New Help for Dogs With Megaesophagus

Bailey Chair

There’s some exciting, hot-off-the-press news for dogs with megaesophagus. Researchers at the University of Missouri’s College of Veterinary Medicine have new insights about this frustrating and often devastating disease.

What is megaesophagus?

The term megaesophagus refers to weakness, dilation, and decreased motility of the esophagus, the muscular tube that normally propels food, water, and saliva efficiently from the throat down into the stomach. For dogs with megaesophagus, these swallowed materials either remain within the dilated esophagus or are regurgitated back up. Regurgitation resembles vomiting, but unlike vomiting, regurgitation tends to occur without warning. There’s no retching, grazing on grass, or assuming a particular body posture. Regurgitation takes everyone by surprise, including the dog.

As a result of this “surprise factor” the major life-threatening complication for dogs with megaesophagus is aspiration pneumonia. Food material can be readily and inadvertently inhaled into the lungs during a bout of regurgitation. Malnutrition can also be a significant issue for dogs with megaesophagus.

Causes of Megaesophagus

Megaesophagus tends to affect middle aged and older dogs, and there is no breed predilection. Most of the time, an underlying cause can’t be found, and the disease is referred to as, “idiopathic megaesophagus.” Diseases that can cause megaesophagus include:

  • Myasthenia gravis: a neuromuscular disease
  • Addison’s Disease: a hormonal disorder
  • Esophagitis: inflammation of the lining of the esophagus
  • Esophageal tumors
  • Esophageal foreign bodies
  • Esophageal trauma

Standard treatment

Treatment of idiopathic megaesophagus revolves around maintaining the dog in an upright position following mealtime so as to allow gravity to help move swallowed food, water, and saliva down into the stomach. The usual recommendation is to maintain the dog in an upright position for approximately 20 minutes following meals. Bailey Chairs (see photo) have been specifically designed for dogs with megaesophagus. They comfortably keep the dog upright and eliminate the need for direct human supervision throughout the process.

A new diagnostic test

New diagnostic testing and treatment described by folks at the University of Missouri College of Veterinary Medicine focus on an anatomical structure called the lower esophageal sphincter (LES). This sphincter acts like a valve between the end of the esophagus and the stomach, opening when food and water are swallowed and then closing so that food is not refluxed from the stomach back into the esophagus.

It turns out that some dogs with megaesophagus have LES dysfunction- their sphincters remain closed, even during the swallowing process. The researchers have been very clever in figuring this out. Using fluoroscopy (a type of video x-ray) they observe the “flight pattern” of swallowed food material as it travels down the esophagus. Such fluoroscopic swallowing studies have been around for a long time, but what’s new about the Missouri technique is how the dogs are restrained. Traditionally, dogs are held on their sides for these swallowing studies, a far cry from how dogs normally position themselves for swallowing. This new research has employed a nifty holding chamber developed to allow the dogs to eat and be restrained for the fluoroscopy in a normal upright position. This technique is providing much more accurate information about esophageal and LES function.

A new treatment

The Mizzou team has fashioned their treatment protocol for dogs with LES dysfunction after what is being done in human medicine. Using endoscopy, in which a long video telescope device is inserted into the esophagus, the LES is manually expanded via a technique called balloon dilation. Next, Botox is injected into the LES. This chemical paralyzes the sphincter muscles, allowing the LES to remain open. Thus far, some of the treated dogs have shown marked improvement. As Dr. James Schachtel, a member of the research team has stated,

This approach gives these dogs a chance, whereas a lot of them didn’t have much of one. At this time, it is early in the evaluation process, but it’s a novel approach that shows promise. This subpopulation can receive a really significant benefit from our direct ability to detect their malady. It can give them a really good quality of life. This is a revolutionary diagnostic technique for a disorder identified with a pathological outcome. It offers us the opportunity to use therapies that have been successful in people, so we’re optimistic we can experience similar success with canines.

