Why did my vet recommend a specialist?

Many of our daily appointments consist of pets that are not feeling well for a variety of reasons. In many instances, we can determine the problem and treat effectively by obtaining a thorough history, performing a comprehensive physical exam, perform in-office diagnostics or send lab work out to a reference laboratory, and dispensing appropriate medications or treatments. However, in some instances, problems may be more complicated or require diagnostics beyond the scope of a general practice, and a veterinary specialist may be recommended.  

Many people are surprised to hear that there are specialists for animals! So, what exactly is a veterinary specialist you may ask? A veterinary specialist is a veterinarian who has gone through at least four additional years of training above and beyond the four-year veterinary school education. This typically consists of a one-year internship program, followed by a three-year residency program focusing on their preferred area of specialty. They then have to sit for their national specialty examination before receiving their board-specialty certification.  

Below are some examples of specialists and why we may refer a pet to them. We’ll discuss other specialities in two weeks with our next post.

Emergency & Critical Care SpecialistLet’s face it, sometimes our pets get so sick that they needs some pretty intensive care! Emergency clinics that have a criticalist on staff have the capacity to do some extremely intensive care, including ventilatory support (i.e. breathing for the patient in an acute lung injury), in-hospital feeding tubes, extensive nursing management and tend to be on the cutting edge with treatment options for some really complicated, really sick cases.

InternistWhen we just can’t seem to find the answer to a pet’s metabolic woes or advanced diagnostics (such as endoscopy or bronchoscopy) are needed — and an internal medicine specialist is often recommended. They excel at complicated case work-ups and are very good at long-term patient and chronic disease management. The types of cases that we often request their assistance with are complicated diabetics, certain respiratory disease, multiple metabolic disease processes occurring at once, and certain infectious, inflammatory and autoimmune diseases. Their wealth of knowledge can be invaluable with making treatment decisions and when changing medications, doses, etc. to find just the right balance for a given patient. Subspecialties within internal medicine include:

Cardiologist: Sometimes we will hear a heart murmur or abnormal heart sound when performing a physical examination. A murmur is turbulent blood flow through the heart, but just listening to the heart doesn’t tell us exactly why the murmur is present. In these cases, we will refer your pet to a veterinary cardiologist to perform an examination and an echocardiogram (an ultrasound of the heart). This will help determine the source of the abnormality. Puppies and kittens may have congenital abnormalities that can be fixed via surgery. Cardiologists also can place pacemakers in certain conditions where the abnormality has to do with the electrical conduction through the heart.

Neurologist: Unfortunately, sometimes our pets go through a variety of neurological disorders. This can include herniated disks in their back, tumors within the brain, congenital abnormalities, seizures, etc. Seeing a veterinary neurologist can help narrow down the cause for some of the signs you are noticing at home and they can also perform MRIs/CT scans on your pets to determine the next best step for treatment. Veterinary neurologists are also trained to perform spinal and brain surgeries.

Oncologist: Many types of cancers in veterinary patients can be surgically removed by your primary care veterinarian, but there are certain types of cancers that do best with surgical removal followed by chemotherapy and/or radiation therapy. These are two types of treatments have to be administered by a veterinary oncologist and may help prolong the quality of life-span of your pet.

SurgeonMost primary care veterinarians can perform routine surgeries, including limb amputations. However, sometimes your pet has injured themselves to the point of needing a veterinary surgeon to repair the damage, or requires a complicated surgery that is beyond the scope of general practice. Examples of this include torn ACL repairs, performing a total hip replacement, complicated tumor removals, surgery entering the chest cavity or around the heart, repairing complicated congenital defects, to name a few.

Veterinary specialists are great resources for your pets when your primary care veterinarian thinks their expertise will be needed to help make your pet feel better, faster! We are fortunate to live in an area with numerous specialty-trained veterinarians to help us provide the best care for our pets.

New Years Resolutions 2017

We all know the drill — new year, new commitment to healthier living, lifestyle and relationships!

From your pet’s point-of-view, here are a few:  

  • I will resolve to limit myself to a strict calorie intake appropriate for my lean body weight — just like the rest of us, maintaining a lean body weight is the number one thing we can do for our pets to help them stay healthy! Unlike us, pets can’t count calories, so it’s up to us to be sure they are being fed an appropriate and balanced diet. It’s also important to be sure your pet is eating an age-appropriate diet — the AAFCO (American Association of Feed Control Officials) designates every food as appropriate for all life stages, maintenance, or growth and lactation.  

While an all life stages food may seem appealing, this often may not be the best choice for a pet with underlying health conditions or that is overweight. Additionally, for some medical conditions (i.e. kidney disease, pancreatitis) a prescription diet may really help to prolong the health and well-being of the pet.  

