Thursday, February 27, 2014

10 things I want my clients to know about Pet Food

Nutrition has become somewhat of an obsession. Because nutrition is such a hot button issue right now, I was writing a post that I had been referring to as my "nutrition manifesto." It was going to be a monster of a post addressing all of the myths and misconceptions that I discuss with clients on a daily (sometimes hourly) basis. However, now there so many good articles out there outlining the facts better than I could, I decided instead to make a top ten list of what I want all my clients to know about feeding pets. 


1. Grain-free is a marketing ploy and a fad. Grain free diets are no more nutritious than other diets including grains, but they can cost an owner up to twice as much. This is purely profit. Eventually grain free foods will fall out of favor as new trends emerge. Also, grain free does NOT mean low carb. 

2. Raw food has no benefit (none), and can make your pet sick or even die.  Feeding raw does not cure allergies, does not provide superior nutrition, is often not balanced, and does not make your cat or dog like their "wild" ancestors or counterparts.

3. Your dog is not allergic to corn. At least, it is extremely unlikely. Food allergies are much less common than the general public is led to believe by certain companies. Of all allergic dogs, the majority are flea allergic, many are environmentally allergic, and less than 5% are food allergic. And most food allergies are to the animal protein in the food (beef, chicken, etc). That means that a minute percentage of dogs are truly allergic to corn or wheat, so small it is difficult to compute. Corn is an excellent source of energy and essential fatty acids. It is not evil.

4. By-products are perfectly acceptable ingredients in pet food. The term "by-product" refers to parts of a carcass not used by the human food chain (read: Americans). This does not mean by-products are bad. By-products include highly nutritious organ meats like liver and spleen. By-products do NOT mean feathers, hooves, etc. 

5. Only three companies (out of the seemingly thousands that make pet foods now) employ board certified veterinary nutritionists. These companies are Hill's, Purina, and Waltham (Royal Canin & others). Because the company employs a person who is trained to formulate balanced foods, I know that these companies want their foods to be complete and balanced for the animals they feed. In other words, they actually care about nutrition, and not just profits. 

6. Pet store employees are not trained in nutrition. They are trained in sales. The foods they push are the ones with the highest profit margins. Don't spend hundreds of dollars a year on pet food and forego flea treatment or wellness care.

7. Picky eaters are made, not born! It is important to choose one food and stick with it. Changing a dog's food every day, week or even just buying whatever bag is on sale can be very detrimental to the health of the dogs gastrointestinal tract by causing diarrhea and gassiness due to bacterial population changes. It is also the best way to create picky eaters. Dogs are smart and they recognize patterns. If you give in to a begging dog, he will beg again.

8. Dogs are omnivores, not carnivores. Dogs are not wolves. Dogs were domesticated between 15 and 30 thousand years ago. They evolved eating the scraps of humans, which included just about anything. If your dog was "wild," it would not be chasing down an elk with it's packmates. It would be rooting through the trash to find food. If your dog is a brachycephalic breed (smush face), it would die rather quickly in the "wild."

9. Cats are obligate carnivores. Cats need animal protein in their diets to survive. (This does not mean that your cat cannot eat some grains). Please do not try to make your cat a vegetarian, or worse, a vegan. It WILL die.

10. Your veterinarian is the best source for information about your pet's diet. Not Dr. Google. Contrary to the belief of some "online experts," vets are not 'bought out' or bribed by certain food manufacturers. We just recommend the foods we see actually benefitting pets. Most vets are Type A, detail-oriented, results-driven people. We want to see our patients live long, healthy lives, and that includes having good, balanced nutrition. Some veterinarians may be more interested in nutrition than others, and can at least get to you a legitimate resource to answer your questions.


I have added a new Nutrition Resources Page at the top of the blog. I will continue to update this page with links to studies, articles, and informative resources.

(Also, I invite other opinions and experiences but because nutrition is so emotional, I reserve the right to close comments on this post and/or block users as necessary. You have been warned.)


