Euthanasia Outside of the Veterinary Hospital

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

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

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

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

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

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

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

Best wishes,

Nancy Kay, DVM

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

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

Solving the Mystery of Feline Hyperthyroidism and its Human Health Implications

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

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

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

PBDEs

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

PBDEs and hyperthyroidism

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

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

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

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

Cats as modern-day canaries

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

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

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

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

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

Best wishes,

Nancy Kay, DVM

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

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

Support for Cancer Patients Using Herbs and Supplements

 

It’s estimated that 80 percent of people with cancer take herbs and/or supplements as part of their treatment regimen. This trend has extended to animals- more and more people are administering these products to pets diagnosed with cancer. More commonly used supplements and herbs are described below. Further studies on most if not all of them are warranted to know how best to incorporate them as part of a cancer-fighting regimen for for dogs and cats.

Omega-3 fatty acids

Omega-3 fatty acids have multiple proven anti-inflammatory properties. There is evidence in human patients that they help reduce “cancer cachexia,” the profound weight loss associated with certain types of malignancies. They may also reduce radiation therapy side effects and infections following cancer surgery. Lastly, some studies suggest that omega-3 fatty acids may have a direct impact on cancer cells that diminish their ability to proliferate.

While omega-3 fatty acids are used extensively in veterinary medicine, there is only limited research pertaining to their use. In a study of canine lymphoma, some but not all dogs receiving a fatty acid supplement had improved treatment outcomes.

In another study performed on dogs undergoing radiation therapy for nasal cancer, those receiving omega-3 fatty acids experienced lower levels of inflammation compared to the placebo group.

The optimal fatty acid dose for dogs and cats with cancer isn’t known. The good news is that omega-3 fatty acids tend to be quite safe, even at higher dosages.

Yunnan baiyao

A primary ingredient within the herbal mixture Yunnan baiyao is panax notoginseng, a substance believed to reduce bleeding tendencies. For this reason, it may be recommended for dogs with cancerous processes with a propensity for bleeding such as nasal tumors, bladder cancer, and hemangiosarcoma.

Although this herbal treatment is commonly prescribed, there is limited and conflicting published research about its use. One study found that Yunnan baiyao may directly kill hemangiosarcoma cells. Other research found no benefit in blood clotting in response to this product. There has been no evidence that Yunnan baiyao is harmful.

Curcumin

Curcumin is the primary component within the commonly used cooking spice, turmeric. A number of studies have demonstrated its ability to inhibit the growth of cancer cells. Unfortunately, most over-the-counter turmeric products are poorly absorbed from the gastrointestinal tract. Efforts are currently underway to develop an injectable form of curcumin. A delivery method referred to as “liposome encapsulation” shows promise for allowing curcumin to achieve high concentrations within body tissues.

I’m-Yunity

The active product within I’m-Yunity is the mushroom, Coriolus versicolor. Also known as the turkey tail mushroom or cloud mushroom, this herb may inhibit cancer cell growth. Studies on people with cancer indicate that it can enhance survival times when combined with other treatment methods.

A study of dogs with hemangiosarcoma, demonstrated that I’m-Yunity is well tolerated. Dogs receiving the highest study dosage experienced a longer duration of time before cancer progression, however, actual survival times within the treatment groups did not significantly differ.

Valproic Acid

Valproic acid is a fatty acid that has been studied in the past for its anti-seizure properties. It also has an effect on DNA that may render it more susceptible to chemotherapy drugs. It has been shown to enhance the impact of doxorubicin (a chemotherapy drug) on canine osteosarcoma cells grown in the laboratory.

Potential interactions

While herbs and supplements are available without a prescription, it is imperative to have conversation with your veterinarian before giving them to your dog or cat. While some of these products are like chicken soup (“It couldn’t hoyt….”), others are unsafe or counterproductive. For example, garlic, vitamins E, A or C, grape seed extract, red clover and the ginsengs all have antioxidant properties that can interfere with the effects of radiation or chemotherapy.

Does your pet receive any herbs or supplements? If so, what is the intended purpose?

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.

