Guidelines for Managing Cancer in Dogs and Cats

Photo Credit: Flicker CC license, Jon_scally, Best budsGiven the ever-increasing incidence of cancer in our pets, it was a smart move for the American Animal Hospital Association (AAHA) to recruit a team of veterinary oncologists to draft the first ever “Oncology Guidelines for Dogs and Cats.” Written this year, the material covers multiple facets of small animal oncology (cancer diagnosis and treatment) and makes recommendations that are consistent with a high standard of care. And, people with pets have a right to know about this high standard of care. I’m a big believer in veterinarians presenting all options, regardless of cost.

I’ve previously referenced AAHA’s vaccination, anesthesia, and preventive care guidelines. Such guidelines are crafted by teams of veterinary experts and the AAHA topics range from “Judicious Therapeutic Use of Antimicrobials,” to “Diabetes Management.” As is true for all of the AAHA Guidelines, those pertaining to oncology do not represent rules that veterinarians must follow. Rather, they are suggested standards of care.

Now, being the savvy consumer of veterinary medicine that you are, I encourage you to take advantage of these published guidelines. They are yours for the taking, and will allow you to feel more confident that your pet’s medical care is in capable hands.

Oncology Guidelines

As I read through these guidelines I was delighted to see that a great deal of emphasis was placed on client communication and support. Cancer most commonly affects older pets, and those many years have allowed time for a particularly strong human-animal connection to mature and develop. Introduction of the “C” word into this relationship can generate some emotional havoc that benefits from truly exceptional client support. The new oncology guidelines emphasize the need for excellent listening skills, empathy, asking of open-ended questions, and offering options. This is fabulous, and I am proud that my beloved profession is making such forward progress on the client communication front.

In addition to client support, the oncology guidelines address the following components of cancer management:

  1. Diagnosis of the cancer
  2. Staging of the cancer: determination of the extent of the local disease and the presence or absence of spread (metastasis)
  3. Cancer treatment
  4. Safety of the personnel handling chemotherapy drugs
  5. Referral to a specialist in oncology when appropriate
  6. Patient support

The guidelines include specific recommendations in a table format pertaining to the most commonly diagnosed forms of cancer in small animals including: mammary (breast) cancer, lymphoma, hemangiosarcoma, osteosarcoma, anal sac carcinoma, mast cell tumor, oral melanoma, soft tissue sarcoma, and squamous cell carcinoma.

Dr. John Berg, chair of the AAHA oncology guidelines task force, stated,

The guidelines are not meant to be an oncology textbook but are more like a snapshot of what is currently being done by specialists for animals with cancer. There is a constant flow of new clinical research coming out in veterinary oncology. It can be difficult for busy practitioners to keep up with all the information coming out in all fields, not just oncology, and the guidelines are intended to give practitioners a broad overview of how oncology specialists- medical oncologists, radiation oncologists, and surgeons– currently approach cancer diagnosis and treatment.

If your dog or cat has recently been diagnosed with a cancerous condition, or this disease is suspected, I strongly encourage you to take a look at these oncology guidelines. Guaranteed you will become a better medical advocate for your pet.

Has one or more of your pets experienced cancer? If so, what type of cancer and what was the outcome?

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.

Tracheal Collapse: A Common Cause of Canine Coughing

Photo Credit: ChristianPerezPhoto, Flicker CC License, Igor“My dog can’t stop coughing, and I’m not getting any sleep!” What veterinarian hasn’t heard this complaint? Many different disorders cause coughing in dogs. One at the top of the list, particularly in smaller breeds, is a disease called tracheal collapse (aka, collapsing trachea).

Normal tracheal anatomy and function

The trachea is part of the upper respiratory system. Also known as the windpipe, it transports air from the nose and mouth down into the lungs, and then back again. The trachea is made up of rings of cartilage that are aligned side by side to maintain a smooth cylindrical shape that creates minimal resistance to airflow. (Visually speaking, the trachea looks like a tiny corrugated culvert pipe that you would find at a building supply store.) The entrance to the trachea is the larynx, a structure also comprised of cartilage, which opens during breathing and closes during swallowing. This clever design prevents inhalation of food material.

The inside lining of the trachea contains millions of fine cilia. These microscopic hairs trap any foreign material particles that are inhaled. Using a coordinated sweeping action, the cilia then transport these particles, often embedded in mucous, up to the throat where they can be disposed of via coughing or swallowing.

Tracheal collapse

An inherited defect in the tracheal cartilage is thought to be the major player in the development of tracheal collapse. Imagine the normal “O” shaped tracheal cylinder collapsing in on itself, resulting in a “C” shaped internal lumen. This is problematic, not only in terms of airflow in and out of the lungs, but also in terms of removal of inhaled debris. Best-case scenario, the collapse causes some airway resistance-induced coughing. Worst-case scenario, it results in obstruction of airflow.

The collapse can occur throughout much of the trachea or only in a small section. The collapse tends to be a dynamic process- it is more pronounced during inhalation or exhalation, depending on which portion of the trachea is affected.

Any time the body’s normal anatomy is disrupted, the stage is set for secondary issues to arise. Not surprisingly, many dogs with tracheal collapse have concurrent respiratory tract infections.

Dogs at risk

Small breed dogs are the “poster children” for this disease, particularly Yorkshire Terriers, Pugs, Pomeranians, Poodles, and Chihuahuas. Middle aged and older dogs are most commonly affected. Overweight dogs and those who live in households with smokers may be at greater risk.

Symptoms

Tracheal collapse invariably causes coughing, and it is classically described as sounding like a “goose honk.” While I’ve heard some coughing dogs sound like geese, it’s important to emphasize that the cause of a cough cannot be diagnosed based on the sound of the cough, and tracheal collapse is no exception. There’s plenty of overlap between the sounds and causes of canine coughing.

