Five Red Flag Indicators That It’s Time to Find a New Vet

August 11th, 2013

When someone learns that I’m a veterinarian, their face predictably light up with a smile. It appears that most folks believe that vets are wonderful. After all, we clearly love animals and we must be very smart- everyone knows how difficult it is to get into veterinary school. In fact, people seem far less skeptical of their vet’s capabilities and intentions than they are of their own physician’s.

Time for a reality check. Not all veterinarians are deserving of such benefit of the doubt. Official veterinary disciplinary boards exist for a reason, and I certainly had a few vet school classmates I wouldn’t let near one of my own sick animals with a ten-foot syringe, then or now!

Five red flags

How can you know if your vet’s performance is unworthy of your patronage? Here are five red flag indicators to prompt you to consider looking for someone new:

1. Your veterinarian is a 100 percent do-it-your-selfer, refusing to enlist help from other veterinarians, particularly specialists, within the community. Gone are the days of All Creatures Great and Small when it was reasonable for one doc to handle all medical maladies, great and small. Advances in diagnostic and therapeutic technologies have made it impossible for any individual to be proficient at everything. If your family vet has been unable to arrive at a diagnosis, your pet’s condition is worsening or not improving in spite of therapy, or a complicated procedure has been recommended, enlisting help from another veterinarian makes really good sense. If such discussion is not forthcoming, your vet is likely a do-it-your-selfer.

2. Your vet prefers telling you what to do rather than discussing options. This “paternalistic” style of communication hinders your ability to ask questions and make well-informed choices, and successfully serve as your pet’s medical advocate. Sentence starters from your vet such as, “You need to…”, “You should…”,  “You have to…”, or an unsolicited, “If I were you I would…” are clues that you are dealing with a paternalistic provider.

3. Your vet doesn’t comply with current professional standards. For example, he or she insists on annual vaccinations (parvovirus for dogs, distemper for dogs and cats). The research supporting extension of the interval between these vaccines from one year to three years first became public knowledge approximately ten years ago. A vet who continues to administer them annually is completely missing the boat in the continuing education department or is eager to collect fees from unnecessary procedures. Neither explanation is remotely reasonable.

4. Your vet has made a significant error while working with your pet. A botched surgery, a missed diagnosis, a medical prescription error are examples that should cause consternation. Yes, mistakes happen, but they warrant some face time with your veterinarian to receive an explanation and determine if you will be staying or taking your business elsewhere.

5. You or your pet simply don’t feel comfortable with your vet. Does your normally delightful dog or cuddly kitty transform into Kujo the minute your vet walks into the exam room? Do you feel uneasy asking questions and openly discussing your worries or concerns? Pay attention to your observations and gut feelings. If it doesn’t feel right, it probably isn’t right.

Your exit strategy

If you are planning to leave a vet you’ve been with for years, chances are you’re concerned about how to do so gracefully, without hurting his or her feelings. In response to this concern I quote my favorite line from the movie Moonstruck. Cher demands, “Snap out of it!” as she briskly slaps Nicholas Cage’s cheek. In this situation, I completely concur with her sentiment. After all, what’s more important, your pet’s health and your own peace of mind or your veterinarian’s feelings?

To expedite a smooth transition, obtain a copy of your pet’s entire medical records including: doctor’s notes, laboratory test results, imaging studies (ultrasound, X-rays), and vaccination history. Simply ask the reception staff to provide this for you. This should be a no hassle process as you are legally entitled to all you are requesting. If asked why you are moving on, I encourage you to provide an honest, constructive response.

As the captain of your pet’s health care team, it is your responsibility to determine who your teammates will be. Choose them wisely and remind yourself that the opportunity to care for you and your pet is a privilege that should be well deserved.

Have you ever had to divorce 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 www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

Is the Kennel Cough Vaccine a Wise Choice for Your Dog?

August 4th, 2013

With more than a dozen canine vaccines to choose from figuring out which ones your dog truly needs can be a challenge. The kennel cough vaccine is one you will need to consider. Unlike distemper and parvovirus vaccinations which are recommended for each and every dog (these diseases are ubiquitous, highly contagious, and life threatening), the kennel cough vaccine helps prevent a medical issue that is treatable and without universal risk of exposure.

In determining whether or not your dog should receive the kennel cough vaccination, the chicken soup philosophy of, “It couldn’t hurt!” doesn’t fly. All vaccines can cause negative side effects and a risk-benefit analysis should be performed for each and every one of them. The information below will help you determine if the kennel cough vaccine makes good sense for your dog.

What is kennel cough?

Kennel cough, also referred to as “canine contagious cough complex” (fabulous alliteration!) is an infectious, contagious form of tracheobronchitis (inflammation of the windpipe and bronchial passageways). More than ten different organisms can cause kennel cough. The two most commonly discussed are Bordetella brochiseptica (a bacteria) and parainfluenza (a virus).