  • I will bug and pester my owners until they take me for at least two (preferably three to four) long walks a day, or engage in an appropriate play session with me — getting plenty of exercise is good not only for the waistline, but also for your pets. Exercise is critical for maintaining balanced behavior and reducing boredom in dogs and cats.
  • I will be sure that my parents pay attention to those pesky reminders from the veterinarian letting them know when I need to get my vaccines updated, so that I stay protected from some of those icky diseases out there.  
  • I promise to take my heart-worm and flea/tick prevention regularly and won’t spit it out — even though I sometimes resist, I know that these are good for me and are protecting me from lots of gross bugs and diseases! — in addition to preventing heart-worm disease, the monthly preventative pill also protects against hookworms and whipworms, which are intestinal parasites quite common in our area.
  • I will get my owners involved in a new activity — I’ve even heard of activity-specific meet-up groups for other dog owners! 
  • I will be cooperative for getting my teeth brushed, much as it pains me! — Daily (or a minimum frequency three days a week) teeth brushing is the single best (and least costly) way to maintain good oral health. Most dogs will get very comfortable with this once it becomes a routine — some even come to love brushing thanks to flavored toothpastes (cats too!)  
  • I will work on my obedience during leash walking so I pay full attention to my owner and no other dogs on walks — Many dogs are leash reactive and this is a very common occurrence that is hard for some owners to pick up. Working with a certified trained dog trainer and daily “homework” on walks can help solve some leash aggression and can also help the dogs (and owners) anxiety!
  • I will try to love when my owners play with my feet! — Many dogs and cats are scared of getting their nails cut. Petting their paws at home and getting them used to you feeling their nails and isolating each digit can actually help the anxiety that comes with nail trims, as this can de-sensitize them to the feeling of their nails being touched for the trims.
  • I resolve to experiment with new serving equipment for my food. It’s out with the bowl and in with the puzzle toys for me! Traditional food bowls are unstimulating and allow for too fast meals. Puzzle toys and food toys for both dogs and cats increase mental activity and decrease regurgitation from rapid eating.

Low-Stress Cat Transportation

Does your cat hide as soon as you break out the carrier from the garage or the closet? Have you ever had to cancel or reschedule an appointment because you can’t corral your kitty?

Read on for some tips on making transportation (be it to the vet office or just for a trip) a little bit easier for everyone.

Preparation:

Easy transportation starts with a good carrier. A hard sided carrier with an easy to remove top is best. Hard sides provide structure and prevent the carrier from collapsing in on your cat while you’re carrying it. A removable top circumvents the need to remove the cat from the carrier once they arrive for their appointment. Many cats prefer to stay in the bottom half of their carrier while being examined and receiving vaccines because it is familiar.

Pheromones on the bedding will also help many cats enjoy the experience of being in their carrier. The kitty pheromone we particularly like is called Feliway and can be purchased as a spray or a plug-in diffuser. Feliway is a synthetic version of the facial pheromone cats leave naturally while rubbing their faces against an object or a person when they are comfortable in their environment. The spray is most appropriate for use with the carrier; 10 sprays should be applied to the bedding at least 15 minutes before your cat will be going in the carrier, to allow time for the alcohol solvent in the spray to evaporate. This application will last for up to 5 hours, but can be reapplied as needed.

After you’ve picked out an appropriate carrier, put it somewhere your cat already likes to sit. Most cats will prefer it on an elevated surface. Take the top half of the carrier off so it’s more open.  Play with your cat in and around the carrier. Place bedding (towel, old sweater) that you cat likes, food, treats, toys, or catnip in the carrier to entice your kitty to enter the carrier on their own. Once they enter the carrier, reward with treats. If your cat is suspicious of this new piece of furniture, leave it out (with the top off) with food or toys inside and allow them to explore it over a period of days or weeks.  It’s crucial to leave the carrier out all the time, rather than pulling it out just before a car ride – as then they know something is up and only associate it with potentially traumatic experiences.

Game time:

Again, when it’s time to transport your cat in the carrier, spray pheromones in the carrier at least 15 minutes before it’s time to go. Allow your cat to get in on their own whenever possible. Transport one cat per carrier. Even cats that share a bed or sleep in a carrier together at home may become overly stressed when transported together and fights could occur. Cover the carrier with a pheromone-sprayed blanket to reduce sights and sounds both during transport and upon arrival to the clinic. If your cat enjoys them, place treats, toys, or catnip in the carrier.

When moving the carrier, hold it with both hands at chest level to avoid swinging and the cat being at eye level with dogs. Ignore the handle on the top of the carrier – it’s not a suitcase! When the handle is used, the carrier will tend to swing slightly and that can be very scary for the carrier’s occupant. Avoid startling noises during the transport. Quiet, familiar, calm music or silence in the car is fine. Secure the carrier on the floor behind the passenger seat. Once in the hosptial, face cat away from unknown people and pets in the waiting room.

Returning home:

It can be hard for cats to reintegrate with housemates after a vet visit. Your cat will smell very different, be stressed, might not be feeling well, and could even be sedate from medications used in the hospital. If any sedation was used, keep your cat in a separate space until the sedation has worn off. A good rule of thumb is 12 hours of separation. When it’s safe to re-introduce your cats, start by re-establishing a common scent profile. Take a rag or shirt and rub down the cat who was out of the house, then take that fabric and rub down the other cat, continue with the same fabric for each cat in the house, end by re-rubbing the cat who was out of the house. This will get everyone smelling the same and minimize signals that the cat who was gone is now an outsider. Supervise interactions until you’re sure they are getting along well. This may sound excessive, but we hear horror stories from owners whose cats have been at odds for weeks after one has visited the vet or other outside situation.

