Were You Smarter Than a Vet Student About Ear Infections?

Thanks to everyone who took this ear infection quiz. Congratulations to Arlene Millman of Huntington, New York, winner of the book drawing. She’ll be receiving a copy of Speaking for Spot!

Below are the correct responses to the quiz questions along with explanations. I hope you learn something new!

  1. Ear infections can be caused by:
  2. Allergies
  3. Water in the ear canals
  4. Hormonal imbalances
  5. All of the above

Most ear infections have an underlying predisposing cause that alters the health of the ear canal thereby setting the stage for yeast or bacteria to set up housekeeping. A moist environment within the ear canal is one such predisposing cause. Hormonal imbalances and allergies can cause inflammation within the lining of the ear canals which can result in secondary infection.

  1. Which of the following is not a cause of ear infections?
  2. Yeast
  3. Foreign bodies
  4. Viruses
  5. Tumors

Anything that disrupts the normal architecture of the ear canal, such as a tumor or foreign body, can result in secondary infections. Those of you who live west of the Mississippi are likely familiar with foxtails, far and away the most common foreign body to land in a dog’s ear canal. Yeast organisms thrive in warm moist environments, and are a common cause of canine ear infections. Viruses are not a cause of ear infections.

  1. Ear mites are common in
  2. Adult dogs
  3. Adult cats
  4. Kittens and puppies
  5. Feral cats

Ear mites are readily contagious with close contact, so it makes sense that they are common within feral cat colonies. While ear mites do occur in dogs and cats of all ages, these creepy crawlies are a relatively uncommon cause of ear infections.

  1. The cause of an ear infection can be reliably determined by
  2. The appearance of the discharge
  3. The odor of the discharge
  4. An otoscopic exam (looking in the ear canal with an otoscope)
  5. None of the above

Microscopic examination of discharge from the ear canal is the very best way to diagnose whether an infection is caused by yeast, bacteria, or mites. This determination cannot be made simply by smell or visual inspection.

  1. Infection-associated tears in the eardrum (tympanic membrane)
  2. Are very uncommon
  3. Dictate a change in treatment strategy
  4. Cause deafness
  5. Are typically very slow to heal

Infection-associated tears in the eardrum are relatively common. When this is the case, it’s presumed that there is also infection within the middle and inner compartments of the ear, a condition referred to as otitis media interna. These tears tend to heal rather quickly. The tear itself does not typically cause deafness, but chronic inner ear infections certainly can. Finding a tear within the tympanic membrane definitely changes treatment strategy compared to finding infection only within the external ear canal. For example, systemic rather than just topical antibiotics might be used and ear cleaning is avoided for fear of flushing debris deeper into the middle and inner ear compartments.

  1. Patients with recurrent or chronic ear infections are sometimes referred to:
  2. A veterinarian who specializes in dermatology
  3. A veterinarian who specializes in neurology
  4. A veterinarian who specializes in surgery
  5. Any of the above

Referral to a veterinary specialist makes really good sense when ear infections recur frequently, cannot be resolved, and/or lead to other abnormalities. Given that the lining of the ear canal is an extension of the skin, referral to a dermatologist (skin doc) is a logical choice. If the ear infection affects the inner ear and neurological symptoms such as a head tilt or dizziness develop, help from a neurologist may be recruited. A veterinarian who specializes in surgery may be called upon to either open up or entirely remove the external ear canal. These are last resort treatments, used when the ear canal has become profoundly scarred and narrowed as a result of chronic inflammation.

  1. Which of the following is not a potential strategy for preventing ear infections?
  2. Regular ear cleaning
  3. Regular swimming to help flush out the ear canals
  4. Ear canal surgery
  5. Feeding a special diet

Food allergies can create ear canal inflammation that sets the stage for infection, hence the need for a special diet. Regular ear cleaning works well to manage some dogs and cats with recurrent ear infections. As mentioned in question 6, surgery is used to treat some animals with severe ear canal changes caused by chronic inflammation. Water deposited in the ear canals as a result of swimming can be a cause of recurrent ear infections for some dogs. It is never considered a preventive strategy.

  1. Which one of the following statements is true?
  2. The treatment for ear infections is typically the same regardless of cause.
  3. Most ear infections are contagious from one ear to the other.
  4. Most ear infections arise because of some other underlying issue.
  5. Ear infections invariably cause scratching at the ears and/or head shaking.

The treatment strategy for ear infections varies from patient to patient depending on the type of infection present as well as its underlying cause. Other than ear mites that trundle over the top of the head from one ear to the other, ear infections are not considered to be contagious from ear to ear. Because both ear canals are typically impacted by the same underlying issue (water in ear canals, allergies, hormonal imbalances, etc.) that sets the stage for infection, it makes sense that both ears are often affected. Lastly, while head shaking and ear scratching are common indicators of an ear infection, not all dogs and cats demonstrate these symptoms.

