Don’t Wait Too Long to Get a Second Opinion

Photo Credit: Susannah Kay

 

By the time I met Lucy, her condition had deteriorated to the point that I was unable to provide her with significant help. Rather than talking about treatment options, her care providers and I were forced to discuss end-of-life decision making. If only I’d been able to get my hands on this darling little Sheltie sooner, the outcome could have been so different.

Lucy was suffering from a disease called hyperparathyroidism , an overproduction of parathyroid hormone resulting in excess calcium within her bloodstream. The treatment of choice for this disease is surgical removal of the overactive parathyroid gland. Such therapy is typically quite straight forward and results in a complete cure.

Poor Lucy. In spite of nine office visits with her family veterinarian over the course of six months because of symptoms caused by her parathyroid disease, appropriate treatment was never recommended and the extra calcium in her bloodstream over such a prolonged period caused irreversible kidney damage. By the time Lucy arrived at my doorstep, she was suffering from profound kidney failure with weakness, loss of appetite, vomiting, and debilitation. There was no going back for this little sweetie.

What gets in the way of a second opinion

There are a few reasons I can come up with as to why veterinarians will watch a patient deteriorate week by week and without a clearcut diagnosis, and yet still not discuss a second opinion. Perhaps they truly believe that there’s nothing more to be offered by someone else. Perhaps they think they “know” that their client would not want to get a second opinion because of cost and/or inconvenience. Maybe the veterinarian has a strong desire to hold onto the case, either because of their own ego or for financial gain.

Why is it so darned difficult for some folks to request a second opinion for their beloved pets? For some, veterinarians represent authority figures and their abilities are not to be questioned. One client told me that she viewed her relationship with her veterinarian to be like her relationship with her pastor- ask no questions! I’ve heard other clients state that requesting a second opinion would imply mistrust which would result in delivery of poorer quality veterinary care in the future. Some hold off on obtaining a second opinion (or they do so secretly) because they don’t want to hurt their veterinarian’s feelings.

My sense of Lucy’s caregivers is that they believed their veterinarian was doing the best job possible. They never thought to question his diagnosis (or lack thereof) and didn’t seem to know that they had the option of a obtaining a second opinion. They ultimately chose to come see me based on the recommendation of a friend who was concerned about Lucy’s decline. 

The need to be an effective medical advocate

When I hear such rationalizations from folks who have postponed second opinions for their pets, I’m always tempted to respond with a line from the movie, Moonstruck in which singer/actress Cher slaps Nicholas Cage across the cheek while commanding, “Snap out of it!” Fortunately, the grownup in me manages to intervene with more mature counsel and I encourage the individual to step up to the plate as their pet’s medical advocate. The well being of their pet must be the number one consideration.

Putting total blind faith in any one veterinarian makes no sense, no more so than relying on any one medical doctor to safeguard our health. The veterinarian is only one member of an animal’s health care team, and it is the team captain who needs to call the shots. The team captain is the one who feeds, cares for, loves, and truly knows that animal better than anyone else. When there is no diagnosis in spite of multiple tests, or the animal’s health is declining in spite of therapy, it’s time for the team captain to order up a second opinion.

A situation like Lucy’s is heartbreaking. Don’t let her story happen to one of your family members.

Have you ever obtained a second opinion for one of your pets?

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.

 

 

 

NT-proBNP Testing for Canine Heart Disease

Photo Credit: Flicker CC, chichangwang, pupsShould your dog ever develop coughing or labored breathing, your veterinarian may recommend an NT-proBNP blood test. This stands for N-terminal pro-B-type natriuretic peptide. Now, how’s that for a mouthful?

What the heck is NT-proBNP?

B-type natriuretic peptide is a hormone that is manufactured and stored within the heart. When stretching of the heart muscle occurs in association with certain types of heart disease, proBNP divides into two smaller protein molecules that are released into the bloodstream. These two smaller molecules are called C-BNP and NT-proBNP.

How BNP testing is used

The amounts of C-BNP and NT-proBNP within the bloodstream increase in people, dogs, and cats with various types of heart disease. In human medicine, BNP testing is commonly used in patients that present with difficulty breathing. The beauty of the BNP test is that it helps determine whether or not heart disease is the cause of this symptom. In fact C-BNP measurement is a more accurate way of diagnosing congestive human heart failure than either chest x-rays or an ECG.