Kennel cough spreads from dog to dog via respiratory tract secretions, so it makes sense that places where dogs congregate (boarding or grooming facilities, dog shows, dog parks) are potential hotbeds of infection. Kennel cough produces a hacking, incessant, keep-you-awake-all-night kind of cough. Recommended therapy most commonly consists of a cough suppressant and antibiotics to treat any possible causative bacterial agent or prevent a secondary bacterial infection. Complete recovery is anticipated within 10 to 14 days.

The vaccination

All kennel cough vaccinations protect against Bordetella. Some also include protection against parainfluenza. When considering whether or not the kennel cough vaccine makes good sense for your dog, consider the following:

  • Bordetella and parainfluenza are only two of the many microorganisms capable of causing kennel cough. Just as is the case with the human flu vaccine, vaccinated individuals can still develop the disease if exposed to one of the other causative infectious agents.
  • Immunization against parainfluenza is almost always a component of the distemper/parvovirus combination vaccination. Repeating the parainfluenza component within the kennel cough vaccine adds no extra protection. If you choose to vaccinate for kennel cough, ask your veterinarian if he or she administers Bordetella alone or in combination with parainfluenza. If the latter is used, question the rationale behind this practice.
  • Kennel cough vaccines come in three forms; those administered as an injection under the skin, those given intranasally (directly into the nostrils), and a recently released vaccine that is administered orally. Duration of immunity for all of them is one year. It is thought that the intranasal kennel cough vaccination provides better protection than the injectable form. This is a result of the “local immunity” conferred- protection right at the site where kennel cough organisms enter the body. The intranasal vaccination can be more difficult to administer to a wiggly dog and can produce mild, short-lived kennel cough-like symptoms (primarily nasal discharge and coughing). The oral vaccine is new enough that detailed comparisons to the other forms have not been completed.
  • If a dog has never received a kennel cough vaccination, two dosages of the injectable form of the vaccine must be administered three to four weeks apart before immune protection is achieved. Only one dosage is required for the oral and intranasal vaccines. Following vaccination, establishment of immune protection requires 7 to 10 days for the injectable vaccine and 3 to 5 days following the intranasal or oral forms. What all of this means is that administering a kennel cough vaccine to your dog the day before he enters a boarding or grooming facility may get him through the door (many establishments require this vaccination be on board), but may not provide significant disease protection during his stay.

When conflict arises

What should you do if your vaccine preferences and those of the grooming or boarding facility you wish to use are at odds? Discuss your rationale with the business proprietor. If there is no wiggle room, you will need to acquiesce or find an alternative facility with less stringent requirements. What should you do if your veterinarian insists on administering unnecessary vaccinations to your dog? I encourage you to step up to the plate as your dog’s medical advocate and find yourselves a more progressive practitioner!

What decision will you make about the kennel cough vaccine 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 www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

 

 

 

 

 

 

 

 

 

 

 

Thinking of Breeding Your Dog?

July 28th, 2013

For many people the prospect of producing puppies is ever so tempting. There are all kinds of reasons for wanting to bring new dogs into the world ranging from replicating that ideal dam or sire to the desire to earn money through the sale of puppies. The process appears straightforward. Get two dogs together at the just the right time and voila- a couple of months later a litter is born. The pups are adorably entertaining, and eight weeks later these little income generators go off to their new homes to live happily ever after. Who wouldn’t want to breed their dog?

Time for a reality check! Before you begin propagating puppies, please consider the following:

What are the potential complications? Only rarely do the processes of breeding, pregnancy, whelping (giving birth), and raising pups take place without at least one significant medical hitch. It is important for you to realize that all aspects of creating, growing, and raising pups pose significant health risks for the female you are tempted to breed (that girl who is likely a beloved family member). Medical complications are often serious and most of them require veterinary care. Additionally, unspayed female dogs are particularly predisposed to breast cancer and pyometra (development of pus within the uterus), both of which can be life threatening. Prior to breeding your dog, have a frank conversation with your veterinarian regarding potential medical risks and what would be involved should they arise.

Is your dog a suitable candidate? Just because you have a purebred dog does not mean he or she should be bringing puppies into the world. Breeding should be reserved only for those dogs with ideal temperament and conformation. Additionally, breed related health issues should be investigated and health clearances provided before an individual dog is bred. For example, Labrador Retrievers are predisposed to hip dysplasia. The prospective breeding dog’s hip joints should be assessed via X-rays taken after two years of age and assessed by a radiologist either at Orthopedic Foundation for Animals (OFA) or PennHIP  . Labradors with inferior quality hips should not be bred. Visit the national breed association website for your breed of interest to learn more. I also encourage you to work with a reputable breeder or two to help you determine if your dog’s temperament, conformation, and health clearances make him or her a suitable candidate for breeding.

