Trick or treat or a trip to the ER

Photo Credit: http://www.sxc.hu/photo/1306743

I saw this title on a veterinary newsletter that I subscribe to and I had to steal it.  It is so true and there may be some dangers around Halloween that you have not yet considered.

The first and most obvious emergency we see around Halloween is chocolate toxicity.  Chocolate contains two compounds, both in the class of chemicals called methylxanthines, to which dogs and cats are particularly sensitive.  The first is caffeine.  The second is theobromine.  In general the more bitter or darker the chocolate the more theobromine the chocolate contains.  The smaller the dog the less it takes to cause toxicity.  Methylxanthine toxicity can cause increased heart rates, hyperactivity, tremors and even death.  Sometimes we also see increased thirst, increased urination and lethargy.

Photo credit: http://www.sxc.hu/photo/683215

Chocolate and other candies also contain a lot of fat and sugar.  Dogs and cats are not designed to digest this level of fat and sugar.  High fat meals can result in vomiting, diarrhea and in severe cases pancreatitis.  Pancreatitis is a severe inflammation of the pancreas in the abdomen.  The pancreas is the organ that produces insulin in the body as well as most of our digestive enzymes.  Pancreatitis leads to severe vomiting, diarrhea, pain in the abdomen and can be life threatening. 

Another toxin we are seeing more and more with candy or gum ingestion is toxicity from a sugar substitute called xylitol.  Dogs are extremely sensitive to xylitol and even a small amount can lead to a severe drop in blood sugar called hypoglycemia.  Severe hypoglycemia can cause seizures and collapse.  Xylitol also has effects on the liver leading to sudden liver failure, problems with the ability to clot the blood and hemorrhage.

It is very, very important to keep your Halloween candy away from your pets.  If you think that your pets have gotten into the candy contact your nearest open veterinarian immediately for emergency treatment.  If we catch the ingestion early it may be possible to induce vomiting, hopefully limiting the toxic effects.  This should be done under the supervision of a veterinarian so that the signs of toxicity can be looked for and treated as needed.

Photo Credit: www.dogtripper.com

Have a safe and fun Halloween!

Emergency preparedness

Do you have an emergency kit and plan for your family?  Did you remember to include your pets in your plan and to include a supply kit for your pets as well?  If you did congratulations!  If you forgot to include your pets, or perhaps haven't put together your emergency plan September is Emergency Preparedness Month.  There a lot of resources out there for putting together an emergency plan for both yourself and your pets. 

Here are a few tips I picked up this weekend speaking with some members of the Washington State Animal Response Team (WSART). 

• Put together an emergency kit for your dog or cat.  For a small dog using some easy to find items this can cost less than $10.
• Use food samples that you pick up at pet stores or community pet events.  These often are packaged to last longer than baggies of food which should be changed out every 90 days or so.
• If you include canned food in your kit be sure to choose pop top cans in case you don't have access to a can opener.
• Include information about your pet including vet's name and contact information, description, identifications (tattoos or microchips), medical information.  Include some pictures of you with your pet to aid in reuniting you with your pet.
• Sometimes veterinary clinics, training facilities, boarding facilities will give out slip leashes.  These are a great addition to your pet kit as they are easy to use and quick to grab.  Also include a sturdy leash and collar but the slip leads can also be helpful if other animals are spotted in the neighborhood.  In a pinch then can even be fashioned into a halter for a horse, a muzzle or a harness for a cat.
• Think about the container you store your pet kit in.  A sturdy plastic tote can make an excellent water bowl or litter box in a pinch.
• In addition to a microchip purchase a pet tag or collar with a tag that includes your name and cell phone number.  In a disaster cell phones may be the best way to get in touch with you.
• Keep a supply of any pet medications you will need in your kit at all times.  Change these out every 90 days and replace with a fresh supply. 

There is so much other wonderful information out there about putting together a plan for emergencies.  The  WSART website has information for setting a plan, what to include in your kit, and putting together a pet first aid kit.  Check them out here then click on Documents on the left side of the page.  At the bottom you will see an article titled Disaster Preparedness for Pets.  This is one of the most comprehensive articles on preparing with your pet that I have seen.  You can find additional information at http://www.ready.gov/america/getakit/pets.html.

Dog bite prevention

I wanted to share with you an article I wrote recently for a local publication called Pet Connection Magazine.  This free publication can be found in groomers, vets and pet focused businesses throughout the South Sound.  You can also find them on the web at http://petconnectionmagazine.com/.

Each year in the United States there are an estimated 4.7 million dog bites.  Of these, 800,000 require medical treatment.  Children, especially young children, are the most likely victims of these bites, followed by the elderly and postal carriers.  It doesn’t have to be this way.  There are things we can do, things we can teach our families and things we can teach our dogs to reduce the number of bites.

First, be a responsible dog owner. 

• Be sure your animal is healthy and well vaccinated.  Disease and pain can increase the chance that a dog will bite. 
• Choose a pet that has a friendly, trainable personality.  Any dog, whether 2 lbs or 200 lbs can bite.  Meet the dog and talk to the breeder or shelter caretakers about the dog’s personality. 
• Neuter or spay your dog.  Un-neutered dogs are at increased risk of aggression and biting behavior. 
• Socialize your dog.  Puppies need to be exposed to a wide variety of people, situations and other dogs early in life.  The prime socialization period is before 12 weeks of age.  Look for puppy classes where the attendees are screened for health and appropriate vaccination schedules.  Older dogs can still be socialized.
• Do not allow roaming. Dogs roaming loose are much more likely to display abnormal aggressive behavior then dogs kept close to home.  They may also form a pack making them even more dangerous.

Second, teach your children how to be safe around dogs. 

• Teach your children how to handle the dog.  Gentle petting on the back is good.  Avoid hair or tail pulling, fingers in or near eyes and mouth.
• Teach children when and how to approach a dog. Never approach a dog that is eating, sick, caring for puppies, or restrained in any manner.  
• No running or screaming.  This can trigger abnormal behavior.
• Ask to touch.  If the owner is present, ask them if it is ok to pet their dog before approaching.  Then let the dog sniff you before gently petting them on their back. If the owner is not present, do not approach the dog.
• Supervise children.  Never leave young children alone with dogs.  They will experiment even if they are good at following rules in your presence! 
• Be BORING.  Teach your children “Stand like a tree. Lay like a rock.” when approached by dogs.