Have these answers surprised you? Have you learned anything new?

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.

 

Are You Smarter Than a Vet Student About Ear Infections?

Ear infections are so darn common, particularly amongst dogs, and can be the cause of multiple veterinary hospital visits. If you care for a dog or cat with recurrent or chronic ear infections, it behooves you to become as informed about this issue as possible. Here’s an opportunity to test your knowledge about this common malady.

Submit your responses and your name will be entered into a drawing for a copy of Speaking for Spot  or Your Dog’s Best Health (winner’s choice). The correct responses will appear in my next post. Good luck!

  1. Ear infections can be caused by:
    1. Allergies
    2. Water in the ear canals
    3. Hormonal imbalances
    4. All of the above
  1. Which of the following is not a cause of ear infections?
    1. Yeast
    2. Foreign bodies
    3. Viruses
    4. Tumors
  1. Ear mites are common in
    1. Adult dogs
    2. Adult cats
    3. Kittens and puppies
    4. Feral cats
  1. The cause of an ear infection can be reliably determined by
    1. The appearance of the discharge
    2. The odor of the discharge
    3. An otoscopic exam (looking in the ear canal with an otoscope)
    4. None of the above
  1. Infection-associated tears in the eardrum (tympanic membrane)
    1. Are very uncommon
    2. Dictate a change in treatment strategy
    3. Cause deafness
    4. Are typically very slow to heal
  1. Patients with recurrent or chronic ear infections are sometimes referred to:
    1. A veterinarian who specializes in dermatology
    2. A veterinarian who specializes in neurology
    3. A veterinarian who specializes in surgery
    4. Any of the above
  1. Which of the following is not a potential strategy for preventing ear infections?
    1. Regular ear cleaning
    2. Regular swimming to help flush out the ear canals
    3. Ear canal surgery
    4. Feeding a special diet
  1. Which one of the following statements is true?
    1. The treatment for ear infections is typically the same regardless of cause.
    2. Most ear infections are contagious from one ear to the other.
    3. Most ear infections arise because of some other underlying issue.
    4. Ear infections invariably cause scratching at the ears and/or head shaking.

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

How Will Our Animals Respond to the Eclipse?

I’m mighty lucky in that a short hike to a clearing in the woods adjoining my property will place me in the zone of totality (I simply love this expression) for the upcoming eclipse. And the best part is, I suspect that, other than my husband and me, only deer, birds, bears, coyotes, turkeys, bobcats, and other wildlife know about this clearing.

True confession- I’m really not a big fan of astronomy. Nonetheless, the experience of delving into darkness at 2:30 in the afternoon sounds pretty darned exciting. I just read an Annie Dillard essay called “Total Eclipse” in which she treats the reader to this fabulous line- “Seeing a partial eclipse bears the same relation to seeing a total eclipse as kissing a man does to marrying him.” Her essay, and this metaphor in particular, has amped up my eclipse excitement exponentially!

And then there is the anticipation of what I will see immediately following the eclipse. Will nocturnal animals be out and about, lured from their nests, dens and burrows by the midday darkness? Perhaps on our return hike from the woods we’ll be treated to the sight of a skunk, or raccoon, or owl. How cool would that be!

I’ve heard some people express concern about how their pets and livestock will fare during the eclipse. I’ve received questions such as, “Should I keep the dogs and cats inside?” and “Should I put a fly mask on my horse?” In terms of eye protection, I’ve been providing reassurance that there is no need to worry. Just as is true for any other day, there’s nothing about the eclipse that will compel our animals to look directly at the sun. Dogs, cats, pigs, horses, goats, chickens, etc. simply don’t stargaze, moon gaze or sun gaze.

What I don’t know for sure is if the eclipse will elicit any behavioral changes in our critters. Might they experience anxiety, curiosity, fear, or confusion? I suspect some will, particularly those who reside at the anxious end of the behavioral spectrum (I live with one of these). I predict that, for the vast majority of our furry and feathered family members, the eclipse will be nothing more than a “yawn” moment.

If eclipse-related animal behavior has piqued your curiosity, I encourage you to check out the iNaturalist app. The California Academy of Sciences invites you and other citizen scientists to use this app to record and submit what your animal does during the eclipse. Your data will become part of a project called Life Responds.

I hope you manage to enjoy the eclipse wherever you are and please tell me about any interesting animal responses you observe!

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.

 

Fear Free Approach is Thriving

Representatives from the Fear Free Certification Program recently announced that approximately 5,500 veterinary professionals have achieved certification status and 14,000 more are in the midst of doing so. These are some monumental statistics given that the Fear Free approach was conceptualized just a few short years ago by Dr. Marty Becker, a wonderfully innovative and caring veterinarian. When he first told me about this new idea percolating in his brain, he was over-the-top excited. His mantra, “Take the ‘pet’ out of ‘petrified,” has caught on big time and his Fear Free Program has provided a win-win-win situation for veterinary professionals, their clients, and, most importantly, their patients.