Friday, January 24, 2014

It just keeps getting better....


Mr. Seeker: Well sometimes I take the dog's pain medication. You know, if mine runs out. So I like to keep a stash on hand, just in case. 
.. Haha, buh-bye. 

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Ms. Psycho: You charge how much for euthanasia?! That's ridiculous! I could just throw the dog off the balcony! 
.. Umm, ok. Our way is pain free and legal, but you know, details. 

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(We are having cake for a staff member's birthday. A client sees it as he walks past the employee-only area to the bathroom.

Mr. Sweet Tooth: Oh, is that cake?
Nurse: Oh yeah, it's Fred's birthday today so we're having cake.
Mr. Sweet Tooth: Oh. 
[awkward pause as Mr. ST stares at the cake.]
Nurse: Do you want a piece?
Mr. ST: Oh yeah, I'd love one. 

We give him a piece of cake. As if that wasn't weird enough, he then pops his head back into the room and asks for another piece!!! WTF?!? Get your own freaking cake! 

----------

We get an rx request for medication for an animal we have never seen. The astute receptionist calls the client to ask if there has been some mistake.

Ms. IQ:  Oh no, you've seen him. It's for Fluffy.
R: But on this request, you put a different name, different weight, and even different species. If its for Fluffy why didn't you just put the correct information?
Ms IQ: Because I want to buy a bigger dosage and just split it because that's cheaper.
R: (checks with me) Um, that's not how dosing works for this medication. And we can't dispense meds for an imaginary animal.
Ms IQ: Look, I'm very smart and I split my mom's heart medication and it worked just fine.
R: Um, okay.... but this -
Ms. IQ: If you're not gonna give it to me I will just have to get it illegally!
R: Okay, you do that....

For further info on this topic, see Drug Doses are Just Guidelines Anyway.

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Wow, people. What WILL you say next week. We are waiting with baited breath.

Tuesday, December 31, 2013

The last day of the year

With only a few hours left to go in 2013, I am reflecting on what a truly wonderful year this has been for me. My husband and I have our health, happiness and a baby on the way. We were able to purchase our second house, and I finally realized a dream I have had since I could speak: I own my very own horse. (Of course, I am ironically not riding him since I am pregnant, but this too shall pass).

Every year does get better and better, and also passes by more quickly. Everything our elders told us about time passing is true, and I try to remember the small joys and moments that will later make all the difference. I am excited for the next year and what it will bring. I have no 'resolutions;' only that I might live my life and really be present for it.

Many of my closest friends and family have lost those closest to them this year, and for you, and for your loved ones, may I offer this candle. The light of their lives will burn for you forever.


To Everyone: A blessed and happy, healthy 2014 and beyond.


Tuesday, December 3, 2013

The Truth About Non-Anesthetic Dentals (Gentle Dentals)

Dental care is extremely important for the long term overall health and function of our pets. Periodontal disease, which is irreversible damage of the gums and structures below the gums, can have many negative effects on the animal. First and foremost, pain and inflammation in the mouth can lead to a poor appetite, weight loss, and lower quality of life. Infections in the mouth can travel via the bloodstream to organs such as the heart, liver and kidneys. Dental disease is just as important as other diseases and deserves to be treated.

A new trend that has emerged in pet care is the non-anesthetic dental cleaning, or gentle dental. I suppose this came about as a way to capitalize on people's fears about anesthesia and as a "cheaper" alternative to a professional dental cleaning. Basically, as I will discuss, it is a quick and easy way to make a buck. There is no benefit for the pet and it can actually be detrimental to the animal in a few ways.

Gentle dentals:
- are generally not performed by anyone with any actual training (in fact in California, it is illegal to perform this procedure without a veterinary license)
- do not allow the lingual surface of the teeth to be cleaned or evaluated (the side of the teeth touching the tongue)
- scratch the enamel and damage the gums
- cannot be used to extract teeth
- give owners a false sense of security
- Most importantly: can not clean under the gum line which is where the problems lie!