In the world of veterinary medicine, we rely on NT-proBNP measurements. While an increased NT-proBNP result points to heart disease, in no way does it differentiate the type of heart disease at play. For this reason, assessing the amount of BNP in the bloodstream is typically used as a screening test when heart disease is suspected. If the result is consistent with a heart abnormality, other diagnostic testing such as chest x-rays, an ECG, and an echocardiogram (ultrasound of the heart) are often indicated to gather more specific information.

Coughing and labored breathing are commonly reported symptoms in dogs. And, in some cases, it can be difficult to know whether heart or respiratory tract disease is at the root of the problem. The NT-proBNP test can be of tremendous help in terms of pointing the diagnostic workup more towards one direction than the other.

An imperfect test

As is true for many diagnostic tests, NT-proBNP assays are imperfect in that the results can be influenced by a variety of factors, from improper sample handling to non-heart disease abnormalities such as dehydration, kidney disease, and hypertension (high blood pressure). Additionally, there can be overlap of blood NT-proBNP concentrations between healthy animals and those with significant heart disease.

Mitral valve disease

The most common type of heart disease in dogs is myxomatous mitral valve disease . This results in a leaky mitral valve that can ultimately lead to heart failure. The presence of a characteristic heart murmur (left sided and systolic) in an adult small breed dog reliably diagnoses this disease.

Some dogs with mitral valve degeneration live their entire lives without ever developing any problems referable to this disease. For others, heart failure develops as a consequence, but the “if and when” are unpredictable. Unfortunately, there is no documented benefit to treatment of any sort prior to the onset of heart failure. The NT-proBNP assay makes all of this less of a guessing game. It is recommended for dogs with known mitral valve disease who are symptom-free. The test is used as a way of predicting whether or not the onset of heart failure will be imminent (within the next three to six months). For dogs identified as being at high risk, careful at home monitoring is recommended looking for the earliest symptoms of heart failure such as an increased respiratory rate during rest or sleep, exercise intolerance, weakness, and coughing. Should one or more such symptoms arise, immediate veterinary intervention will likely prevent a heart failure crisis and the need for hospitalization for emergency care.

Dilated cardiomyopathy

A pretty darned awful heart disease referred to idiopathic dilated cardiomyopathy  occurs mostly in larger breed dogs. For reasons that are unknown, the heart muscle becomes weak and flabby and its normal dynamic pumping action fails. Dogs with dilated cardiomyopathy often show no evidence of their disease until something dramatic happens such as fulminant heart failure or a severe heart rhythm abnormality resulting in sudden weakness, collapse, or even death.

Doberman Pinschers, Irish Wolfhounds, Great Danes, Newfoundlands, Portuguese Water Dogs, Saint Bernards, and Airedale Terriers are particularly predisposed to dilated cardiomyopathy. Boxers have their own unique version of this disease referred to as arrhythmogenic right ventricular cardiomyopathy .

As a screening test for high-risk breed groups, NT-proBNP results can help identify dogs who have an increased probability of having occult (asymptomatic) dilated cardiomyopathy. If this screening test is positive, more involved testing such as an ultrasound of the heart and/or Holter monitoring (a device worn by the dog to record a 24-hour ECG) is warranted.

Do you have experience with a dog with heart disease? Was NT-proBNP testing part of the diagnostics used by your veterinarian?

Best wishes,

Nancy Kay, DVM

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

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

 

 

Canine Primary Hyperparathyroidism

Hyperparathyroidism is a hormonal imbalance caused by excess (hyper) production of parathyroid hormone. This disease occurs in middle-aged and older dogs, males and females alike. Keeshonds appear to be genetically predisposed to hyperparathyroidism.

What is parathyroid hormone?

Parathyroid hormone (PTH) is produced within the parathyroid glands. Most dogs have four of them and they are pretty darned tiny, measuring in at two to four millimeters. They are located just beneath the skin surface of the neck adjacent to the thyroid glands.

PTH is responsible for maintaining normal levels of calcium and phosphorus levels within the body. It accomplishes this by regulating the amounts of calcium and phosphorus absorbed by the gastrointestinal tract, eliminated from the body by the kidneys, and released from bones into the blood stream. Too little parathyroid hormone (hypoparathyroidism) results in a blood calcium level that is too low and a phosphorus level that is too high. Too much parathyroid hormone (hyperparathyroidism) results in just the opposite- elevated calcium and decreased phosphorus.

Causes

Primary hyperparathyroidism is caused by a benign tumor within one or more of the parathyroid glands. Parathyroid tumors are functional meaning they produce excess PTH. The adjective “primary” is used when describing this form of the disease because the abnormality is within the gland itself.

Secondary hyperparathyroidism occurs when either kidney disease or a dietary deficiency triggers the parathyroid glands to produce excess PTH.