These steps can help reduce the stress of a vet visit for your cat and for your family. If you experience any issues during this process, let your veterinarian know and they can help you troubleshoot. A less stressed cat is a calmer and happier cat, and a happy cat can be examined fully and allow necessary tests to be done more easily so the highest quality medical care can be provided for your furry friend.

Dogs and Cats are Not Small Humans

Sometimes it’s hard to say that our fur-kids really are not human. Many of us love them and treat them like they are. While we could argue behavioral and psychological reason for and against that perspective, one thing that is pretty straight forward is drug metabolism…

Dogs and cats are not small humans and cats are not small dogs. Each species has very different abilities to metabolize certain drugs and as such, there are some human medications that should NEVER be given to our pets, some that can under direct supervision of a veterinarian, and some that are fine to use but may require a different doses for our pets than humans.

NEVER:

Tylenol (acetaminophen), in cats: Causes a life-threatening inability to deliver oxygen to tissues.

Pepto Bismol in cats and dogs: Contains aspirin in a form that is not useful for treating any condition and often causes GI bleeding.

Breath Fresheners in dogs and cats: Some human breath fresheners can contain xylitol, which has the potential to cause the blood sugar to drop dangerously low (hypoglycemia), causing loss of motor control or even seizures; and even liver failure.

Ibuprofen in dogs and cats: Very easy to overdose and can cause symptoms ranging from upset stomach, gastrointestinal bleeding, kidney failure and acute neurologic symptoms.

Pseudophedrine and phenylephrine in dogs and cats: Can cause gastrointestinal symptoms, agitation and heart rhythm disturbances.

ONLY UNDER VETERINARY DIRECTION & SUPERVISION:

Aspirin in dogs and cats: If given at high enough doses to help with inflammation, aspirin almost always causes gastrointestinal bleeding. There are far better and far safer medications to help with inflammation (arthritis and pain). We can use it safely in very low doses to reduce platelet activity and clotting in certain disease situations that predispose clotting.

Immodium AD in dogs: While not toxic to most dogs, some dogs may carry a genetic mutation that makes the more sensitive to the effects of this drug and can lead to seizures and even coma.

GenTeal Eye Lubricant: This is a useful artificial tear supplement when your dog has been accurately diagnosed with Keratoconjunctivitis Sicca (AKA “Dry Eye”). Eye issues can quickly go awry, so always have a veterinarian exam before trying to treat at home.

Tylenol in dogs: The dose range is pretty narrow and it’s definitely not a first-line pain medication in dogs. We tend to use it more with severe pain, and in combination with codeine. Overdosing can cause severe liver disease and so should only be used exactly as directed and prescribed by your veterinarian.

Antihistamines in dogs and cats: Claritin (loratidine), and Zyrtec (cetirizine) can be used to reduce itching. Claritin and Zyrtec tend to be better for general allergies in our dogs, but they do not cause drowsiness in dogs and cats they way they do in humans, so don’t try these as a sedative. Talk to your veterinarian about dosing. **Be sure NOT to use an antihistamine that contains Pseudophedrine – such as Zyrtec-D or Claritin-D**

SAFE TO USE (though we still recommend consulting with your veterinarian before starting these medications):

Pepcid AC (famotidine) in dogs and cats: Pepcid and other antacids such as Zantac (ranitidine) or Prilosec (omperazole) are safe for pets and used for many different diseases (such as gastroenteritis, kidney failure and liver failure). Check with your veterinarian for dosing.

Antihistamines: Benadryl (diphenhydramine) tends to be better for acute allergic reactions (such as bug bites and contact allergies that cause hives) and may cause mild drowsiness. It doesn’t do nearly as good a job for general allergies as some of the newer antihistamines. The dose is 1mg per pound of body weight every 8-12 hours for allergic reactions (so a 25lb dog would get 25mg every 8-12 hours). If the symptoms are not improving within 24 hours of starting Benadryl or if the allergic reaction is getting worse in spite of using Benadryl — your pet needs to be seen by a veterinarian!

Meclizine in dogs: This is a motion sickness medication, similar to Dramamine, that can be helpful for reducing car sickness and doesn’t cause much drowsiness. The dose is 12.5mg-25mg per dog given 1-2 hours before a car ride.

Topical ointments with a numbing cream: In most cases, a topical Bacitracin ointment is likely okay to use, but when they are supplemented with a pain numbing cream, such as hydrocortisone or tetracaine, these can be toxic if ingested.  Most dogs and cats tend to lick ointments immediately after application and we often recommend the use of an e-collar (i.e. the cone of shame) when using topical medications.

