or a dog, vasectomy surgery involves clamping, cutting, or ligating (tying off) the vas deferens, the duct that transports sperm out of the testicle and into the semen. Local anesthesia is all that is needed to accomplish this surgery in men. (Most men will lie still when told to do so.) Vasectomy surgery is performed in dogs using general anesthesia.

Vasectomy versus castration

Castration is referred to as “neutering” because the reproductive organs (testicles) are removed. With vasectomy surgery, the testicles remain in place, so the dog is not considered to be “neutered.”

Whether castrated or vasectomized, the end result is a sterile dog. And, there is a period of surgical recovery with both procedures. Castration tends to be a “bigger deal” surgery in that the incisions are larger and there is more overall tissue trauma. Performed by someone with significant experience, a vasectomy tends to be considered a relatively minor procedure.

The testicles are where testosterone is produced. So, it makes sense that castration (removal of both testicles) reduces testosterone production to almost nil. A very small amount of testosterone continues to be produced by the adrenal glands. Vasectomized dogs maintain normal testosterone production.

Choosing whether or not your dog should live his life with or without testosterone is a big-deal decision these days. There is mounting evidence (pun intended) that removal of testosterone, particularly in dogs under a year of age, might be associated with negative health implications. There are plenty of pros and cons to consider, and they should be discussed at length with a veterinarian you hold in high regard. Be sure to do some investigating yourself. I have compiled a bibliography on canine spay/neuter research, including that which is most current. Please shoot me an email if you would like a copy.

Be forewarned

If you opt to sterilize your dog via vasectomy, here are some things to consider:

– There is no “Vasectomy 101” course being taught in veterinary schools (yet). Most veterinarians who perform vasectomies are somewhat self-taught. While this surgery is pretty darned simple, be sure that you are working with a surgeon who has several vasectomies under his or her belt (pun intended). If you are having difficulty finding an experienced surgeon, look for a surgical specialist. He or she will be able to handle your request.

– If ever you become unhappy with the role testosterone is playing in your vasectomized dog’s life (he’s humping everything in sight, he’s jumping the fence to be with the neighbor’s dog who is in heat), you can always opt for castration at a later date.

– Following vasectomy surgery, a male dog can successfully breed for up to two months. Do not let your vasectomized dog interact with a female in heat during this time period.

– You might be ostracized and/or interrogated at dog parks and other public venues where only neutered dogs (those without reproductive organs) are allowed.

– Proprietors of doggie day care facilities may refuse your vasectomized dog because they hold negative and sometimes inaccurate impressions of testosterone-driven behaviors.

Would you ever consider a vasectomy for your dog?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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 and Your Dog’s Best Health.   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 and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

Guidelines for End-of-Life Care

Photo Credit: Shea Cox, DVM

Some truly lovely guidelines pertaining to end-of-life care for pets have recently been published. I use the word lovely because everything within this document feels exceptionally loving and humane, not only for the animals, but also for their human companions. The guidelines were a collaborative effort, created by the International Association for Animal Hospice and Palliative Care and the American Animal Hospital Association.

Here are some examples that will give you a sense of the wisdom and compassion found within these End-of-Life Care Guidelines.

End-of-life care and decision making embody the critical final stage in a pet’s life and are as important and meaningful as the sum of the clinical care provided for all prior life stages.

End-of-life care should focus on maximizing patient comfort and minimizing suffering while providing a collaborative and supportive partnership with the caregiver client.

Timely, empathetic, and nonjudgmental communication is the hallmark of effective client support.

Veterinarians should not allow an end-of-life patient to succumb to a natural death without considering the option of euthanasia and ensuring that other measures to alleviate discomfort and distress are in place.

Hospice care

The end-of-life care guidelines defines animal hospice as follows:

A philosophy or program of care that addresses the physical, emotional, and social needs of animals in the advanced stages of a progressive, life-limiting illness or disability. Animal hospice care is provided to the patient from the time of a terminal diagnosis through the death of the animal, inclusive of death by euthanasia or by hospice-supported natural death. Animal hospice addresses the emotional, social, and spiritual needs of the human caregivers in preparation for the death of the animal and the grief experience. Animal hospice care is enhanced when provided by an interdisciplinary team approach.

There are many similarities here between animal and human hospice care. The major difference is that, in human hospice, death is neither hastened nor postponed. With the exception of a handful of states, euthanasia is not legal in this country.