Symptoms

Many dogs with hyperparathyroidism appear completely normal. The disease is suspected when an elevated blood calcium level is picked up on routine blood screening. Symptoms associated with hyperparathyroidism are a result of increased calcium within the bloodstream. The most common symptoms associated with hyperparathyroidism include:

  • Increased thirst
  • Increased urination
  • Decreased appetite
  • Vomiting
  • Weakness
  • Lethargy

Some affected dogs develop calcium-laden bladder stones that can cause straining to urinate, increased frequency of urination, and blood within the urine.

Diagnosis

Blood testing is the mainstay for figuring out whether or not a dog is hyperparathyroid. An increased ionized calcium level in conjunction with an increased or normal PTH level is consistent with the diagnosis of hyperparathyroidism. The diagnostic icing on the cake is identification of an enlarged parathyroid gland via ultrasound of the neck.

Treatment

Surgical exploration of the neck to remove the enlarged parathyroid gland(s) is the most common treatment for hyperparathyroidism. The surgeon identifies and removes the enlarged gland(s).

A nonsurgical method of treatment is referred to as glandular ablation. Using ultrasound guidance, a small volume of ethanol is injected directly into the parathyroid gland destroying the tissue. Extreme care must be taken to prevent any of the ethanol from leaking out of the parathyroid gland capsule.

Following either form of treatment, the patient’s blood calcium level must be followed closely for a period of a several days to a few weeks. It’s not uncommon for the calcium level to plummet following surgery or gland ablation. This is because the remaining parathyroid glands have been “on vacation” as a result of the overachieving gland. They need a chance to wake up and ramp up PTH production.

It’s important to note that, over time, an elevated blood calcium level can cause kidney damage that is often irreversible. For this reason, it is important to treat in a timely fashion, even those dogs who are free of significant symptoms. 

Prognosis

The outcome with treatment of primary hyperparathyroidism is excellent assuming that:

  • A veterinarian with a high skill level is involved. For surgical treatment, it is ideal to employ a veterinary surgical specialist. A veterinarian who specializes in radiology or internal medicine is the best choice for performing ablation therapy.
  • There is vigilant monitoring and treatment of fluctuating blood calcium levels following parathyroid gland surgery or ablation.

Have you ever had a dog with hyperparathyroidism? If so, how was your dog treated 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.

 

 

 

Vet Set Go: Promoting Kids’ Aspirations to Become a Veterinarian

 

 

Do you know any youngsters who are passionate about animals and want to become a veterinarian? If so, be sure to tell them about Vet Set Go , an organization that provides a wealth of information about how to make the dream of becoming a veterinarian come true. And right now, Vet Set Go is accepting applications  for middle schoolers to win tuition, food and housing at this summer’s Auburn University’s Junior VET Camp.

Chris Carpenter: founder of Vet Set Go

The founding father of Vet Set Go is veterinarian Dr. Chris Carpenter, himself a graduate of Auburn University College of Veterinary Medicine. He’s been working for years helping teens and tweens explore their dreams of becoming veterinarians. As Dr. Carpenter has stated,

“Unlike other professionals, the majority of veterinarians practicing today made their career decision when they were very young. In fact, I made my decision to become a veterinarian when I was eleven years old. Today’s aspiring veterinarians are no different. Working with animals is a calling for them and they are passionate about it.”

Dr. Carpenter is keen on promoting a love of science amongst girls. “What I love about Vet Set Go is how we leverage a tween’s love of animals to motivate them to explore science in a fun way. Most of Vet Set Go’s audience is tween girls. And even if, in the end, they decide not to become a veterinarian, they now understand that a career in science can be fun. I tell my 13-year-old daughter every day to keep doing well in her science class because a career in science will open up so many doors for her. I want every tween girl to understand that. Veterinary medicine is just one of the fantastic possibilities.”

The Vet Set Go website

Dr. Carpenter’s passion to help kids explore their dreams evolved into Vet Set Go, the first and only web community dedicated to kids wanting to become veterinarians. His goal was to go beyond classroom presentations and provide kids with a way to get behind the scenes and meet and interact with veterinarians and see what they do. 

Vet Set Go website features  include:

“Meet The Vets”: Behind the scenes videos demonstrating what different veterinarians do

“Science of Veterinary Medicine”: Visitors follow actual cases as they are happening in the clinic

Free games: Interactive ways to help future veterinarians explore a variety of topics

Community: A place for veterinary teams and future veterinarians to share their stories

Contest to attend Junior VET Camp

Between now and May 4th, students may enter the Vet Set Go Contest to receive free tuition meals and housing for this summer’s Junior VET Camp at Auburn University. Three winners will be selected and ten runners-up will receive a free copy of Vet Set Go’s award-winning quick start guide to becoming a veterinarian. Applicants must be either in or about to enter middle school.

