Euthanasia/Saying Goodbye

Perhaps not the Healthiest of Paws this week - but the topic of Euthanasia and Saying Goodbye is not one to take lightly. Often letting a pet go is akin to having a family member die, which can affect everyone (other pets included) differently, and sometimes profoundly.

Making the Decision

This decision is never easy, and nor should it be. Our general thought is that if we wait until the decision to let our pet go becomes very easy we have likely waited too long and for the wrong reasons. When working through this decision, especially with chronic illnesses and geriatric patients, we do like to use a Quality of Life scoring sheet, and recommend multiple people close to the pet fill it out independently and see where everyone is on the same page and where they’re not.

This looks at hurt, hunger, hydration, hydration, hygiene, happiness, mobility and more good days than bad and is sometimes called the hhhhhhmm scale. These qualities of life are all scored 0-10 and added up. A score of greater than 35 indicates the pet has an acceptable quality of life to continue with pet hospice.

We always need to keep in mind that when addressing quality of life the most important factor is our pet’s quality of life, and that trumps how much we may miss them.

What is Euthanasia?

The word euthanasia itself is derived from Greek roots: eu ‘well’ or ‘good’ + thanatos ‘death’. And in veterinary medicine we tend to look at it as the intentional ending of a pet’s life to relieve pain and suffering.

The process of the euthanasia is going to be a little different between individual veterinarians and veterinary clinics. It may involve sedation, and/or placement of an intravenous catheter and by far most common method is with the overdose of a euthanasia solution that slows and then stops the heart. Depending on the circumstances around the euthanasia - it may be performed at the veterinary clinic or in your home.

Coping with the Loss

Below are some excellent resources/hotlines/groups for coping with the loss of a beloved pet:

The American Veterinary Medical Association

The  Association for Pet Loss & Bereavement

ASPCA Pet loss support: (877) GRIEF-10

People Animals Love: To get in touch, please call the PAL office at (202) 966-2171.  You will receive a return call from a grief counselor within 24 hours.  If calling after business hours, please leave a message and PAL staff will return your call promptly on the next business day.

Bereavement Groups:

  • Arlington Animal Welfare League: The support group will meet quarterly at 7:00 pm on the second Wednesday of the month at the shelter. There is no charge to attend these meetings, and all are welcome. No reservations are required.

  • Alexandria Animal Welfare League: Meets The First Wednesday of Each Month at 7:00pm at the shelter at 4101 Eisenhower Ave. No fee and everyone welcome.

Feline Environmental Needs

As anyone who loves a cat knows, cats are interesting creatures. Is easy to fall in the trap of thinking if your home is comfortable and happy for you, it will be perfect for your animals. But cats are not tiny humans (or dogs) and have their own set of unique set of preferences and needs.

SAFE SPACES:

Cats value their personal space. They need enclosed and secluded locations to allow them the opportunity to withdrawal and ability to control their surroundings.

A cardboard box placed on it’s side for is a perfect place to hide (or perch). Flip the lid up inside the box so the top is clear for sitting. Another great safe place is a cat carrier. If you leave your cat’s carrier out at all times and make it somewhere your cat is happy, it becomes a safe space at home as well as a portable space safe! Think of your cat’s carrier as a tool of security and comfort, rather than a tool primarily for transportation.

The more cats in your household, the more safe spaces you will need in your home. A good goal is the number of cats in the house plus 1. So if there are two cats, you’ll need a minimum of three different good hiding spots. Also consider any health issues your cats may have when choosing locations. For example, a geriatric cat probably has some arthritis and will need locations with floor access, whereas a kitten will enjoy higher perches. Finally, think about your cat’s outside environment, if they do venture outdoors, and make sure hiding options are provided there as well.

RESOURCES:

Aim to provide multiple, separated key environmental resources of: 1) food/water 2) bathroom 3) scratching posts. Provide a minimum of two of each resource (two water bowls, etc) and S-P-R-E-A-D everything out. Even the food and water bowl should be separated from each other across multiple rooms for maximal feline comfort. Some cats want to cuddle with their housemates, but sometimes when we provide the option to spread out, we find that the cats end up resting separately. They didn’t actually want to sleep together - there was just nowhere else to go.

PLAY and PREDATORY OPPORTUNITIES:

Cats require opportunities to hunt and play. Putting food down twice a day does not allow cats to exercise their predatory instincts and leads to begging, obesity, stress and anxiety. In the wild, cats hunt 10-20 times each day. This is an entire topic unto itself, so hop over to our last post for suggestions of fun and easy ways we can use food to give our cats a chance to engage in these normal behaviors.