Additional resources on toxic and non-toxic household items, plants and medications can be found at ASPCA’s Animal Poison Control’s website: http://www.aspca.org/pet-care/animal-poison-control

Hypoallergenic Diets

Does your pet have chronic or intermittent diarrhea, but otherwise feels great? Does he or she itch and scratch constantly, have hair loss, repeated skin infections, ear infections or rashes? If you answered yes, read on, as your pet could possibly have a food allergy.

What are the most common food allergies?

Contrary to all the pet-food company marketing, it is rarely grains! The vast, vast majority of the time, the allergy is to the animal protein source, with chicken being the most common, and then beef.

What’s the difference between a food allergy and a food sensitivity?

An allergy implies that the body’s immune system is involved in the symptoms; whereas food sensitivities can cause similar but often milder symptoms that are due to a local reaction in the GI tract (think lactose intolerance in people). A food sensitivity may improve simply with a diet change to a new brand or variety, whereas a food allergy is related to the body being sensitized via the immune system to a specific ingredient.

How is a food allergy diagnosed?

Unfortunately, a true food allergy can be difficult to definitively diagnose. There is noaccurate blood test for food allergies (though Dr. Google may suggest otherwise), and the only way to really diagnose a food allergy is to do a STRICT trial with a hypoallergenic or hydrolyzed diet for 8-12 weeks. Because it can take days to weeks for an offending protein to fully be eliminated from the body, and also significant time for the GI tract to heal following insult, the full 8-12 weeks is vital to ensure we allow enough time to see clinical improvement if it is going to happen!

Not only that, in order to make a truly definitive diagnosis, at the conclusion of the food trial one must reintroduce the original food to see if the symptoms return! Understandably, many owners are reluctant to go this final step if their pet’s symptoms are significantly improved, but without it we do not know if improvement was just a coincidence (or perhaps due to some other treatments that may have been initiated at the same time or a changing of seasons).

Essentially, a food trial is a diagnostic test — but one that takes 8-12 weeks to get results.

What make a diet hypoallergenic?

A hypoallergenic diet is designed to be absent of the ingredients most likely to trigger a true allergic response. Again, protein sources are much more likely to be the culprit than grain or other ingredients. There are two ways to address this protein issue — one is with a “novel” protein — i.e. a protein that the patient has never been exposed to previously — and the other is with a “hydrolyzed” protein — i.e. a protein that is broken down into such small pieces during the manufacturing process that it is not recognized as foreign by the body.

A thorough dietary history is very important when figuring out which hypoallergenic diet route to go. If the pet has been exposed to a variety of protein sources throughout their life, a hydrolyzed diet may be a better option.

It is important to note that many of the over-the-counter (OTC) diets that may tout themselves as being lamb, bison, turkey, etc. actually do have chicken further down the ingredient list. OTC diets are frequently contaminated with minuscule amounts of non-ingredient proteins as well. Thus, for the purposes of a strict food trial, we are more apt to recommend a prescription diet that is strictly controlled in the manufacturing process and is guaranteed to be a single protein source. In a very sensitive pet, even having a trace of the offending protein (such as, may remain if there was not strict cleansing of the equipment between processing of different diet varieties) could be enough to trigger symptoms. There are a limited number of OTC options that may be viable alternatives to a prescription diet, but these should be discussed with and approved by your pet’s veterinarian prior to going to the effort of a full food trial with them, as in some cases they may not be sufficiently “hypoallergenic.”

This sounds hard!  

There’s no arguing that a strict food trial requires some restraint and diligence on the part of the owner! Treats play an important role in our relationship with our pets, and having to be really strict can be tough…but it important to remember that it’s for a relatively short period of time and that eventually you will be able to slowly reintroduce things into your pet’s diet.

It is also important that all members of the family be on board with a food trial before it’s initiated — again, all it takes is a single exposure to the offending protein to set things back to the beginning!

Good news — you finished the food trial and your pet’s symptoms are improved. Now what?

At this point, we’d typically recommend SLOWLY reintroducing things back into your pet’s diet, but still being sure to avoid the suspected offending protein — i.e. each week, add one new item back into the diet, monitoring for recurrence of the original symptoms.

Bad news — you finished the food trial and your pet’s symptoms are not improved. Now what?  

Fret not — all is not lost! You’ve still gleaned some very valuable information by ruling out a food allergy. In the case of skin symptoms, environmental allergies may be a factor and in the case of GI symptoms, a whole plethora of other possibilities remain. It will be important to work with your pet’s veterinarian to continue looking for the cause of chronic skin or GI symptoms.

Strange Veterinary Terms

Have you ever heard your doctor or pet’s veterinarian rattle off a list of strange words that seem to make no sense? Most of these are derived from Latin roots and serve to concisely describe what otherwise may be a wordy description.

Borborygmi  of Greek origin, indicating a rumbling of the gastrointestinal tract as the small intestine contracts to move ingesta through

Brachycephalic  Greek for “short head,” or a “smooshed”-faced skull conformation — i.e. Pugs, Boxers, Boston terriers, Shih Tzus

Coprophagia  The eating of feces, derived from Greek copros – “feces” and phagia – “to eat.” This rather icky tendency, especially in dogs, is also typically behavioral in nature, rather than due to a nutritional deficiency. Though animals such as rabbits will do this to maintain gut bacterial populations.