Finally, train your dog. 

• Give your dog a job.  Use positive reinforcement training methods to teach your dog what is expected when they are approached by a stranger. 
• Give your dog a break.  Allow your dog to avoid stressful or fearful situations.  Don’t take them places that cause stress, give them a safe place in your home to retreat to such as a bedroom or always open kennel that is off limits to visitors.
• Get help.  Work with your veterinarian and a recommended positive reinforcement trainer.  Be willing to accept that some situations may never be right for your dog and need to be avoided.

Dogs are wonderful companions and a great deal of fun.  Regular contact with dogs has many benefits including reducing blood pressure and anxiety.  By taking some simple and proactive steps we can enjoy the company of dogs while significantly reducing the risk of dog bites.

Additional resources:
    www.avma.org
    www.preventthebite.org
      

Microchips

This one is going to be a short post but SO important.  Are your pets microchipped?  Do you know if they are registered?  Have you updated your contact information from when your puppy got microchipped 8 or 10 years ago?

Microchips can be amazing at reuniting lost pets and their loving families.  It can happen to any of us, no matter how careful and loving a pet owner.  They slip out when your back is turned, get frightened when traveling and bolt away into the woods or fields, or just wander off when your child leaves the door/gate open!

Humane societies, rescue organizations, animal control officers and veterinarians almost all have microchip scanners and often more than one type of scanner!  They will check your pet for a chip and call the company that has that chip registered.  But here is where they may hit a dead end.  If the information that company has for you is not up to date they don't have anyway to track you down!  They can call the shelter or vet that implanted the chip and hope that there is more information there.  But that may not be accurate either.  The only way to find you is if you provide the information and update it regularly.  This is especially critical in an emergency situation.  There is chaos enough during these types of crises and rescuers do not have time to spend hours trying to track you down.  Make sure they only have to make one phone call.

To register your pet's chip you will need the chip number.  Many companies will allow you to register any chip your pet has, however, I would encourage you to at least register it with the manufacturer as this will be the most likely place a rescuer will call when the chip is found.

Here are the contacts for some of the most common chip manufacturers.

• Home Again http://public.homeagain.com/index.html  1-888-HOMEAGAIN
• AVID  1-800-336-2843
• ResQ (Bayer)  www.petlink.net  1-877-PETLINK (1-877-738-5465)
• 24PetWatch 1-866-597-2424  www.24petwatch.com
• AKC Companion Animal Recovery https://www.akccar.org  1-800-252-7894

You can also check to see if the chip is registered anywhere with this website.

• http://www.petmicrochiplookup.org/

Many companies will charge you a one time fee to register your chip.  Your chip may already have been registered by your veterinarian in which case you may just pay a smaller, update fee.  I know we are all trying to save money these days but this one time lifetime registration fee is worth it if your beloved dog or cat gets away from you.

Don't know if you pet has a chip?  Ask your vet to scan your pet for you and write down the manufacturer and chip number.  Then you can use one of the above sites to confirm and update your pet's registration.  

Diet trial: a diagnostic test

"My dog is allergic to....." I hear all kinds of things that people have determined their dog cannot tolerate. And in some cases those may be true allergies. In other instances that may be less than accurate. Perhaps the processing of that food doesn't agree with the dog. Or there are additives that cause some intestinal distress. I think we can all agree that there are some things that perhaps do not agree with us (beans and some green vegetables, for example) but we are not truly allergic to them. This is often true of dogs and cats as well.

The only way to determine if there is a true food allergy is to test for the food allergy. Step one of the food allergy test is to choose a food that is least likely to cause an allergic reaction. This can be tricky if we don't have a good complete history of what the animal has eaten in the past. We do know what the most common food allergens are in dogs and cats. Here they are in order:

Dogs: beef, dairy, wheat, egg, chicken, lamb/mutton, soy

Cats: beef, dairy, fish, lamb, poultry, barley/wheat

Dogs and cats can display some allergies to carbohydrate sources such as corn, rice and potato but these are much less common. However, as I said yesterday animals can develop an allergic reaction to any food protein that it has been exposed to. So just because you have been feeding a Kangaroo/sweet potato diet for your dog's entire life does not mean that it doesn't have a food allergy. It just means that your dog's allergy is much more likely to be to kangaroo than to beef or chicken.

There are three ways to choose a food. The first is to create a home cooked diet. For animals with intestinal signs of food allergy a simple diet of a single whole protein and a single carbohydrate plus some vegetables is probably safe enough for the 2-3 weeks it takes to see an improvement. However, to see improvement in skin itchiness we need to feed the trial diet for at least 2-4 months. If you are doing a home cooked meal it is important that you do this in consultation with your veterinarian and a veterinary nutritionist to be sure the home cooked diet is complete and balanced to meet all your pets needs.

A simpler way to conduct a food trial is to use a commercially prepared food. When choosing a novel protein diet you will need a food that does not contain any of the food allergens that your dog has been previously exposed too. It is very difficult to find a food that meets this criteria with an over the counter diet. You may be feeding your dog or cat small amounts of beef, chicken or soy proteins inadvertently since these are often sources of other vitamins and minerals, even in diets that market themselves as fish or other "novel" protein diets. And it may not be obvious from reading the label whether or not these proteins are found in the diet. So if you really want to know if you dog has a food allergy it is worth using a prescription novel protein diet that guarantees that there is no other protein sources in the food. Down the road it may be possible to switch to an appropriate over the counter diet in consultation with your vet but it is not a great choice when conducting this diagnostic test.

Another commercial option is to use a diet with hydrolyzed protein. These diets have been specially treated to break down all the intact proteins into a small enough size to prevent them interacting with the immune system in the body. Your pet will still get all the benefits of the protein (which the body would be breaking down anyway in the stomach and intestine) without the chance of interactions with the immune system.

Once you have chosen your food option, in consultation with your vet, it is time to start the first stage of the test. And it can be both simple and difficult! Feed your pet. Not too hard, right? True, but while you just have to feed your pet the chosen diet you must be very careful not feed your pet anything else. That includes treats, table scraps, food your kids dropped, eating via hunting, treats from the neighbors, chews such as rawhide and bones and flavored medications.