Anesthesia is required to properly evaluate, clean, probe, and polish a pet's teeth. No cat or dog, no matter how cooperative, will hold its mouth open for a long period of time so a person can perform necessary dental procedures, which may include extractions. This is why we must anesthetize them for the procedure.

Anesthesia is safe, and actually it is generally safer to fully anesthetize a pet for a dental than to give "twilight" or light sedation. Pre-operative bloodwork is routinely performed to assess organ function prior to anesthesia. Appropriate pain control medications are given before anesthetizing. In a properly anesthetized patient, the pet is intubated (a tube is inserted into the trachea) to ensure oxygen is getting to the lungs and to prevent water or rinse from going down the trachea. The pet is monitored by the anesthetist (nurse or doctor) and has its temperature, blood pressure, oxygen tension, and pulse rate measured by a machine.

Rarely, a complication may arise that could not have been predicted or avoided by the doctor or pre-op bloodwork. With our safe medications, proper precautions and careful monitoring, this is rare.

Once under anesthesia, a veterinarian or nurse will remove all the tartar and plaque from all surfaces of the teeth (inside, outside and in between). All teeth will be probed for pockets, areas of infection, loss of enamel or nerve exposure, broken teeth, and root exposure or resorption. Any teeth that are non-viable (dead) or freely mobile in the socket will be extracted using proper procedures and often a nerve block to reduce pain sensation to the area. Dental x-rays may be performed to evaluate roots and bone structure.

The remaining teeth will be cleaned and polished. The teeth are cleaned on the visible surface and under the gum line. This is where the bacteria mainly reside and most "bad breath" comes from bacteria hiding out under the gum line. Periodontitis (irreversible gum damage) starts here. This is why many people who had a non-anesthetic dental done on their pet still report bad breath, even though the teeth may look very nice. If the teeth are not cleaned below the gums, the whole procedure is basically worthless. Anesthesia is necessary to clean under the gums in our pets.

Polishing is a very important step in a dental cleaning. The polisher is a not just a fancy toothbrush. It actually is meant to help smooth the microscopic scratches in the enamel that were inevitably created by the other instruments. It is a vital step to maintaining a healthy tooth and preventing new bacteria and plaque from attaching to the tooth and possibly penetrating the enamel to the underlying structures in the tooth. Polishing cannot be performed in a gentle dental.

Here is a picture of the lower incisor teeth of a dog who had two recent non-anesthetic dentals. All of them had to be extracted.
Note the tartar, recessed gum line, bleeding and root exposure of the incisors. 
The money (not a small amount either) that the owner spent on the gentle dentals would have been much better spent on a professional cleaning earlier in the course of disease. 

Nearly all pets will need at least one, if not more, professional cleanings in their lifetimes. Home care is possible, and daily brushing of a dog or cat's teeth will most certainly prolong the healthy lives of the teeth and the pet and increase time between professional cleanings. Dental care is extremely important for any pet.

Update: A video on how to brush your dog's teeth
http://www.youtube.com/watch?v=wB3GIAgrTPE


Resources

The American College of Veterinary Dentistry position statement: 

Ten Steps to Dental Health

Dangers of Anesthesia Free Cleanings





Saturday, October 12, 2013

Cats are not small dogs, but dogs are people?

When I was a little girl, about 3 or 4 years old, I had a talking Mother Goose. Under one of her wings was a cassette holder. I could pop in a tape and she would read me stories.

Not only did she read me stories, she read to all of my stuffed animals as well. She had a lovely little bonnet and pretty blue eyes with black eyeliner, and she looked around and winked and blinked kindly as she told her stories. We could read together for hours.

One day, her voice started to slur. I took her to the hospital wing and let her recharge (new batteries). But it didn't help. She got slower and slower, and then she stopped talking altogether. My Mother Goose was dead.

