en Staging for Canine and Feline Cancer Patients – Using Diagnostic Imaging to Look Inside Your Pet  
The staging process is one in which I have to partake on an ongoing basis with my dog, Cardiff, so I’m well aware of the sometimes frustrating process of having increased concern for cancer recurrence based on abnormalities that are discovered in his diagnostics. But if Dr. Avenelle Turner (Cardiff’s oncologist at Veterinary Cancer Group) and I didn’t stay on top of all facets of his internal workings, we could overlook minor abnormalities that can collectively create a bigger picture of concern for his whole body health.
Unfortunately, staging doesn’t just involve one simple diagnostic test. Instead, many types of tests are used to create a complete picture of a pet’s health. Part 1 covered the basic concepts of staging, Part 2 dealt with blood diagnostics, Part 3 gave the scoop on poop and pee, and now in Part 4, I will shed light on diagnostic imaging.
Radiographs: Using Still Life to Look Inside
Also known as x-rays, radiographs are a routine and relatively simple means of looking inside of our pets’ bodies to determine the states of normal tissues or the presence of abnormalities. 
Radiographs create a static (still) image that permits veterinarians to get a basic picture based on organ systems and structures appearing white, black, or in varying shades of gray.
Until the advent of digital radiography, film was exclusively used. Fortunately, digital radiography has become highly utilized by veterinarians as there are numerous advantages over film, including improved imaging quality and less patient and employee exposure to x-rays.
Very dense structures such as bones and metal look white on x-rays, as all of the x-ray beams are blocked by the high density and do not enter the imaging plate or piece of film. Air can be seen inside organs like the lungs, trachea (windpipe), stomach, intestines, and other organs, which appear black as air has no density to block the x-ray beams. Muscle, fat, skin, and solid organs like the spleen, liver, and other structures appear in various shades of gray.
At least two radiograph views are needed to create a 3-D image in the mind of the doctor who is reviewing the images so that what is really going on in the body can be best understood. A pet’s body or limb will be viewed from the right or left side in a lateral (“Lat”) projection and a bottom to top view in a ventrodorsal (“VD”) projection (or vice versa in the dorsoventral [“DV”] projection).
No sedation or anesthesia is generally needed for radiographs to be taken, but dogs and cats that aren’t amenable to being positioned due to behavioral or health reasons may need to be sedated or anesthetized to attain suitable radiographs.
Cardiff now has radiographs of his chest and abdomen every 3 to 4 months to look for evidence of other disease processes or for the presence of lymphoma in other tissues, including the lymph nodes that are contained within his chest cavity that course along his esophagus (“food tube”) and blood vessels.
Radiographs are great to get a baseline of normal and abnormal, but they don't always provide more specific information about a particular organ system. For example, both times that Cardiff had a small intestinal tumor that was causing the intestinal diameter to reduce and prevent food and fluid from properly moving through, radiographs of his abdomen did not reveal the presence of the masses. They were discovered via ultrasound, which has been the more crucial diagnostic test in determining whether Cardiff is still in remission or is having a recurrence of intestinal T-cell lymphoma.
Ultrasound: Viewing the Internal Body in Motion
Whereas radiographs create a static image, ultrasound produces a real-time, moving picture of your pet’s internal organs.
The abdominal organs and tissues like the heart and blood vessels are better imaged via ultrasound than are structures like bones, joints, lungs, and others. Ultrasound waves do not penetrate air or very dense structures (bones, metal, etc.), so looking inside the chest cavity for abnormalities is relatively non-diagnostic unless the heart and blood vessels are the organs being evaluated.
An ultrasound of the heart is called an echocardiogram and is a crucial component of thoroughly evaluating heart appearance and function.
Adriamycin (Doxorubicin), one of the many chemotherapy drugs Cardiff has received, has a toxic effect on the heart, so I've repeatedly pursued echocardiograms as part of Cardiff’s ongoing staging process in an effort to reduce the use of the drug. Radiographs can give basic information about the heart, such as its overall size and whether particular structures within and around it are enlarged or shrunken, but the echocardiogram sheds light on how well the heart valves are functioning to prevent blood from flowing in an abnormal direction (against the flow).
Generally, patients don’t need to be sedated or anesthetized for an ultrasound to be performed, but behaviorally challenging pets may need to be mildly sedated to be still enough to be appropriately positioned and for the few to many minutes needed to complete the ultrasound. Additionally, the site being evaluated via ultrasound is commonly clipped free of hair, and alcohol or ultrasound gel is applied to the skin to facilitate the entry of ultrasound waves into body tissues, all of which may be upsetting to the animal.