If your pet is showing primarily intestinal signs of a food allergy you will be looking for at least a 50% improvement in 2 to 3 weeks. This would include no more vomiting, improved stool quality, and stabilization of weight or weight gain (if that is needed). If your dog has Itchy and Scratchy on board it is going to take a bit longer to see improvement. You will need to feed the trial diet for a minimum of 8 weeks and as long as 16 weeks. In that time you will be looking for at least a 50% improvement in level of itching. It is often best to keep a log, rating the amount of itchiness on a daily on a scale of 1 to 10. Remember, many dogs have both environmental allergies and food allergies so the symptoms may not completely resolve.

So you have fed your pet the trial diet and only the trial diet carefully for 8 weeks. You feel pretty sure that your pet is feeling better and is less itchy. So we are done, right? Well, not quite. To truly prove that there is a food allergy present we need to challenge the pet with the previous diet or protein. This means stopping the trial diet and putting them back on their old food. Good news is this part of the test is usually pretty quick. We often will see the problems come back within a week or two on the old food and then we can say with confidence that our diagnostic test has proven the existence of food allergy in this dog. If we choose to expose the dog to individual proteins, one at a time, as opposed to a complete food we may even be able to say specifically what the dog is allergic too.

What if you didn't feel like your pet improved while on the chosen diet? Does that mean your dog or cat does not have food allergies? Maybe. Unfortunately, as with many of our diagnostic tests there are grey areas. There are many reasons why your animal did not respond to the food trial. Perhaps they were getting some other food that you didn't know about (is someone sneaking food under the table?). Perhaps our diet history left out a food and we inadvertently chose a trial diet that contained that protein. Perhaps there is enough similarity between a protein in our chosen trial food and what your dog is allergic too that we are still getting an allergic reaction. If we saw a little improvement but not enough it might be worth considering trying another trial diet. Or it may be more important to pursue other causes of your pets symptoms, perhaps with a referral to a dermatologist for environmental allergy testing.

Itchy scratchy

Meet Itchy and Scratchy. They are the two most common complaints my clients call me about. Now sometimes, this is just a simple case of an ear infection or bug bite or even a nervous animal that chews itself like people chew their nails. But most often Itchy and Scratchy are present because of allergies.

An allergy is an abnormal response of the immune system to a normal, non-harmful, part of the pet's environment. This may be a pollen, bug bite or component of their food. The most common type of allergy that we see in dogs is called atopy. Next most common is flea allergies. Not all flea bites will cause a dog to itch. But a flea allergic pet will have a strong, very uncomfortable reaction to even a single flea bite. And finally, food allergy which is an abnormal reaction to a protein in the animal's food.

Atopy is also identified as environmental or seasonal allergies. Atopy is triggered by substances that the animal comes in contact with through the skin or respiratory tract. In animals, the allergy shows itself with skin reactions. These are the dogs and cats with itchy feet, red itchy armpits and groin areas and chronic ear infections. They may show all of these symptoms or only one. They may become worse at certain times of year as certain pollens increase. They may be worse in one part of the country than another. Atopy typically develops when the animal is about 1 to 3 years old. It would be rare for atopy to show up after about 7 years of age.

Atopy is treated in a couple of different ways. The ideal treatment for atopy would be with hyposensitization, also called "allergy shots". In this treatment the animal is tested to determine the exact things that it is reacting too. These allergens are then made up in a vaccine type injection and the animal is given a series of injections to try and train the immune system to stop overreacting to the allergens. This is the only treatment that really treats the underlying cause of the allergy symptoms. Sometimes this treatment may not be possible or may not work for a particular pet. Other treatment options include suppression of the immune response with drugs. Cyclosporine is one option. This was originally designed as a post-transplant, anti-rejection drug. At lower doses it is safe and can be very effective at controlling the symptoms of atopy. Another treatment option is steroids like prednisone. While steroids are safe enough for short term treatment and can be life-saving in certain disease processes we have to be careful with long term use. Therefore, steroids are not an ideal way to treat atopy unless the symptoms are mild and the steroids can be used infrequently for short periods of time.

Flea allergies are the easiest allergies to treat. Prevention is key here. Keep your pets on regular, year-round flea control and you will never have to worry about them being allergic. If you get behind and your pet gets fleas, removing the fleas and treating the symptoms of the allergy will fix the problem. Flea allergies are usually identified by a very characteristic area of irritation, usually around the base of the tail, extending up the spine and sometimes around the base of the ears. The area will be come very red, possible swollen. Often hair will fall out and the pet may develop secondary bacterial infections leading to more irritation and hair loss. And, of course, if we find fleas on the exam we become even more suspicious of a flea allergy.

And finally, food allergy. Spend any time in a pet store and you are going to hear stories about food allergies and food allergic dogs. However, the actual incidence of food allergy is probably fairly low in the general pet population. And there are a lot of myths out there about food allergies. I hear two most commonly. The first is that their dog is on a "special" diet that doesn't cause allergies. But the truth is any diet can potentially result in an allergic reaction regardless of the components. All it takes is protein from the food, and all food contains protein, to interact with the immune system leading to an abnormal reaction by the immune system and resulting in an itchy dog. The second myth I hear a lot is that their dog has been eating the same food for years so it can't be allergic to it. But it takes multiple exposures, possibly over months to years to lead to an allergic response. So a dog that suddenly develops itchy skin at 7 or more years of age is more likely to have a food allergy than atopy.

And just to complicate matters all of the allergies look pretty much the same: Itchy and Scratchy rear their ugly heads. And sometimes more than one type of allergy is present. It is thought that up to 30% of dogs with atopy also have a food allergy. This is especially true in those itchy dogs that may also show some intestinal symptoms such as soft stools, weight loss or vomiting.

Later this week I want to talk about how to diagnose a food allergy through a diagnostic test called an elimination diet. This is where you get to be the scientist or doctor at home, running a well designed experiment (no risk involved, I promise) on your dogs diet.

And if you have any interest in more myths about food allergies in dogs check out this link.