While not all dogs with megaesophagus are candidates for this therapy, it is wonderfully refreshing to finally have a new strategy to treat this frustrating disease.

Do you have a dog with megaesophagus? If so, what has your experience been like? The University of Missouri team encourages veterinarians, pet owners and breeders to contact them about their megaesophagus testing and treatment protocol. You can do so by calling the Small Animal Hospital at 573-882-7821.

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.

 

Were You Smarter Than a Vet Student About Intestinal Parasites (Worms)?

Photo Credit: Danielle Rowland

Photo Credit: Danielle Rowland

Thanks to everyone who sent your responses to me. The winner in the book drawing is Wanda Woodworth from Little Elm, Texas. She will be receiving a copy of Speaking for Spot.

Now, here are the answers you’ve been waiting for.

  1. Dogs are susceptible to all but which one of the following parasites?
    1. a. protozoa
    2. b. pinworms
    3. c. stomach worms
    4. d. whipworms

People get pinworms, but dogs do not. Dogs are, however, susceptible to whipworms, coccidia (which are protozoa), and stomach worms.

  1. Which of these parasites is not transmissible between dogs and cats by way of their feces?
    1. Roundworms
    2. Coccidia
    3. Tapeworms
    4. Giardia

Fleas carry tapeworm eggs and are the primary source of transmission of tapeworms. When dogs inadvertently ingest fleas during grooming or chewing at their skin, tapeworm infection occurs. Roundworms, coccidia, and giardia are transmitted between dogs and cats via their feces.

  1. Which parasite is least likely to shed eggs that will show up in a fecal flotation (microscopic evaluation of the feces)?
    1. Roundworms
    2. Hookworms
    3. Coccidia
    4. Tapeworms

Tapeworms are exceptionally stingy about shedding their eggs so they rarely show up in a fecal flotation, the annual recommended screening test for parasites. The best way to diagnose this parasite is by seeing tapeworm segments around the dog’s anus (when dried, they look like small sesame seeds). Roundworms, hookworms, and coccidia are readily diagnosed by the presence of their eggs in the stool sample.

  1. Puppies are commonly infected with roundworms because of which of the following?
    1. Larvae (young stages of the worms) can be transferred to the puppies while they are in the uterus.
    2. Interactions between puppies transmit parasites from one to another.
    3. Larvae can be transferred to the pup through the mother’s milk.
    4. All of the above.

Yep, puppies are true targets of roundworm infection because of the combination of mechanisms listed above. Even if the mama dog has tested negative for parasites, pregnancy is likely to activate latent encysted stages of roundworms within her body.

  1. Which species can transmit a potentially lethal form of roundworms to dogs?
    1. Raccoon
    2. Fox
    3. Horse
    4. Squirrel

The roundworm (Baylisascaris procyonis) occurs in raccoons throughout the United States and Canada. Although unommon, this parasite can cause life ending neurological disease in dogs. Infection can occur when a dog has access to raccoon feces. Monthly deworming medication (commonly combined with heartworm prevention) is protective. Given the number of dogs who love to eat horse poop (mine included), thank goodness the eggs ingested this way are harmless.

  1. Tapeworms commonly cause:
    1. Diarrhea
    2. Weight loss
    3. Itching around the anus
    4. All of the above

The notion that tapeworms rob the body of nutrition is nothing more than an old wives’ tale. (Why are their no old husbands’ tales?) They cause neither weight loss nor diarrhea. As tapeworm segments migrate out through the anus, they create an itchy sensation for the dog resulting in scooting and licking and chewing at the anus. Close visual inspection will reveal small dried tapeworm segments in the fur around the anus.

  1. Which canine intestinal parasites are zoonotic (can cause health concerns in people?)?
    1. Roundworms
    2. Hookworms
    3. Giardia
    4. All of the above

Roundworm eggs are problematic for people (most commonly children) who accidentally ingest roundworm eggs. The larvae that develop from the eggs can migrate, most commonly to the retina resulting in blindness. This syndrome is referred to as ocular larva migrans. Hookworm larvae found in dirt or sand can invade human skin, most commonly the soles of the feet, resulting in an irritated rash. When giardia eggs are inadvertently eaten, gastrointestinal symptoms including nausea, intestinal cramping, and diarrhea can occur.