HUMAN-CAT INTERACTION:

This one is simple. Provide positive, consistent, and predictable human-cat social interaction. Do not force your cat to play with you and allow space to retreat. If you need to train your cat, use positive methods rather than punishment (so no shaking a can of pennies to scare your cat off the counter). It’s nearly impossible for humans to be 100% consistent with punishments (sometimes you’re not home or as otherwise occupied when your cat jumps up on the counter), so we appear unpredictable and therefore scary to our cats.

SMELL:

Provide an environment that respects the importance of a cat’s sense of smell. When it’s time to launder a cat’s bedding, don’t wash everything at the same time. Leave a few things out of the wash until the washed load is back in the home and smelling “normal” again to your cat. If you wash everything at the same time, all her beds/toys will be foreign to her, which can be very unsettling for cats.

The smell of their housemates is also very important for cats. If one leaves and comes back smelling different it can cause discord in the household. To minimize this, arrange vet trips for all cats at the same time. Use a pheromone diffuser (such as Feliway) upon return. If you have to take just one cat, take some care reintroducing that cat to the house. Separate the recently out of the house cat from the others until all is calm. Establish a “common scent profile” to get everyone smelling the same and minimize signals that the cat who was gone is now an outsider. To establish a common scent profile, use a cloth to rub down the cat who was out of the house, then take that fabric and rub down a housemate, continue with the same fabric for each cat in the house, and end by re-rubbing the cat who was out of the house. More information about successful transportation can be found here.

If we can meet as many of these needs as possible, we can maximum the healthy and well being of our feline companions.

Feline Prey & Play

Cats love to hunt! Their instinct to display predatory behaviors is incredibly strong. In the wild, cats are mentally occupied by the constant activity of obtaining their next meal. Only 25-50% of a wild cat’s hunting attempts are successful and they eat 10-20 small prey per day (averaging 20-30 calories each). That can mean up to 80 hunts every day!

House cats, on the other hand, are usually offered canned food once or twice a day and have a bowl of dry food nearby that is kept full (at the cat’s insistence). So that’s three, really easy, “hunts” - it doesn’t require much mental gymnastics to sneak up on a bowl of kibble. No wonder your kitty is asking for more food as soon as she finishes her meal - it’s just too easy! Letting cats outside would give them opportunities to hunt, but puts them at risk for picking up infectious diseases and car accidents, and can have deleterious effects on wildlife populations.

Without adequate opportunities to hunt, cats tend to have more anxiety, struggle with obesity, frustration, and are prone to stress-related diseases. Luckily, we can use food and play indoors to provide cats opportunities to engage in pseudo-predatory play and feeding behaviors.

Uses of dry food (kibble):

  • Hide small amounts of food in multiple locations throughout the house. This works best in single cat homes, but can work for multi-cat homes as well. If you have one cat who is much more assertive about getting food and another who is more laid back about food, you may need to do a combination of separate bowl feeding and food scattered around the house. Use the bowl feeding to balance out hunting differences.

  • Your average cat kibble has 2-3 calories in each piece - that means to mimic hunting behavior, each “kill” should be about 10 pieces of kibble.

  • Food toys or puzzle feeders greatly increase the mental and physical effort that goes into mealtimes. There are many products you can buy online or in stores, but homemade puzzle feeders are also great and very low cost.

    • Cat Amazing is a cardboard treat maze that many cats love

    • Videos of DIY toys made from common household materials

Uses of wet food:

  • Feed a very small amount of wet food at regular intervals (2-5 times per day depending on your schedule)

  • Instead of putting the wet food in a bowl, fill a shallow cardboard box with empty yogurt cups (open side up) and put a teaspoon of wet food in just a couple of the cups

Uses of non-food toys:

  • “Kill the bear” This is a game to play with your cat to allow them to go through all the motions of hunting and killing prey in a safe way. Designate a plush toy that is only for this game. Get on the ground, get your cat’s attention by shaking the toy rapidly at ground level, then throw it across the floor in front of your cat. The goal is for your cat to pounce on the bear, sink her teeth in, and grab it with both front feet -- this is a full hunting sequence. Play this game once every other day with your cat for a great emotional outlet.

With changes in feeding strategies, it’s important to watch out of weight loss or gain. Many indoor cats can stand to lose a couple pounds, and feeding in a way that encourages movement around the house can help with this weight loss. We don’t want more than 1% weight loss a week (about 0.1 pound a week for the average cat). If you think over/under eating will be a problem in our household, bring everyone by for a weight check before changing feeding strategies and then reweigh them a month later.