Since I hadn't had any actual pets, hers was the first death I really experienced. Now I experience it regularly.
--

We often say in veterinary medicine that "cats are not small dogs," as a response to many situations in which cats differ greatly from our canine companions. But are dogs small people?  This New York Times article, Dogs Are People, Too, was published a few days ago and highlights some recent work that was done with dogs and MRIs. Dogs were trained to remain still in an MRI machine while completely awake so that their brain activity could be accurately monitored in different situations. What they found was that dogs had very similar brain activity to humans in a particular part of the brain called the caudate nucleus, which is activated during positive emotions.

This is very interesting research and the closest yet to proving that animals have emotional lives. Animal behaviorists have been studying this for years attempting to design scientific experiments to gain more ground in this area of research. (Most likely Julie Hecht at Dog Spies and Dr. McConnell at The Other End of the Leash can better explain this). Every animal lover "knows" that their cats and dogs have emotions. But how can this be proven beyond a shadow of a doubt?

This research is the first step. But the author took it one step further already. He suggests that reconsideration should be given to animals as property and mentions many rescue groups refer to pet owners as guardians. I don't believe this particular author was quite aware of all the implications of his statement.

A few years ago, California was considering changing ownership to guardianship for pets. Thankfully, no serious attempts at passing a law were made, and the idea lost traction. "Guardianship" of animals will bring about many changes in the relationships humans have with their pets, and not good ones. There will be many unintended consequences of such a decision, as there often are when well-intentioned but misinformed people make decisions such as this.

Considering animals on a level with humans or at least more than "property" will mean that euthanasia will no longer be an option to end animal suffering. Animals with painful, terminal illnesses will have to suffer, just as humans with terminal illness do. The difference is humans can understand what is happening to them, but animals cannot.

"Guardianship" will mean that every animal must be treated to the fullest extent possible, even if it is not in the best interest of the animal, and even if the "guardian" can't pay for it. Veterinarians already experience this attitude from the general public ('I can't afford to pay for this, but you should fix this for free because you love animals.') We do not receive large insurance payments, or subsidies to operate from the state or federal government. We only survive on what we charge for our services. Veterinarians would not survive in such a world.

The word euthanasia means "well" (Gr. eu) "death" (Gr. thanatos). It is a completely painless way to end suffering, and most vets consider it a gift we can give to animals. Nearly every client whose animal I euthanize asks me, "This must be so hard, how can you do this all the time?' As we cry together, my answer is always the same. It is hard, but it is almost always in the best interest of the animal. I would rather let animals leave this earth easily and comfortably than allow them to suffer until they die on their own.

I would fight, and fight hard, before losing that ability.

Since Mother Goose passed on, I have experienced many deaths. At most, I cry. The human-animal bond is very special and it is my wish that all animals are treated humanely and with compassion and love, by their owners.

--
See Dr. McConnell's post here and many interesting and thoughtful comments.

Sunday, August 18, 2013

Who has the right to own a pet?

Something we debate on an almost daily basis is whether people should have pets when they can't, or worse, won't, afford care that their pets require. This is a concept that I have struggled to write about for awhile, now. Who has the right to own a pet? Does everyone? Is it truly a right, or in fact a privilege to own an animal?

I'm not referring to people who have extenuating circumstances that are out of their control, like a lost job or sudden disability. I'm talking about people who already don't have a job who then decide to go out and 'rescue' an animal. Or the people that are raising multiple children on low income and get their kids a puppy. Which they don't vaccinate. And then it gets parvo. Which costs a lot more money to fix than the vaccine would have.

I'm not talking about thousands of dollars in expensive surgeries or hospitalization, here, although that is a potential need that may arise in any animal. Certainly even people that can and do afford basic medical care for their pets may be thrown off guard by an emergency. I get that, and I'll work with them, even though I do think its important to plan ahead and 'self-insure', or get pet insurance. I'm just referring to basic needs. Annual exams. Flea and heartworm control. Vaccines. Taking care of ear infections before they reach a critical mass. Radiographing a possible broken or diseased bone. Yes, these things cost money. Maybe if people stopped spending so much money on "premium foods" (by the way, who told you it was premium? the same company that makes it?) which are only making their dogs fat and at greater risk for problems, they would have extra cash on hand to buy flea control that is safe and effective.