House calls

I initially started this blog to provide my clients with some information to help them care for their pets. But I think I need to talk a little about what I do and what makes Doorstep, and other house call practices, unique.

The name of my practice is a perfect description of what I do. I come to your door and provide veterinary services in your home. I like to think it is a great melding of modern medicine and old fashioned service and care. So much of what we do daily as vets is essentially outpatient care. And it is based on trained hands, ears, eyes and mind. And I can take those with me wherever I go. I do carry a small amount of equipment with me because sometimes we may need to collect samples to look more thoroughly into your pets internal health with blood, urine or fecal tests. Most of the time pets are so patient and tolerant that we can collect these samples with a minimum of fuss.

People often ask me, why would I want a house call vet? And there are some advantages and disadvantages to the choice. Here are some of the reasons to choose a house call vet.

Stress of the vet visit: Many animals experience a certain level of stress from the trip to the veterinary clinic. And often times this stress is low level and short term and so not a cause for concern. But there are some animals that are profoundly disturbed either by the car ride or the vet clinic itself. These animals may shake uncontrollably, become aggressive or fractious, urinate or defecate on themselves or in the carrier, and continue to show abnormal behavior for hours or even days after the visit. These animals may benefit from having their vet come to them. It eliminates the car ride and the often overwhelming sensory input of the vet clinic. By coming to the home I can take some time to get the pet used to my presence, take frequent breaks during the course of the exam for some relaxation and immediately allow animals to retreat to a safe place as soon as I am done. Now, inevitably there may be a time when we need to have the animal in the hospital so it may be of benefit to work on calming your pets fears about trips to the clinic. But in the meantime we can be sure that your pet stays healthy at home.

Mobility issues: These may be on the part of the pet or the owner. Cat carriers and walkers are not a good combination. Nor are tall jumps into the backs of SUV's for large arthritic dogs. By having me come to you, both you and your pet are relieved of the difficulty of travel to and from the vet hospital.

Our crazy, modern lives: I talk about house call visits being old fashioned care. But in our crazy over-scheduled lives getting to the vet hospital can sometimes seem like just one more thing to add to our day. This can be especially true for families with young or multiple children who are trying to balance not only their own schedules but nap/meal/activity schedules for their children. When the I come to you, you can continue with your day right up until the I arrive. And if you have children, your kids can continue to play in a safe comfortable environment freeing up your attention for the visit. Veterinary clinics are by necessity full of great (and not so great things) for your kids to get into. This can make the trip itself exhausting and distracting for the parents limiting their ability to communicate with the doctor. And distraction on the part of both parent and vet could lead to questions going unanswered and misunderstandings about recommendations and options.

Personal attention: And the final benefit of a house call visit is the unique personal attention that you get from this process. Does your pet have behavior problems that you have been struggling with? By coming to your home, I can get a very good picture of the environment that your pet lives in helping to guide my recommendations. House calls are often a longer interaction as well allowing us to truly discuss all of the issues that you are facing with your pet, not just the specific issue that you called about that day.

Now there are some limitations to house calls as well.

Cost: House calls are time consuming. Not only must I travel to your home and then on to my next appointment, but I always spend much more time with each patient. A typical visit in the clinic lasted about 10-15 minutes. Maybe a little more for sick pets. And in the clinic I could simultaneously juggle multiple patients. Unless you have multiple pets I can only be in one place at a time. This limits the number of patients that I can see in a single day. So there is an additional cost associated with the house call. This is quoted as a house call or travel fee and is in addition to the physical exam fee and any other costs associated with the visit. The cost of this fee will depend on your geographic location.

No specialized equipment: Because I do not own a mobile hospital I do not have the equipment to provide radiographs, anesthesia, surgery or hospitalization. So things like broken bones, swallowed balls, dentistry and seriously ill pets will still need to be sent to a traditional hospital. Some mobile vets do have these specialized vans and can provide surgery, radiographs and dentistry in your driveway. Hospitalization will probably still need to be referred to another hospital.

No emergency: For most mobile vets, including me, it just isn't possible to provide much in the way of emergency care. In most cases, a true emergency is going to require the use of some of that specialized equipment anyway. And I may be too far away to be useful as well. This is especially true in our urban area where emergency hospitals are probably closer and fully equipped. I also need to take some time off to take care of myself and my family. I do still want to know if there is a problem and will work hard to maintain communication w

ith you and the veterinary clinic where you have taken your pet.

Practicing house call medicine is a very different experience than traditional small animal practice. It is much more personal with a stronger bond between myself, my patients and their owners. I love that spending the extra time with my clients allows us to become a team looking out for the best interests of the pets. I love seeing the animals relaxed and happy in their comfortable environments.

Buying your pet's medicine online

Veterinary medicine is expensive. And if you live somewhere with heartworm or have an older pet that needs medication daily for a chronic condition, online purchasing may seem like an ideal way to save a little money. But there are some things you need to watch for when you are comparing online pharmacies.

There have been many instances of online pharmacies selling counterfeit medication or flea preventatives. In some cases the prescriptions have lead to disease and death because the counterfeit medication was actually toxic. In other cases the medication may have been improperly stored or expired making it less effective.

So how can you protect yourself? Start by very carefully researching the online pharmacy you are considering. Check to be sure that the pharmacy is licensed by the state Board of Pharmacy where it operates. If you can't even figure out where the pharmacy is based, that should be a red flag that this pharmacy may not be safe to use. Call the company and asked if there are licensed pharmacists that can answer questions if they arise. Ask your veterinarian if they have ever worked with that pharmacy and if they had any problems or concerns.

Just like the pharmacy down the street, online pharmacies must require a written prescription from your veterinarian before filling a prescription drug request. Many flea and tick products are not prescription (Frontline and Advantage) but arthritis medication is. If the pharmacy offers to fill the prescription for you based on a questionnaire that is another red flag. A questionnaire does not substitute for a patient-client-doctor relationship, regular hands-on physical exams and recommended laboratory work. Giving medications without these safeguards could lead to serious illness.

And finally, some reputable online pharmacies have agreed to go through an accreditation process to ensure that their practices are safe and legal. This program, called Veterinary-Verified Internet Pharmacy Practice Sites (Vet-VIPPS), requires strict quality control, regular inspections, strict confidentiality and internet security. This is still a new program, currently 2 years old, so there are a small number of pharmacies currently accredited but using one of these pharmacies will give you an extra layer of protection to be sure that your pet is getting the correct medications. You can find out more about this accreditation program and pharmacies that are participating here.