For best results, include both dry and wet food in your cat’s daily routine and use as many of the above strategies as you and your kitty have energy for. Happy Hunting!

Just a Spoonful of Sugar Helps the Medicine go Down...

TIPS & TRICKS FOR ADMINISTERING MEDICATIONS TO PETS:

As veterinarians, we are fortunate to have a wealth of prescription medications, supplements, vitamins, and other oral products at our disposal to help us effectively treat conditions ranging from thyroid disease to separation anxiety, skin infections to chronic arthritis pain, and dry coats to liver dysfunction.

Veterinarians are able to prescribe not only FDA-approved veterinary-specific drugs, but also can prescribe medications designed for human consumption “off-label” — thanks to the Animal Medicinal Drug Use Clarification Act of 1994, which allows veterinarians to prescribed approved human drugs for appropriate animal uses.

But…the actual act of administering these medications is often easier said than done.  There’s no argument that having to administer a pill is a bit of a hassle, but more so for some pets than others.  The occasional very food-motivated dog may be willing to gobble down their medications simply thrown in with their meals; others need to be enticed with all sorts of delicacies in order to get them down…and cats are a whole other story!

Here are some of our tips:

  1. As mentioned above, some cooperative pets will eat a pill simply mixed in with their food – especially if a bit of canned food is used.
  2. Hot dogs, deli meats, chicken, cheese, peanut butter or bread – often something really enticing or high value such as these foods will be all that’s needed to administer a medication.  For example, the pill can be wrapped in a small bit of cheese and administered.  The caveat here is that any of these have the potential to cause mild GI upset — so we recommend using as small amount as possible, and monitoring to be sure your pet is tolerating them well.
  3. Pill Pockets and similar products, have been a game-changer for administering pills.  These are soft treats with a divot or hole in the center to allow a pill to be placed.  When the treat is “smooshed” around the pill it creates a palatable treat, effectively disguising the medication.  For especially finicky pets, we recommend using one hand to place the medication in the hole, and the other to “squish” the treat, so that there is no residue from the medication on the outside of the treat.  In our experience, about 50 percent of cats will also take Pill Pockets willingly — so this is often our first recommendation for cats.
  4. Manual administration – this involves using hands, fingers, or a special “pill popper” to get the pill to the back of the pet’s throat, where it will then be swallowed.  Care needs to be taken to follow this type of administration with a bit of water, to be sure that the pill does not become lodged in the back of the throat or the esophagus — where certain medications can cause a lot of damage.
  5. Some medications can be specially compounded into a more palatable or easy-to-administer form such as chicken-flavored liquid (surprisingly, we have found that chicken-marshmallow is a popular flavor), or a meat-flavored soft-chew (instead of a bitter tablet).  We recommend talking with your pet’s veterinarian about whether this may be an option for difficult-to-administer medications.  In some cases, two medications can be combined together, to allow only one administration.
  6. For some pets, a liquid formulation is preferable to a tablet or capsule formulation — if you know your pet does better with pills versus liquid, or vice versa, be sure to mention this to your pet’s veterinarian, so they can dispense the medication in the preferred form, if available.  Additionally, For a few conditions, a long-acting injection may be substituted for a daily or twice daily oral medication, so it is worthwhile asking your veterinarian about this if you know your pet is difficult to medicate.

To make matters worse, some medications are best given on an empty stomach due to how they are absorbed. In these cases, we often recommend putting the medication in a mini marshmallow, as this is palatable to many dogs and does not stimulate the gastric secretions like cheese, peanut butter, or even bread might.

Here are some videos demonstrating various techniques of administering medications to cats, who tend to be the most unwilling participants.

While it may take a bit of trial and error, it’s quite often possible to find a method that works consistently and with as little stress to both owner and pet as possible.

Heartworm Disease - The Basics: What Do You Need to Know?

Heartworm disease is caused by the parasite Dirofilaria immitis.  This is a worm that lives in the heart, lungs, and surrounding vasculature.  It is a serious disease that primarily affects the heart and lungs but can also affect the liver, kidneys, central nervous system, and if left untreated, can cause death.  Heartworms are transmitted by mosquitoes: they take a blood meal from an infected animal and transmit the microfilariae (larval stage/baby worms) into another animal with subsequent blood meals. These microfilariae will then make their way to the heart where they grow into adult worms, causing heartworm disease. Mosquitoes are required for the parasite’s life cycle which means that a dog cannot re-infect itself.