Magnetic Resonance Imaging and Computed Tomography: Imaging for Higher Sensitivity Areas
When radiographs and ultrasound don’t quite create a complete image of a pet’s internal structures, other imaging techniques like magnetic resonance imaging (MRI) and computed tomography (CT) are needed.
MRI is the preferred imaging technique to look at structures like the brain, spinal cord, nerves, and intervertebral discs. CT scans are primarily used to look for masses occupying the space within soft tissue structures like the lungs or nasal cavity, or in body cavities like the chest or abdomen.
According to Southern California Veterinary Imaging (SCVI), a “recent study in the Journal of College of Veterinary Radiology found that CT scans are five to six times more sensitive than radiography at detecting soft tissue nodules (metastasis) within the lungs.”
Both MRI and CT take multiple images in sequence while coursing over the targeted body part.  The slice-like images can then be viewed to see the progression of normal and abnormal findings. MRI and CT are the best way to determine the extent to which a disease process is affecting an organ or body system.
Unlike with radiographs and ultrasound, MRI and CT require the patient to be fully anesthetized so that the body part needing to be studied is completely still.
Nuclear Imaging: A Closer Look at the Bones
Sometimes, more advanced tests need to be performed to detect the presence of cancer when radiographs, ultrasound, MRI, or CT scans just can’t quite seem to find the abnormal cells. 
Nuclear imaging involves the injection of radioactive isotopes into the body which move to areas of tissue where there is increased cellular activity. One of the most practical applications of nuclear imaging being used in the cancer staging process is during bone scans.
When there is a disease process like osteosarcoma (OSA, a malignant bone cancer), the cancer is rapidly growing and damaging bone cells. SCVI reports that “30-50% of bone loss must be present in order for the changes to be visible on x-rays,” so the bone scan can help veterinarians to identify areas of concern that may merit biopsy or amputation and to confirm the OSA diagnosis before evidence of bone loss can even be seen using radiographs. Earlier identification of the cancer means that the disease can be treated quicker and can spare the patient pain and potential metastasis to other sites.
Well, you now have a sense of what goes into the elaborate process involved in staging your pet for cancer. As the process isn’t a simple one, it’s important to have a positive relationship with your veterinarian or veterinary oncologist to help guide you through the series of choices one can pursue in providing the most appropriate cancer management plan for your pet. 

Maria and Dr. Rachel Schochet of SCVI performing an abdominal ultrasound.
]]> TheDailyVet Mon, 09 May 2016 11:00:00 +0000 34157 at
Tragedy at the Zoo: Tiger Keeper Who Made the Rules Dies After Breaking the Rules  
By all accounts, Stacy Konwiser knew what she was doing. As the lead tiger keeper at the Palm Beach Zoo, Konwiser was an experienced handler and was familiar with the protocols meant to keep both animals and people safe. When she was fatally attacked earlier this month, she was in an area called the “tiger night house” and, according to the investigation, it was clearly marked as an area to which a tiger had active access.
This is not a matter of whether or not the Palm Beach Zoo has adequate protocols and safety standards in place. It does, and those protocols mandate that a keeper should never be in an area to which a tiger has access. Konwiser should not have been in that enclosure at the time she was attacked.
So the question is, why was she in there? One can only assume it was a horrible mistake or oversight on Konwiser’s part that took her life, but we’ll never know. She was well aware of the dangers with these animals, and as the author of the protocols that are in place she would know that entering an enclosure with a tiger would likely result in this.
I have had the honor of touring a tiger sanctuary here in San Diego and seeing these creatures up close, within the bounds normally reserved for zookeepers. The tiger decided to come up to the fence and jump up on it right in front of me, with just the chain-link fence between us. I have never felt so small in my life. No one in their right mind would knowingly put themselves near one of these tigers without protection. They are magnificent and brutal.
When Konwiser was attacked, the zoo had to make a split second decision about whether to shoot the tiger with bullets or with tranquilizers. They chose the latter. Several factors went into that choice, including the risk of further injury to Konwiser or other people from bullet ricochets, as well as the fact that this was one of only 250 Malayan tigers in the world. This tiger was not doing anything unexpected. He was in his normal place doing his normal things and when an opportunity presented itself, he did what a tiger would normally do.
There is no right or wrong answer as to whether the zoo made the right decision on that count. Were one to ask a person as dedicated to these creatures as Konwiser was whether an animal deserved to die because of a mistake someone else made, I would venture that her answer would be “no.” The tiger is still alive and the zoo has no plans to change that.