Wow, Vet Set Go would have been my dream come true when I was growing up!

Please tell me about the kid you know who wants to become a veterinarian.

Best wishes,

Nancy Kay, DVM

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

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

 

 

Odds Improve for Dogs with Hemangiosarcoma

Photo Credit: Flicker CC, gronga, cottage cheeseA new drug developed at the University of Minnesota is showing significant promise for dogs with hemangiosarcoma (HSA), a frequently diagnosed form of cancer that affects primarily large breed dogs. Recent studies on Golden Retrievers and Vizslas have demonstrated a link between neutering and the occurrence of this disease in these two breeds.

HSA most commonly occurs within the spleen, liver and heart. Because these tumors arise from blood vessel cells, they are extremely vascular (blood filled) and prone to abrupt and dramatic bleeding.

To date, treatment options for HSA have involved removal of the tumor (if possible) followed by chemotherapy. Even with such aggressive therapy, only 50 percent of dogs with this disease survive for as long as four to six months. Just 10 percent survive for a year or longer.

eBAT

The new chemotherapy drug being used to specifically target HSA is referred to as eBAT. Dr. Daniel Vallera, the University of Minnesota Medical School professor who developed eBAT stated, “HSA is a vascular cancer, meaning it forms blood vessels. eBAT was selected for this trial because it can simultaneously target the tumor and its vascular system.”

Results of a study  using eBAT in clinical cases involved 23 dogs of various breeds and sizes, all documented to have hemangiosarcoma within their spleens. Following splenectomy (removal of the spleen), each dog received three eBAT treatments. Amongst the dogs in this study, the six-month survival rate was 70 percent, and six of the 23 dogs (26 percent) lived for more than 450 days. That’s a remarkable improvement!

According to Dr. Jamie Modiano, professor at the University of Minnesota College of Veterinary Medicine and co-author of the eBAT study results, “This is most likely the most significant advance in the treatment of canine HAS in the last three decades.”

And, compared to chemotherapy drugs that have traditionally been used to treat HSA, negative side effects from eBAT were minimal in the group of dogs studied. Veterinarian and lead author of the study, Dr. Antonella Borgatti stated, “In this trial we aimed for a sweet spot by identifying a dose of eBAT that was effective to treat the cancer, but caused no appreciable harm to the patient. Essentially we’re treating the cancer in a safer and more effective way, improving quality of life and providing a better chance at survival.”

The promising results of this canine HSA study may provide some crossover benefits to the world of human oncology. There are significant similarities between HSA in dogs and a type of cancer in people called angiosarcoma. The results from the canine study make a strong case for clinical trials using eBAT in people with this disease.

What has your experience been with hemangiosarcoma?

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.

 

 

Veterinary Medicine, Incorporated

Photo Credit: Flicker CC, sagesolar, upwardTwo giant corporate players have been making veterinary headlines as of late.  Mars, Incorporated, the candy maker (M&M’s, Snickers, Twix, etc.), pet food manufacturer (Royal Canin, Pedigree, Iams, Whiskas, etc.), and owner of Banfield Pet Hospital with its more than 900 locations has plans to acquire VCA Antech and its almost 800 veterinary hospitals. The purchase price is said to be $9.1 billion. Pending approval of federal regulators, this mega-deal is set to close before the end of 2017.

Corporatization of veterinary medicine is nothing new. It’s been going on for decades. The more recent trend is the consolidation of veterinary corporations. To date, the Mars-VCA deal is the largest such transaction on record.

Another relatively new trend is the consolidation of independent veterinary practices. The first large-scale merger happened in 2010 when 17 facilities joined together to create Companion Animal Practices, North America. This company grew to 56 locations before being acquired by VCA Antech. Mixed Animal Veterinary Associates North America (MAVANA) has been another successful merger in which 21 mixed animal and equine veterinary practices spread across 10 states joined forces. Dr. Scott Spaulding, founder of MAVANA stated,

It seemed to me there was an opportunity to put together some practices to develop a corporate structure to pull a lot of the business administration part out of the practice at the local level and put it at the corporate level. By pooling our resources, we can hire experts in those fields, and that’s what we’re in the process of doing right now with MAVANA.