Tracheal collapse coughing tends to worsen in response to excitement, activity or exercise (when air is moving more vigorously through the trachea). The cough may be persistent, even to the point of occurring round-the-clock. Sometimes, there is audible wheezing, particularly during inspiration. Other symptoms associated with tracheal collapse can include lethargy, reduction in appetite, and decreased stamina.

At its worst, tracheal collapse causes labored breathing, purplish or bluish colored tongue and gums thanks to oxygen deprivation, and syncopal (fainting) or collapsing episodes. Tracheal collapse symptoms are easily exacerbated by exposure to smog, smoke, or increased temperature, humidity, or pollen.

Making the diagnosis

Beyond a thorough physical examination and basic blood work, shooting x-rays of the chest and neck to evaluate the full length of the trachea is the usual starting point in the diagnostic workup. Given that tracheal collapse is often associated with only inhalation or exhalation (not both), x-rays can miss the diagnosis. For this reason, fluoroscopy (like an x-ray but shot in movie mode) is the ideal diagnostic tool. Not only does fluoroscopy confirm the diagnosis, it demonstrates how much of the length of the trachea is involved. This is important when considering treatment options. Tracheoscopy (viewing the inside of the trachea with an endoscope) is sometimes recommended to confirm the diagnosis and gather samples to rule out an underlying respiratory tract infection.

Management tools

While there is no cure for tracheal collapse, there are multiple management strategies. The goals of treatment are twofold: minimizing coughing and maintaining a good quality of life. Realistically, it is often difficult to eradicate the coughing altogether.

Weight loss can make a positive difference for obese dogs with tracheal collapse. Because this takes time, it is important to implement other strategies concurrently. It’s a no brainer that dogs with tracheal collapse and cigarette smoke exposure have a lot to gain by lifestyle changes made by their beloved humans.

Avoidance of known environmental factors that precipitate coughing (heat, humidity, smog, etc.) can make a big difference. Replacing the neck collar with a chest harness eliminates external pressure on the trachea.

Medications

It’s almost always necessary to rely on medications when managing dogs with significant tracheal collapse symptoms. For some dogs, only short term or intermittent use is needed. Other dogs thrive only when medications are given long-term if not lifelong.

Medications are used for the following purposes:

Antitussive therapy (cough suppression): For dogs with collapsing trachea, coughing begets more and more coughing. (Think about the coughing you do after inhaling a small food particle into your windpipe!) And, once a vicious coughing cycle begins, it can be huge challenge to interrupt. Often, more than one antitussive medication must be tried to find just the right just the right recipe to quiet the cough.

Control of secondary inflammation: Anti-inflammatory medications are sometimes needed to control the inflammation associated with the tracheal collapse. Until the inflammation settles down, it can be difficult to control the coughing.

Treatment of secondary infection: Antibiotics are often indicated as tracheal collapse sets the stage for secondary bacterial infections within the respiratory tract.

Sedation and/or reduction of anxiety: Severely affected dogs may suffer from chronically interrupted sleep and/or anxiety induced by constant coughing and labored breathing.

Oxygen therapy

In severe cases of tracheal collapse, a day or two spent within an oxygen cage may help turn a corner. Such oxygen therapy requires access to a 24-hour hospital and round-the-clock supervision.

Tracheal stents

When medical treatment fails to restore a good quality of life, placement of a tracheal stent is a reasonable consideration for some dogs. The stent is made of a metallic alloy. Using fluoroscopy (see above) the collapsed stent is placed within the area of tracheal collapse. Once deployed, the stent expands to support the tracheal walls. While this procedure can make a hugely positive difference in severe cases of tracheal collapse, not every dog is an ideal candidate. There can be problems associated with anesthesia as well as complications caused by the stent.

Surgery

There are surgical techniques that involve placement of support rings around the outside trachea. The goal is to provide structural support. This is an aggressive procedure that can be fraught with complications. With the increasing popularity of tracheal stents, this type of surgery has, for the most part, fallen by the wayside.

Prognosis

The prognosis for dogs with tracheal collapse varies from excellent to awful. The outcome depends on the degree of collapse, which portion(s) of the trachea is involved, and the dog’s individual response to medication.

Veterinary specialists

If your dog develops tracheal collapse, a veterinary specialist might just become your dog’s new best friend. The best way to diagnose tracheal collapse is via fluoroscopy (see above), a piece of equipment used almost exclusively by veterinary specialists.

The more finesse and experience a veterinarian has using medications to treat tracheal collapse, the greater the likelihood of a positive outcome, particularly in severely affected dogs. A veterinarian who specializes in internal medicine will have lots of experience treating this disease. Lastly, a highly specialized skill set is necessary for success with placement of stents, in terms of patient selection, stent selection, and accurate deployment of the stent. I strongly encourage seeking help from an internist if a really good response to initial treatment for tracheal collapse isn’t observed. Ask your family veterinarian for referral.

Do you have a dog with tracheal collapse? If so, what kind of dog do you have and what has been the response to treatment?

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.

Audible Versus Edible: Which Type of Reward Does Your Dog Prefer?

sfsblog_audible_edibleWhich does your dog prefer, a yummy treat or verbal praise from you? Does your answer differ between the dogs in your household?

A team of researchers took it upon themselves to answer this basic question- do dogs prefer food or praise? Their results, published in Social Cognitive And Affective Neuroscience, evaluated 15 dogs of various breeds. Prior to the study, the dogs were trained to lie very still within an operating MRI machine while having their brains imaged (no easy feat!) in order to avoid any effects of sedation or anesthesia.