Konwiser’s tragic death is a wake-up call to all of us who do dangerous things on a daily basis, whether it’s working with apex predators or simply driving to the grocery store. We live with rules and regulations (double check the gates! Put on your seatbelt! Don’t check your cell phone while driving!) meant to keep up safe, yet so often we tell ourselves “just this once I’ll let it pass.” When that one time turns out all right, it becomes easier next time to also ignore the rules. And when rules become guidelines, and then just suggestions, mistakes will happen.
And good people will pay the price.
Image: Nicki / Flickr
]]> TheDailyVet Thu, 28 Apr 2016 11:00:00 +0000 34046 at
Why Isn’t Cancer on the List of Top Diseases Covered by Health Insurance?  
I assumed cancer would be the top disease on the list for both species. It is the most frequently diagnosed illness in older pets and treatments can be expensive, therefore making it a “model” disease to be represented on a survey for pet insurance.
I was stunned to discover that not only was cancer not the top disease reported, it didn’t even make either list.
The top ailments in dogs included:

Allergic dermatitis
Otitis external
Benign skin neoplasia
Pyoderma and/or hot spots
Periodontitis/dental disease
Cystitis or urinary tract infection
Soft tissue trauma

The top medical conditions for cats included:

Feline cystitis or feline lower urinary tract disease (FLUTD)
Periodontitis/Dental disease
Chronic renal disease
Diabetes mellitus
Upper respiratory infection
Allergic dermatitis
Inflammatory bowel disease

The results of the Nationwide report undeniably represent several areas of bias.
Though pet insurance is becoming more popular, a rise in the number of pets covered by insurance over the past 5-10 years is a relatively recent finding. Most owners purchase policies for their pets when they are puppies or kittens. As cancer is more frequently diagnosed in older animals, a disproportionate number of animals currently covered by insurance would be of a younger age than those expected to develop cancer.
Another confounding factor is that some insurance companies do not automatically provide reimbursement for diagnostic tests and treatment plans related to cancer unless owners have a specific rider for such coverage. Therefore, despite being insured, pets may not be eligible for reimbursement for cancer care simply as a result of lack of coverage.
Another possible reason for cancer not showing up on the survey is that despite the frequency that this disease is diagnosed in companion animals, owners are reluctant to spend money on the necessary recommended treatments.
This could result, at least in part, from the higher costs associated with medical care for pets with cancer. The diagnostic and therapeutic options I endorse can run into thousands of dollars. Few owners have such resources, regardless of what sort of assistance comes from an insurance company that is helping with the bottom line.
Setting these possibilities aside, I’m concerned that the absence of cancer on the list of frequent diseases covered by an insurance company is the result of owners who avoid seeking consultation with a veterinary oncologist out of fear, anxiety, or misinformation.
Each time an animal is diagnosed with cancer, veterinarians are responsible for disseminating information to the owner about the specifics of the disease, including potential causes, testing, and treatment options.
It is imperative the information put forth is accurate. Misinformation and miscommunication lead to distortion of the facts and could contribute to lack of treatment.
As an example, I recently met with an owner who, upon leaning of a diagnosis of lymphoma in her dog, described to me how her veterinarian instructed her that chemotherapy would cost upwards of $15,000 and would likely result in her pet experiencing significant illness from treatment for the remainder of its life, which would only be for a few short months.  
Though she was provided with information, nearly every aspect of what this owner was told was incorrect.
While chemotherapy may be costly, protocols vary and treatment plans can be tailored for individual patients and their owner’s financial capabilities. Even so, $15,000 is a gross overestimation of the cost of a typical protocol.
Dogs undergoing chemotherapy for lymphoma are not constantly sick. In fact, more than 80% experience no side effects whatsoever.  Those that do have a bad reaction are typically treated supportively and recover. And veterinary oncologists would never continue to treat a pet that is constantly sick from treatment.
The prognosis for dogs with lymphoma may be variable; however, most pets are living between 1-2 years after diagnosis rather than “only a few months,” as suggested by my owner’s veterinarian.
When myths and misconceptions prevent owners from seeking options for their pets with cancer, animals may not be afforded the opportunity to receive potentially beneficial care.
I don’t necessarily wish to see cancer topping the list of diseases covered by insurance companies, but I’d like to see every owner and animal have a fair chance at survival when this devastating diagnosis is made.
Image: Captain Pancakes / Flickr
]]> petinsurance-bronze TheDailyVet Wed, 27 Apr 2016 11:00:00 +0000 34041 at
New Drug May Mean That FIP is No Longer a Death Sentence for Cats  
We may be on the verge of a big breakthrough in FIP treatment, however.