Some people do not believe in euthanasia for their pets, and these guidelines accept that the pet owner has the ethical and legal right to choose for or against this process. However, animal hospice does not accept the decision to allow a pet to die without euthanasia unless effective measures provided by a veterinarian are in place to alleviate discomfort and distress.

Hospice care pyramid

The end-of-life care guidelines feature a three-tiered “Animal Hospice Care Pyramid” that illustrates the many ways in which the hospice patient’s care is to be managed. The base of the pyramid addresses the components of maintaining the patient’s physical comfort, including:

  • Pain management
  • Management of symptoms
  • Hygiene
  • Nutrition
  • Mobility
  • Safety
  • Environmental needs

The middle tier addresses the animal’s social engagement with family members, both people and other pets in the household. The goals are to provide mental stimulation and avoid social isolation.

The very top of the pyramid addresses the emotional needs of the animal specifically at the end of his or her life. The objectives here are preservation of dignity (maintaining grooming, managing self-soiling with urine and feces), stress reduction, and, to the greatest degree possible, preserving the animal’s role in the household such as providing human companionship and barking at the UPS truck.

Client support

Found within these end-of-life care guidelines is a lengthy description of how hospice veterinarians can attend to the emotional needs of their clients. It is well recognized that most people begin the grieving process for their pets well before death occurs. It makes sense then that hospice care veterinarians must be prepared to provide emotional support at the time of their very first client interactions.

Other topics

The end-of-life care guidelines are rich with other important information including the specifics of the euthanasia process. Throughout, empathy is stressed. An example is, “Never rush the process- clients want, and and need your undivided attention and you have an obligation to give it to them.”

The guidelines also address compassion fatigue amongst veterinarians and their staff members. In depth suggestions for detecting this issue and providing emotional self-care are included within this document.

I encourage you to take a look at these end-of-life care guidelines. While no one wants to think about the loss of a beloved animal, reading this piece is ironically restorative in the sense that it’s filled to the brim with suggestions for creating a loving and gentle final passage.

Would you ever consider hospice care for your pet?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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 and Your Dog’s Best Health.   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 and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

How to Ensure You Are There Should Your Hospitalized Pet Pass Away

Photo Credit: Jennifer Lombardo

Wherever I’ve worked, with one exception, I’ve had the ability to ensure that my clients were allowed cage-side access pretty much 24/7 with their very sick pets (and I didn’t last very long at the job where this wasn’t an option). I wanted my clients there, particularly if I felt that these might be their beloved pets’ final days, hours, or minutes.

Despite my darned good intuition about the status of my patients, every once in awhile, one would pass away unexpectedly. I still hold grief about these animals, knowing they took their last breath in a strange place, surrounded by strangers. And, I held such sadness for their human companions. These folks were often plagued with guilt at having not been with their pets at the time of death. Having facilitated a pet loss support group for several years, I know that navigating through the grief process is often far more difficult for those who have lost their pets under such circumstances.

Jen, Louie, and Bruno

Jen is one of my regular readers. Her email provided me with the impetus to write about this topic:

Hi Dr. Kay,

 

I am not sure if you are able to help me or give me some guidance. I am not even sure if I am headed in the right direction with this but here it goes…

 

I had two English Bulldogs, Louie who lived to be 11 years old and Bruno who lived to 8 years old. They died this year 3 months apart.

Bruno was first.  He died of sepsis caused by prostatitis. Louie died 3 months later from cardiac arrest after having a seizure during treatment for ventricular tachycardia. I feel that both dogs were sick and, in the end, would have died, but what bothers me the most is how I was unable to stay with them at the time they needed me the most.

 

I left Bruno in a cell in the hospital alone overnight for 12 hours where he slowly died due to his sepsis (despite all they were doing for him) and I wasn’t allowed to stay with him and be there to comfort him and let him know that I didn’t just abandon him.

 

I was with Louie when he died, but the doctor who admitted him was more concerned with the fact that I told her I was not leaving my dog than discussing a code status and a plan with me. Louie was intubated and had CPR done on him and I did not want that. I was in the next room and she could have sent someone to get me and ask me what I wanted done. If she had established this right at the beginning he wouldn’t have had to go through that.

 

So I am writing to you because I don’t know how I can help these animals that cannot speak and make their needs known, to be able to have their owners present during their hospitalization. I don’t know where to start and I have no idea if you can help me. If not, I understand, but thank you for listening to my story.