Part one of the study

MRI scans of the dogs’ brains were performed while they were exposed to various stimuli. The researchers paid special attention to the ventral caudate portion of the brain, the area most active in response to rewards.

The dogs were presented with three different objects: a toy car (associated with verbal praise), a toy horse (associated with a food reward), and a hairbrush (associated with nothing). Compared to the control group (the dogs presented with the hairbrush), the dogs presented with the toy car or toy horse demonstrated significantly more activation within the caudate portions of their brains. Roughly equal or greater brain activation to the car (praise) versus the horse (food) was observed in 13 of the 15 dogs.

Part two of the study

This phase mimicked part one, except that the expected praise accompanying presentation of the toy car was withheld during some of the trials. Dogs who valued the social reward more than a food treat during part one of this study showed the greatest difference in brain activation between receipt of versus withholding of the expected praise.

Part three of the study

This phase took place outside of the MRI scanner. The researchers challenged the dogs with a simple Y-shaped maze. Released at the “bottom” of the Y, the dogs had the choice of traveling to either a bowl of treats or their owners where praise was doled out. Most of the dogs chose their owners. The degree of brain activation previously demonstrated in response to the stimuli turned out to be an accurate predictor of which way the dogs would travel in the Y maze.

Conclusions

We all know that dogs are super-social creatures. We also know that some are profoundly food oriented. Interestingly, 13 of the 15 dogs in this study demonstrated roughly equal or greater brain activation to the expectation of praise than they did with expectation of a food reward.

While this is interesting stuff to think about with our own dogs, the more practical application may be with working dogs. Those who place higher value on praise may be better suited for therapy/assistance dog/service dog roles. By contrast, a food-motivated dog might be a great choice for a search and rescue role.

Given the preponderance of obesity in our canine pet population, I love that this study emphasizes the point that many (if not most) of our dogs can thrive on receiving praise and social interaction for good behavior or a job well done. Food treats are not the best or only reward option, either in terms of our dogs’ brains or their waistlines!

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.

 

Financial Assistance for Veterinary Care

SFSBlog_financialassistance_Tripp_NK

Photo Credit: © Nancy Kay

Of the many pages on my website, the one that consistently receives the most hits contains a list of organizations that provide financial assistance for veterinary care. Without any intention on my part, this particular page has risen to the top in the ranks of SEO (search engine optimization). Not only are folks who need help somehow directed to my website (I’ve no clue how SEO really works), many take the time to write to me personally with hopes of receiving funds to care for their beloved pets.

The emails are pretty darned heart wrenching, particularly the ones I receive from senior citizens on a fixed income with a dog or cat whose health has taken a turn for the worse. I hear about cancer, organ failure, and broken body parts. And, with each and every correspondence, I get a hit of an immensely strong human-animal connection. Yes, the family budget is excruciatingly limited, but the love these folks seem to feel for their pets is limitless.

I’m in the process of reviewing this list of organizations that provide financial assistance and am shocked by what I’m finding. A good number of these mostly nonprofit organizations have dropped out of cyberspace. Perhaps the people behind the scenes ran out of time or money or energy.

Here’s where I’m hoping that you can help me out. Might you know of any organizations that provide financial assistance for veterinary care? I would love to hear about them even if they are region, disease, or circumstance-specific. Please send their website addresses to me (double check first to make sure they are not already on the list). Your efforts will be rewarded with an opportunity to win a copy of Speaking for Spot or Your Dog’s Best Health. The choice will be yours if your name is pulled from the hat.

Please forward your leads to me at dr.kay@speakingforspot.com.  Thanks in advance for your help.

Have you ever needed financial assistance to pay for your pet’s health care?

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.

 

A Smart Phone Device Records Canine and Feline ECG’s (Electrocardiographs)

ECGECGA decade or so ago, I never would have dreamed of running an ECG (electrocardiograph) on a dog or cat using my smartphone. When I learned this new technology exists, my response was “ Wow! Really?” A company called AliveCor has produced just such a product.

Word on the street is that increasing numbers of veterinarians and their clients are using this smartphone-device even though this new technology has not been thoroughly “vetted”. Now, along comes a study that does exactly that. Researchers at the Cornell College of Veterinary Medicine (hurray for my alma mater) have evaluated the accuracy of the smartphone-based ECG device for use in dogs and cats, and the results are very encouraging.

What exactly is an ECG?

Before describing the study, bear with me while I run through a simple explanation of an ECG. An electrocardiograph tracks electrical conduction within the heart via electrodes (electrical conductors) that are attached to the animal (including Homo sapiens). This electrical activity is what keeps our hearts beating and dictates the rhythm of the beats. Disturbances of the normal electrical conduction pattern can result in an abnormal rhythm (aka, arrhythmia). You may have heard of atrial fibrillation as there are plenty of magazine ads and television commercials advertising medications to treat this disorder. Atrial fibrillation is an example of a cardiac arrhythmia.

While an ECG can be used to measure heart rate, its primary purpose is evaluation of the heart rhythm. An ECG is a staple test when evaluating dogs and cats with heart disease. An ECG is also commonly run with any number of maladies (infection, trauma, heatstroke, toxicity, cancer, etc.) that can secondarily disrupt the normal heart rhythm.

The smartphone device

The smartphone device ECG technology utilizes electrodes that are attached to a handheld case in which the smartphone is inserted. The device can also be connected via Bluetooth- this allows the ECG to be recorded. This technology was approved by the FDA for use in people in 2012, and has been found to allow rapid and easy generation of ECG tracings that can readily be stored, printed, and electronically shared.

