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

 

Vaccine Antibody Titers: Are They a Good Choice for Your Dog?

SFSBlog_vaccinetiters

Photo Credit: © Susannah Kay

Perhaps you know a little bit about antibody titers (aka, vaccine titers, vaccine serology, and titer testing), but find the topic to be confusing. Rest assured, you are in good company. The topic is somewhat complicated, and recommendations as to how to use antibody titers vary widely.

Until relatively recently, antibody titer testing was quite pricey and involved sending the dog’s blood sample to a specialty laboratory. The testing process is now far more affordable and readily available. It can be performed right in the veterinary hospital with results provided during the course of an office visit. Given this ease, accessibility, and affordability, it makes really good sense to figure out if antibody testing is a good choice for your dog. Here’s some information to bring you up to speed on this topic.

Antibodies and the immune system

Our immune systems have the amazing ability to recognize and then get rid of things that should not be in our bodies, such as bacteria and viruses. There are two major defense strategies by which the immune system operates, and both are involved in preventing diseases such as canine distemper, adenovirus, parvovirus, and rabies.

Antibodies are the first line of immune protection. These protein molecules act as efficient foot soldiers within the bloodstream that attack and defend against the “bad guys.” When we measure antibody titers, we assess this component of the immune system.

The second arm of immune system protection is referred to as cell mediated immunity. As the name implies, specific cells within the body (phagocytes and lymphocytes) are activated to capture the “bad guys.” These cells also release substances that trigger ongoing immune system activity. The function of this portion of the immune system can be measured, but only in highly specialized laboratories. Antibody titers provide no information whatsoever about cell mediated immunity.

Running antibody titers

All that is required to run an antibody titer is a blood sample, something that is quick and easy to collect from most dogs. The component of the blood used for the test is called serum- hence the term “vaccine serology.”

Antibody titers assess the concentration of disease-specific antibodies within the bloodstream. For example, a high parvovirus antibody titer suggests adequate disease protection. Therefore, no need to revaccinate against parvovirus for now. Conversely, a low or nonexistent antibody titer suggests that revaccinating is warranted.

Current in-hospital test kits allow determination of antibody titers against canine distemper, parvovirus and adenovirus. Assessment of rabies-specific antibodies is also available but, because everything to do with rabies is government-regulated, this testing is performed only within specialized laboratories. Additionally, vaccinating against rabies is required by law- antibody test results are unlikely to “excuse” a dog from having to be revaccinated at officially designated intervals.

Interpreting antibody titer test results

In theory, antibody titer testing provides a “yes” or “no” answer as to whether or not the animal has adequate immune protection against a particular disease. Unfortunately, things are not one hundred percent black and white. Here are a few caveats to consider:

  • In hospital test kit results are based on color change. This introduces an element of subjectivity on the part of the person interpreting the results.
  • On the color scale there is a gray zone that can be difficult to interpret as positive or negative.
  • This testing assesses antibodies only. The other arm of immune protection (cell mediated immunity) is not evaluated. Therefore, one cannot be 100% certain that complete immune protection is present, even if testing documents an adequate antibody level.
  • Likewise, if the antibody concentration is interpreted as inadequate, it’s possible that cell mediated immunity is adequate enough to deliver immune protection.

Titers versus simply revaccinating

It’s natural to view vaccinating as simply a “routine procedure.” Not so much, however, if your dog happens to be one who suffers an adverse vaccine reaction. Some adverse reactions occur immediately following the injection, others not until days or even weeks later. Vaccine reaction symptoms vary from mild to severe, and, on rare occasion, they can be life threatening. The American Animal Hospital Association defines immunization as “a medical procedure with definite benefits and risks, and one that should be undertaken only with individualization of vaccine choices and after input from the client.”

I recall a much-beloved Dachshund named Henry, who was five years old when I met him. He’d received a distemper, parvovirus, and adenovirus vaccination two weeks prior and was suffering from a horrific vaccine reaction. The vaccine triggered Henry’s immune system to attack and destroy his own platelets- blood cells necessary for normal blood clotting. He was bleeding internally. Though we tried to stop the bleeding with transfusions and medications, we lost the battle, and poor Henry passed away. Poor Henry’s vaccination was hardly a “routine procedure.”