Some thoughts on saying goodbye

I didn't realize it had been so long since I had written anything for this blog. It has been a hectic couple of weeks. But since I am home with a cold today it seems like a good time to do a little writing.

I have been seeing a lot of euthanasia's lately and thinking about the toll that this takes on both the owners and the veterinarian helping them. Making a decision to euthanize is such a difficult decision. There is fear that we are making the wrong decision or that we don't have the right to make life and death decisions like this. There is guilt and second guessing and of course over it all the grief of loosing that wonderful partner that our pets become.

They give us so much in their short lifetimes: unconditional love, acceptance, empathy, entertainment, laughs and yes a few headaches and heartaches to provide fullness of experience. We love our dogs right back, often with a simplicity that we struggle to find in our human relationships. And we learn, whether consciously or not, lessons in patience, kindness, and humility. A client of mine recently said that her cat had been sticking around to be sure she learned all she needed to know. I think the final lesson was one in letting go. Perhaps the hardest lesson of all to learn.

I was speaking to a college student this weekend who is considering applying to veterinary school and we briefly touched on this topic. She was concerned that she wouldn't be able to provide this service to her clients. And as a veterinarian it is something that we must all reflect on in our professional lives. When would I be willing to provide this service? Under what circumstances might I refuse? Is there something I can do to help both myself and the owner feel that this is a good decision?

My philosophy has always been that euthanasia can be such a blessing that we can give to our pets. It is a truly courageous and selfless act that we do when we choose euthanasia. We can remove pain, preserve some dignity and spare our beloved pets unnecessary suffering. But in doing so we must give up something unbelievably precious to ourselves. And it is there that we must reach deep into our hearts to find the love our pets have given us and return it, in full measure, by saying good bye. Each euthanasia I participate in is unique and special. I learn something from each of these pets and their loving owners. I too grieve, even if I have only met the pet at this ending of a life, and I try to take a little time to say my own goodbye to each wonderful furry life that I am lucky enough to have contact with.

Thank you for the lessons in love, courage and dignity to all those that have passed and all those who will pass through my life in the future.

I'm being interviewed!

Yes, tonight you can watch me sit down with Trisha Novotny the mom and blogger behind the website 24/7 Moms. She and I are going to talk about pet loss, making euthanasia decisions and how to talk about these decisions with your kids. And for the second half of the show we will talk about some simple basic pet care tips. Hope you can join us.

The webcast airs at 6 pm PDT and then repeats at 8 PM PDT. And there are giveaways if you would like to join in on the chat room.

Find the webcast at http://247moms.blogspot.com/2011/07/pet-talk-on-247-moms-live-webcast.html

Choosing a trainer

Choosing the appropriate dog trainer may be one of the most important steps to a long and happy relationship with your dog. And I do believe that everyone should try and attend at least one basic obedience class with your dog, whether young or old. Choosing the right trainer for you and your dog will make this relationship more successful.

First of all, choose a trainer that uses reward or positive reinforcement training. Punishment based training that involves yanking on the leash, yelling, rolling the dog or shocking the dog are not effective long term and do not help you to build a relationship of trust with your dog. Punishment training is much more likely to induce fear in your dog leading to long term negative consequences.

Look for a trainer that attends regular continuing education and holds certification in their field. They should be constantly looking to improve their methods. New behavior research is always being published and they should be regularly reviewing the latest research.

Ask to observe a class to see if you think it would be a good fit for your learning style. Also watch the interactions in class to see if both owners and dogs appear to be relaxed and enjoying themselves. Are dog tails up and wagging with happy alert expressions on their faces? This is a happy dog. If they tail is tucked, the ears are down and the dog is trying to hide they are not having a good time. Also watch how the instructor interacts with the owner and pet. They should be encouraging and patient as every dog (and owner) will learn behavior at different rates.

For more information about choosing a trainer and also the reasons for positive versus punishment training check out www.avsabonline.org

New puppy?

Photo Credit: http://www.sxc.hu/photo/1111753

Are you thinking about getting a new puppy? Summer is puppy season. And many people begin to think about adding a dog to their family during this season. But where to go to get the new dog? What kind of dog should you get? There are a lot of resources on the web about how to choose the correct dog for you. The American Kennel Club has a ton of resources about temperament, exercise needs and grooming needs of the recognized breeds. Shelters and rescues can be good for helping you determine the temperament and needs of an individual dog.

Photo Credit: http://www.sxc.hu/photo/530901

If you are thinking about purchasing a pure bred dog make sure you can go and visit the breeder. You should see a small number of happy healthy dogs that are allowed to socialize with the other dogs and humans in the household. You should be shown medical records for both the puppies and their parents testifying to the health of all of the dogs. You should go prepared to ask questions about inherited and genetic disease risks for that particular breed and the breeder should willing provide evidence of the existence or absence of those problems. Ask to see actual veterinary records or for a release to speak directly with the breeder's veterinarian about these concerns.

Here are some resources for researching inherited disease in various dog breeds.

Canine Health Information Center (CHIC) at http://www.caninehealthinfo.org/breeds.html

Canine Inherited Disorders Database maintained by the University of Prince Edward Island at http://ic.upei.ca/cidd/.

You can also check out more information on hips, heart and eye problems through the following resources:

Canine Eye Registration Foundation (CERF) at http://www.vmdb.org/history.html

Orthopedic Foundation for Animals (OFA) at http://www.offa.org/index.html

OFA's Cardiac Database at http://www.offa.org/cardiac_about.html

University of Pennsylvania Hip Improvement Program (PENNHip) at http://research.vet.upenn.edu/pennhip/GeneralInformation/WhatisPennHIP/tabid/3232/Default.aspx

Photo Credit: http://www.sxc.hu/photo/1258144

Perhaps you would like to adopt a puppy or even better have some interest in an older dog. Then you are likely to be looking into area shelters and rescues. Even here we can find problems with the management, care and adoption policies. Again, you should always be allowed to meet the dog you have interest in, even if they are currently being fostered. If you have other pets or children at home they should have some time to meet the pet before you take him or her home. Shelter or rescue pets should be spayed or neutered or there should be a refundable deposit to be sure that they are spayed or neuter soon after you adopt. There should also be some temperament testing done by the shelter or rescue agency. Ask if they have used the ASPCA's SAFER test or Sue Sternberg's Assess-A-Pet. Make sure the animals have continued to receive appropriate vaccinations, deworming and other veterinary care during their stay.