The good

While it’s tempting to view large veterinary conglomerations and corporations as a Darth Vader character in a James Herriot story, they do have a bright side. Reinvestment of profits gleaned from improved business practices and economies of scale (a proportionate savings in costs created by an increased level of production) can provide bigger and better state of the art veterinary facilities and technology. This translates into improved diagnostic and treatment options.

Additionally, large veterinary corporations have the ability to gather data from their literally millions of patients and turn this information into meaningful research that can benefit animals wherever they receive veterinary care.

Lastly, without corporate buyout options, most veterinarians who own really large veterinary hospitals would not be able to come up with a financially feasible exit strategy for themselves. Few veterinarians have the capital required to make a multi-million dollar purchase.

The bad

Although an estimated 85-90 percent of veterinary clinics and hospitals within the United States remain independently owned, in some regions of the country, corporations own a disproportionately high percentage of veterinary facilities. For example, the San Francisco bay area supports a large number of veterinary specialty practices. VCA Antech (soon to be Mars) owns all but a couple of them. Such monopolies take choice out of the hands of the consumer.

VCA is a publicly traded company, meaning its business metrics and acquisition activities have been public knowledge. Such information can be useful in terms of the business of running a veterinary hospital. For example, private veterinary practice owners might derive reassurance that their financial “slow season” seems to match up with VCA’s “slow season.” All such public information will go underground once VCA’s approximately 800 hospitals are acquired by Mars.

The ugly

Having nonveterinarians call the shots can be worrisome in terms of the best interest of the patients. Banfield Pet Hospital and VCA have both been criticized for tying the hands of their veterinarians, requiring that they follow strict medical protocols rather than making decisions based on the needs of individual patients and clients. In fact, a recent Bloomberg Businessweek article featured a veterinarian accusing Banfield of pushing its employees to prioritize profit over the health and safety of the animals they are treating.

Reactions within the profession

Reactions to the Mars-VCA merger from those involved in the veterinary profession have been mixed. Dr. Eileen Jefferson is the owner of Ethical Veterinary, a mobile practice in Stone Ridge, New York. She is concerned that,

Veterinary medicine stands to be reduced to the financial interest of shareholders in a candy company, and at the expense of veterinarian-owned hospitals. Using a fast-paced, cookie-cutter retail model has the potential to undermine the science and ethics central to traditional veterinary practice. More than ever, animals are regarded as family members. As a veterinary practice owner, I see that clients are increasingly interested in time spent with the veterinarian, thoughtful education, continuity of care, and patient-tailored medical decisions. The trend toward corporate veterinary practice doesn’t seem to to match what clients are actively seeking for their animals.

MAVANA founder, Dr. Scott Spaulding, views the VCA-Mars merger as potentially positive for the veterinary profession. Based on his experience as a practice management consultant and member of the AVMA Veterinary Economics Strategy Committee, he recognizes that one of the largest financial hurdles most practices deal with is the lack of capital. Pertaining to the the acquisition of VCA, Dr. Spaulding stated,

It’s a capital-intensive business. We have to have facilities and a large enough staff. We also invest heavily in surgical facilities and the latest diagnostic technologies. With $9.1 billion coming into the veterinary industry, I think that is definitely needed by veterinary medicine and that it will have a tremendous long-term impact.

In response to the VCA-Mars transaction, the American Veterinary Medical Association (AVMA) issued forth the following uber-politically correct statement:

We support every veterinarian engaged in veterinary medicine, no matter where they practice. In addition, regardless of practice ownership, the interests of the patient, client, and public require that all decisions that affect diagnosis and treatment of patients are made by veterinarians in the context of a veterinarian-client-patient-relationship, and veterinarians must have the authority to exercise professional judgment in making clinical decisions.

How do you weigh in on this topic?

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.

 

Alaska’s New Divorce Law: Pets Are More Than Property

Photo Credit: Flicker CC, Davidegorla, HugMy interest is always piqued by news of changes in laws that view animals as family members rather than personal property. Case in point is a newly amended law in Alaska (Amendment HB 147) that requires consideration of the best interest of companion animals who are caught up in the tangle of divorce. In the past, the animals would have been placed with whomever was deemed to be the more “rightful owner.”

The Animal Legal Defense Fund (ALDF) has called Amendment HB 147, “groundbreaking and unique.” A recent ALDF blog post stated, “Even though judges throughout the U.S. can already choose, in their discretion, to consider an animal’s best interests, no other state legislature has required judges to do so when adjudicating property distribution upon the dissolution of a marriage.”

Will other states follow suit?