Using antibody titers wisely

I encourage you to include antibody titers as part of your vaccination discussion with your veterinarian. For more than a decade now, we’ve known with certainty that distemper, parvovirus, and adenovirus vaccinations provide protection to adult dogs for a minimum of three years, emphasis on the word “minimum.” In fact, for some dogs, immune protection extends well beyond three years, and may even be life long. It makes sense then to consider antibody titers in lieu of automatically revaccinating every three years. Here are some other ways antibody titer testing can be put to good use:

Puppies: After completion of the puppy vaccination series at 14-16 weeks of age, an antibody titer can be used to verify that adequate protection has been achieved. If not, revaccination for distemper, parvovirus, and adenovirus at 18-20 weeks of age is indicated.

Dogs with prior adverse vaccine reactions: Whenever a dog has had an adverse reaction to a vaccine, there’s always the potential for a repeat performance. One is left with the dilemma of whether or not to revaccinate. Antibody titer testing can be tremendously helpful in this situation. If the results reveal adequate protection- whew! Another vaccination and its potential side effects can be avoided.

Dogs with immunological disease: It is usually recommended that dogs with a history of autoimmune disease (immune mediated disease) receive as few vaccinations as possible. Because the dog’s immune system has been triggered in the past to attack the body’s own cells, the very last thing the dog needs is a vaccination that will, with certainty, trigger the immune system. Antibody titer testing can really help in such cases.

Dogs who are sick: A vaccination may be the very last thing that a chronically or seriously ill dog needs. Conversely, if the dog’s immune system function is depressed, the vaccine may be truly important. Antibody titers can help sort this out.

Veterinarian insistent on annual vaccinations: Unfortunately, even more than a decade after learning that core vaccinations provide a minimum of three years of protection, some veterinarians continue to insist on revaccinating each and every year. (Picture me shaking my head in disbelief as I type this.) If, for some reason, you insist on continuing to work with such a veterinarian, I encourage you to opt for antibody testing in order to avoid subjecting your dog to the risks of unnecessary vaccinations.

Is serology right for you and your dog?

There is no “right” or “wrong” here. After reading all of this, you may think that vaccine serology is the right way to go. Or, you may opt to forego antibody titers and simply revaccinate your dog every three years. Either way, you will be stepping up to the plate as your dog’s informed medical advocate. Way to go!

Resistance from your veterinarian

If your veterinarian is opposed to vaccine serology or, worse yet, he or she is hell-bent on vaccinating your adult dog for distemper, adenovirus, and parvovirus once a year, you’ve got some decision-making to do. Do you subject your dog to unnecessary vaccinations (and the risks associated with them), or do you find yourself a new veterinarian, one who isn’t operating in the “stone age”?

If you and your dog really like this veterinarian, I suggest having conversation about vaccination schedules and serology. Refer your vet to this article or any of the many others that have been written. Remind him or her that veterinarians who are vaccinated for rabies protection are not automatically revaccinated. Rather, antibody titer testing is used to determine if another rabies vaccination is due.

If you choose to find a more progressive veterinarian to help care for your beloved dog (and I heartily encourage you to do so), request an interview during which you can determine the prospective vet’s philosophy concerning vaccines and antibody testing. Discussing all of this with your veterinarian is a perfectly reasonable expectation, and your input is an invaluable part of the decision-making process.

Have you investigated antibody titers 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

 

 

 

German Shepherd Dogs: The Impacts of Early Neutering

SFSBlog_germanshepherds_maccath_flickerCC_stick2getherGenerations of veterinarians in the United States have been taught to recommend neutering for dogs between four to six months of age, and certainly before their first birthday. Relatively recent research has revealed compelling negative implications of such “early neutering” in Golden Retrievers, Labradors, Vizslas, and Rottweilers. Now, along comes more compelling research, this time pertaining to German Shepherd dogs.

German Shepherd research

It’s difficult to find a dog more loyal and intelligent than a well-bred German Shepherd. It’s also difficult to find a breed more prone to joint maladies. Recently published research out of the University of California, Davis explored the impacts of early neutering on the incidence of joint diseases, various cancers, and urinary incontinence (involuntary urine leakage) in this breed.

Medical records from 1170 neutered and intact (not neutered) purebred German Shepherds were retrospectively evaluated throughout the first eight years of the dogs’ lives. The records were investigated for the incidence of joint disorders (hip dysplasia, elbow dysplasia, cruciate ligament disease), various types of cancer (osteosarcoma, lymphoma, hemangiosarcoma, mast cell cancer, mammary cancer), and urinary incontinence.

