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.

A Banner Year for Heartworm Disease

Photo Credit: Flicker CC, KatleneNiven,cat and dogIf ever there was a year to be vigilant about heartworm prevention, this is it. The number of dogs and cats diagnosed with heartworm disease within the United States is expected to increase this year because of above-average precipitation and temperatures, ideal conditions for the propagation of mosquitoes that transmit heartworms to our pets.

The nonprofit organization, Companion Animal Parasite Council (CAPC), tracks trends for various infectious diseases within the United States including heartworm disease, Lyme disease, anaplasmosis, and ehrlichiosis. A CAPC announcement released earlier this year states, “Given the ongoing trend toward above average temperatures and rainfall, CAPC is forecasting high levels of heartworm disease activity in 2017 for most of the country, with an especially active year for the Western United States.”Geography of heartworm disease

According to an American Heartworm Society survey, the number of cases of heartworm disease seen per veterinary clinic was 22 percent higher in 2016 than in 2013.  The five states with the highest incidence of heartworm infections in 2016 were, in order, Mississippi, Louisiana, Arkansas, Texas, and Tennessee.

The CAPC is predicting more heartworm disease this year in the lower Mississippi Valley as well as in the Rockies and westward. The incidence is also expected to be higher than usual in the Upper Midwest, the Ohio River Valley, New England, and the Atlantic Coast States. Interestingly, the CAPC predicts that West Texas, from Amarillo to Laredo is expected to have no increase and may have a decline in heartworm disease cases. (Texas readers, please do not take this is an invitation to back off on giving heartworm prevention!)

What this means for you and your pets

Don’t get caught with your pants down when it comes to giving heartworm prevention medication to your dogs and cats. Heartworm infection is a “poster disease” for the old adage, “An ounce of prevention is worth a pound of cure.” Treatment of heartworm disease is risky, pricey, and quite miserable for both pet and pet caretaker. And, the animal who isn’t treated for heartworm disease experiences some pretty darned awful symptoms along with a significantly decreased life expectancy.

There used to be areas within the United States considered to be “safe zones” where heartworm disease didn’t exist and prevention wasn’t necessary. This is no longer the case. Heartworm disease has been diagnosed in all 50 states.

If you aren’t already giving heartworm prevention medication to your dog or cat, consult with your veterinarian right away to get the ball rolling. The first thing your pet will need is a heartworm test to make sure that infection hasn’t already occurred. Keep in mind that animals typically show no symptoms of this disease for the first six months or more following infection.

If you’ve been giving preventive medication to your pet, but not on a regular basis, it’s time to create a reminder system that results in better compliance. Talk with your veterinarian about whether or not heartworm testing is warranted to make sure that a heartworm-carrying mosquito didn’t sneak up on your pet during a lapse in medication.

The American Heartworm Society website provides a great resource should you want to learn more about heartworm disease.

Have you ever treated a pet for heartworm disease? If so, how did it go?

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.

 

Preventing Summertime Dehydration

Photo Credit: Flicker CC, DBurkett, chaseSome of us take the phrase, “dog days of summer” quite literally- we want to go everywhere accompanied by our beloved dogs! Know that the heat of summer has the potential to be hazardous to your dog’s health. Without significant forethought and planning to accommodate higher temperatures, it’s easy for even the healthiest of dogs to become dehydrated, and dehydration can be a precursor to deadly heatstroke.

What exactly is dehydration?

Dehydration refers to a shortage of water within the body. Do you know that approximately 80% of your dog’s body mass is comprised of water? Not only is water a component of what flows within blood vessels (arteries and veins), water is also an essential component within cells and the tissues surrounding them. Given its ubiquitous nature, it’s easy to understand why having an adequate amount of water within the body is essential for maintaining normal blood pressure, circulation, and bodily functions.

Causes of dehydration

Dehydration results when too little water is consumed in relationship to the amount lost from the body. For example, a dog who is sick with vomiting or diarrhea and doesn’t feel good enough to drink lots of water to make up for these fluid losses can readily become dehydrated. Kidney failure can cause dehydration because the damaged kidneys produce abundant urine regardless of how little water is consumed.

Summertime heat promotes dehydration, particularly when a dog isn’t interested in or doesn’t have access to drinking lots of water. Think about the tennis ball obsessed dog who doesn’t like to interrupt a good game of fetch in order to gulp down some water. Whereas this may not be a problem in cooler temperatures, water loss associated with heavy summertime panting can quickly result in a fluid deficit.