First a bit of background. FIP is caused by a coronavirus. This particular virus infects many kittens, usually only causing mild diarrhea from which the kitten recovers with little or no treatment. For most individuals, that’s the end, and the virus is never heard from again. But for other cats, the virus remains dormant in their bodies for a period of time before mutating and causing the disease we call FIP.
If cats can’t fight off the FIP virus, they develop a range of nonspecific symptoms like fever, lethargy, depression, poor appetite, and weight loss. In the “wet” form of FIP, fluid accumulates in the abdomen or chest. If no such fluid accumulations are found, a cat is said to have “dry” FIP. Neurologic abnormalities, difficulty breathing, and eye problems are all also possible with FIP.
Diagnosing cats with FIP is not easy. Immunological testing is available but is not good at differentiating between individuals who have been exposed to the “diarrhea-causing” form of the virus versus those who have current FIP infections.
In cats with wet FIP, the fluid is often fairly characteristic—you can stretch long strings of it out between your fingers because of its high protein content. This may be enough to lead to an FIP diagnosis when a cat’s symptoms also all point in that direction.
The dry form of FIP is usually a diagnosis of exclusion, meaning that a veterinarian has to rule out other potential causes of a cat’s symptoms and then is left saying “there’s not much else left to explain what’s going on; it’s probably FIP.” Tissue biopsies are an option when a definitive diagnosis is desired.
Once a cat has been diagnosed with FIP, owners have to choose between palliative care and euthanasia if a cat’s poor quality of life warrants it, but that might be changing if the results of a recently published paper hold.
Scientists gave FIP virus to eight cats. Once those cats reached a stage where their symptoms were bad enough that under normal circumstances they would inevitably die (some did receive medication and fluid therapy to keep them comfortable), treatment with an experimental, antiviral protease inhibitor called GC376 began. The cats received subcutaneous injections twice a day. Unfortunately, two cats were euthanized because their condition deteriorated to an unacceptable level, but the other six cats made near miraculous recoveries. According to the authors of the paper:
All six remaining cats showed rapid improvement in attitude and resolution of fever (Fig 3B). The profound absolute lymphopenia [low counts of a certain type of blood cell that fights infection] observed in all cats prior to antiviral treatment also returned to normal before the next blood testing one week later (Fig 3D) and weight losses were reversed and normal growth resumed (Fig 3C). Ascites [fluid buildup in the abdomen] and scrotal swelling indicative of peritonitis also gradually resolved after a week of antiviral treatment. All cats that received antiviral treatment for 14–20 days appeared normal by clinical observation and laboratory testing. The six recovered cats… have remained healthy showing no signs of relapse during an observation period up to 8 months. These experiments demonstrate that the protease inhibitor was able to reverse disease progression when treatment was initiated at advanced clinical stages of FIP.
If future studies go on to confirm that this potential drug is effective against naturally-occurring FIP, the disease may no longer be a death sentence for infected cats.
Reversal of the Progression of Fatal Coronavirus Infection in Cats by a Broad-Spectrum Coronavirus Protease Inhibitor. Kim Y, Liu H, Galasiti Kankanamalage AC, Weerasekara S, Hua DH, Groutas WC, Chang KO, Pedersen NC. PLoS Pathog. 2016 Mar 30;12(3):e1005531. 
]]> TheDailyVet Mon, 25 Apr 2016 11:00:00 +0000 34010 at
Staging for Canine and Feline Cancer Patients – The Urine and Fecal Testing Stages  
Having covered the concept of staging and how blood testing is a crucial aspect of the staging process, let’s cover other bodily substances that can be evaluated in the process of determining where a pet sits in terms of being in remission or having determinable evidence of cancer.
Urine Testing — Urinary Tract Health
Most owners take their pet’s urine for granted until there is a problem, such as inappropriate urination, straining to urinate, bloody urine, or other alarming tendencies. In actuality, urine is a substance that serves a crucial role in the body and provides many key bits of information as to a pet’s overall health.
Urine is produced by the kidneys and is almost exclusively composed of water. The kidneys (along with the liver and digestive tract) function to remove harmful toxins and metabolic wastes from the body. Toxins can be ingested in food or water, absorbed through the skin, or produced through the process of day-to-day cellular functioning and activity.
Why Do Pets Need Urine Testing as Part of Their Cancer Treatment?
Many chemotherapy and other drugs commonly prescribed to pets are excreted through the kidneys and can potentially have the undesirable side effect of causing kidney damage.