  1. Which statement is true pertaining to over-the-counter dewormers?
    1. They typically include medications effective against most types of intestinal parasites.
    2. They are just as effective as those prescribed by a veterinarian.
    3. When used regularly, they can take the place of an annual stool check (fecal flotation).
    4. They can be a huge waste of your money.

While it’s tempting to purchase over-the-counter dewormers for purposes of price and convenience, I discourage you from doing so. There is little guarantee of effectiveness. Most contain just one type of medication, yet different parasites require different deworming drugs. For example, coccidia, tapeworms, and roundworms each require a different medication to be cleared from the body. Additionally, recommended dosages may be inaccurate.

How did you do? What topic would you like to see featured in the next, “Are You Smarter Than a Vet Student” quiz?

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 Intestinal Parasites (Worms)?

Photo Credit: Photolist, Flicker CCHere’s an opportunity to test your knowledge about intestinal parasites. Be sure to send your responses to me your responses to me and I will enter your name into a book drawing. If selected you will receive a copy of Speaking for Spot or Your Dog’s Best Health (the choice will be yours). Good luck and, as always, look for the answers a week from now.

1. Dogs are susceptible to all but which one of the following parasites?
a. protozoa
b. pinworms
c. stomach worms
d. whipworms

2. Which of these parasites is not transmissible between dogs and cats by way of their feces?
a. Roundworms
b. Coccidia
c. Tapeworms
d. Giardia

3. Which parasite is least likely to shed eggs that will show up in a fecal flotation (microscopic evaluation of the feces)?
a. Roundworms
b. Hookworms
c. Coccidia
d. Tapeworms

4. Puppies are commonly infected with roundworms because of which of the following?
a. Larvae (young stages of the worms) can be transferred to the puppies while they are in the uterus.
b. Interactions between puppies transmit parasites from one to another.
c. Larvae can be transferred to the pup through the mother’s milk.
d. All of the above.

5. Which species can transmit a potentially lethal form of roundworms to dogs?
a. Raccoon
b. Fox
c. Horse
d. Squirrel

6. Tapeworms commonly cause:
a. Diarrhea
b. Weight loss
c. Itching around the anus
d. All of the above

7. Which canine intestinal parasites are zoonotic (can cause health concerns in people)?
a. Roundworms
b. Hookworms
c. Giardia
d. All of the above

8. Which statement is true pertaining to over-the-counter dewormers?
a. They typically include medications effective against most types of intestinal parasites.
b. They are just as effective as those prescribed by a veterinarian.
c. When used regularly, they can take the place of an annual stool check (fecal flotation).
d. They can be a huge waste of your money.

Don’t forget to send your answers to me for a chance to win a book.

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.

 

Setting Up a Trust for Your Pet

Photo Credit: Alan Kay

Photo Credit: Alan Kay

A dear friend of mine just entered hospice care. After a courageous battle, she is finally surrendering to ovarian cancer. In a conversation shared yesterday, she told me that she wants her beloved horse Partner to go to one of our mutual friends along with her truck and trailer and money to take care of him for the rest of his life. When asked if all of this was in writing (my hope was that all of this was already recorded in a notarized legal document), she responded with, “No.”

So, while I’m now aware of my friend’s intentions for her horse, there’s no guarantee that her wishes will be carried out when all is said and done. She is concerned that her husband might not be happy with her plan (he doesn’t know about it yet, nor does she want him to). I’m in the process of contacting my friend’s attorney to see if he is available to talk with her and prepare an appropriate document. In all honesty, I’m afraid that we are running out of time. I’ve typed something up myself that my friend can sign today with hopes that this will suffice in terms of carrying out her wishes.