Study Results

Joint diseases: The incidence of one or more joint disorders was significantly higher in male shepherds castrated before one year of age (21% of dogs) compared to the intact male population (7% of dogs). Females spayed before one year of age also had an increased incidence of joint disease (16%) compared to their intact counterparts (5%). Of all the joint disorders the incidence of cruciate ligament disease increased the most in proportion to early neutering.

Cancer: Mammary cancer (breast cancer) was diagnosed in 4% of intact female shepherds compared with an incidence of less than 1% in dogs spayed before one year of age. No significant differences in the incidence of the other cancer types studied were discovered when intact and neutered shepherds were compared.

Urinary incontinence: The incidence of incontinence in intact females was 0%. Amongst the population spayed before 6 months of age, the incidence was 4.7%, and for those neutered between 6 and 11 months, the incidence was 7.3%. The average age of onset of incontinence was 5.2 years.

Conclusions

The increased incidence of joint disease in early-neutered German Shepherds resembles data collected on Golden Retrievers, Labradors, and Vizslas. The theory behind this association relates to closure of growth plates, the regions within bones that promote lengthening. When reproductive hormones arrive on the scene (puberty), they signal the growth plates to close, and lengthening of bones ceases. When a dog is neutered prior to the onset of puberty, the growth plates don’t receive this signal and the bones continue to lengthen. It is theorized that this excess lengthening disrupts normal joint alignment that, in turn, causes joint disorders later in life.

The increase in mammary cancer in intact females in this study aligns with other research results. Interestingly, the effect of early neutering on the incidences of the other cancers studied vary significantly compared to what has been learned about the impact of early neutering in Golden Retrievers, Vizslas, and Rottweilers. In these breeds, early neutering is associated with dramatic increases in multiple types of cancer. These differences are fascinating and underscore the value of performing breed-specific research.

The increased incidence of urinary incontinence in early neutered dogs isn’t surprising. This association has been demonstrated in a number of previous studies.

I can think of multiple occasions throughout my professional career when new information has prompted me to question what I’d been taught to be the “norm” in veterinary practice. All of the research to date pertaining to the impacts of early neutering has caused me, and hopefully plenty of other veterinarians, to question the standard recommendation to neuter dogs before one year of age.

What about your dog?

Is it reasonable to extrapolate the results from any of this breed-specific research to your dog? I don’t know the answer to this question, but do encourage you to discuss it with your veterinarian before your dog is automatically neutered prior to his or her first birthday.

I have a “granddog” named Fisher. He’s a super lovable, kind of goofy, large, mixed-breed dog who wasn’t neutered prior to his adoption from a shelter (surprising given that most shelters insist on this). I encouraged my son to postpone neutering Fish until after his first birthday. My thinking was that neutering later rather than earlier might prevent future joint maladies. My son’s last dog, a fabulous Hurricane Katrina rescue named Tipper, experienced torn cruciate ligaments in both knees! Mr. Fish was neutered just last week, a couple of months after his first birthday.

I present all of the information above with the caveat (and my strong personal belief) that prevention of unplanned litters of puppies should trump all other considerations. If a dog cannot be responsibly supervised, neutering before the onset of sexual maturity is a clear first choice.

Is your dog neutered? If so, at what age was the surgery performed?

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

 

A Primer on Canine Tetanus

SFSBlog_tetanusOdds are really good that none of the dogs you’ll ever know will develop tetanus. So, why have I chosen to write about this disease? Blame it on Facebook (FB). For those of you who use FB, when I describe the vegetative trance one can enter while scrolling through a FB news feed, you know exactly what I’m talking about. This is the state I was in when I happened to scroll past a photo of a Labrador’ish-looking dog whose facial expression appeared pretty much just like the dog pictured here. This very classic photo pulled me right out of my FB trance.

The text accompanying the photo was a plea for help in the way of “Can anyone tell me what is wrong with my dog?” The FB poster indicated that her vet had already examined her dog a few times, but there was still no diagnosis. Even with baytril (an antibiotic) and pain medication on board, her dog was steadily getting worse. Her dog was still able to walk, but appeared very stiff.

I don’t usually get involved in requests for a “photo diagnosis.” A single photo can usually translate into a dozen or more diagnoses. However, this particular photo was classic- a textbook case of tetanus. And, I knew that, without appropriate treatment administered just as soon as possible, this dog would be doomed. I felt a moral obligation to respond.