 

Jen

Ensuring you are with your pet

Jen’s story is pretty darned haunting, and it begs the question, what can one do to make sure that her story won’t become yours? Here are some pointers to ensure that you will be with your hospitalized pet when he or she passes away:

  1. Choose your veterinary hospital wisely. For help with this I encourage you read the chapter called “Finding Dr. Wonderful and Your Mutt’s Mayo Clinic” in Speaking for Spot. If hospitalization for your pet is necessary, look for a facility that provides round-the-clock care with constant monitoring, generous visiting hours, and a hospital policy dictating that you are to be called, any time day or night, the moment your pet’s condition declines.
  1. Have a heart-to-heart talk with your veterinarian about the seriousness of your pet’s condition. Does she think that it’s likely your pet could pass away while in the hospital? If so, what is her best guess as to when this might occur?
  1. Let the hospital staff know that you absolutely want to be contacted any time day or night should your pet’s condition take a turn for the worse. Emphasize how important this is to you.
  1. Provide the contact number for the phone that you will keep by your side, the phone that will be set to the loudest ring tone under your pillow while you are sleeping.
  1. Visit with your pet as much as your schedule and the hospital policy allow.
  1. Have a frank discussion with the veterinary staff about whether or not you would want your pet resuscitated (brought back to life) should he suddenly stop breathing or his heart stop beating. Unless you authorize DNR status (do not resuscitate), the staff will feel obligated to try to bring your pet back to life.
  1. If there is nothing more that can be done to reverse your pet’s terminal disease, and the quality of life has become vastly diminished, it is likely time to consider either euthanasia or home hospice care. Either way, you will be able to ensure that you are with your pet during this very important time.

When your pets passed away, were you able to be there?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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 and Your Dog’s Best Health.   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 and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

Lymphoma’s Newest Enemy

Photo Credit: Flicker CC license, farm9, MieleFor the first time in a very long time, a new drug has been approved for dogs with lymphoma. The drug is called Tanovea-CA1 and it is produced by VetDC Inc., a startup company associated with Colorado State University. Earlier this month, Tanovea-CA1 received conditional approval from the Food and Drug Administration for treatment of dogs with lymphoma.

What is lymphoma?

Lymphoma is one of the most commonly diagnosed forms of cancer in dogs. Golden Retrievers are the unfortunate poster-puppies for this disease. Lymphoma arises from lymphocytes, normal white blood cells involved in the immune system. In dogs, lymphoma most commonly arises within the lymph nodes, spleen, and bone marrow, but because lymphocytes circulate virtually everywhere, it makes sense that lymphoma can grow anywhere within the body.

Lymphoma cells tend to be quite responsive to chemotherapy and radiation therapy, and it’s not unusual to achieve complete remission (no obvious trace of the cancer remaining) in response to treatment. What is very rare, however, is for lymphoma to be cured. Invariably, there is relapse of the cancer. While “rescue chemotherapy protocols” are often capable of zapping the cancer back into remission, over time those crafty lymphoma cells figure out how to develop significant drug resistance. With rare exception, lymphoma is a terminal disease.

Tanovea-CA1

The active ingredient in Tanovea-CA1 is rabacfosadine, first developed for use as a cancer-fighting drug in people. In dogs rabacfosadine has been documented to have anti-tumor activity in “naïve” lymphoma patients (those who have not yet been treated) as well as in those with a relapse of their cancer following treatment with other chemotherapy drugs. Tanovea-CA1 is an every-three-week treatment administered intravenously for up to five dosages. For now, Tanovea-CA1 has received “conditional” FDA approval, meaning it can be given to a dog for up to one year. The conditional approval may be extended with ongoing evidence of effectiveness.

How does Tanovea-CA1 compare?

The gold standard treatment for canine lymphoma utilizes a drug called doxorubicin that is often combined with three other drugs (cyclophosphamide, vincristine, and prednisone) in what is called a CHOP protocol.

In a study combining Tanovea and doxorubicin in 54 dogs with lymphoma, an 81% positive response rate was observed. This Tanovea/doxorubicin one-two punch was found to be generally safe and well tolerated.