My friend’s situation is not unique. Who the heck knows if we will predecease our pets? Just as for our children, having certainty about how our animals will be cared for after we pass away not only protects them, but also has the potential to provide us with tremendous peace of mind. Setting up a legal trust is the best way to make all of this happen.

What is a pet trust?

A pet trust is a legal arrangement that provides for an animal’s care and maintenance in the event of the pet guardian’s disability or death. The “grantor” (called the “settlor” or “trustor” in some states) is the person who creates the trust. A “trustee” is designated and holds property such as cash “in trust” for the benefit of the pet. Payments to a designated caregiver(s) are made on a regular basis.

Rules and regulations

It’s now possible to make provisions for a pet through a trust in all 50 states. Minnesota was the last hold out and, earlier this year, became the final state to pass legislation approving pet trusts.

Rules pertaining to pet trusts vary from state to state. In most cases the trust terminates when the animal passes away or after 21 years, whichever occurs first. While this works well for most dogs and cats, it has the potential to be problematic for animals with longer life expectancies such as horses and parrots. Some states allow a pet trust to continue past the 21-year term if the animal remains alive. After the pet passes away, any remaining funds are typically distributed amongst heirs as directed by the terms of the trust.

Trust details

When crafting a trust, think about who you might want to care for your pets if you are no longer able to, and then talk to that person(s). Better to check out the viability of your plan in advance than surprise your friend or relative with such news after you are gone. While not necessary for the intended caregiver to sign off on the legal document, it is certainly wise to know in advance that you have their buy in.

Instruction within the trust can be very specific, including as much detail about your pet’s care as you like. For example, you might specify preferred types of food, favorite toys, sleeping arrangements, exercise regimens, and the number of veterinary visits per year. Consider specifying how much veterinary intervention you would want should illness arise. Details about care of your pet’s remains following their death can be included.

Think about how much money would be needed to properly care for your pets and how the funds should be distributed to the caregiver(s). Remember to factor in funds for grooming, boarding, and veterinary costs.

Lastly, identify your pets within the trust with as much detail as possible. In addition to their names include details such as breed, size, identifying markings and microchip numbers. Consider including photographs.

Making a trust happen

If you don’t already have a trust prepared for your pets, I encourage you to make this a priority. Ideally, enlist the help of an attorney who specializes in estate planning. If this isn’t feasible, type up a document (as I am doing today for my friend) and sign and date it. It might be a good idea to also have the document signed by a witness or two. I suspect there are on line templates one can follow as well.

Performing such “grown up tasks” isn’t much fun, and it’s certainly no fun to think about someone else caring for your beloved animals someday. Nonetheless, I encourage you to get a trust prepared for your pets. Guaranteed, after doing so, you will feel some peace of mind having provided this true expression of love for your animals.

Do you have a trust in place for your pets? If not, will you consider making this happen?

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.

Suicide and Other Mental Health Concerns Amongst Veterinarians

Photo Credit: prioritypethosp_FlickerCc_gentletouchIn 2014, Dr. Sophia Yin, a gifted and universally revered veterinary behaviorist, took her own life. Her passing sent shockwaves through the veterinary and dog training communities and reignited intense interest in mental health issues amongst veterinarians. There are plenty of troubling reports about depression within the profession and the suicide rate appears to be growing, perhaps at a rapid pace.

Consider the facts

A first of its kind survey in 2014 investigated the psychological well being of 10,254 veterinarians practicing within the United States. The data revealed that, compared to the general adult population, veterinarians more frequently:

– Suffer from psychiatric disorders (6.8% of male and 10.9% of female respondents)

– Experience bouts of depression (24.5% of male and 36.7% of female respondents)

– Entertain thoughts of suicide (14.4% of male and 19.1% of female respondents)

The suicide rate amongst veterinarians is not higher than the rate within the general population, but is higher when compared to other health professionals. According to a report in the Canadian Veterinary Journal, the rate of suicide in the veterinary profession is close to twice that of the dental profession and more than twice that of human medical doctors.