I posted a comment letting the FB poster know that her dog likely had tetanus and was in need of intensive therapy. I encouraged her to seek help ASAP, ideally by way of an emergency hospital, or veterinary specialist such as an internist or criticalist. I asked if the dog had a recent wound that would have allowed the tetanus organism to gain entry.

The response arrived within seconds. Sure enough, a week or so ago the dog had been limping due to a cut on his toe. She thanked me profusely and let me know that she would get help for her dog right away. I wished her the best of luck and our FB conversation ended.

The cause of tetanus

Tetanus is caused by Clostridium tetani, a soil bacterium that can enter the bloodstream via a wound, most commonly on the foot or in the mouth. Puppies can develop tetanus because they chew on sticks and other soil-contaminated goodies, and they have open wounds in their gums created by the loss of baby teeth.

The clostridial organism produces a toxin called tetanospasmin that binds to nerve cells and interferes with the function of a particular neurotransmitter (a chemical released from a nerve cell that transmits an impulse) responsible for inhibiting muscle contractions. Disabling this inhibitory neurotransmitter results in relentless muscle spasms.

Symptoms

Tetanus symptoms usually begin around the face and eyes. Dogs lose their ability to blink accompanied by changes in facial features. This classic facial appearance (the one that prompted me to respond to the FB post) is referred to as risus sardonicus.

With time, symptoms become more generalized throughout the body ultimately resulting in a spastic paralysis- the dog is unable to move at all because of muscle rigidity. Without appropriate treatment, death occurs due to paralysis of the muscles responsible for breathing.

To see a dog with tetanic symptoms, have a look at this video. Not to worry, this video has a happy ending.

Diagnosis

There is no simple test for diagnosing tetanus. Rather, the diagnosis is made based on symptoms and the history of a wound that allowed the clostridial organism to gain entry into the bloodstream.

Treatment and prognosis

Clostridium tetani is an anaerobic bacterial organism, meaning that it thrives in environments devoid of oxygen. A wound festering beneath the skin surface is an ideal incubator. For this reason, it is important to treat the wound (if one is found) where the bacteria gained entry. This involves debridement- opening the wound and removing as much infected tissue as possible.

Appropriate antibiotic therapy is imperative. Penicillin-related drugs work well against the clostridial organism and, at least initially, they are typically administered intravenously. With improvement, oral antibiotics are appropriate. (Baytril, the antibiotic the FB dog was being treated with, is ineffective against Clostridium tetani.)

Additional treatment is dictated by the severity of symptoms. Muscle relaxants are commonly administered along with medication to reduce anxiety. If the dog is unable to eat because of “lock jaw”, nutrition is provided by way of a feeding tube. And if the dog is unable to move, intensive nursing care is required.

Dogs with tetanus are usually super-sensitive to stimuli, and sights and sounds can intensify muscle contractions. For this reason, these dogs are often sedated and kept in a dark quiet room during the recovery period. Long-term treatment- up to a month or more- is often required.

The prognosis for tetanus is good, assuming the dog receives early intervention and aggressive treatment. As with most diseases, the earlier the diagnosis is made and treatment started, the better the prognosis.

Prevention

Dogs are not routinely vaccinated against tetanus because they are so much less susceptible to this disease than are other species such as horses, livestock and people. This being said, it does make sense to thoroughly clean even minor wounds, particularly those on the feet.

How the story ends

So, how did things turn out for the dog I “met” on FB? I sure wish I knew. Silly me, I failed to note the woman’s name and, because we are not FB “friends”, I am at a loss as to how to find her again. I suspect things turned out well, and I’m glad my FB conversation prompted me to teach you about tetanus!

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

Obesity and Diabetes: An Epidemic Amongst People and Pets

 

 

If you’re like me, you’ve become used to hearing about theastronomical incidence of obesity and diabetes within the United States. And, predictions of how many of our children will ultimately develop diabetes is downright scary. Given this information, I wasn’t the least bit surprised to learn that two recent surveys demonstrate that the incidence of obesity and diabetes is also on the rise in our dogs and cats.