Crepitus  Grinding, creaking, cracking, grating, crunching or popping that occurs when moving a joint; Latin for “rattle” or “crack,” most often appreciated in arthritic joints

Cryptorchid — A condition that occurs when one (or both) testicle does not descend into the scrotal sac

Dolicephalic — Greek for “long”-faced skull conformation — i.e. Collies, Greyhounds, many other sight-hound breeds

Emesis — Vomiting, from the Greek word emein, which means “to vomit.” We often prescribe antiemetics to control or stop vomiting in our patients.

Hematemesis — Blood in the vomit

Hematochezia — Blood in the stool

Hematuria — Blood in the urine

Idiopathic — A condition with unknown cause or spontaneous origin and derived from Greek idios – “one’s own” and pathos – “suffering.” Basically, a fancy way to say “we don’t know.”

Melena — of Greek origin. The passage of black, tar-like stools indicating the presence of digested blood (happens with gastric or small intestinal ulceration & bleeding).

Ovariohysterectomy — Removal of the ovaries and uterus (commonly referred to as a spay)

Orchiectomy — Removal of the testicles (commonly referred to as a neuter or castration)

Peristalsis — Muscle contractions that propel food throughout the gastrointestinal tract

Pica — The appetite for non-nutritive substances such as dirt, hair or paper. In dogs and cats, is more often due to behavioral or primary gastrointestinal tract disease — that results in inadequate absorption of nutrients — reasons rather than an inadequate diet. Derived from the Latin name of the magpie bird, who reportedly was willing to eat nearly anything.

Polydactyl — Quite literally, “extra fingers,” typically seen in cats that will have more than the typical five digits

Stomatitis — Inflammation of the mouth; from Greek work stoma for “mouth”

Tenesmus — Straining to defecate; via Greek teinesmos, “straining,” fromteinein, “stretch, strain.”

And, even though this isn’t particularly relevant to us in veterinary medicine, this one is just too fun to not mention:

Sphenopalatine ganglioneuralgia — An “ice cream headache,” which is actually referred nerve pain at the sphenopalatine ganglion area of the brain caused by quick consumption of COLD beverages or foods

Running with your Dog

So you want to run with your dog?

Running with your dog can be great exercise for both of you, especially since most pets don’t get the opportunity to really stretch their legs as much as they like living in the more urban environment that we do. We’ve put together a few tips to keep your pup safe, happy and healthy while engaging in an running regimen:

AGE — The first thing to take into consideration when considering running with your pet is the age of your pet. Dogs should be near skeletal maturity before any sort of serious running routine is started (this can be 9-12 months in a smaller breed dog, but not until closer to 18-24 months in a large/giant breed dog). Short, relaxed runs are okay starting at around 9 months for most breeds.

TRAINING — It is important that your dog has basic leash and obedience manners in order for you to safely run with them. If he/she is pulling and barking uncontrollably at every dog or person you pass, this will not likely lead to a safe, fun or efficient work-out for you.

ENDURANCE — Just as we need to work up our endurance, so do our pets! As a very general rule, we recommend starting with 10 minutes of exercise, and working up in 5 minute increments over the course of each week until you reach your desired time/distance. There is no exact formula for how much a dog can do, so it is important to watch for your dog for signs of exhaustion — these may include lagging behind, stopping to catch their breath, prolonged panting post-exercise, lameness associated with exercise, or coughing or labored breathing.

WEATHER — Again, just as for us, the time of day/year is important to take into consideration. As a general rule of thumb, if it is a hot day outside, place your hand directly on the cement. If you cannot keep your hand on the cement for 5 full seconds, then it is too hot for a dog’s paws. It is also preferred to run early in the morning or later in the evening, when the sun has gone down when it is >75 degrees outside. Humidity also plays a huge role for dogs as they do not get rid of body heat in any significant fashion through sweating. Sweating is important for evaporative cooling — but since they really only sweat in their feet and most of their evaporative cooling is done through panting — they are working with a really small surface area to get rid of heat. When it is very humid out — that evaporative cooling mechanism doesn’t work well at all — which means heat transfer doesn’t work well. This is why in the DC summers, even in the air conditioning, dogs tend to act hot (panting, wanting to sit near fans, etc…). It’s cooler inside, but the humidity is still much higher than in the winter at similar temperatures and so they have a harder time staying cool.

INJURIES — The weekend warrior or rare/intermittent/poor training is, similar to us, one of the main causes of musculoskeletal injuries in our dogs. We can’t expect a dog with little training to up and run without minimally being sore afterward. Other injuries we can see from a lack of training and conditioning are cruciate injuries (i.e. ACL tears), meniscal injuries, as well as any number of muscle, ligament and tendon sprains and strains.

In addition to the musculoskeletal system — we can see dogs injure their foot pads from running on rough/abrasive surfaces; or even burn their pads from running on hot surfaces. These injuries tend to hurt the worst a few hours after the happen and can lead to significant pain as well as secondary infection.