In developing Fear Free, Dr. Becker recruited a 160-member advisory panel including practicing veterinarians, technicians, hospital and animal shelter designers, board certified veterinary anesthesiologists, and specialists in animal behavior.

Fear Free objectives

The objectives of the practice of fear free veterinary medicine include:

  • Reduction or removal of anxiety triggers that can cause pets to become fearful at home during house call visits or en route to and within the veterinary hospital
  • Enhancement of the quality of medicine
  • Increased compliance with treatment recommendations
  • Improved safety for the veterinary team

“The success of this program is owed to three main factors,” says Dr. Becker. “First, Fear Free is the right thing to do; nobody gets involved with veterinary medicine to make life worse for animals. Second, Fear Free allows veterinary professionals to practice a higher quality of medicine while elevating care for their patients. Finally, pet owners are actively searching for individuals with certification to take care of their pets, so practitioners are flocking to certification because of market demand.”

In order to achieve Fear Free Certification status, students immerse themselves in learning about a variety of topics examples of which include canine and feline behavior and body language, ways to minimize stress in the waiting room, gentle handling techniques, the use of treats and pheromones, and the use of complementary therapies and medications that can help reduce fear, anxiety, and stress.

Dr. Thomas Meyer, current president of the American Veterinary Medical Association, expressed his feelings about Fear Free by stating, “Fear Free has added an amazing fresh perspective in our professional interactions with our patients and clients. Our entire veterinary team has bonded to make sure each pet’s visit is a positive and enjoyable experience. Our clients see how we embrace the human-animal bond by our commitment to a Fear Free visit. This is a game changer and must for every pet.”

What Fear Free things happen at your veterinary hospital?

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.

 

 

Things Your Vet Might Recommend for Your Pet’s Diarrhea

SFSBlog_diarrhea_madartichoke_together_FlickerCCDiarrhea becomes a fact of life for most of our pets at some point or another. If the diarrhea persists for more than a few days or is recurrent, it’s a good idea to check in with your veterinarian even if your dog or cat seems to be feeling just fine otherwise.

Beyond performing a thorough physical examination, there are a number of things your veterinarian may recommend. Below is the rationale behind these recommendations.

Diagnostic testing

Whenever possible, having a diagnosis in hand (ugh, given the topic, this sounds kinda gross) is the very best path for getting the problem resolved. A variety of diagnostic tests are readily available to determine the cause of your pet’s diarrhea. The usual starting point is a fecal exam to look for intestinal parasites. Next come blood and urine testing to rule out underlying issues such as hyperthyroidism (kitties), liver or kidney disease. Specialized blood testing looking for issues such as inadequate production of digestive enzymes, decreased levels of folate or cobalamin (both are B vitamins necessary for normal gut health), or hormonal imbalances that can cause diarrhea may be indicated. If results from these tests fail to provide a diagnosis, imaging , typically x-rays and/or abdominal ultrasound, is the usual next step. Lastly, your veterinarian may recommend getting an up close and personal look at the bowel and collection of biopsies by way of either surgery or endoscopy.

Empirical therapy

Empirical therapy refers to administration of treatment without knowledge of the underlying diagnosis. Such therapy will likely be recommended for your pet’s diarrhea should you and/or your veterinarian determine that the testing needed to establish a diagnosis isn’t feasible. Listed below are empirical treatments commonly recommended for dogs and cats with diarrhea.

Fenbendazole

Intestinal parasites are a common cause of diarrhea in dogs and cats. Depending on the life cycle of the worms, sometimes they and/or their eggs simply don’t show up on fecal screening. For this reason, your veterinarian may recommend empirical deworming with fenbendazole, a highly effective broad spectrum executioner of most intestinal parasites.

Food trial

Your veterinarian may recommend a novel protein diet to help rule out a food-responsive enteropathy, in essence, a food allergy that can cause diarrhea. Back in the day when I was just a pup, we would prescribe lamb for such food trials. Lamb has become such a common ingredient in commercially prepared foods, that, by the time they arrive at adulthood, most dogs have already been exposed to it. Nowadays, novel protein sources such as kangaroo, ostrich, rabbit, quail, alligator, and duck are commonly recommended. Some veterinarians prefer hydrolyzed protein diets in which the protein has been broken down into molecules that are so small they escape detection by the immune system, thus avoiding an allergic reaction.

When fat is not properly absorbed within the gut, diarrhea is a predictable outcome. For this reason, your veterinarian may recommend a diet with reduced fat content.