Obesity survey

Every year, the Association for Pet Obesity Prevention (APOP) conducts a survey that tracks the prevalence of obesity in dogs and cats. The 2015 survey assessed 1,224 dogs and cats who received wellness examinations within 136 veterinary clinics. For every animal, a body condition score (BCS) was assessed and reported. This score was based on a five-point scale as well as the animal’s actual body weight. The animals were then classified as being ideal, underweight, overweight, or obese.

The APOP survey revealed that approximately 58% of the cats and 54% of the dogs evaluated were overweight or obese. Wow, these percentages are striking! Based on body size alone, more than half of our pets have a significant health issue!

The APOP defines obesity as an animal being 30 percent or more above ideal body weight. APOP board member, Dr. Steve Budsberg, notes that there is a lack of consensus amongst veterinarians about exactly how obesity is defined. “Our profession hasn’t agreed on what separates ‘obese” from ‘overweight.’ These words have significant clinical meaning and affect treatment recommendations.”

The APOP is pushing for the adoption of a universal pet BCS  system. Doing so would allow veterinarians to more consistently and accurately assess their patients, report their findings, interpret veterinary research, and communicate with colleagues and clients. According to Dr. Julie Churchill, another APOP board member, “There are currently three major BCS scales used worldwide. We need a single standard to ensure all veterinary health care team members are on the same page.”

Another APOP board member, Dr. Ernie Ward, takes this one step further. “By defining obesity as a disease, many veterinarians will take the condition more seriously and be compelled to act rather than ignore this serious health threat.” I couldn’t agree more. Having practiced veterinary medicine for over 30 years, it’s clear to me that there is a lack of consensus amongst my colleagues about exactly how to define pet obesity and what to do about it.

Diabetes survey

Every year for the past several years, Banfield Pet Hospital has issued forth a State of Pet Health Report. Their 2016 report, released on April 20, draws on data from approximately 2.5 million dogs and 500,000 cats in more than 900 hospitals across the United States. Now, that’s a whole lot of animals!

This report demonstrated a 79.7 percent increase in dogs with diabetes between 2006 and 2015 with 23.6 cases per 10,000 dogs. Over this same time frame, the incidence of feline diabetes increased by 18.1 percent. This translates into 67.6 cases per 10,000 cats.

The highest incidence of canine diabetes in 2015 was found in Kentucky, Wisconsin, Nevada, Montana, and Iowa. Feline diabetes rates were highest in Arkansas, Wisconsin, New Mexico, Delaware, and the District of Columbia. That’s a double whammy for the state of Wisconsin!

The increased incidence of diabetes, particularly in dogs, is astounding to me. While there are a number of factors that may be responsible for this increase, I’ve no doubt that obesity plays a significant role.

Discussing obesity can be tricky

Frankly speaking, eating too much and exercising too little are traits sometimes shared between people and their pets. If my client isn’t exercising, it is likely that my patient isn’t either. For some folks, food becomes the “language of love,” the way they bestow affection upon their four-legged family members. Additionally, I believe many people develop blinders that prevent them from recognizing just how heavy their pet has become.

Now, picture this. A veterinarian is examining an obese patient. Alongside this patient is the client who is also overweight. Naming the diagnosis of obesity and recommending weight loss can be tricky business. The veterinarian likely has concerns about offending the overweight client, so much so that discussion about the pet’s weight problem may be limited or it may not happen at all. Imagine what you would say if you were in the veterinarian’s shoes.

My modus operandi has always been to have very frank conversation about what I know- being overweight is a significant health problem. I remind myself that the client before me truly loves their pet and, like me, wants that delightful animal to live just as long a life as possible. With this perspective I can boldly talk about the fact that their overweight pet is predisposed to a variety of maladies such as osteoarthritis, heart disease, high blood pressure, and diabetes. I discuss body condition scoring and as well as weight loss strategies. With this approach, I believe (hope) that I reduce the number of clients who are put off by the “weight loss conversation.” Bottom line, treatment followed by prevention of obesity translates into one of the best health insurance policies possible.

Check out how to assess your pet’s body condition score (BCS). Next, provide me with a photo of your dog or cat and the BCS you came up with. I will be sure to enter your name into a drawing for your choice of a copy of Speaking for Spot or Your Dog’s Best Health. I’ll also let you know if I think you are on the right track with the BCS you chose.

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 www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

 

 

 

Helping Dogs Left in Hot Cars

Photo Credit: Genewolf, Flicker CC, Dogs in CarWith the approach of summer, as temperatures increase so too do my thoughts about what I will do when I happen upon a dog left in a car on a hot day. Inevitably, I encounter this situation at least once a year, usually in a grocery store or shopping center parking lot.