Just like you or I, dogs also need to be kept hydrated. Dehydration and overheating are two of the most common non-orthopedic problems that we see dogs present for when they are not appropriately conditioned for their run, when they are pushed too hard or when they are run in high heat or humidity.

Individual health concerns to consider are health issues (such as heart disease, kidney disease and breed type). Dogs with underlying medical conditions often need to go at a slower pace and go shorter distances. Brachycephalic breeds (i.e. “smoosh-faced”) physically cannot get the same amount of oxygen through their nose/mouth and into their lungs as a dog with normal conformation and are at risk of overheating, fainting or developing significant respiratory problems if they are pushed too hard.

INDIVIDUAL TEMPERAMENT/DRIVE — this may seem a little silly because we’re talking about dogs, right? Don’t they all want to run? Well, actually…No. Some dogs just won’t ever be good running buddies, and that’s okay. Some dogs will be on the other side of the spectrum and will be so devoted to you and the run that they will end up pushing themselves to significant injury. Know your pet and their individual drive and respect that when training.

Birth Control - When to Have Your Pet Spayed or Neutered?

One of the most common questions we discuss with new dog and cat owners is when to spay or neuter their pet.

Backing up just a bit, the word “neutering” refers to a surgical procedure that renders the animal sterile, both male and female. “Neutering,” however, has come to be associated more with the procedure in male dogs (i.e. castration) rather than female dogs; “spaying,” on the other hand, refers to sterilization by removal of the reproductive tract in female dogs. For our purposes, we will use “neutering” to refer to the procedure in males dogs and “spaying” for female dogs.

Traditionally, most veterinarians in the U.S. have been taught that early spaying and neutering is the best medicine for our canine and feline patients. However, this has recently become a controversial topic in veterinary medicine.

“Early” has typically referred to younger than six months, or pre-puberty, though often dogs and cats are spayed or neutered as young as seven to eight weeks.  The advantage of early sterilization have been touted as:

  • Fewer unplanned pregnancies and therefore fewer unwanted and homeless pets. This is a VERY important reason for sterilization.
  • Decreased risk of prostatitis (infection or inflammation of the prostate).
  • Decreased risk of mammary cancer in female dogs and cats. After the first heat cycle in a female dog, the risk of mammary cancer goes up to 8 percent, after two heat cycles it increases to 26 percent. (Most mammary cancers in cats are malignant and about half of mammary cancers in dogs are malignant.)
  • Eliminate risk of uterine, ovarian, vaginal or testicular cancers.
  • Eliminate risk of pyometra (a hormonally influenced, severe and often life-threatening uterine infection) in female dogs and cats.
  • Decreased risk for perianal adenomas (a benign skin tumor around the anus).
  • Less roaming, especially among male dogs. This is specific to an individual’s containment set-up. However, the No. 1 risk factor for a dog to be hit by a car is to be an intact male.
  • Improved behavior/less aggression. Spaying or neutering can decrease some behavioral habits or aggressive tendencies, especially when inter-dog related. However, most cases of behavioral and aggression problems are not due to sex hormones.
  • Less marking behavior in male dogs and cats. There may be some truth to this, especially with cats, though often marking is a behavior issue in dogs and not dominated by sex hormones.
  • Spayed and neutered dogs live longer.

Recently there has been talk among veterinary professionals about whether early spay/neuter is all it’s cracked up to be — and that perhaps there are even some risks associated with the early spay and neuter of dogs (i.e. before sexual maturity and generally considered less than 6 months of age). The potential risks of early spay and neuter include:

  • Increased propensity to obesity
  • Increased risk of cranial cruciate ligament disease (the dog version of an ACL tear) in large and giant breed dogs.
  • Increased risk of hip dysplasia in large and giant breed dogs
    Increased risk of urinary incontinence, especially in female dogs.
  • Increased risk of some types of cancer, including:
    • Lymphoma — a cancer of a specific type of white blood cell.
    • Hemangiosarcoma — a highly malignant cancer of blood vessels.
    • Mast cell tumors — a potentially malignant cancer of the skin.
    • Osteosarcoma — a highly malignant cancer of bone.
    • Transitional cell carcinoma — an aggressive cancer of the bladder or urinary tract.

There is little research reviewing the risks of pediatric spay/neuter in cats. However, cats sexually and skeletally mature at a younger age than most dogs which may be why there are few documented concerns with risks of early spay/neuter. Observationally, we see an increase in propensity for male cats to develop urethral obstruction (they can’t pee) if they were neutered well before sexually maturity and have an underdeveloped (small, with a very small urethral opening) penis.

When a pet is sterilized, the sex hormones, such as testosterone, estrogen and progesterone, are removed as well. It is well-documented that removal of these hormones slows metabolism, leading to the propensity for obesity. Removal of these hormones is also thought to speed bone growth (the sex hormones have an inhibitory or slowing effect on bone growth and joint development) in young animals, leading to increased cruciate ligament injury and hip dysplasia. The increased risks of some cancers are also thought to be related to lack of these sex hormones, which likely have an inhibitory effect on certain types of cancer.