The addition of fiber to the diet can be of benefit for diarrhea. Canned pumpkin is a commonly recommended source of fiber- good luck getting your kitty to eat this!

Food trials are typically prescribed for a four to six week time period, although improvement is often observed within the first couple of weeks.

Antibiotics

Just like us our pets have different types of “normal” bacteria that reside within their gastrointestinal tracts. When there is shifting of bacterial populations such that there is overpopulation of some and crowding out of others, a variety of gastrointestinal symptoms, including diarrhea, can develop. This condition is referred to as antibiotic responsive enteropathy (formerly known as small intestinal bacterial overgrowth or SIBO). Your veterinarian may recommend empirical treatment with a particular type of antibiotic along with a probiotic. The hope is that this combination will restore a healthier balance of bacterial flora within the gut.

I want to emphasize that bacterial infections within the bowel are as rare as the proverbial hen’s teeth. Any antibiotic you give for diarrhea should be aimed at treating antibiotic responsive enteropathy rather than infection. The exception to this is the diarrhea called granulomatous colitis, also known as histiocytic ulcerative colitis. Sometimes referred to as “Boxer colitis” because it occurs almost exclusively in Boxer dogs, this disease is caused by bacteria and responds dramatically to treatment with the antibiotic enrofloxacin (Baytril).

Other medications

Should the above steps fail to remedy your pet’s diarrhea, your veterinarian may prescribe any one of a number of empirical medications. They run the gamut from gut motility modifiers to intestinal coating agents to anti-inflammatory medications. Corticosteroids such as prednisone or prednisolone are recommended as empirical treatment for diarrhea. Steroids have the potential for lots of side effects, so thorough discussion with your veterinarian should precede their use.

Bear in mind that none of these empirical therapies are an ideal substitute for obtaining a diagnosis. If your pet’s diarrhea fails to resolve in response to any of the treatments recommended, revisiting the option of further diagnostic testing is warranted.

In general, veterinarians who specialize in internal medicine have the most expertise diagnosing and treating chronic or recurrent diarrhea. Your time and resources, and, most importantly, your pet may be best served by working with such a specialist.

Has your pet had chronic diarrhea? If so what was the cause? What treatment fixed or failed to fix the problem?

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.

Dear Dr. Kay……

As a change of pace I thought it might be fun to share a few questions I’ve received from readers like you. I hope that they, along with my responses, are of interest and who knows, you may just learn something new.

Patient restraint

From Alice:

When vet technicians are asked by the veterinarian to hold a dog for examination, vaccination, drawing a blood sample, etc., they often do their best to completely immobilize the dog by getting it in a lock-hold and clamping down hard. I try to train my dogs to cooperate with minor veterinary procedures, with good success. Yet it is often difficult to persuade a vet/vet tech to give the dog a chance to be a willing participant. Can you offer some guidance about when it’s reasonable for me to make this request and what would be the most effective way to convince the vet/vet tech to give it a try? Also, when is it appropriate for the client to hold/restrain the dog? I realize vet techs have training that the owner does not, but I hate handing my dogs off to the vet tech to hold when I’m right there in the room with the vet. By far, the most stressful part of the vet-client relationship for me is being forced to hand off the dog to vet techs. Gah, I’m getting stressed out just writing this! Your thoughts?

My response:

Hi Alice. Those of us who have worked with plenty of animals in a veterinary hospital setting know that flexibility is the key to great restraint- comfortable for the pet and safe for everyone who is working with that animal. Some animals do best when restrained on their sides, some while sitting, some while standing, and others while lying down sternally. Some do best with a humane muzzle or something covering their eyes so they can’t see what’s going on. Others react strongly to a muzzle or blindfold. Some animals need to be held firmly while, for others, less is more. So application of a “one restraint fits all” approach doesn’t make good sense. We should attempt to be successful with each and every patient we see.

Some owners want to be involved with restraint of their pets. I know plenty of vets who are dead set against this for fear of liability should the owner become injured, and I can’t say as I blame them. I do encourage owners to be present, but I generally discourage them from performing restraint unless they are clearly experienced and I get a good strong sense that their pet will be okay with this.  A special finesse is often required to effectively restrain a pet in a veterinary hospital setting.  And, it feels lousy if an owner gets hurt in the process.  Simply having the owner in the room and visible is usually adequate in terms of providing a “calming presence”.

I find that recruiting the owner to help restrain is consistently useful and practical when I’m working with law enforcement dogs (and these dogs are typically muzzled for whatever we do per their handler’s recommendation).

So, how can you ask your veterinarian to be more receptive to doing things differently? I encourage a respectful conversation about this. Schedule a meeting time. Let the doctor know what your observations have been and how others (like me) feel about this topic. The late great Dr. Sophia Yin has written a wonderful book about in-hospital restraint techniques. The title is Low Stress Handling, Restraint, and Behavior Modification. Consider purchasing a copy for your veterinarian. Best of luck!