After peering through the window to see what shape the dog is in, I will have a decision to make. Will I try to find the owner, hang out by the car for a short while hoping the owner shows up (and if they do show up, turn the situation into a teaching opportunity), call 911, or bust through one of the car windows myself? And, if I opt to break and enter, what might the legal ramifications be? Would I be considered a Good Samaritan or would I be charged with a misdemeanor, or even a felony?

In researching this matter I was pleased to come across an enlightening article on this topic. It was written by the Animal Legal Defense Fund (ALDF). Given that I live in North Carolina, I now know that contacting a law enforcement or humane officer right away is the best bet from a legal point of view. Truth be told, if the dog were in trouble, I suspect I would break into and enter the car myself, and deal with the legal implications later. Wouldn’t you?

Here is the ALDF article. Have a look and see if your state is mentioned.

HOW TO (LEGALLY) HELP DOGS IN HOT CARS THIS SUMMER

By, Animal Legal Defense Fund

Even on a day when it’s 70 degrees outside, the temperature inside a car with all the windows closed can hit 90 degrees in just 10 minutes. On a hot day, the temperature inside a closed car can shoot as high as 116 degrees in the same amount of time.

What can you do, within your legal rights, if you see an animal in distress in a locked car? The Animal Legal Defense Fund, the nation’s preeminent legal advocacy organization for animals, has some tips.

If you see an animal in distress, call 911.

Most states allow a public safety officer to break into the car and rescue an animal if its life is threatened. Calling 911 is the first step to saving that animal’s life.

Know your state laws.

More and more states are adopting “hot car” laws that prohibit leaving a companion animal unattended in a parked vehicle, with six enacted in just the last two years and two more pending. Although 20 states have some form of “hot car” laws, the laws differ drastically from place to place:

  • Only two states—Wisconsin and Tennessee—have “good Samaritan” laws that allow any person to break a car window to save a pet.
  • In 16 states, only public officials such as law enforcement and humane officers can legally break into a car to rescue an animal (Arizona, California, Delaware, Illinois, Maine, Maryland, Nevada, New Hampshire, New York, North Carolina, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, and Washington).
  • In New Jersey and West Virginia, no one has the authority to break into a vehicle to save an animal, not even law enforcement.
  • Legislation is pending in Florida and New York to give any concerned bystander the legal right to help an animal in distress. Pending legislation in Pennsylvania would make it illegal to confine a dog or cat in a vehicle in conditions that would jeopardize its health but only a police, public safety, or humane officer would have the legal right to rescue the animal.

Penalties for hot car deaths of companion animals are still limited. Most states limit penalties to misdemeanors or civil fines and infractions, even for repeat offenders. Maine and South Dakota’s laws don’t impose a penalty at all.

Let people know it’s not okay to leave their pet unattended in a car.

When an animal dies in a hot car, most of their humans say they left them “just for a minute.” If you see someone leave their pet in a parked car, tell them that even if it’s a pleasant day outside, the temperature inside the car can skyrocket fast. Cracking a window doesn’t eliminate the risk of heatstroke or death.

Get the message out with an ALDF sunshade.

The Animal Legal Defense Fund has created sunshades that remind pet owners of the risks of leaving animals unattended in a car. The sunshades feature the message, “Warning: Don’t leave dogs in hot cars,” in lettering large enough to be readable from across a parking lot. They also urge people to call 911 if they find animals locked in a car and in distress. The sunshades are available at https://tinyurl.com/haapdea and all proceeds benefit ALDF.

For more information on keeping dogs safe this summer visit http://aldf.org/cases-campaigns/action-alerts/dogs-in-hot-cars.

About ALDF

The Animal Legal Defense Fund (ALDF) was founded in 1979 to protect the lives and advance the interests of animals through the legal system. To accomplish this mission, ALDF files high-impact lawsuits to protect animals from harm; provides free legal assistance and training to prosecutors to assure that animal abusers are punished for their crimes; supports tough animal protection legislation and fights harmful legislation; and provides resources and opportunities to law students and professionals to advance the emerging field of animal law. For more information, please visit aldf.org.

Are you clear what you will do when you come across a dog locked in a car on a hot day this summer?

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
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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 www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.