Study design

A total of 78 animals were included in the study– 51 dogs and 27 cats. ECG’s were recorded simultaneously using the smartphone-based device and a standard ECG machine. Three board certified cardiologists compared the 30-second ECG recordings from both devices.

Study results

Heart rate values (the number of beats per minute) of the two methodologies were within one beat of each other. Heart rhythm assessments were comparable (agreement amongst the cardiologists) with the exception of 2 of the 51 dogs and 4 of the 27 cats. This comparable to the “normal” rate of disagreement between cardiologists comparing ECG’s generated via standard machinery.

Conclusions

My impression is that this smartphone device is super practical and efficient. I must qualify this by saying that I’ve not used the device myself. Does this mean that veterinarians should run out and list our fancier, more expensive ECG machines on eBay? No, not at all. The standard ECG machine provides far more information, beyond simply heart rate and rhythm, which is particularly important when assessing dogs and cats with primary heart disease.

My sense is that the smartphone device will be most useful as:

  • a rapid screening device for cardiac arrhythmias (rhythm disturbances), particularly in emergency hospitals where it’s important to collect this information as quickly and easily as possible.
  • a screening tool for house call veterinarians. The smartphone device is clearly more portable than standard ECG machines.
  • a way for veterinarians to monitor patients with known arrhythmias in the hospital.
  • a way for people to monitor their own pet’s cardiac arrhythmia in the home setting; the ECG can be electronically transmitted to the veterinarian
  • a diagnostic tool when a standard ECG machine is not affordable or available. The cost for the smartphone device is approximately $300. Standard ECG machines cost thousands.

Did I mention that this device also works on horses? Care to know more about this smartphone device? Check out the AliveCor Veterinary Heart Monitor user manual and watch this YouTube video.

Has an ECG ever been run on one of your pets? If so, what was the reason?

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.

 

Followup: Canine Cruciate Ligament Disease

Photo Credit: OrthoPets

Photo Credit: OrthoPets

In response to my recent blog post comparing surgery of canine cruciate ligament disease to treatment with a brace (orthosis), I received several excellent comments, one of which I want to be sure you have the opportunity to read.

The comment contains detailed information about orthoses (knee braces), how they work, how they are fitted, and when they should be considered. The comment was submitted by Dr. Ilana Strubel, a veterinarian who is certified in the fields of integrative veterinary physical rehabilitation, veterinary orthotics and prosthetics consultations, chiropractic, acupressure, nutrition, and animal behavior.

Not only did Dr. Strubel’s comment provide insights from her own experience, she also included material written by the folks at OrthoPets whose vision is, “to improve our patient’s quality of life through innovative prosthetic and orthotic solutions.” Before writing this, I spent some time on this company’s Facebook page. I invite you to scroll through their many photos and videos. I think you will say, “Wow!!” just like I did.

Here is what Dr. Strubel had to say:

Thanks for posting this well written piece featuring the first real published information about the use of stifle orthosis (knee brace) for conservative treatment of the ruptured cranial cruciate ligament in dogs. I am a veterinarian certified in canine rehabilitation, and I work very closely with OrthoPets. Together, as a team, we select who would be a good candidate for a stifle orthosis, and make very careful measurements to design custom stifle orthotics (as well as many other types of veterinary orthotic and prosthetics).

 

If the orthotic measurements and fittings are done by a more experienced and trained rehabilitation professional, the outcome is usually better. Also, in my experience, the level of skill and knowledge of orthotics manufacturers vary widely. This too will greatly affect the outcome for both fit and function.

A custom medical device usually does require acclimation and adjustment for both the dog and the caregiver who must learn to don the device correctly. But once the fit and function is good, the patients do really well!

 

Here are some more considerations written by OrthoPets for individuals thinking about a stifle orthotic solution as an alternative to surgery for the dog.

Is a stifle orthosis the right solution for you and your dog?

Injury to the cranial cruciate ligament (CCL, also called the ACL) is the most common orthopedic injury in the dog. This injury is due to a partial or complete tear of a ligament inside the stifle (knee). The resulting instability leads to pain and arthritis.

Stabilization is recommended for best short and long-term function, quality of life, and comfort. Stabilization is traditionally done surgically, either with a joint realignment surgery (TPLO or TTA) or with a pseudo-ligament surgically placed outside the joint (tight rope or lateral suture). These procedures are considered the standard of care, in general. In the past 10 years, the use of custom orthosis (brace) has become available as an alternative to surgery when surgery is not appropriate for any reason. These reasons may include other health issues, unacceptable surgical or anesthesia risk, advanced age, and financial constraints, among others.

Because an orthosis is not the correct therapy for all patients, before choosing an orthosis the following points are important to keep in mind:

  1. The device MUST be put on every morning and removed every night. The device is to be used all day everyday, but must be removed at night. It is NOT like a human knee brace, worn only for sport. The orthosis stabilizes the stifle from the outside only when ON, while surgery does so from the inside permanently. Because of this, it must be used whenever your dog will be standing and/or moving about. The device is not used at night and your dog must not be allowed to move about at night (jump on or off bed, wander the house, go outside through a dog door, etc.).
  1. Adjustments are expected and are a normal part of the custom orthosis process. The device is custom-made for your dog. Every effort is made to accurately fit the device and 2 complimentary adjustments are included in order to meet the requirements for an appropriate fit. Your veterinarian will coordinate these adjustments. Importantly, your dog is much more active at home than at the veterinary clinic. Increased activity and activity intensity can expose fit issues requiring further adjustment. Additional adjustments, if needed, are most commonly required in the first few months and as time goes on (see importance of follow-up #4). Please follow all instructions with regard to monitoring the leg and contact your rehabilitation veterinarian promptly if you have concerns.
  1. Follow-up is critical to success. An orthosis is considered a “durable medical device.” This means that proper use is necessary to meet therapeutic goals and to ensure its safe application over the lifetime of your dog. During the first few months of fitting, your rehabilitation veterinary team with the help of your OrthoPets-trained veterinary case manager will work with you, coaching with regard to device use and rehabilitation. Annual to twice annual appointments are advised depending on age and activity of your dog. At these appointments your doctor will thoroughly assess your dog’s orthopedic condition and evaluate the condition and fit of the device. Recommendations will be made for continued success in the device. If adjustments are required, it will be necessary to ship the device to OrthoPets with a turnaround time of 1-3 business days excluding shipping time.
  1. Even with an orthosis, surgery may be required. When the cranial cruciate ligament is torn sometimes the meniscus is also torn. The meniscus is a comma shaped cushion on the inside of the stifle. There are two, one on the middle and one on the outer side of the stifle. The middle or medial meniscus is most commonly injured, and this may occur at the time of the initial cranial cruciate injury or any time later due to too much activity on an unstable joint. A torn meniscus is very painful and if not treated it will cause continued lameness despite stabilizing the joint with surgery or an orthosis. If this occurs, a surgical procedure called a partial medial meniscectomy is required.  It can be done by itself or with a surgical stabilization (see first paragraph). A torn medial meniscus is diagnosed either at surgery, by MRI (rarely), ultrasound where available, or based on clinical judgment with or without use of an orthosis. If your veterinarian suspects a meniscus tear please see our handout on options available for your dog.
  1. The Role of Rehabilitation: Whether your dog undergoes surgical or orthosis stabilization for a torn cranial cruciate ligament, and whether or not surgery is required for a torn medial meniscus, it will take time to recover to full, comfortable function. If an orthosis is part of therapy most dogs adapt quickly to wearing an orthosis. Behavioral techniques can facilitate this. Also, your dog will need to learn basic skills while wearing the device. These include: transitions (sitting, lying down, and getting up), stairs, getting into vehicles safely, and managing on different types of surfaces (ground, carpet, hardwood floor, etc.). Finally, orthopedic injury leads to compensatory abnormal movement and associated muscle strain and weakness. The best way to ensure the highest level of success is to follow recommended rehabilitation schedule and techniques. Each patient’s condition and abilities are unique and, as such, an individualized rehabilitation program is needed. It is important to work with a certified canine rehabilitation therapist (CCRT) who will custom design your dog’s physical therapy program.

Orthotics (braces) for dogs is a new solution to an old problem. Modern medicine moves forward at a rapid pace. It takes a lot of time and many tens of thousands of dollars to perform a controlled clinical trial to compare a new therapy to the standard therapies in common use. As such, there is limited published data directly comparing use of a stifle orthosis to surgical stabilization for CCL injury in the dog. As the industry leader using our unique, anatomically aligned, and mechanically sound custom design, OrthoPets provides stifle orthoses for nearly 1,000 dogs per year. This level of experience allows us to carefully select the patients best suited for a stifle orthosis, design appropriate rehabilitation protocols for best success, and troubleshoot interesting individual patient challenges. This is not a substitute for clinical data, but is referred to as empirical (or experiential) data. This is the current state of orthotics for animals. OrthoPets continues to work closely with university professionals at Colorado State University College of Veterinary Medicine to develop studies to prove and improve the use of orthotic devices in animals.

If your dog tears a cruciate ligament, will you consider a brace rather than surgery as a first treatment?

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.

Cruciate Ligament Disease: A Comparison of Surgical and Nonsurgical Treatment Outcomes

SFSBlog_cruciateligamentI was intrigued by the results of a recently published study in which the researchers focused on cranial cruciate ligament disease (CCLD) in dogs. Specifically, they evaluated owner satisfaction with outcomes of two very different treatment options, one involving surgery and the other using a custom fitted brace (orthosis).

An all too common injury

The cranial cruciate ligament is vital for maintaining stability within the knee joint (stifle). Tearing of this ligament is ridiculously common, particularly in medium and large sized dogs.

In most cases, the tear occurs abruptly, often in association with exercise or activity. It results in a sudden onset of lameness with the dog often unwilling to bear any weight on the affected leg. More and more, we are learning that neutering before one year of age predisposes to cruciate ligament disease, at least in some breeds. This association has been clearly documented in Labradors, Golden Retrievers, Vizslas, and German Shepherds.

Traditional treatment recommendations

As far back as I can remember, surgical repair has been the primary recommendation veterinarians make for treatment of CCLD in medium and large sized dogs.

The recommendation for nonsurgical management (restricted activity, a knee brace, anti-inflammatory drugs, pain medications, the tincture of time) is usually reserved for smaller dogs with the thinking that, the lighter the load carried by the knee, the less there is a need to restore “perfect” function. For medium and larger sized dogs nonsurgical management is typically the “go to” when there are extenuating circumstances such as financial constraints, anesthesia risks, advanced age, concurrent diseases, opposition to surgery, or an inability to successfully manage post-operative care. And, these extenuating circumstances commonly arise.

Study design

The researchers distributed online surveys to people whose dogs were treated for CCLD. The questions were developed to evaluate their overall satisfaction with treatment outcomes. All the dogs were medium to large sized dogs and all were treated via one of the following two methods:

  1. Surgical treatment with tibial plateau leveling osteotomy (TPLO) procedure

Of the many types of surgeries used to repair torn cruciate ligaments, the TPLO has long been regarded as a gold standard. This surgery has an excellent track record for restoring normal function and minimizing development of arthritic changes within the knee.