Urinary accidents- behavioral versus medical

From Debra:

Hi Doctor. My question is about dogs marking inside. I just rescued a 2.5 yr old neutered Pug. I have 2 spayed female mutts at home, one is 16 yrs, the other is 3 yrs. All 3 dogs are non-alpha type dogs. My females are both shy and not aggressive or domineering in anyway. Day 3 after I brought the new Pug home, I caught him marking twice and redirected him outside, and I saw evidence 3 other times. He is successfully using a doggy door. I got some bellybands and kept them on him for a week or so and the markings stopped. But now it’s started up again 4 weeks later, mostly when he is left alone for more than 2-3 hours and always in the same place near the back door on the tile floor of kitchen and bathrooms. I went back to the bellybands, and also moved his food bowl right to the place where he was marking as it was pretty nearby anyway. I’m firm with him about listening to me, sitting before eating and staying off the furniture. I have no other issues with him. Is there ANYTHING else I can do? I read somewhere that I should start feeding him first before the other two dogs so that he would feel dominant and the marking would stop. Any truth to this? I do feed him last, within seconds of the other dogs, but he is last. Oh, and his foster and previous owner said he did NOT mark in their homes. And I am thoroughly cleaning markings after I find them. Thanks!!

My response:

Hi Debra. First and foremost, congratulations and kudos to you for rescuing your new dog. I encourage you to set up an appointment for the new guy with your veterinarian for a thorough physical examination and urine testing. An underlying medical issue such as bladder stones or a urinary tract infection could be the cause of what you are describing. If he gets a clean bill of health, I recommend moving on to a savvy dog trainer or behaviorist for help. Back to basics crate training may be in order. Feeding this new guy earlier than the established two is certainly an easy thing to try. And then when the other two are eating, you can be outside with the new guy praising the living daylights out of him every time he urinates in the appropriate spot. I hope this helps get you started. Let me know what you figure out.

Cost concerns

From Deanna:

Hello Dr. Kay, and thank you for answering my question! I have two senior dogs who have visited a holistic vet regularly throughout their lives (and at great expense: titers instead of vaccines, regular check ups, visits at every hint of a problem, etc.). I recently suspected one of my two dogs had a bladder infection. After urinalysis, it was confirmed and she suggested a course of antibiotics and a follow up test to make sure the infection was gone. I was shocked when the vet charged me again for that follow up test — a total of nearly $175 including drugs. Now it looks like he’s developing another infection, and there is no way I can visit this vet every 3 months at that price! Is it customary to charge this much for treating a chronic ailment? What is the best way to express my feelings about this as a regular customer, or do I need to look for another vet? We’ve gone to her for 11 plus years but I just can’t afford her care at this rate, which is a shame.

My response:

Hi Deanna. I always encourage people to lay their financial cards on the table, and I recognize that this can be difficult to do. Remember, what you and your veterinarian have in common is a desire to preserve your dog’s health and comfort for as long as possible. Rarely is there only one option for successfully managing a patient. It behooves you to learn what other less expensive options exist. Additionally, if affordable, consider investigating why your dog is having recurrent bladder infections. If they can be prevented, you will likely save a good deal of money.

Sooner rather than later

From Al:

I’ve told all the dog people I know that Speaking for Spot is one of those great books where you say, “Geez, I wish I had this when we were going through all the stuff we went through with our dogs” and they need to get it. And that there’s a lotta stuff in there that it’s taken most of us 10-15 years or more of not always so pleasant experience and several dogs to learn, or that we didn’t learn even with all that experience. Somebody can save themselves a whole lotta time and grief by just getting it, reading it now, and being way ahead of the game.

My response: Thank you Al for this wonderful feedback. I wrote Speaking for Spot because I am passionate about people becoming savvy and effective medical advocates for their pets. This is not the first time I’ve heard, “I wish I’d had your book back then…..” Thanks for sharing your enthusiasm with the dog people you know.

Do you have a question you’d like to ask me? If so, please post it here.

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.

 

Nellie Appears to Be Older Than We Thought

Nellie. Photo Credit: Susannah Kay

I recently published information about the changes that occur as our dogs age and what we can do to enhance their longevity. As of late, I’ve unexpectedly discovered that this information has become relevant in my own household.

I first set eyes on Nellie when a Good Samaritan picked her up as a stray in a neighboring town and dropped her off at my hospital. A receptionist delivered her to the treatment room with her arms fully outstretched, carrying this little waif as far away from her clothing as possible. Can’t say as I blamed her. Until she’d been bathed, there’d be no cuddling with this greasy, grimy, smelly, bleeding ragamuffin of a dog.