And finally, stay away from the Internet! Anyone can stage or Photoshop a photo. You have no idea of the conditions that your puppy was raised in unless you can view it yourself. You also have no first hand knowledge of the health of the parents, puppies or temperament of any of the dogs without meeting them. The most critical period of socialization for puppies begins before they leave the kennel and if they have been kept in a cage the entire time they may not be appropriate household pets.

Want more information? I just found the best website about how to research breeders, rescues, shelters and what red flags to look out for. Check out www.pupquest.org. Written by a veterinarian with extensive experience in animal shelters and rescues this website has a ton of information about finding the best source for you new lifelong companion.

Want more? Here is are two free downloadable books by Dr. Ian Dunbar, a notable veterinarian and animal trainer. http://www.dogstardaily.com/files/BEFORE%20You%20Get%20Your%20Puppy.pdf

http://www.dogstardaily.com/files/AFTER%20You%20Get%20Your%20Puppy.pdf

Photo credit: http://www.sxc.hu/photo/288602

Tough times

Times are tough right now. This is true for nearly everyone in the United States. There are, of course, a lucky few that have been relatively unaffected by the recent recession, but they seem to be few and far between. Many veterinarians are also struggling with slowing business, increasing costs (health care anyone?) and changing expectations from our clients. We know our clients are also struggling as we see them forced to make more and more decisions based on the cost of care options rather than what they know is best for their pet. We recognize that these can be painful decisions. Your veterinarian really does want to help you make the best decisions for you and your pet.

I know that price shopping for veterinary care is a reality. Pets rarely have insurance and the cost of care has increased as the sophistication of veterinary medicine and life expectancy of pets has increased.

If you choose to price shop I would encourage you to ask more specific questions beyond just "what does it cost." For example, find out what exactly the quoted cost includes. Spay surgeries are commonly shopped services. But you need to find out what exactly is included in the price quoted to you over the phone. This is a MAJOR abdominal surgery and you should be sure your pet is being treated appropriately. Do they provide pain medication? Does that medication last beyond the day of surgery or will your animal be coming home with additional pain medication? What type of anesthesia do they use? How do they monitor anesthesia? How long does the animal stay in the hospital after surgery to monitor for complications? You may still chose or be forced to choose the less expensive option. Just be sure you are doing it with open eyes and with a complete understanding of the differences.

Be very careful about "shopping" for emergency care. Be sure you fully understand all the risks of delaying treatment, transport of your pet, or treatment at a less experienced or equipped hospital. You may decide that you would rather your family vet treat your pet because you are more comfortable with them and their staff. But be sure to speak with your vet first and determine that they are fully prepared to handle whatever the emergency is. I would hope that my colleagues would be honest with you about what they feel they can or cannot handle.

When choosing where to take your animal for veterinary care also consider some of the intangibles that come with the service vets provide. Is the clinic clean and safe? Are the staff friendly and knowledgeable? Are they willing to take the time to answer your questions? Are they willing to offer and explain options to you? Do they follow up on your visits? Keep in mind that some of the personal care such as longer appointments, followup calls and in depth discussions may result in a clinic that must charge a bit more to cover their costs.

As more time is spent with each patient and client the clinic must charge enough to continue to pay their payroll, rent, equipment expenses, supply costs, utilities, taxes and many other costs that come with running a full service outpatient clinic, surgical center, hospital and dental office all rolled into one! Less expensive clinics will likely have great doctors but may have less time to spend with you, have fewer staff to monitor patients or less equipment to help treat your pet. In some cases, that may not matter. In others it may be a factor in your decision making.

Price shopping is a reality. Each veterinarian must face this reality and decide how to handle it. You, as a client, must also decide how you are going to deal with the realities of veterinary expenses. Just be sure you are asking the right questions so that you understand exactly what kind of care your pet will be receiving. At times price shopping will make sense where the risk to your pet are low. At other times price shopping may be riskier and more expensive in the long run.

How to become a veterinarian

I get asked all the time "how long does it take to become a veterinarian?" There are several ways to answer that but I thought it might be interesting to go back through my progression from a little girl with a big dream to actually seeing my first patient.

Like many kids I first talked about wanting to be a vet as a child. I loved my cat and desperately wanted a dog. Unfortunately, with no fenced yard and no easy way to fence it that wasn't possible. So instead I played with every dog I came across. In high school, when I was getting more serious about making college and career decisions I began working in a small animal veterinary clinic in my hometown. I started there doing very menial tasks: mopping floors, cleaning cages, filing charts and the best part, walking dogs. I loved that hour or so in the day where I got to spend time with all the different personalities of dogs. As boring as most of that job was I was still determined that I would go to veterinary school.

In order to get into veterinary school you must first complete a certain level of pre-veterinary courses, mostly science and math. For most students this means earning a bachelors degree first. A small number of students manage to get all of these courses done in 3 years and are eligible to apply for veterinary school without the bachelors degree. And the bachelors degree does not have to be in a science. I went to veterinary school with students from a variety of backgrounds including some with graphic arts, French, English and sociology degrees.

I personally chose to pursue a bachelors degree in Biochemistry because I really loved my science classes. I attended a small liberal arts college in Boston called Simmons College. While there I was fortunate to work in several active research labs and for a while I was pulled between continuing toward a veterinary degree or towards further education and a research career. I also continued to pursue opportunities to work with animals including volunteering in the live animal exhibits at the Boston Museum of Science and helping to oversee laboratory animal welfare at a large research institute in Boston.

I spent one summer doing both research science and working with a vet trying to make a decision. I found that, while I enjoyed the challenge of the research science, it was a very lonely place to work. While I do tend to be introverted I really like people and I miss it if I don't have regular contact with a variety of people. And that is what you get when you work in the veterinary field. No animal walks through that door without a person at the other end of that leash or carrying the carrier.