How much money will you make? The expenses associated with breeding a dog and raising pups are often greater than the income produced. The need for a Cesarean section (C-section), one sick puppy, or a case of mastitis (infection within the dam’s mammary gland) can negate any potential profit. Don’t forget to factor in the stud fee that should be fairly pricey if the male has been cleared for health issues and represents his breed well. Lastly, as the old adage counsels, “Don’t count your chickens before they hatch!” There’s never a guarantee of how many pups will arrive, much less survive the birthing process. You may end up selling two pups when the financial expectation was for eight or ten.

Do you have time? Raising pups is a whole lot of work! Done correctly, a huge amount of round-the-clock cleaning and monitoring is required, not to mention at least a couple of trips to the veterinary hospital for “herd health” visits. If you are raising a litter, plan to recruit lots of help or give up your day job for a minimum of six weeks.

Is it the right thing to do? The pet overpopulation issue is not exclusive to mixed breed dogs. Before breeding your own dog I encourage you to visit your local shelter or humane organization where you will find plenty of homeless purebred dogs. Contact the local rescue organization for the breed you fancy and find out how many dogs they have in foster care waiting for placement. Abstaining from breeding your dog may be the truly socially conscious thing to do.

Still have the desire to breed your dog? If so, please consult with your veterinarian and spend time with some reputable breeders before getting started. This way you will be able to proceed in a manner that is responsible to your dog, the people who will be adopting your puppies, and the breed you are promoting.

If you have ever purposefully bred your dog, I invite you to share your experiential wisdom.

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.

 

Vets, Signs, and Videotape

July 21st, 2013

I am traveling this week, so am providing you with a second look at a previous topic.

Rarely am I bothered by client misbehavior, but when a client answers their cell phone while we are in the midst of discussion, I admit to feeling a bit peeved. So why in the world would I invite my clients to whip out their cell phones during the course of an office visit? Because I want to see video of my patients’ symptoms! Unless you are like me- still using a cell phone that my daughter considers prehistoric- your cell phone allows you to have instant access to shooting video. And if I can watch videotape of your pet’s confusing symptom or odd behavior, I’m more likely to figure out the underlying issue, more so than with just your verbal description (no offense intended). And when I have a better sense of the underlying issue, I can more expediently, and often less expensively, guide you towards rational diagnostics and/or therapy.

Unless the odd behavior or new symptom is occurring round the clock, the likelihood of it happening in my exam room is slim to none. You’d be surprised what symptoms fully resolve when animals are under the influence of adrenaline. So, if your dog or cat is doing something bizarre that you think will be difficult to accurately describe to your vet, I encourage you to grab your cell phone and shoot a video (feel free to include some Jacques Cousteau narration if you like). By all means, nix the video if you sense you are observing something that is life threatening, and get to the nearest veterinary hospital ASAP.

Here’s a classic example of how videotaping a medical problem can be wonderfully helpful. A common symptom in dogs is referred to as “reverse sneezing.” It occurs when a dog feels a tickling sensation in the back of their throat. It is somewhat equivalent to a person clearing their throat. However, when dogs reverse sneeze, the symptoms appear ridiculously overly dramatic. They assume a stiff posture with head and neck rigidly extended forward. This is accompanied by forceful, noisy inhalation and exhalation that can last for several seconds, even minutes. Check out the example of reverse sneezing in the video below.

For the uninitiated, reverse sneezing is a scary thing to watch- clients commonly report that they think their dog is having an “asthma attack.” Show your vet a video of reverse sneezing and he or she will be able to recommend what to do about it as well as provide plenty of reassurance that, no matter how dramatic the symptoms appear, they are not causing any oxygen deprivation. As much as video is helpful in this situation, I must admit I will miss watching my clients trying to imitate reverse sneezing (oops- I just revealed one of this veterinarian’s dirty little secrets)!

Here are some examples of other behaviors/symptoms that should prompt you to grab your cell phone and shoot some video (if you can think of others, please let me know):

1. Weakness
2. Trembling
3. Incoordination
4. Falling down/collapse
5. Episodes of pain
6. Symptoms associated with passing urine or stool
7. Making odd noises (in this situation audio taping is a must along with video)
8. Coughing (again, adding audio is great)
9. Labored breathing
10. Limping/lameness
11. Odd behavior

Have you ever shared video with your vet? If so, did it prove to be beneficial in making decisions about how to proceed?

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.