Nellie, as she would come to be called, was in heat, had a horrible skin infection, and had been peppered with BB’s. She was a skinny little soul, in need of an additional four to five pounds on her six-pound frame. Her nipples were somewhat enlarged suggesting puppies in the not too distant past.

Nellie was completely emotionally shut down. Once placed in a hospital cage, she didn’t move, much less eat or drink. She offered no protest whatsoever to being examined or bathed. There was neither a growl nor a single wag of her tail.

Nellie’s eyes were her most compelling feature- beautiful large eyes that were an unusual collage of varying tones of brown. Nellie’s horrific condition convinced me that it would not be in her best interest to go looking for her owner. Her eyes convinced me that she needed to come home with me.

Nellie spent her first week or so in my home not moving from a particular spot on a family room couch. Coaxing and cajoling were needed to get her to eat, drink, or go outside. Having just lost our two elderly dogs, Nellie had no canine companionship to set an example. She had to go it alone.

Ever so gradually, Nellie’s personality emerged. A good two years were required to receive the “full Nellie effect” in terms of her behavior and temperament. She is a super affectionate silly little girl who loves her daily walks with Quinn, her very best canine buddy. Best of all, she loves to sneak kisses. When you least expect it, Nellie’s tongue will snatch a lick after which she appears thoroughly delighted with herself. And, she is nondiscriminatory licker- she seemingly loves everyone!

To this day Nellie continues to demonstrate some fear/anxiety. When approaching a doorway she creeps up to it ever so slowly, just one step shy of being fully stopped. If I’m holding a door open for her, I’d best not be in a hurry. Once she reaches the door’s threshold, she scampers through. And, when a person approaches Nellie too quickly, she crouches to the ground, sometimes rolling over on her back.

When my husband (also a veterinarian) and I first met Nellie, we guesstimated her age to be somewhere between one and two. That was ten years ago, putting her current guesstimated age at 11 or 12. For an 11-pound dog, this would mean that Nellie is just embarking upon senior citizenship.

It’s now become apparent that our initial evaluation of Nellie’s age was inaccurate and we’re realizing that she likely became a senior a few years ago. We’ve recently noticed that Nellie’s hearing is dissipating, she’s not playing quite as much, and she is beginning to slow down a wee bit on our morning walks. Physical exam findings and laboratory testing have ruled out any underlying disease processes.

Such age-related changes are not expected in an 11-year-old tiny breed dog. I suspect that we underestimated Nellie’s age by a good two to three years, darn it! Given the changes we’ve been observing, I suspect our 11-year-old girl is more likely 13 or 14.

Such age miscalculations are easy to make. From birth to approximately six to nine months of age, one can quite accurately ascertain a dog’s age by its teeth. Once older than this, determining a dog’s age when there is no known history relies on one part intuition and three parts guesswork.

Our recognition that Nellie is older than we thought is somewhat sad news for us. We likely won’t have as much time with her as we’d originally thought.  And yes, we do know that, as unpredictable as life is, time frames are never guaranteed.

Now that I’ve discovered that I’m caring for a canine senior citizen, I must put my own advice on enhancing canine longevity to work as I take extra measures to keep Nellie comfortable, happy, and part of our family for as long as possible.

How old is your dog and what’s your level of certainty?

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.

 

Seven Things You Can Do to Enhance Your Dog’s Longevity

I recently addressed common age-related changes in dogs. Thinking about such changes begs the question, what can we do enhance the longevity of our canine companions. Here is a list of my top seven recommendations all of which I think are quite reasonable and doable. See what you think!