 

Impacts of Opioid Abuse On the Veterinary Profession

Photo Credit: Flicker CC, jlhopgood, MyaIf you pay attention to the news, you’re aware of the growing problem of opioid addiction within the United States. The Centers for Disease Control and Prevention reported 33,000 opioid-related deaths in 2015 with West Virginia having the highest rate followed by New Hampshire, Kentucky, Ohio, and Rhode Island.

How does opioid abuse impact the world of veterinary medicine? Certainly there are veterinarians who struggle with opioid addiction, a topic for another article. This post focuses on the fact that, as opioid prescribers, veterinarians and veterinary hospitals are viewed as potential supply sources for addicts. Theft is a problem as is the issue of pet owners taking narcotics prescribed for their pets. There are too many cases of lies and scams, and some addicts have even gone so far as to maim their own pets in order to obtain a pain medication prescription.

Kentuckian Heather Pereira used a razor blade on two separate occasions to cut her dog with the goal of leaving the vet hospital with drugs. Dr. Chad Bailey, the veterinarian who stitched up Pereira’s retriever became suspicious when she returned to the clinic three days after the first visit for more pills. She claimed that her child flushed them down the toilet. It was discovered that Pereira has no children, and she was convicted of trying to obtain controlled substances by fraud.

Other examples

When two Plainfield, Illinois veterinarians got together, the conversation happened to include challenges with clients. One of the vets talked about a client who was suspiciously trying to refill a tramadol prescription for her dog (tramadol is a commonly abused pain medication). On one occasion, the client claimed that the airlines lost her dog’s drugs and she then requested an early script renewal for an extended trip she would be making to assist her mother with cancer treatment. It dawned on the second veterinarian that this individual had been running the same exact scam on her.

In Ashland, Ohio Dr. Kristine LaFever became suspicious when a young couple came in requesting tramadol by name for their dog. They refused the drugs Dr. LaFever recommended and left the hospital empty-handed. A week or so later Dr. Donald Kaeser arrived for work at the same clinic and found the control drug safe had been pried open and all of the tramadol and phenobarbital (an anti-seizure medication) was missing. Through blood left at the scene, the DNA trail led police to the tramadol-demanding couple, one of whom was sentenced to two years in prison. The other was placed under house arrest for 120 days. The clinic has not replaced the stolen tramadol. “We’ve gone to not carrying it,” Kaeser said. “If we think a pet needs it, we’ll just call in a prescription.”

Pet overdoses

An additional opioid-related problem that appears to be on the rise is overdose cases amongst pets. More and more, animals are being treated for accidental and, in some cases, intentional overdoses. Madeline Bernstein, president of the Society for the Prevention of Cruelty to Animals in Los Angeles has observed, “We do see a lot of cases where the dogs are overdosing because either they’re getting into the stuff or edibles, or idiots think it’s funny to get their dog high or to share their heroin with their dog.” Bernstein deems this to be animal abuse and works hard to get offenders prosecuted.

Guidelines for Veterinary Prescription Drugs

The American Veterinary Medical Association has been paying close attention to the rapidly growing problems associated with human drug addiction and veterinary prescriptions. The organization’s Guidelines for Veterinary Prescription Drugs states, “Veterinary prescription drugs should be dispensed only in quantities required for the treatment of the animal(s) for which the drugs are dispensed. Avoid unlimited refills of prescriptions or any other activity that might result in misuse of drugs.”

Veterinarians are being advised to carefully track control drug prescriptions and actively perform audits (pill counts) on the medications they keep on site. By law, all controlled drugs should be under lock and key 24/7.

Additionally, veterinarians are being asked to formally report clients they suspect of abusing drugs prescribed for their pets. Sgt. Paul Rodriguez with the Los Angeles Police Department provides some guidelines. “We have to have a little more than just a hunch. A veterinarian reporting someone coming in for the same prescription three times in one month is a tip police can use to investigate further and actually send a detective to go and do some follow up questioning.“

Most veterinarians I know pay really close attention to recommended prescription drug guidelines. They don’t want to jeopardize their careers, and a problem relating to controlled drugs (missing pills, pill audit discrepancies, prescribing more than seems reasonable) can do just that.

Have you ever shared your pet’s medications, or vice versa?

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.

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.