Why Some Pet Photos Make Me Nervous

July 14th, 2013

Call me an uptight veterinarian or an overanxious mom if you like, but I get a deep-in-the-gut unsettled feeling every time I view a particular type of pet photo that has become all the rage these days, particularly on Facebook. I’ll bet you’ve seen these photos- the ones in which pets and young children are posed together. Have you seen the one of the newborn baby practically buried under the massive head of the family dog? How about the image of a young child carrying (dangling) a kitty by one leg? And then there is the photo that frightens me the most- the one in which a youngster is face-to-face with the muzzle of a dog, and the expression on that dog’s face is usually one of confusion or subjugation. When I view these images I cringe, wondering if and when that animal is going to lash out at that young child. I have the desire to shake the photographer while screaming, “Danger, danger!” These “kids and pets” photos are as anxiety producing for me as a high budget suspense movie.

Big Ben

I’d like to tell you about Ben, a patient of mine many years ago who helped set the stage for my “nervous condition”. One or two adults along with two young children typically accompanied this lovely Saint Bernard to his appointments with me. The children were always busy interacting with their dog. At any given moment one might be dragging Ben around the room by his collar. Whenever Ben did manage to lie down, he was treated him like a beanbag chair, the two children leaping and falling onto his soft belly. Ben always remained the gentle giant, ridiculously tolerant of the children’s disrespectful behavior. My attempts to tactfully educate the parents about setting limits for their kids failed miserably. They reassured me that their children were simply demonstrating love for Ben who, in return, would never dole out anything but affection.

I was saddened but not surprised to receive a phone call from the children’s mother asking if I knew of anyone who might be willing to adopt Ben right away, and it needed to be a home without children. It seems that Ben finally snapped, both literally and figuratively. He bit the youngest child in the face prompting an emergency room visit and extensive reconstructive surgery. The child would be permanently scarred (likely emotionally as well as physically) and the family needed to rehome Ben or have him put to sleep. Given the bite history, a suitable home for Ben could not be found. I remember crying as I set about the task of euthanizing my beautiful and dignified patient.

Respect and safety

When it comes to teaching young children about interacting with animals, I am all about two things: respect and safety. The respect part of the equation translates into a child behaving gently and kindly towards animals- no tugging on ears or tails, placing fingers inside mouths, pulling on collars, using the animal as a body pillow, lifting the animal without help from a grownup, or interrupting sleep or meals. Such respect is not intuitive for most youngsters. It is something that must be taught and carefully supervised- no different than when teaching other important life lessons such as the danger of running into the street.

The safety piece is simple. Neither the child nor the animal should sustain injury as a result of their interactions. I would need dozens more fingers and toes to count the number of animals I have treated who have been unintentionally injured, often seriously, by the actions of a young child. Flip the coin and ask seasoned emergency room physicians how many young children they have treated who were injured by the family pet. They too would need more fingers and toes. Be it the child or the animal who is injured, in most cases they are victims of adults not paying attention.

What you can do

Here are some things you can do to enhance safe and respectful interactions between young children and animals. Feel free to add to the list:

  • Actively teach young children how to interact with animals in a gentle, respectful fashion. Role model this behavior every chance you get.
  • Be reminded that every animal is capable of unpredictable behavior. Never leave a young child unsupervised with an animal, even if that animal happens to be the beloved family pet.
  • An eating or sleeping animal is wearing a “do not disturb” sign which should be respected.
  • If your pet enjoys spending time in a crate or other small, enclosed shelter, consider this to be their sacred space and bar young children from entering.
  • Avoid subjecting your pet to unnatural, uncomfortable poses for the sake of a photo!

Do you have young children and pets? How closely do you supervise their interactions?

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.

 

Tracking Breeders of Pet Store Puppies

July 7th, 2013

The ASPCA recently launched a new consumer tool as part of their No Pet Store Puppies Campaign, and I encourage you to check it out. This tool contains a searchable database linking pet stores that sell puppies to United States Department of Agriculture (USDA)-licensed commercial breeding facilities (puppy mills). By entering a pet store name and zip code you can learn which puppy mills produce their “merchandise”. Plug in the breeder name and/or USDA license number and learn which pet stores they do business with. Lastly, enter a particular breed and learn which licensed facilities are producing them.

This new database contains more than ten thousand photos of commercial breeding facilities collected during the course of USDA inspections. These photos are not for the faint of heart. I suspect they will tug at your heart as they did mine. The purpose of these photos is to provide a reality check for those consumers who intrinsically believe that any commercial dog breeder licensed by the USDA must be providing humane treatment for their dogs.

Please share this new tool with anyone you know who is contemplating a puppy purchase from a pet store. I hope you will also share it with friends and family members who buy their pet supplies from stores that sell puppies. While you’re at it, please take the official ASPCA puppy mill pledge to stop buying anything from stores that sell puppies. Together we can make a difference.

Please share this blog post with at least one other person and you will put a big smile on my face! Thank you.

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.

Were You Smarter Than a Vet Student?