  1. Keep your dog at a slim trim body weight. Obesity dramatically contributes to ever so many age-related debilitating issues such as arthritis (a huge problem for way too many dogs), diabetes, and heart disease. Feed your dog as little as it takes to maintain an ideal body condition score. Remember, in general, older dogs require approximately 30 percent fewer calories to maintain a healthy body weight. If your dog is overweight, ask your veterinarian to help you devise a plan to tackle this problem.
  1. Speaking of feeding your dog, be sure to choose diets that are nutritionally complete, of very high quality, and appropriate for your dog’s stage of life. Once you have a senior citizen on your hands, a diet that is higher in fiber and less calorically dense is usually the best choice. Multiple small meals may be better suited to your dog than feeding a larger meal once daily.
  1. Get out there and exercise with your dog! Not only will exercise help burn calories, it will strengthen muscles, enhance circulation and improve your dog’s heart and brain function. The activity you choose should be appropriate for your dog’s level of strength and stamina. No weekend warriors allowed. Shorter more frequent walks may be better than going for a five mile run. Gradually build up the duration and exertion of your dog’s activity level.
  1. Speaking of exercise, be sure to take the steps necessary to allow your dog to be active. If arthritis pain is getting in the way, work with your veterinarian to find the right combination of remedies to allow your dog to be comfortable enough to exercise. There are a myriad of treatment modalities to choose from- acupuncture, massage, underwater treadmill therapy, supplements, anti-inflammatory medications, and the list goes on and on. Inactivity promotes a downhill cascade of events that is just about guaranteed to negatively impact your dog’s longevity. Do what it takes to prevent your favorite pooch from becoming a couch potato.
  1. Prevent your canine senior citizen from encountering physical harm. As your aged dog experiences loss of hearing and/or vision, leash walks and closer supervision become a necessity. Teaching hand signals at an early age will pay off as your dog begins to experience age-related hearing loss. Double check the whereabouts of your older dog before pulling into or backing out of your driveway. Older dogs are less agile. Add to this deeper sleep and diminished hearing or vision and, without extra caution a driveway tragedy can happen. (Unfortunately, such tragic accidents occur all too often.) Whereas youngsters can recover from broken body parts lickety split, such is not the case for older dogs.
  1. Act sooner rather than later when your dog isn’t feeling well. Compared to young and middle-aged dogs, seniors have less physical reserve and are more prone to becoming compromised following a spate of symptoms such as lethargy, not eating, vomiting, or diarrhea. Whereas a 24-hour “wait and watch” approach might be reasonable for the youngster with such symptoms, waiting this long with an older dog before contacting your veterinarian may have dire consequences.
  1. Schedule regular checkups with your veterinarian even if you think your dog is perfectly healthy. Once a year is ideal for young and middle aged dogs. Switch to twice yearly exams for seniors. A head to toe physical examination, discussing how your dog is faring, and blood and urine testing (particularly if your dog is elderly) will allow your veterinarian to detect abnormalities early, prevent minor issues from becoming major issues, and outline a preventive health care plan for your beloved best friend.

What are you doing to keep your older dog fit as a fiddle?

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.

 

Dogs and the Aging Process

Just like us, our dogs transition through a number of physical and functional changes as they age. This aging process is physiologic in nature, meaning alterations happening at the cellular level are responsible for the changes we observe.

Some of the age-related transformations we see in our dogs aren’t really problematic, and they may even feel endearing, such as the dignified graying of the muzzle or increased interest in lap time and human companionship. The changes that are of concern are those that result in impairment of normal function. Some examples are listed below.

Changes in muscle mass and body condition

Sarcopenia is the term used to describe loss of muscle mass or muscle wasting.  It’s common for dogs to experience sarcopenia as they age. Both the number and size of myocytes (muscle cells) decrease with age.

In addition to loss of muscle mass, many older dogs develop increased fat stores. On average, the percentage of body fat in young adult dogs is between 15% and 20%, while that of older dogs is between 25% and 30%. This may be related to age-associated slowing of the basal metabolic rate. Most dogs reduce their physical activity level as they enter their senior years, and it’s estimated that a dog’s total daily energy requirement (calories needed) decreases by 30% to 40% during the last third of their lives.

The loss of muscle mass in combination with increased fat stores can create a typical “geriatric look,” a dog who is not overtly underweight, but has a bony appearance and feel. The most significant impact of sarcopenia is weakness.

Changes in hearing

Age-related hearing impairment is caused by degeneration within the cochlea, a structure within the inner ear. The cochlea is responsible for producing nerve impulses in response to sound vibrations. Loss of hearing is almost universal in aged dogs and can have significant impact on normal activities.  For example, the dog who was always off leash on walks must now be leashed.  There are no solutions for correcting the hearing loss, but positive behavioral adaptations can be a big help. A way to be proactive is to teach hand signals in conjunction with verbal commands before the hearing loss occurs.

Gastrointestinal tract changes

With advancing age, many changes occur within the canine gastrointestinal tract. Examples include decreased stomach acid production, delayed emptying of the stomach, alterations within intestinal bacterial populations, decreased motility within the colon, and alterations in cells lining the intestinal tract. All of these can translate into gastrointestinal symptoms such as vomiting, diminished appetite, and abnormal or irregular bowel movements. The liver is part of the gastrointestinal tract, and liver cells undergo changes associated with the aging process. Increased liver enzymes are commonly discovered on blood tests results run on senior dogs.

Cardiac and vascular changes

Beginning in midlife, the amount of blood pumped out of the heart (cardiac output) gradually decreases. By the time the dog is geriatric, this cardiac output may decrease by as much as 30%. Additionally, the heart muscle loses some of its flexibility with the aging process. It becomes somewhat stiff resulting in less effective heart contractions. These changes can result in diminished activity and stamina.

Additionally, as dogs age, the lining of their blood vessels thicken and calcium may be deposited within the wall of the aorta both of which can contribute to an increased workload for the heart. For some dogs, these changes can promote the development of heart failure.