Both dogs and cats can get heartworm disease from mosquitoes!  A cat is an atypical host, and unfortunately many times goes undiagnosed. In some cats, 1-3 adult worms can be devastating and create respiratory issues, and one of the main risk factors for cats developing feline asthma is heartworm! The treatment that we use for dogs cannot be used in cats, so prevention is key for kitties.

What are the symptoms?

Some dogs are asymptomatic, meaning that they act normally. There are no changes in their breathing, exercise levels, or appetites.  With chronic infections or heavy worm-burdens, owners can notice coughing, exercise intolerance (unable to go on a walk without stopping and/or coughing), decreased appetite, sleeping more, and even weight loss.

Clinical signs in cats can be very subtle to very dramatic.  These symptoms can include coughing, asthma-type symptoms, vomiting, weight loss, lack of appetite, and fluid build up in the abdomen.

Grading Scale

There are 4 grades to heartworm disease:

  1. Grade I: Asymptomatic dog, tests positive on the annual test that is recommended by veterinarians.  Chest x-rays, blood work and urine testing is normal.

  2. Grade II: Asymptomatic or mild symptoms in dogs.  Chest x-rays will show some abnormalities or the pet may have mild changes on blood work and urine testing.

  3. Grade III: Symptomatic dogs, chest x-rays show obvious changes and blood work and urine testing is very consistent with chronic inflammation and parasitic infection.

  4. Grade IV: Severely symptomatic dogs, chest x-rays show enlarged and abnormal vessels; they may have fluid build-up in the abdomen and are in right-sided congestive heart failure.  These pets have a guarded prognosis (and in some cases treatment may need to involve surgical extraction of the worms from the heart, through the jugular vein)

Why is annual testing recommended if my pet is on regular prevention?  

Heartworm disease can be devastating.  The earlier the detection, the better chances for survival.  Since many dogs are asymptomatic at time of diagnosis, the only way it is found is through an annual test, which requires only a small amount of blood  

All pets over the age of 7 months old should be tested for heartworm disease on an annual basis, but we start giving the heartworm preventative medication as young as 8 weeks of age.

How is heartworm disease treated?

If your dog has been found to have heartworm disease and all the testing indicates that it is safe to then go ahead with treatment, it is done with a medication called Immiticide (an arsenic derivative!).  The American Heartworm Society recommends giving three injections: one injection on day one and the other two injections one month later, 24 hours apart.  Post-injection care includes strict exercise restriction for 30 days (so, for a traditional treatment - that means TWO MONTHS of STRICT restrictions), keep them on all prescribed medications (often steroids to reduce inflammation in the lungs, sedatives as needed and pain medications for injection-site discomfort) for the heartworm disease, and monthly heartworm prevention.

There is no approved treatment for cats.

What is the best way to prevent this disease?

Keeping dogs and cats on monthly prescription preventatives, year round (even in the cold months), is the best way to prevent this disease.  The two main ways to administer this are topical or oral medications.  Both are only available as prescriptions through a veterinarian.

This is definitely a disease where prevention is a lot better (and cheaper) than treatment!

The life cycle and intricacies of treatment are a lot more complicated that the basic information we’ve provided here. If you’re interested in learning more - ask your veterinarian! At Clarendon Animal Care we work with a number of local rescue groups and manage heartworm positive dogs frequently - we’re always happy to answer any questions you may have about this disease - detection, prevention, management, and general biology/life cycle.

The American Heartworm Society is also a great point of reference for pet owners.  Please visit www.heartwormsociety.org for additional information.

The “Chew” on Pet Dental Treats

Chewing is such an important part of our pet’s dental health (and with dogs, helps with mental stimulation as well!) - yet we commonly see dogs presenting with broken teeth from chewing seemingly “appropriate” treats; and cats and dogs with severe periodontal disease despite regular dental treats...what gives?

So...about brushing, that’s not happening...what other options do we have?

As we discussed in our last article, brushing your pet’s teeth regularly is the best way to prevent periodontal disease - but as we all know, that is not always feasible.

So, I guess we should start with WHY is chewing so important? The mechanical act of chewing does two important things: 1) it causes mechanical massage/stimulation of the tooth/gingival surface which increases blood flow and can help physically remove plaque and 2) it causes salivary stimulation which has anti-microbial properties and can reduce plaque (bacterial colonies) buildup.