What are the reasons?

Those attempting to explain the high incidence of psychiatric disorders, particularly suicide, within the veterinary profession have proposed multiple theories.

Dealing with death

Veterinarians square off with death of their patients frequently, often on a daily basis. In fact, they may be involved in multiple euthanasia procedures in a single day. Putting animals to sleep is taxing for people who love animals and worked exceptionally hard to enter a healing profession. Even more psychologically devastating are “convenience euthanasias,” those dictated by the needs of the client rather than the well-being of the patient.

Unfamiliarity with failure

Speaking in generalities, veterinarians tend to be a very success-driven bunch. They are high achievers who make straight-A’s and succeed at most anything thrown their way. After all, how else would they have been accepted into veterinary school?

Fledgling veterinary school students are well acquainted with success and far less familiar with failure. Dr. Elizabeth Strand, psychiatric social worker at the University of Tennessee College of Veterinary Medicine believes that, “Veterinary students are used to being the cream of the crop and are not used to being with others as smart as they are. They’re not used to failing. ‘Failing’ to them can mean getting a ‘B’ instead of an ‘A’. A mindset that says, ‘Either I do it perfectly or I’m bad’ is a mindset that we try to change.”

New veterinary school graduates encounter many situations that can be perceived as failure including: angry clients, difficulties with coworkers, clients devastated because of the loss of a beloved pet, and medical or surgical blunders that result in negative consequences. Without the skillset to deal with such “failures,” the psychological fallout can be significant.

Financial factors

Following graduation, some veterinarians find themselves unable to pay their bills despite working super-long hours. The average debt load for veterinarians fresh out of school is $150,000- $175,000. A post-graduation first full time job pays, on average, $50,000-$60,000. Dr. Malcolm Getz, author of Veterinary Medicine in Economic Transition, has stated that the ratio of debt to income for the average new veterinarian is roughly double that of M.D.’s.

Competition within the profession can be fierce, particularly in locations where there is a veterinary clinic on practically every corner. It can be difficult for new veterinarians to find full time employment with benefits. Many younger vets must piece together part time jobs and/or do relief work in order to pay their bills.

In most states, veterinarians are required to accumulate a set number of continuing education hours every year. This requires attending conferences which tend to be quite pricey once registration, travel, and accommodations are factored in. Some employers pay for their associates to attend, but many do not.

Work-related stressors

Veterinarians tend to work hours way in excess of what is considered full time. If that last appointment of the day requires emergency surgery, the “closed” sign may be hanging in the front door, but the doctor is definitely “in.” It can be difficult for veterinarians to find the time for the ingredients of a healthy lifestyle such as family time, a nutritious diet, regular exercise, a social network, and recreational activities.

Other potential work-related stressors include conflicts with coworkers, inadequate professional support, after-hours on-call duties, unrealistic client expectations, concerns about the possibility of client complaints and litigation, negative social media reviews, and lack of adequate training in client communication. Any and all of these can contribute to anxiety, disillusionment, demoralization, and depression.

Stigma of mental illness

For many people, veterinarians included, there continues to be a stigma surrounding mental illness that gets in the way of accessing support and treatment. This stigma may be particularly problematic for veterinarians who strongly identify with the role of “helper” rather than the role of being one in need of help. Additionally, veterinarians experiencing psychological distress may avoid seeking help for fear of negative career ramifications.

Access to drugs

Veterinarians have ready access to drugs that can kill. Not only does this provide the means for suicide, it may mean that attempted suicides are more likely to result in death.

Suicide contagion

News of the death of a veterinary colleague by suicide travels quickly within the profession. “Suicide contagion” refers to increased vulnerability as a result of the suicidal behavior of others. Perhaps this is a contributing factor to the increased risk amongst veterinarians.