June 30th, 2013

Thanks to all of you (more than 100) who responded to the emergency version of “Are You Smarter Than a Vet Student.” The names of two participants were drawn to receive a signed copy of Speaking for Spot  or Your Dog’s Best Health. The two lucky winners are Jan Gribble from Socorro, New Mexico and Carrie Ann Cassidy who resides in Pinckney, Michigan and writes a blog called “Bichon Frise Owner”. Congratulations Jan and Ann!

Below, you will find the correct answers (in bold font) to the questions I challenged you with last week. I’ve also included some explanations. Please let me know if you disagree with any of them- I’m always open to debate!

1. You’ve just arrived home after a long day at work to find two vials containing two of your own prescription heart medications spilled on the bathroom floor and it is clear that several of the pills are missing. All three of your dogs greet you with smiles on their faces. What should you do?

a. Do some “watchful waiting” to see which dog, if any, develops symptoms.

b. Head to your local veterinary emergency clinic with the pill vials, the remaining pills, and the dog who has always been the gluttonous troublemaker.

c. Head to a veterinary emergency clinic with the pill vials, the remaining pills, and all three dogs. Any time there is the possibility that a toxin has been ingested, immediate action should be taken. The sooner the animal is treated, typically the better the outcome. Treatment often consists of inducing vomiting (home therapy with hydrogen peroxide produces inconsistent results), treating the intestinal tract to prevent further absorption of the toxin, and using intravenous fluids to help flush the toxin out of the body. It is always better to be safe than sorry which is why all three dogs should be evaluated. Perhaps the “gluttonous troublemaker” ate the majority of the spilled pills, but the other two dogs ingested just enough to cause problems for them as well.

d. Use hydrogen peroxide to induce vomiting in all three dogs.

 

2. The following is not a true veterinary emergency:

a. Your dog or cat is suddenly having difficulty using both hind legs.

b. Your dog or cat vomited and the vomited material contains fresh blood.

c. Your dog suddenly began favoring one hind leg while cavorting at the dog park. Whether or not the lameness is treated right away or a few days down the road is very unlikely to make a difference in the overall outcome. When it comes to antifreeze toxicity, partial paralysis of the hind legs caused by a stroke like event or slipped disk, or damage to the lining of the upper gastrointestinal tract, the sooner the animal receives medical care, the greater the likelihood of a positive outcome.

d. You observed your dog or cat licking from a puddle of spilled antifreeze.

 

3. Seizures in pets are not caused by:

a. Inappropriate use of a flea control product.

b. Ingestion of marijuana. Marijuana causes profound sedation in dogs which is often accompanied by urine dribbling (For a good laugh on this topic read “Busted!”. Dogs do not experience seizures (or the munchies) after eating marijuana. Inappropriate use of flea control products (for example, using a canine flea control product on a cat) can cause profound neurological symptoms including seizures. When dogs ingest xylitol, the sweetener contained in most sugarfree gums, the result is a very low blood sugar level which can cause seizures. Lastly, snail bait contains metaldehyde, a compound that is toxic for dogs and causes neurological symptoms including seizures.

c. Ingestion of snail bait.

d. Ingestion of sugarfree gum.

 

4. After parking your car in a large shopping mall lot on a very hot day you notice that a dog has been left in a neighboring car. The car windows are cracked open and the doors are locked. The dog is panting, but looks bright and alert. What should you do?

a. Head into the shopping center to convey your concerns to someone affiliated with mall management.

b. Break into the car.

c. Call 911. This is my preferred answer, given the fact that I purposefully indicated that you parked in a large shopping mall. At a smaller business, it might be reasonable to locate the car owner before calling 911. I will also add that, if the dog in the locked car appeared to be in rough shape and there was not time to wait, I would not hesitate to bust into the car. Lastly, if and when you encounter the owner of the car, I wholeheartedly encourage you to address the individual with a modicum of respect. This is an opportunity for education with hopes that the situation will never be repeated.

d. Hang out and wait until the owner of the car returns.

 

5. Your dog Angel was hit by a car and you immediately transport her to a nearby veterinary emergency clinic, one which you have never been to before. Clearly one of Angel’s legs is broken, she is in pain, and she is experiencing labored breathing. In the rush to get her to the emergency clinic, you forgot to bring along any form of payment to leave a deposit for her care. What is the veterinary staff obligated to do?

a. Hospitalize Angel for observation, but delay beginning any diagnostics or treatment until you return with your deposit.

b. Provide all emergency care necessary to attempt to stabilize Angel’s condition until you return with a deposit.

c. Provide pain medication as needed until you return with a deposit.

d. answers b and c. Do your best to grab a form of payment before you sail out the door, but if you do happen to arrive at the emergency clinic with empty pockets, fear not. The veterinary staff is obligated to do whatever is necessary to relieve pain and stabilize your dog in terms of any issues that are imminently life threatening until you return with payment. Keep in mind, we are talking about your return in a reasonable amount of time.