Alaska’s Amendment HB 147 has set a precedent in the United States in terms of divorce law. It remains to be seen whether or not other states will follow suit. Few laws currently exist within the United States that recognize the best interests of animals within the court system. Alaska’s decision represents significant progress. State Representative Liz Vasquez, a sponsor of HB 147 stated,  “Pets are truly members of our families. We care for them as more than just property. As such, the courts should grant them more consideration. It’s only natural.”

A case in Texas

There have been a handful of court cases in recent years that have challenged the long-standing legal precedent that animals are to be regarded as personal property. One notable example involved Texans Kathryn and Jeremy Medlen. Their lawsuit stemmed from the wrongful euthanasia of their dog Avery by a Fort Worth animal shelter. Avery had been picked up as a stray and was to be held until the Medlens could retrieve him. Shelter workers erroneously placed Avery on the “euthanasia list.” The Medlens sued and attempted to recover “sentimental” and “intrinsic” damages for the loss of their dog. Ultimately, the Texas Supreme Court denied the Medlen’s claim declaring that pets are nothing more than personal property.

The court, however, did sympathize with the Medlen’s grief by acknowledging that, “Texans love their dogs. Throughout the Lone Star State, canine companions are treated- and treasured- not as mere personal property but as beloved friends and confidants, even family members.”

However, the Supreme Court justices felt that this sentiment should not negate a more than a century old precedent that bars emotional damage claims for the death of a pet. As Supreme Court Justice Don Willet wrote, “The Medlens seek emotion-based damages for the death of ‘man’s best friend’ when the law denies such damages for the death of a human best friend. For all their noble and praiseworthy qualities, dogs are not human beings, and the Texas common-law tort system should not prioritize human-animal relationships over intimate human-human relationships, particularly familial ones.”

How do veterinary organizations weigh in?

Professional veterinary organizations typically voice opposition to viewing pets as more than personal property. Here is their reasoning. Currently, veterinary malpractice insurance premiums are extremely affordable. If and when pets become more than personal property and their owners can sue for emotional damages, the cost of veterinary malpractice coverage will skyrocket, perhaps rivaling those of human medical doctors. This would dramatically drive up the cost of veterinary care.

In the Medlen lawsuit, both the Texas Veterinary Medical Association and the American Veterinary Medical Association filed legal briefs requesting that the existing law viewing pets as property be upheld.  About this case, Texas Veterinary Medical Association president, Dr. Jed Ford stated, “The court upheld a legal precedent that has served the people and animals of Texas well for over 100 years. While animals play important roles in our lives, it was critical that the court maintain its position that noneconomic damages are unavailable for the loss of an animal. To have ruled otherwise would have had a dramatic negative impact on the practice of veterinary medicine in Texas and animal care in general.”

How do you weigh in on the legal view that pets are no more than property?

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.

 

X-ray, Ultrasound, MRI and CT: Which Imaging Study is the Best Choice for Your Pet?

Photo Credit: Liverpoolhls, x-ray, Flicker CC licenseWhy has your veterinarian recommended an MRI scan rather than a plain ole’ x-ray of your dog’s back? Why a CT scan rather than an ultrasound of your kitty? Nowadays, when it comes to diagnostic imaging, there are a number of options to choose from. Each of them caters differently to visualizing abnormalities. Knowing the merits and limitations of each imaging option allows your veterinarian to recommend the best choice for your dog or cat.

Radiographs (X-rays)

Of all commonly used imaging modalities, radiographs have been around the longest. High-energy radiation is passed through the body to create a radiographic image. In the past, images were transcribed onto x-ray film. Nowadays, most veterinarians use digital sensors to capture the images. Digital radiographs are preferred because, not only can the images can be enhanced, there’s no need to mess with the nasty chemicals necessary to develop x-ray film.

Radiographic images are great for looking at bones, particularly when wanting to identify fractures or arthritic changes. Chest x-rays can detect pneumonia, enlarged lymph nodes, tumors that are relatively sizeable, and heart enlargement. Radiographs of the abdomen can be useful for finding prostate gland enlargement, most bladder stones, enlargement of the liver or spleen, abnormal gas patterns within the bowel, and some gastrointestinal foreign bodies (those that contain mineral or metal). It’s quite common for veterinarians to choose radiographs as a first diagnostic imaging test. If they don’t reveal an abnormality, a different type of imaging study may be recommended.

In some states, California being one of them, it is required that only the animal be in the room when radiographs are taken so as to avoid repetitive human radiation exposure. Depending on the finesse of the x-ray technician in using gentle restraint devices as well as the malleability of the patient, sedation may be necessary. In states where such radiation exposure laws don’t exist, a technician or two wearing lead-lined gloves and aprons typically restrain the fully awake patient in position when the x-ray is taken.