Kidney changes

The kidneys are comprised of millions of functional microscopic units called nephrons that are responsible for filtering waste from the bloodstream. With age, damage to nephrons results in a substantial decrease in number and permanent loss of function. Once there is a loss of critical nephron mass, kidney failure ensues. The older dog with mild kidney failure may not act sick, but without kidney reserve, becomes far less resilient to other illnesses or physiologic changes that may arise. 

Immune system changes

The immune system is an interactive network designed to provide protection from a variety of potentially damaging agents such as bacteria, viruses, malignant cells, and environmental toxins. Fundamental changes in immune system function occur in older dogs. Between 8 and 13 years of age dogs have decreased production of  lymphocytes (white blood cells that are an integral part of the immune system) in response to various immune system stimuli. Additionally, aging is associated with changes in the distribution of lymphocytes within the body. In general, older dogs are less resistant to infection and less capable of mounting an effective immune response to vaccinations.

Cognitive changes

Changes in cognition (mental capabilities) and behavior are to be expected in dogs with advancing age. Canine cognitive disorder (doggie dementia) is commonly diagnosed these days, particularly compared to a decade or so ago.

Dogs with cognitive impairment may demonstrate confusion, alteration of sleep patterns, and decreased social contact with humans. Cognitive disorders in aged dogs appear to be the result of oxidative damage (damage from oxygen-free radicals) within brain cells. Such changes can begin as early as 7 to 8 years of age. Medical therapy provides benefit for some dogs with canine cognitive disorder.

What age-related changes have you observed in your dogs and how have you managed them?

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.

 

Is the Flu Vaccine a Smart Choice For Your Dog?

Photo Credit: Flicker CC, Maja Dumat, tennisballNews articles about the expanding canine flu “epidemic” are popping up everywhere, and they seem intent on creating fear and worry. Rest assured, there is no need for panic. The better response is to learn about this disease and then consider whether or not vaccine protection makes sense for your dog.

What exactly is canine flu?

A virus known as H3N2 is the cause of the recent spate of canine flu (influenza) cases. The first dogs documented to have this virus were reported in 2015. To date, cases have been documented in most states within the United States. Much like human flu viruses, canine flu is quite contagious, spread primarily via respiratory secretions such as the type aerosolized through coughing and sneezing. The H3N2 virus remains active and infectious within the environment (kennel surfaces, bedding, toys, food and water bowls, etc.) for 12 to 24 hours. The virus is readily killed with soap and water. While the canine influenza virus can infect cats, it is not transmissible to people.

Symptoms

Because H3N2 is a brand new virus, dogs don’t carry any inherent immunity. This means that, once exposed, pretty much all dogs will develop the infection. Approximately 80 percent of those infected develop symptoms (approximately 20 percent remain symptom-free), and they occur within two to five days following exposure. Most infected dogs display the milder form of the disease with a cough that persists for two to three weeks. More severe symptoms can develop such as lethargy, decreased appetite, nasal discharge, and fever.

Diagnosis

A definitive diagnosis of H3N2 infection is made via laboratory testing performed on swab samples obtained from the nose or throat. Other testing such as chest x-rays and blood tests may be recommended to rule out other causes of coughing.

Treatment

Treatment for canine influenza consists of supportive care, antibiotics for secondary bacterial infections, and cough suppressant therapy. While most dogs recover within approximately two weeks, they may remain contagious to other dogs for up to four weeks and isolation from other dogs during this time is recommended.

A small percentage of dogs infected with the H3N2 virus go on to develop pneumonia for which hospitalization may be required. A handful of deaths associated with canine influenza have been reported.

The flu vaccination

A vaccine that provides protection against H3N2 infection is available through your veterinarian. It’s not a perfect vaccination in that it doesn’t always prevent infection, but it should lessen the severity and duration of symptoms. The initial vaccination series involves two injections given two weeks apart. The vaccine is then repeated annually.

Is your dog a good candidate for the flu vaccination? To figure this out, begin by asking your veterinarian if cases of canine influenza have been documented in your locale. If so, and your dog frequents venues where lots of dogs congregate (dog park, grooming parlor, doggie day care facility, competition event, boarding facility), the vaccine makes good sense, assuming that your dog has tolerated vaccinations well in the past. If your dog is a homebody with very limited exposure to other dogs, there is likely no need to consider vaccinating.

The canine flu vaccine should be considered for dogs who are elderly, infirmed or have underlying respiratory tract disease. These are dogs who might not tolerate a two to three week spate of significant coughing.

It is important to talk with your veterinarian and formulate a plan that makes the most sense for your dog. Keep in mind that vaccinations are no different than any medical procedure. They should not be administered without individualized discussion with your veterinarian and consideration of the potential risks and benefits.

Has your dog been vaccinated against canine influenza? If so or if not, what is your reasoning?

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.