The rate of response and duration of remission using the Tanovea/doxorubicin combination were both comparable to CHOP regimen results. Here’s the big difference. The CHOP protocol typically requires 12 to 16 treatment visits to complete. The Tanovea/doxorubicin treatment protocol was accomplished in only six visits. What a monumentally positive difference this would make, not only for the dogs, but for their human companions as well. I don’t yet know how pricing of the two protocols compares.

From my point of view, this is really great news on the canine lymphoma front. I’m on board with anything that makes effective treatment of this disease more efficient and less taxing for everyone involved.

Have you ever cared for or known a dog with lymphoma? If so, what was the breed?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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 and Your Dog’s Best Health.   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 and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

Prostate Gland Cancer in Dogs

Photo Credit: Shirley Zindler

I periodically force myself to write about one of a handful of diseases I truly despise, and canine prostate gland cancer definitely falls into this category. Why do I dislike this disease so much? There is no cure for it and, for as long as I’ve been alive, there remains no effective treatment that consistently keeps it at bay for a significant length of time while preserving quality of life.

The only good news about prostate gland cancer is that it is relatively rare, accounting for 0.67% of all reported malignancies in dogs. And, it is far less common than the other far more treatable forms of prostate gland disease such as bacterial prostatitis, cystic disease, and benign prostatic hyperplasia.

Behavior of prostate gland cancer

The most common form of cancer within the prostate arises from its glandular cells and is called adenocarcinoma. Transitional cell carcinomas are less common than adenocarcinomas. They arise from transitional cells that line the urinary tract.

Prostate gland cancer is a disease primarily of middle-aged and older, large breed dogs. It occurs most commonly in neutered male dogs. This is a bit counterintuitive and we used to believe just the opposite, so I will state this fact again. Prostate gland cancer is more likely to occur in dogs who have been neutered.

Invariably, prostate gland cancer is a very aggressive disease. Not only does it expand within the prostate gland, it readily spreads (metastasizes) to other sites in the body beginning with local lymph nodes and then moves on to the lungs, abdominal organs, and/or bones.

Symptoms

There are often no symptoms whatsoever until the prostate gland becomes significantly enlarged and/or painful. Common symptoms include:

Straining to urinate

Straining to have a bowel movement

Bowel movements that are “ribbony” or small in diameter

Hind end/back stiffness

Hind leg lameness

Blood in the urine

Abnormal discharge from the prepuce

If there is a secondary bacterial infection within the prostate gland, symptoms can include fever, lethargy, loss of appetite, and vomiting.

Diagnosis

The diagnosis may be suspected based on clinical signs and palpation of a large, irregularly shaped, prostate gland that may be painful for the dog. Urine and blood testing are routinely performed as part of the diagnostic workup. A definitive diagnosis relies on biopsy samples collected from the prostate gland. Biopsies are typically collected using ultrasound guidance.

Once the diagnosis of prostate gland cancer is confirmed, other tests are commonly performed to determine the extent of metastasis. This process is referred to as “cancer staging.” Such testing usually involves imaging studies such as ultrasound evaluation, radiographs, and CT (computed tomography) scanning.

Treatment and prognosis

Effective treatment options for dogs with prostate gland adenocarcinoma are pretty much nonexistent. Neither chemotherapy nor surgery provides significant benefit. Radiation therapy is of limited value. Chemotherapy can provide temporary relief of symptoms for some dogs with transitional cell carcinoma. For most dogs with prostate gland cancer, treatment is primarily palliative, aimed at reducing the discomfort associated with the disease and enhancing quality of life.

Ultimately, the cancer-related symptoms become life limiting. It is at this point that either euthanasia or intensive hospice care is indicated.

Have you ever had or known a dog with prostate gland cancer?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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 and Your Dog’s Best Health.   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 and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

Spay/Neuter Recommendations

Next month I’ll be speaking to veterinarians at the North American Veterinary Conference about, “Current Spay/Neuter Research: Tips for Counseling Your Clients.” I love this topic for a couple of reasons. Based on results of some relatively recent and compelling research, the veterinary profession must now question some of its long-held beliefs about neutering dogs. And, shaking up dogma within this profession is usually a really good thing.

Secondly, when it comes to neutering or any other medical or surgical issues, I’m a big believer in folks having the ability to act as informed medical advocates for their pets. Veterinarians play a super important role in facilitating this, and I am thrilled to have the opportunity to coach them on how to go about doing so.