As you can already see, it’s certainly not a clear-cut decision and population control is a very real and needed thing. Additionally, to further confound things, scientific studies in veterinary medicine are not nearly as robust as those on the human side. We are lucky if there are 200 dogs in a study, and often is it much fewer. Many of the studies looking at the risks were done using purebred large and giant breed dogs — so we have to take all of the results with a grain of salt.

Fortunately, there is a large study in golden retrievers underway, being conducted by the Morris Animal Foundation, looking at more than 2,000 dogs over the course of the lifetime. This should provide us with an abundance of information not only about the benefits and risks of early spaying and neutering, but of spaying and neutering in general.

So, what is the best protocol? The answer depends on the breed/size, sex and species of your pet, and what your intended plans are for your pet. For example, a 20 pounds Shih Zhu, who is not nearly as at risk for CCL injury or hip dysplasia, nor several of the aforementioned cancers, would be a good candidate for neutering between 6 to 9 months of age, or spaying around 6 to 7 months of age. Whereas, a great Dane puppy who may reach 140 pounds or more as an adult and is much more prone to orthopedic issues would be a better candidate for neutering at 12-18 months of age (near or after skeletal maturity) and spaying at 9 to 12 months of age (after the first heat cycle, but before the second).

Additionally, many localities within the state of Virginia have a legal requirements for all pets adopted from shelters/rescue groups be sterilized or a signed agreement for sterilization within a specific time frame.

There is no one protocol that suits each and every pet and owner, so it is important to discuss thoroughly with your veterinarian. We also have to remember that even with all the information we have and are still gathering. So many other individual conditions, environmental factors, dietary factors, genetic predispositions and on and on and on, will influence an individual’s outcomes to a very large degree, and likely much more than the age of sterilization.

The Fear Free Initiative

Have you ever gotten the dreaded email reminder from your pet’s veterinary office that your pet is due for his or her yearly checkup and vaccines, and shuddered at the thought of having to take them into the office, even though you know it’s necessary. Stress not — you are not alone, and there is recent good news on this front.

The Fear Free Initiative was created by Dr. Marty Becker, a well-known small animal veterinarian, in order to reduce fear and stress in pets in the veterinary environment — to “take the ‘pet’ out of petrified.” This program provides educational resources to veterinary team members, emphasizing stress-free handling and calming techniques in order to provide the most positive experience for pets (and their owners too — since it’s stressful to us as owners to see our pets anxious or stressed).

Fear-Free certified professionals have undergone a series of training programs emphasizing calming techniques, low-stress handling, recognition of symptoms of FAS, as they refer to the trifecta of fear, anxiety and stress, and the use of pharmacologic aids when indicated.

Stress can have deleterious physiological effects such as delayed wound healing, increased blood pressure and even hypersensitivity to other stimuli such as pain. Additionally, a fearful, anxious and/or stressed animal is more likely to accidentally injure themselves, their owner or the veterinary team working with them.

Knowing how to read an animal’s body language, and understanding what physical signs of fear or stress look like is important for both pet owners and veterinary staff. Animals who are stressed will often start panting, licking their lips, yawning, turning away or avoiding you, trying to hide or sometimes “freezing,” or becoming very still. Most of these behaviors are quite subtle, and they do not always outwardly seem to be signs of fear, but they are all signs of stress.

The best approach when dealing with a stressed pet in a veterinary hospital setting (as well as a grooming, training or any other type of handling situation) is often to temporarily stop and reevaluate the immediate need for the procedure being done — do we “need” to do this, or just “want” to do this procedure? For example, blood work in a sick patient may be a “need,” whereas a nail trim in a healthy patient is a “want.” In some cases, it’s as simple as giving the patient a minute to relax, or increasing the desirability of the food reward being offered as a distraction; other times, the patient may already be so wound-up with fear, anxiety and/or stress, that no matter what type of gentle handling techniques are employed the procedure will not be able to be safely performed. In these cases, the suggestion may be made to reschedule the visit.

If rescheduling is recommended, it is important to ask ourselves what can be done differently for the next visit. In many cases, a low dose of an anti-anxiety or mild sedative drug given several hours prior to the visit can have a significant effect in relaxing the patient — making the veterinary visit much more relaxed and safe for all involved. Other things that can help ease fear, anxiety and stress include acclimating your dog to the car (preferably with some type of safety restraint), and your cat to the carrier. Any music played in the car should be soothing; and, since our pets pick up very easily on our own emotions, the less rushed and anxious you are the more that will carry over to your pet. There are also calming pheromones (we especially like Feliway for cats, and Dog Appeasing Pheromone for dogs) that can be sprayed on carriers, towels and beds prior to the visit.

Sometimes, despite our best efforts, some patient just aren’t able to get to a point where they are calm enough for us to safely work with them. In that case, rather than cause further stress, it is often best to more heavily sedate them (with injectable drugs), enabling us to do an exam, draw blood and perform small procedures without causing a major meltdown. This is safer (and less traumatic) for both the pet, owner and veterinary staff.