TPLO surgery is performed almost exclusively by veterinarians who specialize in surgery. The operation is quite pricey, particularly for dogs who end up tearing ligaments in both knees (happens approximately 50% of the time). TPLO post-operative care is laborious involving a lengthy period of confinement and controlled activity for the dog. (I know this to be true from much personal experience!) The TPLO complication rate is reported to be less than 7%, and most of the complications resolve with appropriate treatment.

  1. Nonsurgical treatment with a custom made knee joint orthosis (brace)

With the recent rise in access to canine rehabilitation therapy (the equivalent of physical therapy in the world of human medicine), the use of custom fit orthoses (braces) to treat dogs with CCLD has grown in popularity.

Study results

Of the 1,022 surveys distributed, 309 were completed- 203 from the orthosis group and 76 from the TPLO group. There were no significant differences between body weight, size, and age of dogs between the two groups.

Factors influencing treatment decisions

The factors that most influenced the decision to treat with an orthosis rather than surgery were cost, convenience, and personal preference. Amongst the TPLO respondents, veterinarian recommendation was stated to be the most influential factor.

Treatment outcomes

The proportion of respondents who reported that their dog’s treatment outcome was excellent, very good, or good was higher (98%) within the TPLO group compared to the orthosis group (86%). The percentage of respondents who reported that their dogs had either mild or no lameness following treatment was also higher in the TPLO group (98%) than in the orthosis group (88%).

Complications

Forty-six percent of respondents in the orthosis group reported that medical attention was required for skin problems caused by the brace. The need for multiple orthosis adjustments was commonly reported. By comparison, only 4% of respondents from the TPLO group reported complications requiring medical attention.

Customer satisfaction

Overall satisfaction ratings were pretty much identical with 85-90% of respondents from both groups reporting that, given the chance, they would choose the same treatment again.

Conclusions

Plenty of prior studies have evaluated CCLD surgical outcomes. This study is one of the first providing well-researched data pertaining to a nonsurgical treatment option.

The results are thought provoking for me on a few different levels:

  • I was surprised that, despite the fact that reports of a normal gait (no lameness) and ratings of outcomes were significantly lower in the orthosis treated group, these respondents reported a high level of satisfaction and willingness to make the same choice all over again.
  • I was surprised that, in spite of the very high complication rate associated with orthosis treatment (46%), respondents reported a high level of satisfaction with this treatment plan and a willingness to make the same choice again.
  • Prior to reading this study, I would have assumed that nonsurgical treatment for CCLD would have resulted in lower customer satisfaction. I would have been wrong. My notion is that the high level of satisfaction within the orthosis group was related to good communication between veterinarians and clients about realistic expectations.

So, how is all of this information relevant to dog lovers and the veterinarians who advise them? It makes a strong case for veterinarians spending time in the exam room discussing all CCLD treatment options with their clients rather than focusing solely on surgery.

Despite the sentiment that surgery is the best treatment choice for CCLD, in many cases, this option simply isn’t feasible. Kudos to the researchers involved in this study for choosing to evaluate a nonsurgical alternative.

Has your dog ever torn a cruciate ligament? If so, what did you opt to do and what was the outcome?

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.

 

Causes and Treatment of Canine Liver Disease

SFSBlog_liverdisease2I’ve got nothing but love and respect for the liver. This amazing, multitasking organ performs a vast array of functions essential for survival. Background information about these functions along with the symptoms and diagnostic testing associated with liver disease, are all found in the first portion of this article. Below is the rest of the story.

Causes of liver disease

More than two hands are needed to count the number of diseases that can affect the canine liver. Listed below are those that are most commonly diagnosed. As you read through them, it will help you to know that:

Hepa or hepato = liver

pathy = disease of

itis = inflammation (keep in mind that things other than infection can cause inflammation)

cholangio = bile vessel (vessels within the liver that are responsible for transporting bile to the gall bladder)

Liver shunt (portosystemic shunt)

As mentioned in the first portion of this article, blood from the abdominal organs flows into the liver via the portal vein before returning to the heart. Shunting is the term used when blood bypasses the liver and flows directly to the heart by way of other blood vessels (shunts). This is problematic for a few different reasons. None of the important products manufactured within the liver (protein, blood clotting factors, glucose, cholesterol, etc.) can be distributed into the bloodstream for transport throughout the body. Secondly, there isn’t an opportunity for substances such as vitamins and minerals to be delivered to the liver for storage. Lastly, the liver doesn’t have access to “detoxing” the blood. Substances normally removed by the liver accumulate in the bloodstream and cause the neurological symptoms commonly associated with liver shunts.

Most liver shunts arise during fetal development and are congenital abnormalities (birth defects). Such shunts most commonly occur in small breeds. Maltese, Schnauzers, Shih Tzus, Dachshunds, Poodles, and Yorkshire Terriers are at the top of the list in terms of frequency.

Shunts can also develop in response to liver disease severe enough to markedly increase pressure within the portal vein. Surgery is the treatment of choice for dogs with single congenital shunts, and is often curative. For dogs with multiple and more complex shunts, medical therapy is the treatment of choice and often provides significant benefit in the short term.

Toxic hepatopathy

Given that the liver is the garbage disposal of the body, it’s no wonder that it’s often the first organ to take a hit when a dog eats or is exposed to something toxic. The classic example is the toxicity caused by ingestion of poisonous mushrooms, an all too common cause of life-ending liver failure. Many toxins affecting the liver are medically treatable and transient. If the damage isn’t devastating, the liver can repair and regenerate remarkably well.