Ultrasound

Ultrasound resembles sonar in that sound waves are emitted to retrieve information. In the case of ultrasound, the sound waves are emitted from a hand held device and information about how they pass through or are blocked by the various tissues they encounter is converted into electrical signals that are then interpreted by a computer and transformed into an image. Ultrasound is a wonderful modality for evaluating abdominal organs such as the spleen, gall bladder, liver, and kidneys. It’s also great for evaluating the heart (referred to as an echocardiogram).

Unlike x-rays that provide silhouette images of structures, ultrasound allows a look inside various organs. For this reason, ultrasound is a commonly used diagnostic tool. Where ultrasound is limited is in evaluating bony abnormalities or things within the chest cavity other than the heart. This is because sound waves are blocked by air (the lungs are filled with air) and bone.

Unless an animal is quite anxious, wiggly, or fractious, ultrasound can be usually be performed with nothing more than gentle restraint. Hair gets in the way of creating a good ultrasound image, so the study site must be shaved. Not to worry, the hair coat will grow back good as new in approximately three months time (a small price to pay for valuable information).

Computerized tomography (CT)

CT imaging is a moving x-ray machine. The x-ray and recording device rotate around the patient. The recording device sends data to a computer that compiles an image. Like a loaf of bread, the image contains multiple slices. The data is then constructed so that the person interpreting the CT scan can view the images one slice at a time or compiled into the whole loaf.

A CT scan is a good choice when an abnormality is detected that an x-ray cannot find. For example, small growths within the bone or lungs that are too subtle to be seen on an x-ray will appear crisp and clear on on a CT scan. Given that the CT machine tends to be noisy and scary and the animal must lie perfectly still for several minutes, general anesthesia is invariably required.

Magnetic Resonance Imaging (MRI)

MRI imaging uses magnetic field and high frequency radio waves to create an image. The beauty of the MRI scan is twofold. First, it creates greater soft tissue (as opposed to bone) detail than any of the other imaging studies. Secondly, it does so without any radiation exposure for the patient. MRI is an ideal choice when evaluating soft tissue structures such as muscles, tendons, ligaments, solid organs (liver, spleen, kidneys), and the spinal cord.

As with CT scanning, MRI imaging requires general anesthesia so that the animal will lie completely still in a very noisy machine over the course of 30 minutes to an hour.

Have any of these imaging studies been used for your pet? If so, what was discovered?

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.

 

 

 

Ovary-Sparing Spay Surgery (OSS)

Photo Credit: Flicker CC, Smerikal, BeautifulMy last blog focused on the boys, specifically canine vasectomy, a surgical technique for sterilizing male dogs without removal of their reproductive organs (testicles). Now, it’s time to talk about the girls! The corollary surgery in female dogs is called ovary-sparing spay (OSS).

What exactly is ovary-sparing spay surgery?

The canine spay surgery traditionally performed in the United States is called ovariohysterectomy in which both ovaries (ovario) and the uterus (hyster) are removed. OSS surgery is simply a hysterectomy- only the uterus is removed and, as the name implies, the ovaries are spared. The hysterectomized dog is sterile, but her ability to produce reproductive hormones remains intact.

Why consider OSS?

There are a few different reasons why people might opt for OSS surgery:

  • They want a sterilized dog, but believe in the importance of maintaining normal reproductive hormones status. Over the past decade or so, we’ve learned considerably more about some deleterious effects of traditional spay surgery particularly when performed before one year of age. The studies to date have mostly been breed-specific (Rottweilers, Labrador Retrievers, Golden Retrievers, Vizslas, and German Shepherds). In these studies, removal of the reproductive organs increased the risk for development of behavioral problems, orthopedic diseases, urinary incontinence, and various types of cancers. At this point, we really don’t know if this information can be extrapolated to other breeds.
  • They want their sterilized dog to achieve “normal” or “breed typical” stature and conformation. Conventional spaying, particularly at a young age, tends to create a somewhat different physical appearance.
  • They want to eliminate the risk of pyometra (see below), but don’t want the loss of normal reproductive hormone production.