When we start thinking about what dental chews, treats and water additives we give our pets - our first question is: has it been proven to actually help? There is a group called the Veterinary Oral Health council whose mission is just that - to determine if and set standards for products that claim to reduce plaque and tartar in our pets. We particularly like the Tartar Shield chews and treats for dogs and cats and the OraVet chews for dogs

Another consideration with chews, especially for dogs, is if they will cause physical trauma to their teeth. We regularly see dogs present with fractured teeth, dental pain and dental abscesses secondary to trauma to their teeth. This generally happens when chews that are too hard are given to our pets (such as antlers, cow hooves, dried natural bones or hard nylon products) - they may be tempting to give as dogs would chew on bones in the wild, however these products are too hard and do not mimic the effect of a dog tearing meat off a carcass.

Some non-dental considerations with chews/treats and water additives:

  • Dietary sensitivities and food allergies: some dogs have sensitive stomachs and can’t tolerate the ingredients of a chew/treat or water additive and some dogs have food allergies that needs to be taken into consideration when giving these treats. Bottom line - if you give your dog a chew/treat or water additive and they develop diarrhea or vomiting, don’t give it!

 

  • The daily caloric impact of the treats: It’s easy to lose track of how many calories your pet is getting each day when you factor in all the treats and “extras” they get. Remember that even if a treat is 50 calories - that may be 10-15% of the daily caloric requirements for a 20# dog. Those calories really add up, and while we want to take care of our pet’s teeth we don’t want to give them another problem (obesity) instead.

 

  • The size of the treat needs to be appropriate for the size of the pet. This is especially important for small dogs trying to ingest a chew that is too large and large dogs given a treat that is too small (and then “inhaling” it). If your pet does not chew the product thoroughly, discontinue use of the treat, as this can pose a risk for the treat becoming lodged in the esophagus (as well as no longer being effective for it’s intended purpose of reducing plaque/tartar.)

  • Pet dogs should be monitored while chewing a chew treat or toy, as they may swallow large pieces, leading to a variety of digestive system disorders.

Is my pet’s dental health really that important?

Well, like people, every pet’s mouth is different. Some animals and breeds are more susceptible for dental disease than others. In some animals a neglected mouth will result with some degree of plaque build up over time, and gingivitis (or inflammation and infection of the gums). But in some animals that neglected mouth will lead to severe infectious of the mouth, abscesses, pain, bad breath, and can make it more difficult to regulate other disease processes (such as diabetes). In the more severe cases, treatment may involve tooth extractions or complicated dental procedures and can lead to infections of the liver, heart and other internal organs.

In the majority of cases, dental disease is a condition where “an ounce of prevention is worth a pound of cure” -- small preventative measures such as regular brushing, appropriate chews, treats and water additives can significantly slow the progression of gingivitis, plaque and tartar accumulation.

Pet Dental Care - The Basics

February is “pet dental health month” so we’re going to dedicate our post this week and the end of the month to pet dental health. Now - this doesn’t mean your pet’s dental health should be neglected for the rest of the year!

In the majority of cases, dental disease is a condition where “an ounce of prevention is worth a pound of cure” -- small preventative measures such as regular brushing, appropriate chews, treats and water additives can significantly slow the progression of gingivitis, plaque and tartar accumulation. So regular dental upkeep and monitoring (yes, that means year-round, and that means actually looking in your pet’s mouth!) are such an important aspect of whole-pet wellness and care.

What is periodontal disease?

Periodontal disease is the inflammation and infection of the structures around the teeth, which include the gums, the ligament that attaches the tooth to the bone, and alveolar bone itself. In the earliest stage of periodontal disease — gingivitis — the inflammation and infection of the gums. In more severe forms of the disease, all of the tissues are involved.

Plaque is the build up of a “slime” layer of bacterial colonies along the gum line. As this plaque sits there longer it starts to mineralize and becomes Tartar.

What is the best way to prevent periodontal disease?

Well, it’s brushing! Unfortunately, though, in order for brushing to be most effective you need to brush your pet’s teeth at least 3 times a week...and like with us...daily is best!  Obviously, your safety is first and foremost in all circumstances, but for most dogs, and even cats, teeth brushing can be a pleasant, non-stressful experience. Check out our video for instructions on how to brush your pet’s teeth. There are fancy pet toothbrushes and enzymatic toothpastes out there - which are all great - but sometimes they create barriers or excuses that keep the brushing from actually happening. One way we recommend to brush teeth is to take a gauze square on your finger - no toothpaste or anything else on it - and wrapping your finger in it; then using that to brush/massage the gum line. You’d be amazed the amount of plaque you can get off (and you can actually SEE it on the gauze) with that technique.