Food is an extremely powerful motivator for most dogs, so we try to use it as often as possible in during exams and treatments. If your pet has a known food allergy, be sure to bring their own tasty treats to their appointment, so the staff has something to offer them! Using high value treats like cheese or hot dogs can sometimes help keep their attention better than regular kibble or dry treats. (Our personal favorite are cans of EZ-Cheese, which we keep stocked in every exam room — cats and dogs BOTH love it!) Because treats are such a great distracting and calming agent, we recommend bringing your pet in on an empty or semi-empty stomach.

Lastly, we recommend asking your veterinarian to make notes in your pet’s chart about which handling techniques work best and which treats they like best. And, if you know your pet likes certain veterinary staff, don’t hesitate to request them when you make your appointment!

To find a Fear-Free certified professional near you, click here! (We are working toward having all our assistants, technicians and veterinarians certified - currently Dr. Ungerer, Dr. Gloor, Alex Leslie (LVT) and Samantha Hunley (LVT) are certified).

For a refresher on general tips for a successful veterinary visit, check out our previous post from earlier this year, “10 Tips for a Successful Veterinary Visit.”

Body condition scoring . . . It’s more than just weight.

Have you ever wondered if your cat or dog is overweight? You probably know evaluating your furry companion’s weight and making recommendations about weight loss and nutrition are part of your pet’s annual physical exam, but did you know you can easily evaluate your pet’s body condition at home between visits?

A body condition score (BCS) is a number assigned to your pet based on evaluation of fat at a few key locations on their body. A BCS can range from 1 to 9 (though some hospitals use a 1 to 5 scale). A BCS of 1 means an animal is severely underweight, probably in danger of death from starvation. On the opposite side of scale, a BCS of 9 means an animal is severely overweight, covered in fat, and at risk for suffering from arthritis and diabetes to name a few complications of obesity. An ideal BCS is 4-5 out of 9. For every number above 5, your pet is an extra 10 percent overweight. For example, a dog with body condition score (BCS) of 7 out of 9 is approximately 20 percent overweight.

To determine your pet’s body condition score, you will need to evaluate the ribs, waist, and hips:

  • Ribs: At an ideal body condition, you will be able to feel your pet’s ribs easily with flat fingers. If you need to use the tips of your fingers, but can still find the ribs easily, your pet is closer to a 6 out of 9. If you have to really work to find the ribs with your finger tips, that’s a 7 or 8 out of 9. If you can’t find those ribs at all, you’re looking at BCS of 8 or 9 out of 9. On the other side, if you can very easily feel the ribs and just barely see them, that’s a 4 out of 9. If you see your pet’s ribs very easily from across the room, they are too thin with a BCS of 3 or less. There are some exceptions for very lean body type dogs such as greyhounds. You can practice on your hand: Make a fist: The knuckles are 3/9, and the backs of your fingers where your rings would sit is a perfect 5/9; now open your hand, palm up: the knuckles where your fingers meet your palm is a 7/9 and the middle of you palm is a 9/9.
  • Waist: There should be a visible “waist” behind the rib cage. In fluffy pets, you should be able to feel it or see it when they are wet. From the side you should be able to see a “tuck” to the abdomen starting where the chest ends and going up toward the hips.
  • Hips: Pets get “love handles” just like we do! You should be able to feel the points of the hips easily, with no squishy bulges on any side. If you can clearly see the hip bones or there is no muscle on them, the pet is too thin.

Here are examples of body condition scoring charts for dogs and cats.

Just like us, pets need to calibrate their food intake based on their weight. Having trouble squeezing in to your jeans? You might skip that second bowl of ice cream for a few weeks. Training like Michael Phelps? You need to up those calories to keep up! Similarly, if you have the skills to evaluate your pet’s body condition at home, you can discover when they’re moving past optimal condition and tone down the treats or level out the food scoop until we’re back on track. If your pet is obese, work with your veterinarian to come up with a caloric plan — for both goals of number of calories/day (treats included!) and dietary recommendations. If your pet is losing condition we may need to adjust the diet to a high-calorie/high-activity diet or look into reasons why your pet may be too thin (as we can sometimes see with chronic diseases, nutritional deficiencies, or cancer, among many other causes).

For those of you who like math — the caloric needs of a pet (assuming middle age, ideal body weight and average activity):

Weight (in kilograms)^0.75 x 70 = daily resting energy requirements

Depending on a pet’s body condition, goals for weight loss or weight gain, activity level and age (i.e. growing pets have different caloric requirements than a senior pet) we will use multipliers of 0.75 – 3 to get a better estimation of a pets specific daily caloric requirements.

In obese pets, sometimes just reducing their regular food to the appropriate daily caloric goal doesn’t satisfy them and can actually short them on needed proteins to maintain healthy muscle, so it’s important to discuss anticipated weight loss plans with your pet’s veterinarian. Keep yourself honest with a regular weigh-in schedule and keep track of goals.

By regularly checking in on weight and BCS you and your veterinarian can see if a weight loss/gain plan is working — and tweak things if they’re not.