 

6. It is Sunday afternoon and your pet Smokey appears suddenly unable to see. Other than appearing somewhat disoriented and bumping into things, he appears quite normal. You should:

a. Plan to call your family veterinary hospital first thing in the morning to schedule an appointment for Smokey to be evaluated.

b. Take Smokey to a veterinary emergency right away. If Smokey’s sudden blindness is caused by glaucoma (increased pressure within the eyes) or detached retinas, immediate therapy is often necessary to restore vision. Postponing therapy by as little as 12 hours may result in permanent blindness.

c. Monitor Smokey at home for a few days to see if the vision loss goes away or any other symptoms develop.

d. Go on line to research the potential causes of blindness.

 

7. Your dog Ralphie receives a regimen of medications for his chronic skin allergies, kidney failure, and diabetes. It is Sunday morning and he has refused his breakfast and is vomiting. You pack him up to take him to the emergency clinic. Besides little Ralphie, what else should you bring?

a. All of Ralphie’s current medications.

b. A copy of Ralphie’s medical records.

c. Ralphie’s current diet.

d. All of the above. With issues as complicated as Ralphie has, the emergency doc will be able to do a much better job if he or she has access to all of his medical information. Keep in mind, your family veterinary clinic will very likely be closed on a Sunday morning- no one will be there to fax or email over Ralphie’s medical records. This is why it is important for you to keep an updated copy of your pet’s medical records on hand- just in case you find yourselves at an emergency clinic on a Sunday morning.

 

8. Your dog Dexter was just involved in a dog fight at the dog park. He appears just fine other than multiple small puncture wounds on his legs and face. He has already returned to playing with the other dogs. What should you do?

a. Continue to let Dexter play.

b. Take your dog home right away to wash the wounds.

c. Have your dog examined by a veterinarian right away. Although the puncture wounds appear small, guaranteed there is a lot of traumatic crushing of tissue that has occurred beneath the skin surface. Additionally, those bite wounds inoculated plenty of bacteria deep under the skin. These two factors combine to create the perfect storm for infection to develop. The puncture wounds should be thoroughly evaluated by a veterinarian and antibiotics prescribed just as soon as possible. Pain medications may also be dispensed. The adrenaline released during a dog fight often initially masks the pain. Within hours, those dog fight wounds will likely be a source of considerable discomfort.

d. Contact your attorney.

 

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.

 

 

 

 

 

Are You Smarter Than a Vet Student?

June 23rd, 2013

Back by popular demand is, “Are You Smarter Than a Vet Student” a test of your veterinary medical savvy. This time we will test your knowledge about veterinary emergencies. Please provide me with your responses. You may be one of two lucky winners to receive a signed copy of either Speaking for Spot  or Your Dog’s Best Health. I will provide answers to these questions in one week. Good luck!

1. You’ve just arrived home after a long day at work to find two vials containing two of your own prescription heart medications spilled on the bathroom floor and it is clear that several of the pills are missing. All three of your dogs greet you with smiles on their faces. What should you do?

a. Do some “watchful waiting” to see which dog, if any, develops symptoms.

b. Head to your local veterinary emergency clinic with the pill vials, the remaining pills, and the dog who has always been the gluttonous troublemaker.

c. Head to a veterinary emergency clinic with the pill vials, the remaining pills, and all three dogs.

d. Use hydrogen peroxide to induce vomiting in all three dogs.

 

2. The following is not a true veterinary emergency:

a. Your dog or cat is suddenly having difficulty using both hind legs.

b. Your dog or cat vomited and the vomited material contains fresh blood.

c.  Your dog suddenly began favoring one hind leg while cavorting at the dog park.

d.  You observed your dog or cat licking from a puddle of spilled antifreeze.

 

3. Seizures in pets are not caused by:

a. Inappropriate use of a flea control product.

b. Ingestion of marijuana.

c. Ingestion of snail bait.

d. Ingestion of sugarfree gum.

 

4. After parking your car in a large shopping mall lot on a very hot day you notice that a dog has been left in a neighboring car. The car windows are cracked open and the doors are locked. The dog is panting, but looks bright and alert. What should you do?

a. Head into the shopping center to convey your concerns to someone affiliated with mall management.

b. Break into the car.

c. Call 911.

d. Hang out and wait until the owner of the car returns.