The take-away: The best brushing is the one that actually happens, and we tend to find that the fewer gimmicks involved set us up better for success. That may be with a classic toothbrush, with a fingertip toothbrush or with a gauze square.

Is my pet’s dental health really that important?

Well, like people, every pet’s mouth is different. Some animals and breeds are more susceptible for dental disease than others. In some animals a neglected mouth will result with some degree of plaque build up over time, and gingivitis (or inflammation and infection of the gums). But in some animals that neglected mouth will lead to severe infectious of the mouth, abscesses, pain, bad breath, and can make it more difficult to regulate other disease processes (such as diabetes). In the more severe cases, treatment may involve tooth extractions or complicated dental procedures. Additionally, periodontal disease in general can lead to infections of the liver, heart and other internal organs, so should never be considered “just a dental” problem.

What happens when we have disease that can’t be managed with at-home care? Well, then we would discuss an anesthetized dental procedure for your pet. This allows us to fully assess the tooth and gingival health, take dental x-rays to assess tooth root and bone health and fully clean (including beneath the gum line) the teeth. Sometimes we find that teeth are far more diseased that what initially meets the eye and extractions or referral to a veterinary dentist may be indicated to bring the mouth back to health.

In our next post we’ll discuss treats and chews for our pets and give some guidance on how to pick the right one for your pet to maximize on their dental health.

More Specialists Your Vet Might Recommend

In a followup to our last post, we will discuss below some of the different veterinary specialties and why we might refer to them.

To recap, 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.

Behaviorist: A veterinary behaviorist is sort of a mental health professional for dogs. For some dogs, anxiety is such a large issue that certain medications we prescribe are not enough to help and, unfortunately, some dogs will hurt themselves in their crates by chewing or scratching (think of it like a panic attack). In these extreme instances, utilizing a behaviorist can help narrow down certain triggers and they can also help prescribe different medications in conjunction with a training program to help resolve these issues. Behaviorists can also be invaluable in handling a pet with difficult aggression issues that may provide a safety concern if not handled appropriately.

Dentist: It’s safe to say that most of our veterinary patients have a varying degree of periodontal disease. A dental cleaning, complete with dental radiographs, and polishing/fluoride treatment, can be done with your primary veterinarian. Many extractions can also be done with your primary veterinarian. However, sometimes the pathology in the mouth is so severe that referral to a veterinary dentist is required. They are trained to perform root canals and other endodontic treatments, or even remove parts of a jaw if there are tumors or abnormalities within the jaw bones.

Dermatologist: Veterinary dermatologists are incredibly helpful in diagnosing a multitude of skin disorders that we see on a daily basis, including allergies. After trying many different types of therapies here at our clinic, sometimes the use of a dermatologist, who may have access to newer drug therapies or diagnostics, is the best way to help your pet find relief. They can also perform skin biopsies, intradermal skin allergy testing, and different skin cultures/cytologies, etc…

Ophthalmologist: Veterinary ophthalmologists examine and correct a variety of different ocular diseases – both within the eye and on the surface. Their expertise includes, but is not limited to, performing surgeries (such as cataract surgery or third eyelid/”cherry eye” correction), managing glaucoma and complicated corneal defects, treating inflammatory conditions of the eye, etc…They also have special equipment to look at ocular structures better than most general practices.

Radiologist: Sometimes our veterinary patients eat abnormal things, or have recurrent bouts of vomiting/diarrhea. Other times we may find something abnormal while we are palpating the abdomen during a routine physical exam. Radiographs (X-rays) are a useful tool for looking at the size and shape of organs and noting if anything appears abnormal.

However, if your pet ingested something soft and we are unable to see it on an X-ray, an abdominal ultrasound will look at the internal structure of organs and determine if this object is stuck. Ultrasounds can also find tumors on some organs that are not easily identifiable via X-ray, such as the adrenal glands. Radiologists also have additional training in reading X-rays, MRIs and CT scans which can help us pick up and find subtle changes that can help us with a diagnosis.

For cats with hyperthyroidism, a veterinarian in a specialty hospital with the capacity to handle radioactive material can also administer a highly regulated radioactive isotope that can treat hyperthyroidism in one injection (with several days in the hospital for monitoring afterwards) if it is indicated by your primary veterinarian. Sounds crazy, but it’s also the treatment of choice in people, as well.

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.

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.