Not for everyone or every dog

While OSS makes perfect sense for some people and some dogs, there are a number of important factors to consider:

  • A dog who has had OSS surgery will continue to have heat cycles complete with a swollen vulva, behavioral changes, and an invitation to all the unneutered male dogs in the neighborhood. The good news is that the amount of vulvar discharge associated with the heat cycle should be significantly diminished.
  • Dogs who have had OSS surgery will be subject to developing mammary (breast) cancer, one of the most common malignancies in female dogs. Removal of the ovaries, particularly before the first heat cycle occurs, protects against this disease.
  • When the ovaries are spared, it’s super important that the uterus, including the cervix, is removed in its entirety. Most veterinarians do not have experience removing the uterus this “aggressively”. Leaving even a remnant behind can result in pyometra (pus within the uterus). This “stump pyometra” can make for a very sick dog, and treatment typically requires surgery. Correctly performed, OSS surgery prevents pyometra from ever occurring. If you opt for OSS surgery, pick your surgeon wisely. Consider working with a veterinarian who specializes in surgery.
  • Although she will be receptive to male dogs when she’s in heat, the female who has had OSS surgery should not be bred. Given that her cervix will have been removed, from an anatomical point of view she may not be able to accommodate the male dog.
  • Just like dogs who have not been spayed, dogs who have undergone OSS surgery may exhibit symptoms of pseudopregnacy, also known as false pregnancy. This is a truly interesting phenomenon in which reproductive hormones trick the dog into thinking she’s pregnant even though she’s not. So, at right around 60 days following her heat cycle, the pseudopregnant dog begins behaving just as she might if she were getting ready to give birth. She might exhibit behaviors such as nesting, aggression, panting, pacing, whining, and not eating. She may even begin producing milk. While none of these are symptoms that typically need to be treated, they can create a nuisance that lasts for quite awhile.

Would you ever consider OSS surgery for your dog?

Best wishes,

Nancy Kay, DVM

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

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

 

Canine Vasectomies

Do you know that vasectomy surgery can be performed on dogs? Indeed this is true, Photo Credit: Nguyen Hoangnam, cute, Flicker CC licenseand, as we learn more and more about the impacts of traditional canine neutering (castration), vasectomy surgery is becoming increasingly popular.

What exactly is a vasectomy?

Whether performed on a human or a dog, vasectomy surgery involves clamping, cutting, or ligating (tying off) the vas deferens, the duct that transports sperm out of the testicle and into the semen. Local anesthesia is all that is needed to accomplish this surgery in men. (Most men will lie still when told to do so.) Vasectomy surgery is performed in dogs using general anesthesia.

Vasectomy versus castration

Castration is referred to as “neutering” because the reproductive organs (testicles) are removed. With vasectomy surgery, the testicles remain in place, so the dog is not considered to be “neutered.”

Whether castrated or vasectomized, the end result is a sterile dog. And, there is a period of surgical recovery with both procedures. Castration tends to be a “bigger deal” surgery in that the incisions are larger and there is more overall tissue trauma. Performed by someone with significant experience, a vasectomy tends to be considered a relatively minor procedure.

The testicles are where testosterone is produced. So, it makes sense that castration (removal of both testicles) reduces testosterone production to almost nil. A very small amount of testosterone continues to be produced by the adrenal glands. Vasectomized dogs maintain normal testosterone production.

Choosing whether or not your dog should live his life with or without testosterone is a big-deal decision these days. There is mounting evidence (pun intended) that removal of testosterone, particularly in dogs under a year of age, might be associated with negative health implications. There are plenty of pros and cons to consider, and they should be discussed at length with a veterinarian you hold in high regard. Be sure to do some investigating yourself. I have compiled a bibliography on canine spay/neuter research, including that which is most current. Please shoot me an email if you would like a copy.

Be forewarned

If you opt to sterilize your dog via vasectomy, here are some things to consider:

– There is no “Vasectomy 101” course being taught in veterinary schools (yet). Most veterinarians who perform vasectomies are somewhat self-taught. While this surgery is pretty darned simple, be sure that you are working with a surgeon who has several vasectomies under his or her belt (pun intended). If you are having difficulty finding an experienced surgeon, look for a surgical specialist. He or she will be able to handle your request.

– If ever you become unhappy with the role testosterone is playing in your vasectomized dog’s life (he’s humping everything in sight, he’s jumping the fence to be with the neighbor’s dog who is in heat), you can always opt for castration at a later date.

– Following vasectomy surgery, a male dog can successfully breed for up to two months. Do not let your vasectomized dog interact with a female in heat during this time period.

– You might be ostracized and/or interrogated at dog parks and other public venues where only neutered dogs (those without reproductive organs) are allowed.

– Proprietors of doggie day care facilities may refuse your vasectomized dog because they hold negative and sometimes inaccurate impressions of testosterone-driven behaviors.

Would you ever consider a vasectomy for your dog?

Best wishes,

Nancy Kay, DVM

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

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