Punching holes in neutering dogma

Here are a couple of examples of long-held beliefs related to neutering that my talk will call into question:

All dogs not being used for breeding should be neutered between four and six months of age.

By allowing dogs to reach sexual maturity before they are neutered (if indeed they are neutered at all), are there health benefits to be gained? Based on recent research data, this certainly appears to be the case for Golden Retrievers, Labradors, Rottweilers, Vizslas, and German Shepherds. Such breed-specific studies have documented that neutering before one year of age may increase the risk for development of behavioral problems, orthopedic diseases, urinary incontinence, and various types of cancers. Can and should this information be extrapolated to other dog breeds? We don’t know (yet).

Neutering prevents/eliminates aggression.

For decades, veterinarians in this country have been taught that neutering dogs prevents/eliminates aggressive behavior. While we know that castration definitely deters some undesirable male behaviors (urine marking, mounting, roaming), it does not pack nearly as mighty a punch when it comes to preventing or eliminating aggression, particularly that which is directed towards people. In other words, neutering is not the end-all, be-all for prevention or treatment of aggression.

What about female dogs? It’s been documented that aggression towards guardians can actually increase in dogs spayed before 12 months of age. And, in a study of Vizslas, the younger the age at the time of neutering the earlier the onset of aggression and other undesirable behaviors.

How veterinarians can counsel their clients

In my upcoming talk, my goal will be to provide veterinarians with tips on counseling their clients about if and when to neuter their dogs. (Unfortunately, I won’t have time to discuss the many options for “how” to neuter.). Here are the talking points I will recommend:

  1. What is the level of client responsibility? Will the dog be managed responsibly so as to prevent unintentional breeding? If not, neutering is a no-brainer. The pet overpopulation issue trumps all other considerations.
  1. What is the dog’s intended use? Will the dog’s occupation be breeding, showing, hunting, athletic competition, or simply couch surfing? If and when to neuter is, in part, determined by the dog’s intended purpose.
  1. An explanation of what we know and what we don’t know. I will provide the veterinarians in attendance with a current bibliography of spay/neuter research. This will hopefully enable them to talk to their clients about what we now know and don’t know with. Please contact me if you would like a copy of this bibliography.
  1. An explanation of the relationship between neutering and behavior. Before deciding when and whether or not to neuter, every client deserves an accurate understanding of the likely impacts of their decision on their dog’s behavior.
  1. Pick your poison! Be it pyometra, a torn cruciate ligament, hip dysplasia, behavioral issues, or cancer, we’ve all worked our way through significant medical and surgical issues with our beloved dogs. Such personal history definitely has a place in guiding decision-making about when, if, and how a personal pet should be neutered. See the example below.

A personal example

I will end my upcoming talk with a personal example involving Jacob, one of my children. When Jacob was in college, he fostered Tipper, a Hurricane Katrina rescue who was convalescing from heartworm disease. Tip was a gem, and the foster quickly turned into an adoption. This was Jake’s first dog independent of our family and, oh my, how he loved and cared for Tipper. He cared for Tipper through surgery and recovery for two torn cruciate ligaments. And, Jacob nursed his best buddy through his final months during which he finally succumbed to cancer.

Approximately six months after Tipper passed away, Jacob adopted an unneutered mixed breed puppy from a shelter in New Mexico. Fisher, as he came to be called, grew into an exuberant, loving, 65-pounder. Jake and I discussed when and if to neuter Fish. Based on his history with Tipper and recent research indicating that neutering before one year of age might predispose to cruciate ligament disease and/or cancer, Jacob opted to have Fisher neutered when he was approximately 18 months of age. Now, we will see what the future holds in store.

Food for thought

Are you aware that in some Scandinavian countries it is illegal to neuter dogs, and they have no animal shelters because there would be no animals to place there? I was shocked when I first learned of this, and it continues to blow my mind. This speaks volumes about the level of responsibility in caring for dogs there versus here in the United States.

More research about the impacts of neutering dogs is surely in the works, and I suspect that today’s neutering recommendations will be considered pure quackery a decade from now.

Clearly, there is no one-size-fits all in terms of if, when, and how dogs should be neutered. We must do away with the blanket recommendation that dogs be neutered between four and six months of age.

How do you weigh in on the topic of neutering dogs?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
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 and Your Dog’s Best Health.   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 and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

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journals.plos.org/plosone/article?id=10.1371/journal.pone.0102241