So I applied to veterinary schools. This process is similar to applying to college. I had to take the GRE test, fill out many forms, write a personal statement explaining why I would be a good candidate, and then I had to wait. It was a long 8 months before I started getting any response from any of the schools. Several of the schools requested an opportunity to meet me for an interview. So I did some traveling, some talking and some more waiting. In the meantime, I had graduated with my bachelors degree and was working as an assistant in a small animal clinic. This particular job was more interesting but I was always frustrated by not really understanding why I was being asked to provide the treatments I was giving. I was ready for vet school!

Finally, in April I was accepted to the University of Minnesota College of Veterinary Medicine. My fiance (at the time, now husband) packed up our apartment and relocated to St. Paul, MN. I started school that fall.

Veterinary school is a challenge. The first two years are spent learning a new language (all that new terminology!), some more basic science and lots about how the body works and what happens when something goes wrong. Or in the case of veterinary medicine, bodies, since we are taught dog, cat, horse, cow, pig, llama, bird, rabbit and several other species. There are a lot of similarities but each species is unique too. By the third year we were getting into specific discussions about diseases and how to diagnose and treat them. We were also beginning to learn how to do surgeries and other procedures. By the end of our third year they were ready to let us touch some actual patients! We spend a solid 14 months working along side our professors examining, diagnosing and treating patients. We spent time with specialists in emergency medicine, internal medicine, surgery, dermatology (skin), opthamology (eyes), and neurology (brain). We also learned about reproduction, genetics and how to interpret laboratory results (pathology). About half way through these 14 months we took a national board exam testing us on our ability to diagnose and treat the main species we might be faced with (dog, cat, horse, cow, pig, bird, pocket pet, llama).

clipart credit: Cliparguide.com

At the end of 4 long, hard years they gave us our diplomas and sent us out to be doctors. At this point we had some options. Most of my classmates and I started jobs in whatever practice we were most interested in: small animal, large animal, mixed practice. Some of my classmates went on to do an internship. This provided them with another year of intense practice while being closely mentored by a senior veterinarian, either at a university hospital or large speciality practice. Some of those then went on to pursue further training in the field of their choice and completed a residency. I have classmates that are now specialists in anesthesiolgy, opthamology, dermatology, emergency medicine, surgery and pathology. Some even went on to work in Public health, the military and industry. So many options for what to do with a veterinary degree.

I chose to go the route of a general practitioner. That means that 1 week after graduating from veterinary school I saw my first solo patient. It was a nerve wracking experience that I wouldn't trade for anything. I have continued to learn so much in the 7 years since I graduated. I haven't always made the best decisions, I have been frustrated by the limitations finances sometimes place on us, and I have been saddened by the loss of wonderful patients that we just couldn't save. But I have met so many incredible, caring pet owners. Don't get me wrong, the pets are fantastic and I love seeing the wide variety of personalities and breeds. But it is the love and compassion of their owners that gives me hope and keeps me going.

It took 8 years of schooling, many years of volunteer work and after school jobs, and a large financial commitment to become a veterinarian. But at this point I wouldn't trade it for any other career.

Summer reads

Are you looking for some summer reads? I have a few suggestions for veterinary related books that you might be interested in.

Of course, James Herriot is the classic veterinary read. The pen of name Dr. James Wight, James Herriot practices veterinary medicine from 1940 through 1980 in the United Kingdom. He tells stories of the bond between human and animal with humor and passion. The characters in his book are wonderful and many current veterinarians were initially inspired by the wonderful stories he shared in his many books.

http://www.amazon.com/Creatures-Great-Small-James-Herriot/dp/0312330855/ref=sr_1_1?s=books&ie=UTF8&qid=1310064341&sr=1-1

For a more modern take on veterinary medicine check out Dr. Nick Trout's book Tell Me Where it Hurts: A Day of Healing, Humor and Hope, My Life as an Animal Surgeon. Dr. Trout is a surgeon at Angell Memorial Animal Hospital in Boston, MA. Dr. Trout looks at a day in the life of a modern veterinarian in an urban practice. But he too touches on the important bond between animal and human and shares thoughts on the many different roles that veterinarian play beyond just doctor: psychologist, social worker, grief counselor, etc.

http://www.amazon.com/Tell-Me-Where-Hurts-Healing/dp/0767926447/ref=sr_1_1?ie=UTF8&s=books&qid=1310064380&sr=1-1

Want to learn more about why your dog does what he does? There is a great new book out on canine behavior called Dog Sense: How the New Science of Dog Behavior Can Make You a Better Friend to Your Pet by Dr. John Bradshaw. Dr. Bradshaw is the director of the Anthrozoology Institute at the University of Bristol in England. He has been studying dog and cat behavior for 25 years. This books covers a variety of topics from how to respond to your dogs misbehavior to the consequences of breeding for looks rather than personality. He also address many common myths about dog behavior, all based in hard science but written in a way that even nonscientists can be comfortable with.

http://www.amazon.com/Dog-Sense-Science-Behavior-Better/dp/0465019447/ref=sr_1_1?s=books&ie=UTF8&qid=1310064412&sr=1-1

Another interesting animal behavior book, this one looking more at the large animal side, is Animals in Translation: Using the Mysteries of Autism to Decode Animal Behavior by Dr. Temple Grandin. Dr. Grandin is an animal behavior specialist who is also autistic. She has been instrumental in the development of humane slaughter facilities and helping large corporations (such as McDonalds) to reevaluate and change their production and buying practices to improve the welfare of livestock. In this book, Dr. Grandin theorizes that autism and its resultant reactions to the world may be very similar to how animals see and react to the world around them. She tells stories of crawling around at "cow level" in holding pens and slaughter facilities to identify simple things that are causing stress and anxiety in the animals. This is not a gory book about the production animal industry but rather a realistic look at how we can make the lives of these animals better and still appreciate the benefits of the products they provide.

http://www.amazon.com/Animals-Translation-Mysteries-Autism-Behavior/dp/B002V1GZCS/ref=sr_1_1?s=books&ie=UTF8&qid=1310064440&sr=1-1

Here is a book near and dear to my heart. All My Patients are Under the Bed: Memoirs of a Cat Doctor is written by Dr. Louis Camuti. Dr. Camuti was a housecall veterinarian in Manahattan who began practicing in 1920 and continued for another 60 years almost exclusively with cats. This is also a great book for all you cat lovers out their who understand what it means to be "owned by your cat." Dr. Camuti is gruff, blunt and as he terms it "a crusty old coot" but he has a full heart for his patients and their owners. And a unique understanding of cats that can only come for lots of time spent in their company. "With dogs and people its love in big splashy colors. When you're involved with a cat your dealing in pastels. I like that about cats."

http://www.amazon.com/All-Patients-Are-under-Bed/dp/0671554506/ref=sr_1_1?s=books&ie=UTF8&qid=1310064477&sr=1-1

And a few more if you still haven't seen something you like!