Chronic active hepatitis

This is a frustrating disease in that the actual underlying cause is poorly understood. A liver biopsy reveals chronic smoldering inflammation without an identifiable infectious agent. Left unchecked, this inflammation can result in scar tissue (cirrhosis) within the liver. Treatment is aimed at reducing inflammation and protecting the health of the hepatocytes (liver cells).

Infectious Hepatitis

Bacterial infection is the most common cause of infectious hepatitis. Infections can arise from gut bacteria (remember, all blood coming from the intestines passes through the liver before returning to the heart) or from a systemic bacterial infection such as leptospirosis. Adenovirus is a viral cause of infectious hepatitis, but is rarely diagnosed because protection against this disease is included in distemper/parvovirus vaccinations. Infectious hepatitis is treated with antibiotics and supportive care such as intravenous fluids and medications to support the health of liver cells.

Cholangiohepatitis

This refers to inflammation within the liver as well as the biliary vessels that transport bile to the gall bladder. Cholangiohepatitis is usually a result of a bacterial infection, and the treatment consists of antibiotics, medications to hasten bile flow and supportive care.

Copper storage disease

Copper metabolism abnormalities result in excess accumulation of copper within the liver cells. Not only does this disrupt normal liver function, it can incite chronic inflammation that may ultimately result in liver failure. Copper storage disease has been identified as an inherited abnormality in Bedlington Terriers, Labrador Retrievers, Doberman Pinschers, Skye Terriers, and West Highland White Terriers. Treatment of this disease utilizes anti-inflammatory medications and chelation therapy. Chelation is the process by which copper is made more soluble in water. This enhances its elimination from the body via the kidneys.

Vacuolar hepatopathy

This refers to the accumulation of globules (vacuoles) of water or fat within the liver cells. It is a default response of the liver to any sort of stress. In some cases, the cause of this hepatopathy cannot be identified. Vacuolar hepatopathy is a typical response to excess cortisone in the body, either by way of Cushing’s Disease or treatment with cortisone-containing medications. The treatment of choice is removal of the underlying cause.

Liver cancer

Several types of cancerous growths originate within the liver, the most common of which include lymphoma, hemangiosarcoma, mast cell cancer, histiocytic sarcoma, and adenocarcinoma. The liver can also develop metastases caused by spread of the cancer from another site in the body. Treatment varies depending on the type of cancer diagnosed.

Drug-associated hepatopathy

A number of different medications can cause liver cell changes. The classic example is the vacuolar hepathopathy caused by cortisone (see above), whether given orally, via injection, or even topically (applied to the eyes, ears, or skin). In most cases, a drug-induced hepatopathy is reversible when the causative drug is discontinued. In addition to cortisone products such as prednisone or dexamethasone, medications that can induce liver disease include:

  • Phenobarbital (antiseizure medication)
  • Anti- fungal medications
  • Some nonsteroidal anti-inflammatory medications
  • Acetaminophen (Tyelenol)
  • Diazepam (valium)
  • Lomustine (chemotherapy drug)

Cirrhosis:

This is a liver comprised of not much more than scar tissue. On ultrasound the liver looks like a small cluster of grapes rather than a normal sized, smooth surfaced organ. Cirrhosis is the end result of a chronic insult (inflammation, toxicity, infection) to the liver cells. These are the dogs who will be first in line if ever canine liver transplants become available.

Treatment of liver disease

Treatment plans for dogs with liver disease vary a great deal depending upon the type and severity of the disease diagnosed. Whenever possible, a liver biopsy should be collected in order to provide a clear-cut diagnosis. If a liver biopsy isn’t feasible, empirical therapy (“best guess” treatment) is provided. In some cases hospitalization is recommended for dogs with liver disease. Other can be successfully managed on an outpatient basis.

Treatment of liver disease often requires a good deal of finesse. For this reason, it is wise to consider enlisting help from a specialist in internal medicine (or surgeon if shunt surgery is required). Don’t hesitate to ask your family veterinarian for a referral.

Depending on the nature and severity of the disease process, recommended therapy for canine liver disease might include:

  • Intravenous fluids or fluids administered under the skin to restore and maintain hydration, hasten delivery of medication, and promote elimination of toxins
  • Plasma transfusion: rich in protein and blood clotting factors
  • Antibiotics
  • Anti-inflammatory medications: cortisone most commonly used
  • Medications to reduce stomach acid production and promote appetite
  • Medications to reduce nausea
  • Diet change: type of diet recommended varies with disease diagnosis
  • Ursodiol (Actigall): a medication that promotes bile flow
  • Vitamin K: supports normal blood clotting
  • Vitamin E: antioxidant that may support liver health
  • Milk thistle (silymarin): an herbal supplement that supports and protects liver cells from damage
  • S-adenosylmethionine (SAMe): a compound that promotes liver cell health
  • Lactulose: binds and inactivates substances in the bloodstream that can cause neurological symptoms
  • Surgery to correct a liver shunt or remove a cancerous growth
  • Chemotherapy: treatment for some liver cancers

Prognosis

With so many different types of liver diseases in dogs, the prognosis truly runs the gamut. The prognosis for canine liver disease varies from good to poor, and is not always predictable. In fact, two dogs with the exact same disease and treatment can have completely different outcomes. Often, the best bet is to initiate therapy and see how the dog responds.

Questions for your veterinarian

  • Do we know with certainty that my dog has liver disease?
  • Do we have a confirmed diagnosis as to what type of liver disease?
  • What are the treatment options?
  • What is the prognosis?

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

 

 

Liver Disease in Dogs: Part I

Photo Credit: Tanakowho on Flicker CC licenseThe liver is an amazingly complex organ and is responsible for multiple functions in the body, all of which are vital for good health. Such multi-tasking means that there are a number of things that can go awry. It’s not surprising then that canine liver disease is so common.