Then versus now

I graduated from veterinary school in 1982, and my sense of things (purely conjecture on my part) is that the prevalence of debilitating psychological distress and suicide amongst veterinarians was not nearly as prevalent then as it is now. My classmates and I were not subjected to the major financial issues that new graduates face today. It was simply far less expensive to go to veterinary school and far easier to make a good living.

While not as measurable as money, the factor that I believe has contributed in a major way to psychological distress within the profession is the way veterinarians are perceived by the public. Back in the day, when I was just a pup, veterinarians were universally well respected. I would go so far as to say that we were revered. Disparaging comments about veterinarians were practically unheard of. It was assumed that our hearts were in the right place and that we were exceptionally bright and well-intentioned professionals. Invariably, we received the benefit of the doubt. I like to say that, back in the day, we were “riding on the coat tails of James Herriot.” (By the way, this wonderful veterinarian would have turned 100 years old on October 3rd of this year.)

Compare this description to the way veterinarians are regarded today. They no longer receive the benefit of the doubt. They must prove themselves as their actions, ethics, and intentions are questioned. Disparaging comments about veterinarians are commonplace. Simply sit in on a conversation at the dog park, join a Facebook dog forum, or read some Yelp reviews. Such societal shrapnel can be psychologically devastating for veterinarians.

How to help

Just as there are factors that contribute to psychological distress and risk of suicide, there are things that provide a positive influence.

A number of recent publications and communications encourage veterinarians to intervene should they sense a colleague’s distress rather than ignore the symptoms.

Additionally, some veterinary schools are now incorporating mental health education and discussion into their curricula. Participants at the recent Association of American Veterinary Medical Colleges’ Health and Wellness Summit received ideas for including personal wellness practices into their veterinary school programs.

Grief counseling is also becoming part of the veterinary student experience. Approximately one year ago Auburn University College of Veterinary Medicine hired a psychologist to train and assist students and faculty members with grief counseling. Dr. Givens, associate dean for academic affairs, stated, “I think anyone who would ignore the statistics indicating the stress so many individuals experience in the veterinary profession is seeking to avoid reality.

What can you do? First and foremost, I encourage you to do the work necessary to find a veterinarian you believe in and enjoy working with. Need help? If so, you’ll find this help within Speaking for Spot in the chapter titled “Finding Dr. Wonderful and Your Mutt’s Mayo Clinic.”  

Once found, make every effort to express appreciation to your “Dr. Wonderful.” Resist any urge to verbalize or post disparaging comments that contribute to the notion that veterinarians are the “bad guys.” Remember, the vast majority of veterinarians chose their professional path for all the right reasons. They genuinely adore animals and want nothing more than to help their patients and their clients.

I welcome your thoughts and opinions on all of this.

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.

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Guidelines for Managing Cancer in Dogs and Cats

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

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

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

Oncology Guidelines

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

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

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

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

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

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

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

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

Best wishes,

Nancy Kay, DVM

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

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

Tracheal Collapse: A Common Cause of Canine Coughing

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

Normal tracheal anatomy and function

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

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

Tracheal collapse

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

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

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

Dogs at risk

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

Symptoms

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

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

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

Making the diagnosis

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

Management tools

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

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

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

Medications

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

Medications are used for the following purposes:

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

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

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

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

Oxygen therapy

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

Tracheal stents

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

Surgery

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

Prognosis

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

Veterinary specialists

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

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

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

Best wishes,

Nancy Kay, DVM

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

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

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

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

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

Part one of the study

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

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

Part two of the study

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

Part three of the study

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

Conclusions

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

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

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

Best wishes,

Nancy Kay, DVM

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

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

 

Financial Assistance for Veterinary Care

SFSBlog_financialassistance_Tripp_NK

Photo Credit: © Nancy Kay

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

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

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

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

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

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

Best wishes,

Nancy Kay, DVM

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

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

 

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

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

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

What exactly is an ECG?

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

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

The smartphone device

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

Study design

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

Study results

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

Conclusions

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

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

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

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

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

Best wishes,

Nancy Kay, DVM

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

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