The Art of Racing in the Rain by Garth Stein: novel told from the perspective of the dog (loved this one!)

Is There a Doctor in the Zoo, Zoo Vet or any other books by zoo veterinarian David Taylor

Culture Clash by Jean Donaldon (behavior)

Horseshoes, Cowsocks and Duckfeet or any other books by Baxter Black

All My Patients Have Tails by Jeff Wells

The Other End of the Leash by Patricia McConnell (behavior)

If Wishes Were Horses by Loretta Gage about attending veterinary school

Have any favorite animal or vet related books of your own?

Pet loss books for kids

I just wanted to share with you some of my favorite books to help you in your conversations with your kids about pet loss and grief. Most of these books will be available through your local library and all are available on Amazon.com. I have included links to Amazon if you would like to take a further look or read additional reviews.

The first is "Dog Heaven" by Cynthia Rylant. There is also a companion "Cat Heaven" book with a similar theme/premise. This is a good book for younger children, preschool and early elementary. It allows families to talk about what happens to our pets when they leave us. While it does introduce the concept of a heaven it is not overtly one religion or another, allowing parents to discuss their own personal views of heaven. It is a sweet book with a comforting image of where your beloved pet may now be enjoying treats, soft beds and lots of fun.

http://www.amazon.com/Dog-Heaven-Cynthia-Rylant/dp/0590417010/ref=sr_1_1?ie=UTF8&qid=1309538695&sr=8-1

"Goodbye Mousie" by Robie Harris tells the story of a little boy who wakes up one morning to discover that his mouse has died. It does a great job of discussing the difference between sleeping and dead, since the little boy is initially convinced that his mouse is "just very, very sleepy this morning." This book also portrays a wonderful little memorial ritual that the little boy puts together for his mouse with special things to go with Mousie in his coffin including a picture so he won't be lonely. This book also addresses the anger that we all feel as a normal part of grief. It is good to give children the understanding that it is ok to feel angry and sad when our pets leave us.

http://www.amazon.com/Goodbye-Mousie-Robie-H-Harris/dp/0689871341/ref=pd_rhf_p_t_4

A book for slightly older children is "The Tenth Good Thing About Barney" by Judith Viorst. This book addresses the uncertainty of what happens after death. Is there a heaven? Do dogs and cats go to heaven? While it does leave that question open it has a wonderful story line about the cycle of life as Barney changes after being buried and helps the plants and flowers to grow. There is also a nice funeral/memorial idea that may help kids to come up with their own rituals for memorializing their pet. Funerals and memorials can be very helpful for children as an outlet for their grief and a good opportunity to discuss what they are feeling and to address any fears they may be experiencing.

http://www.amazon.com/Tenth-Good-Thing-About-Barney/dp/0689712030/ref=pd_rhf_p_t_2

We can always count on Mr. Rogers to provide us with clear explanations of things that happen in our lives. While the pictures are out of date the clear simple explanations in Mr. Rogers' "When a Pet Dies" can help to address the realities of death: "there comes a time when it [your pet] might be too sick or too badly hurt...for you or even the vet, to be able to keep it alive.'' It also discusses the feelings that children will experience: sadness, anger, loneliness and encourages them to talk about these feelings with their loved ones. I also like how it makes it ok to sometimes need some time alone to think about what happened. This alone time can be especially important for slightly older elementary children as they struggle to process death and how they should react to it.

http://www.amazon.com/When-Pet-Dies-Fred-Rogers/dp/0698116666/ref=pd_rhf_p_t_1

And one final book to recommend. This last one would be most appropriate for older elementary age children or even teens and adults if they are willing to read a picture book. This book is about grief in general. It could easily be applied to loss of a family member, a pet, a divorce or even the grief we experience when we need to move away from everything we know. "Tear Soup; A recipe for healing after loss" by Pat Schwiebert and Chuck DeKlyen is a sweet story about a grandmother who has suffered an unspecified loss. She begins to make tear soup. It addresses that everyone grieves in their own time and their own way. It is ok to grieve even when others may want you to move along. As each ingredient goes into the soup, the soup becomes richer and opens doors to sharing the grief with others who are also grieving. There is a wonderful thread of hope and strength despite the grandmother's sometimes intense grief throughout this book. Grandy says that making tear soup has taught her that "there is something down deep within all of us ready to help us survive the things we think we can't survive."

http://www.amazon.com/Tear-Soup-Pat-Schweibert/dp/0961519762/ref=sr_1_1?s=books&ie=UTF8&qid=1309538940&sr=1-1

If you would like some more recommendations for books to read with your children about pet loss you can find more resources at http://csuvth.colostate.edu/_docs/diagnostic_and_support/argus/argus_201101_books_children.pdf

Purring-a "purr"fect sound

There is something so calming about listening to a cat purr especially when they are cuddled up on your lap sharing some bonding time. Purring is the ultimate sign of content from a cat. But they may also purr when injured or even dying. Purring may be a way to indicate that they are not a threat and asking for friendship or interaction.

We still don't understand the full mechanics of how a cat purrs. We do know that they do not have two sets of vocal cords. The current theory is that the cat uses its vestibular folds, located in the voicebox, passing air across them to produce the purr. Cats purr on both the inhale and exhale creating the continuous sound.

Did you know that big cats like lions and tigers can't purr? They can roar, which our little house cats can't do, but no purring out of these guys. I think I prefer my cats soothing, comforting purr any day.