The liver happens to be remarkably resilient and, to a great extent, can regenerate and restore itself following damage. Additionally, because the liver contains multiple lobes, significant disease in only one or two of them doesn’t typically impair liver function.

Liver function

Before blood from the abdominal organs travels back to the heart, it must first pass through the liver via a large vessel called the portal vein. Once within the liver, hepatocytes (liver cells) detoxify the blood, removing any undesirable substances such as toxins or bacteria. This detoxification process is the reason a dog can recover from “food poisoning” after dining on a rotten carcass.

In addition to its role as the “garbage disposal” of the body, the liver also acts as a manufacturing plant, producing substances such as proteins, fatty acids, glucose, cholesterol, and blood clotting factors. These essential products are released from the liver into the bloodstream for use throughout the body.

The liver serves as a storage unit for several essential nutrients, vitamins, minerals and glycogen, an important source of energy release during exercise. The liver also produces bile (bilirubin) and stores it within the gallbladder so it is ready for release into the small intestine when needed for fat digestion.

Symptoms of liver disease

There is no classic combination of symptoms that alerts one to the diagnosis of liver disease. Rather, many liver-related symptoms overlap with those of other illnesses. Symptoms can range from single to multiple, and from mild to severe. Believe it or not, some dogs with significant liver disease demonstrate no overt abnormalities whatsoever (one of the many reasons routine canine senior citizen blood screening is a really good idea).

The more common liver disease-associated symptoms include:

  • loss of appetite
  • lethargy
  • vomiting
  • diarrhea
  • increased thirst
  • jaundice
  • abdominal distention caused by fluid accumulation
  • neurological abnormalities (hepatic encephalopathy)

Diagnosis

There are typically two stages of testing involved in diagnosing liver disease. While the first stage confirms that a liver abnormality is present, this testing doesn’t hone in on the clear-cut cause of the problem. All it says is that some type of liver disease is.  The second stage of testing is used to confirm the exact type of liver disease present. A liver biopsy is often needed to make this distinction although, on occasion, the ultrasound alone is confirmatory. A liver biopsy is an invasive procedure. It’s potential risks and benefits must be carefully evaluated before proceeding, particularly with dogs whose health is significantly compromised.

First stage testing

  • thorough physical exam
  • complete blood cell count (CBC)
  • chemistry profile
  • urinalysis
  • bile acids test
  • blood clotting studies
  • abdominal x-ray

Second stage testing

  • abdominal ultrasound
  • liver biopsy collected via surgery, laparoscopy, or with ultrasound guidance

How liver function is assessed

Several different blood tests are utilized when diagnosing liver disease. The chemistry profile measures ALT (alanine aminotransferase) and AST (aspartate aminotransferase), enzymes contained within the liver cells. Elevations of these two enzymes indicate that at least some of the liver cells are “unhappy,” enough so that they are leaking excess ALT and AST into the bloodstream. This is really the only information provided by these two enzymes. They don’t reveal anything about how the liver is functioning. In other words, one could not diagnose liver failure on the basis of ALT and AST results. Unfortunately, measurements of these two enzymes are often referred to as “liver function tests,’ a term that I believe to be very misleading. (Okay, I’ll jump off of my soapbox.)

So, how then does one evaluate liver function? The chemistry profile also measures albumin, glucose, urea, and cholesterol all of which are manufactured within the liver. Decreased amounts of these four substances in the bloodstream are indicators that liver function is impaired.

Blood clotting factors are also made within the liver, and abnormally prolonged blood clotting times are consistent with liver dysfunction. A bile acids test is yet one more way of screening for impaired liver function.

Stay tuned for Liver Disease: Part II to learn about the causes and treatment of liver disease.

Have you cared for a dog with liver disease?  If so, how did things turn out?

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

 

 

 

 

What is Your Pet’s Body Condition Score?

SFSBlog_bodycondition

Photo Credit: © Susannah Kay

Of the many things that influence your pet’s health, body weight and condition are at the top of the list. Just as is true for us, obesity predisposes our dogs and cats to a variety of health disorders such as arthritis, heart disease, diabetes, and high blood pressure. The more fit your Fido or Fluffy, the greater the likelihood of a long and healthy life.

During your pet’s annual physical examination, your veterinarian will ideally evaluate his or her Body Condition Score or (BCS). This is a visual and hands-on way of determining if your dog or cat is carrying the right amount of body fat and muscle. Assessment of BCS, in conjunction with body weight measurement, helps determine if your pet is too heavy, to lean, or just right. Measuring body weight alone doesn’t do this. For example, without a visual and hands-on determination of BCS, it would be impossible to know if a 70-pound Collie was under or overweight.

Body Condition Score Scales

Veterinarians have a few different BCS scales to choose from. They all produce the same results, namely a more accurate assessment of an animal’s body condition. The scoring systems of the two most commonly used scales range from one to five and from one to nine.

Here’s how BCS scoring works. On the scale that runs from one to nine, a body condition score of one applies to an extremely emaciated dog. A morbidly obese dog would receive a score of nine. Ideal body condition scores land between four and five. On a scale that runs from one to five, a score of three is the number to shoot for.

If your pet’s BCS doesn’t fall within these ideal zones, your veterinarian will collaborate with you to formulate a plan that modifies your pet’s diet and exercise program with the goal of achieving a healthier body condition score.

Take a look at a body condition score chart. What number would you assign to your pet? Remember, figuring this out is a visual and touch assessment. If your dog or cat falls outside of the BCS “comfort zone” I encourage you to schedule a visit with your veterinarian.

Have you heard about body condition scoring before? Is it used by your veterinarian?

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