 

5. Your dog Angel was hit by a car and you immediately transport her to a nearby veterinary emergency clinic, one which you have never been to before. Clearly one of Angel’s legs is broken, she is in pain, and she is experiencing labored breathing. In the rush to get her to the emergency clinic, you forgot to bring along any form of payment to leave a deposit for her care. What is the veterinary staff obligated to do?

a. Hospitalize Angel for observation, but delay beginning any diagnostics or treatment until you return with your deposit.

b. Provide all emergency care necessary to attempt to stabilize Angel’s condition until you return with a deposit.

c. Provide pain medication as needed until you return with a deposit.

d. answers b and c.

 

6. It is Sunday afternoon and your pet Smokey appears suddenly unable to see. Other than appearing somewhat disoriented and bumping into things, he appears quite normal. You should:

a. Plan to call your family veterinary hospital first thing in the morning to schedule an appointment for Smokey to be evaluated.

b. Take Smokey to a veterinary emergency right away.

c. Monitor Smokey at home for a few days to see if the vision loss goes away or any other symptoms develop.

d. Go on line to research the potential causes of blindness.

 

7. Your dog Ralphie receives a regimen of medications for his chronic skin allergies, kidney failure, and diabetes. It is Sunday morning and he has refused his breakfast and is vomiting. You pack him up to take him to the emergency clinic. Besides little Ralphie, what else should you bring?

a. All of Ralphie’s current medications.

b. A copy of Ralphie’s medical records.

c. Ralphie’s current diet.

d. All of the above.

 

8. Your dog Dexter was just involved in a dog fight at the dog park. He appears just fine other than multiple small puncture wounds on his legs and face. He has already returned to playing with the other dogs. What should you do?

a. Continue to let Dexter play.

b. Take your dog home right away to wash the wounds.

c. Have your dog examined by a veterinarian right away.

d. Contact your attorney.

 

Please send your responses to me at Dr.Kay@SpeakingforSpot.com. I will provide answers along with the names of the lucky book winners in one week.

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Methicillin Resistant Infections

June 16th, 2013

Photo Credit: ©Susannah Kay

For several years now there has been a good deal of press about methicillin resistant Staphylococcal infections in people. Such infections are now all too common in veterinary patients as well. Staphylococcal bacteria are normal residents on the skin surface in humans and animals. Although they are part of the body’s standard flora, they are “opportunistic” little buggers, meaning they will gladly create infection when a good opportunity arises such as an inflammatory condition, a wound, a surgical incision, or a compromised immune system.

In humans, methicillin resistant infections typically involve Staphyloccocus aureus, therefore the designation MRSA. While animals occasionally develop MRSA, they are far more commonly infected with methicillin resistant Staphylococcus pseudointermedius, therefore the designation of MRSP. What MRSA and MRSP share in common is a particular gene that confers antibiotic resistance against methicillin and a variety of other antibiotics including penicillins and cephalosporins.

MRSP infections in dogs and cats

MRSP infections in dogs and cats most commonly affect the skin, ears, and urinary bladder. Symptoms of methicillin-resistant infections are identical to those that are methicillin-sensitive. Evidence of a skin infection varies from small raised red bumps to open oozing sores. The feet are commonly affected. Symptoms of ear infections often include redness, tenderness, and discharge within the ear canal. Bladder infection symptoms may include straining to urinate, increased frequency of urination, inappropriate urination (the well house trained dog is now soiling in the house), and blood within the urine. Veterinarians suspect methicillin resistance if the symptoms fail to improve or worsen in response to conventional antibiotic therapy. Methicillin resistance is confirmed with a culture that identifies the species of bacteria along with its susceptibility to a variety of antibiotics.  

Treatment of MRSP

Treatment of methicillin resistant skin or bladder infections in dogs and cats requires oral antibiotics. The drug choice should be based on bacterial culture and antibiotic susceptibility testing. The antibiotics most commonly used are sulphonamides, chloramphenicol, clindamycin, rifampicin, doxycycline, and minocycline. Sulphonamides can cause diminished tear production (dry eye). For this reason, measurement of the animal’s tear production should be measured before and during treatment with these antibiotics. Chloramphenicol can result in bone marrow suppression in people so special precautions should be taken when handling this medication. Vancomycin and linezolid are typically very effective against methicillin resistant infections, however it is recommended that these drugs be reserved for human MRSA patients with hopes of preventing development of antibiotic resistance from overuse. The duration of treatment with oral antibiotics depends on the severity of the infection, but a minimum of three weeks is typically recommended.

Topical therapy (treatment applied directly to the site) is very important in conjunction with oral antibiotics when treating skin or ear MRSP infections. For milder ear infections topical therapy may be all that is needed. Medicated shampoos and frequent bathing may be prescribed. Clipping the hair away from infected skin sites may be necessary for best results.

Recommended precautions

If your dog or cat has an MRSP infection, what precautions should be taken to avoid developing the infection yourself? The good news is that reports of infections in humans exposed to MRSP are exceedingly rare. Veterinarians who specialize in dermatology experience daily exposure in the workplace (MRSP skin and ear infections are so darned common), yet there have been no reports of infection amongst these specialists.