Detecting dehydration

Dehydration causes a variety of symptoms and dogs may demonstrate from one to all of them. Symptoms include: lethargy, weakness, labored breathing, elevated heart rate, and dry and sticky feeling gums (normal gums are slick and smooth to the touch). If you suspect your dog may be suffering from dehydration, do your best to find some shade or an air conditioned environment and encourage drinking. If the symptoms don’t improve within a short time period (five minutes at most), it’s time to seek out emergency veterinary care.

Preventing dehydration

Here are some pointers to keep your favorite fido well hydrated this summer:

  • Exercise your dog early in the early morning or evening hours to avoid the most intense heat of the day.
  • Be sure to take along water and a water bowl (one that is familiar to your dog) wherever you go. Don’t rely on natural water sources being available.
  • Allow for plenty of rest and water breaks during play activity and exercise. Your dog may not know his or her limits and will continue to enthusiastically chase the Frisbee long after it’s time to slow down.
  • Provide water access frequently. When out in the heat, be sure to provide a water stop (for you and your dog) at least once every 15 to 20 minutes.
  • If your dog is preoccupied with something else (other dogs, a tennis ball, etc) or too excited to drink, best to cut your outing short for the sake of preventing dehydration.
  • As much as you love for your dog to go where you go, be reminded that, when temperatures are soaring, your dog’s well being may best served by being left at home.

What precautions do you take with your dog during the summer months?

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.

Euthanasia Outside of the Veterinary Hospital

When you determine that euthanasia is the right choice for a pet, a question to consider is where this process will occur. The ability to perform euthanasia in a professional and humane fashion is not restricted to the veterinary hospital setting.

More and more veterinarians are dedicating their house-call practices to providing an in-home euthanasia service. To do this job well, a very special doctor is required, one who is uber-gentle and compassionate with the animals as well as the human family members involved. In addition to playing the role of psychologist/social worker for folks who are in a profoundly vulnerable emotional state, euthanasia house call veterinarians must be adept at calculating just the right amount of the various drugs used along with placement of an intravenous catheter in a patient whose veins may be compromised and difficult to find because of debilitation, dehydration, and low blood pressure. Additionally, the veterinarian whose practice is devoted to house call euthanasia must be quite resilient from the psychological downfall that can arise from compassion fatigue.

Dr. Kathleen Cooney, veterinarian and author of Veterinary Euthanasia Techniques has been passionate about home euthanasia for the past decade. Her business, called Home to Heaven, provides a house call euthanasia service as well as home hospice care. After starting this practice in 2006, business took off quickly and she now employs more than a dozen staff members, including other veterinarians. “The reason veterinarians are choosing this work is that it is very rewarding and enriching, but also a way to get back into practice,” Cooney said. A euthanasia practice doesn’t require updating a huge bank of medical knowledge and the scheduling is flexible. This might be a good choice for a veterinarian coming out of a research setting or returning from maternity or paternity leave.

During the euthanasia procedure Dr. Cooney describes her goal of facilitating a calm more relaxed patient “where I’m just a friend who’s come to visit, I’m not a threat, and they have no memories of me.” She describes that only approximately 25 percent of her work involves ensuring the animal has a stress-free, pain-free death. The other “seventy-five percent of what I do is for the family,” said Cooney. “A big part of the reason people choose home euthanasia is they want a more enriching experience. These families are looking for more of a ceremonial feel with euthanasia.”

For some animal lovers, neither the home front nor the family veterinary hospital feels like the right setting. They prefer that the euthanasia procedure happen at a place they won’t need to frequent again. For this reason, Dr. Cooney has created The Pet Euthanasia Center in Loveland, Colorado where she lives. In addition to performing euthanasia procedures at the center, she also holds training classes for veterinary staff members pertaining to techniques described within the American Veterinary Medical Association’s Guidelines for the Euthanasia of Animals. More and more such centers are now popping up around the country.

Might you be looking for a house call euthanasia provider in your area? Check out the directory provided on Dr. Cooney’s website. This doc has thought of just about everything!

Have you had a pet euthanized outside of a veterinary hospital setting? If so, how did it go and would you do it the same way again?

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.