There was an article I read a long time ago which I wish I had saved. It talked about a subset of the population that just does not have the ability to plan ahead. Where some can see down the road and adjust their current trajectory to avoid potholes, others simply cannot. At the time, I found this really hard to believe, but the more I work with people, the truer it appears. What I really want to know is: can those people learn to plan better? Do they have the ability to change? Or will they continue on in life not ever able to understand that if they just put flea control on monthly, the hotspots/infestations won't happen?

We always support adoptions and shelters, but is it fair to the animal to be adopted by someone who can't or won't give it basic medical care? Especially since that is how many animals end up at the shelter to begin with?

Is it fair to well meaning people who don't have a lot of disposable income to deny them the love and companionship a pet brings? There is no denying that pets bring happiness, stress relief, even lower blood pressure to their owners.

I don't know the right answer.

Certainly this man doesn't deserve to own a pet. (That is a great blog post by the way, about the worst part of being a veterinarian. Some of the comments are pretty interesting as well). Even though the entire situation was his fault, he chose to try to place the blame and responsibility on his veterinarian, something that is far too common. I would say if he had only planned better, things may have turned out differently, but he clearly never had any intention of caring for his own animals.

As one commenter points out, this is a gray area. If people should save money for their pets, how much should they save? How much is enough? What may be plenty to care for one pet may not even meet the tip of the iceberg to care for another. Life is unpredictable. That's what makes this subject so difficult.

I am no clearer now than I was before.

Monday, July 22, 2013

Kennel Cough can Be Deadly

A couple came in for a second opinion on two puppies they just acquired that were diagnosed with "kennel cough." Kennel cough is a coverall term for several infectious agents, the two main ones being a virus called Parainfluenza and a bacteria called Bordetella bronchiseptica. The technical term for kennel cough is Infectious Tracheobronchitis. It generally causes a self-limiting, hacking cough in vaccinated, mature dogs. Kennel cough can progress to pneumonia in immunocompromised or untreated individuals.

A few stories were floating around before the dogs arrived. First was that they had come from a breeder and the first opinion was the breeder's (not a real first opinion - did your breeder go to vet school?). Second was that they had gone to another vet who didn't treat them appropriately (also hardly believable). I dropped all misconceptions, but as soon as I walked into the room, I knew there was a terrible problem. The puppies both had a respiratory rate of over 100 (normal ~40). They were underweight, had fleas, and were clearly very ill.

I examined both puppies and told the new owners (who had rescued the dogs, not from a breeder) that the pups were extraordinarily ill and would likely require several days worth of hospitalization. I handed them a $1600 estimate that would cover the first 6 hours of initial care. They looked into my eyes and I could see they really cared about the pups. But, they just didn't have the funds for such care.

We reworked the estimate, took chest x-rays for free (I had to see what was in those lungs), and sent them home with detailed instructions on how to care for two puppies with severe infectious pneumonia. The previous vet's records came in, and I added on to their treatment plan with additional antibiotics, flea control, and instructions on nebulization and coupage.

I gave them a guarded prognosis with one ray of light: these were puppies. Healing machines. Their bodies wanted to heal, they just needed some help. Hopefully what we could do would be enough to save two sweet little dogs.

They thanked me. Several times, actually. With real words, and meaning. Even though I had discounted more than their entire bill came to, and we spent a decent amount of time with them, for once I felt like our efforts were sincerely appreciated in a crappy situation. And I really do hope the little dogs make it.

UPDATE: The owner came in today to bring me cookies and say thank you again. The dogs are looking 10 times better! They still have a long way to go but I think they're gonna make it! Yay!