If your dog or cat has an MRSP infection, pay attention to good hygiene. The most important precaution is frequent and thorough hand washing with soap and water after touching or handling your pet and his or her food bowls and bedding. Regularly wash collars, leashes, toys, pet bowls, and bedding. Wash pet bedding, towels, and pet clothing separately from the rest of the household laundry, and dry on high heat. And, perhaps the most difficult step- your pet should not sleep on your bed until the infection is fully resolved. Special precautions should be taken with children (they are not the most diligent hand washer). Lastly, anyone who is pregnant or at increased risk for infection (HIV positive, taking medications that suppress the immune system) should take preventive measures based on advice received from their own physicians.

What about other dogs and cats in the household? They do not need to be separated from the pet with the active infection unless they have immune system compromise, an open wound, or some other factor that predisposes them to infection. Dogs with active MRSP infections should ideally be kept away from community venues (dog parks, doggie day care, training classes, pet facilitated therapy) in order to prevent exposure to individuals who may be more susceptible to infection.

A final note

It is thought that the increased prevalence of methicillin resistant Staphylococcal infections is caused, at least in part, by the overuse of antibiotics. I can certainly attest to the fact that, within the veterinary profession, antibiotics are often prescribed without good reason. If your veterinarian recommends antibiotic therapy for your pet, I encourage you to request justification for doing so. Ask for a description of the indicators that suggest a bacterial infection is the cause of your pet’s symptoms. The very best evidence is a culture that documents the presence of infection. Treatment based on culture, rather than simple suspicion, is the ideal standard of care.

Have you ever had to deal with a methicillin resistant infection?

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.

 

 

Hot Spots

June 9th, 2013

Reference the term “hot spot” these days and one thinks about a point of Internet access. Not so for veterinarians who reserve the term “hot spot” for a common skin problem capable of causing canine misery, particularly in the spring and summer when allergies and fleas make a comeback from their winter dormancy.

Acute Moist Dermatitis

The more technical name for a hot spot is “acute moist dermatitis”, a localized skin eruption that appears very quickly (sometimes in a matter of hours), hence the term “acute”. “Moist” is included in the description because, invariably the sores are wet and messy. Lastly “dermatitis” refers to inflammation of the skin.

What causes them?

Technically speaking, the cause of a hot spot is whatever incites the initial skin irritation, such as a fleabite, trauma to the skin, or allergies. Truth be told, it is the dog’s incessant licking, biting and scratching in response to the irritation that actually creates the hot spot. This self-trauma begets more inflammation which begets more self-trauma- a classic vicious cycle.

For the dog, the end result of all that scratching, licking, and chewing is a cesspool of bacteria, damaged skin and pus hidden beneath a wet covering of densely matted fur. The person discovering the hot spot is invariably surprised because of the seemingly sudden onset and camouflage beneath the hair coat.

For unknown reason, Golden Retrievers and Saint Bernards are particularly predisposed to developing hot spots.

Treatment

While successful treatment of most hot spots requires help from a veterinarian, milder cases can be successfully managed at home. The key is to clip the hair away from the site of inflammation. Bacteria thrive in a moist environment and, until the hair is removed, the hot spot will remain wet and actively inflamed. For some dogs, the hot spot is so painful that sedation is required for the clipping process (always surprising given that, left to his or her own devices, the dog will aggressively scratch, lick and chew at the site). Invariably, the clipping reveals a skin sore far larger and uglier than what was imagined when the site was covered by hair. If you are performing this step at home, please stick with clippers only. Attempting to get the job done with scissors on a wiggly, painful dog is an accident waiting to happen (now the vet must treat a laceration in addition to a hot spot).

Once the site is clipped it should be gently cleansed with an antibacterial product. It’s often not possible to remove all of the crusting and debris during the first go round and the cleansing must be repeated a couple of times daily. Following cleansing, the area should be gently dried with a towel or hair dryer set at a medium or cool temperature.

Clipping and cleaning are all that is necessary for very mild hot spots. More severely affected dogs should receive oral or injectable antibiotics to eliminate the bacterial infection. Antibiotic ointments applied directly to the site are usually avoided, as they tend to keep the healing site too moist.

Antihistamines and/or cortisone may be prescribed in order to “cool off” the inflammatory process and/or treat any underlying allergy.

If fleas are a factor flea control products are recommended for use on the individual with the hot spot as well as all of the other dogs and cats in the household.

Lastly, it is super-important to put an end to the self-trauma. This usually involves use of an Elizabethan collar (the “cone of shame”) and careful supervision for the first several days.

Has your dog ever had a hot spot? Were you able to treat this at home or was a veterinary visit necessary?

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.