Solving the Mystery of Feline Hyperthyroidism and its Human Health Implications

Photo Credit: Flicker CC, Alice1523, catThe unraveling of the cause of a feline disease mystery is providing significant insight into human health matters. The condition known as hyperthyroidism has become an epidemic amongst aged cats in this country. Approximately ten percent of senior kitties are afflicted and suffer from the consequences of production of an excess of thyroid hormone. Typical symptoms include vomiting, diarrhea, increased thirst, heart-related abnormalities, and profound weight loss. Most hyperthyroid kitties can be successfully treated, but all of the therapeutic options are rather arduous and tend to be expensive.

It was while I was in veterinary school in the early eighties that the first cases of feline hyperthyroidism were being recognized. At the time, veterinarians described it as a new disease. Since then, hundreds of thousands if not millions of cats have been diagnosed. And, the incidence of this disease doesn’t appear to be slowing down one little bit.

Since feline hyperthyroidism was first recognized, the million-dollar question has been, what in the world causes it? What is it that changed back in the seventies? Was it a new cat litter or commercial cat food additive? Perhaps it was a byproduct of using chemical flea control products. Until now, the answer to this question has remained elusive.

PBDEs

Recent research has demonstrated that a likely cause of feline hyperthyroidism is a common class of flame retardants known as polybrominated diphenyl ethers (PBDEs). In the 1970’s, large quantities of PBDEs began to be routinely added to many household goods such as upholstery, carpet padding, and furniture cushions. It’s now known that PBDEs readily leach out of such products and latch onto house dust particles, ultimately becoming ubiquitous within the environment. They are found in the soil, water, and air, and it’s now proven that they have no difficulty entering into living breathing bodies. From the eggs of peregrine falcons to the blubber of beluga whales, PBDEs have been documented in a variety of species.

PBDEs and hyperthyroidism

The chemical structure of PBDEs and thyroid hormone resemble one another. It’s theorized that PBDEs may interfere with normal thyroid hormone metabolism, storage, and transport. There’s sound evidence that PBDEs alter thyroid function in rodents, fish, and birds, and it’s believed that kitty thyroid glands are also susceptible, particularly given the typical lounging around lifestyle of housecats and their proclivity for self-grooming.

Linda Birnbaum, a toxicologist, and Janice Dye, a veterinarian, both scientists at the Environmental Protection Agency, evaluated blood samples from 23 cats, including 11 with hyperthyroidism. They found that PBDE levels in cats were 20-100 times higher than those observed in people. They also found relatively large quantities of PBDEs in several types of cat foods, particularly seafood-flavored canned foods.

An Illinois study demonstrated that pet cats had higher PBDE levels than feral kitties, and a Swedish research team documented that PBDE concentrations in blood samples from hyperthyroid cats were significantly higher than in their healthy counterparts.

In spite of all of this evidence, some researchers have been reluctant to put all of their eggs into the PBDE basket. They argue that increased PBDE levels may be the result rather than the cause of feline hyperthyroidism. Because PBDEs are stored in body fat they are released into the bloodstream when cats lose weight, a symptom all hyperthyroid cats have in common. And, even if flame retardants do contribute to hyperthyroidism, they may not be the sole cause.

Cats as modern-day canaries

Much like coal miners used caged canaries to alert them to the presence of toxic gases, our hyperthyroid cats may serve as modern-day canaries. EPA toxicologist Birnbaum stated, “Our household pets are exposed to many of the same kinds of chemicals that we are. I think if we see a health problem in our animals, especially one that has arisen very recently- genetics doesn’t change that quickly- I think it’s kind of raising the canary-in-the-coal-mine issue.”

Since the 1970’s when the use of PBDEs began to increase, the rate of human thyroid cancer has more than doubled. And, research has shown that babies exposed to high concentrations of PBDEs in utero or during early childhood have lower cognition and motor skill test scores.

Peter Rabinowitz, director of the University of Washington’s Center for One Health Research, has created the online Canary Database as a means of indexing papers on animal outbreaks that may be relevant to human health. He encourages scientists and doctors to be more strategic about connecting the dots between the species. “I remain convinced that paying more attention to what the animals are trying to tell us is a really good idea,” says Rabinowitz. “There are still many disease outbreaks in animals that remain sort of unexplored or unexplained.”

PBDEs are now being phased out of household products within the United States and Europe. Unfortunately, because these chemicals degrade ever so slowly, their impact will continue to play out for quite some time.

Have you had experience with a hyperthyroid kitty? If so, do you think that PBDE exposure may have played a role?

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.