Cyclophosphamide (Cytoxan) is cleared through the kidneys and can irritate the inner lining of the bladder and cause sterile hemorrhagic cystitis, where urine appears bloody and urinary patterns are altered. Increased water consumption is encouraged and a diuretic is given with the cyclophosphamide to help flush it from the body, which reduces the potential irritation of the inside of the bladder.
During Cardiff’s ongoing chemotherapy treatment, he’s received cyclophosphamide many times and has never shown any urinary tract side effects.
Some patients get cancers of the urinary tract, including the kidneys (renal carcinoma, etc.) or bladder (transitional cell carcinoma, etc.). As a result, the cancer itself can cause damage to the organs, which can lead to abnormal urinary patterns or urine testing results.
As a result of the potential for so many aspects of cancer and its treatment to affect urine, frequent urine testing is an important aspect of the staging process.
What Kinds of Urine Testing Are Performed on Pets?
Urinalysis is the basic component of urine evaluation; it reveals a complex story about urinary tract and whole body health.
Ideally, a urine sample is collected via cystocentesis, where a needle is placed through the abdominal wall into the pet’s bladder to attain a sterile sample. When evaluating urine for infectious organisms like bacteria, it's essential that the sample comes directly from the bladder—not from the ground where your pet just peed—to achieve accurate results.
Cystocentesis is most-safely performed with ultrasound guidance, as the bladder can be visualized before the needle penetrates its wall and evaluated for conformational problems (wall thickening, etc.) or the presence of other abnormalities (crystals, stones, etc.).
Non-cystocentesis urinalyses are considered contaminated, as one can’t determine if any bacteria discovered may have come from the tissues surrounding the opening of the urethra (the tube connecting the bladder to the outside world). Yet, non-cystocentesis samples can still yield important information.
Urinalysis is often paired with urine culture, where the sterilely-collected urine sample is placed onto nutritive media and the laboratory then repeatedly evaluates the sample for bacterial growth over a few day incubation period. If a urine cultures positive for bacteria, then the antibiotics to which the bacteria are sensitive can be determined through a process called Minimum Inhibitory Concentration (MIC). That way, the veterinarian can prescribe the most-appropriate antibiotic to treat a pet’s specific infection instead of simply selecting a drug that may or may not be effective.
Sometimes, bacteria can grow when a pet isn’t even showing clinical signs. This phenomena is called a subclinical infection and is important to resolve before the pet starts to exhibit urinary tract signs or incurs damage to other organs besides the bladder. Bacteria from the bladder can ascend into the ureters (paired, thin tubes that connect the kidney to the bladder) and cause kidney damage, which will further complicate the whole process of determining how well a pet is doing during cancer treatment.
Urine Specific Gravity (USG) reflects the kidneys’ ability to concentrate toxins in an effort to remove them from the body. If USG is too low, the cause may be traced to one of these conditions:

The kidneys may not be doing their job properly and your pet could be in some degree of renal (kidney) failure.
Your pet may be being stimulated to drink more water as a result of a non-kidney disease process occurring elsewhere in the body (hyperadrenocorticism, diabetes mellitus, etc.
You pet may be taking a medication that stimulates increased water consumption (corticosteroids, diuretics, etc.).
High solute (sodium, chloride, etc.) foods or beverages may be being consumed.

Elevated USG primarily occurs as a result of dehydration, when liquids in the body are concentrated in the tissues and there’s little excess to help flush out toxins through the kidneys.
Urinalysis also evaluates other aspects of kidney and other glandular function, including the presence or absence of glucose, bilirubin, ketones, protein, red blood cells, white blood cells, epithelial cells, mucus, casts, crystals, and more. Additionally, urinalysis takes into consideration the urine’s color, clarity, and pH.
Abnormalities in the any or all the above urine values can help paint a greater picture of health and tolerance of chemotherapy.
Fecal Testing — Digestive System and Intestinal Health
Like urine, we often take for granted our pets’ normal bowel movements until an abnormality arises. Owners are typically promoted to take action in seeking a diagnosis and treatment when poop appears on a fancy living room rug or diarrhea containing blood or mucus sprays the interior surfaces of one’s car.
Feces is the byproduct of food consumption and digestion and usually emerges from the anus just fine until dietary indiscretion (eating something one should not), food changes, digestive tract infections (parasite, virus, bacteria, etc.), or diseases (inflammatory bowel disease, cancer, etc.).
Abnormal bowel movements can also occur as the result of adverse responses to medications, supplements, or herbs.
Why Is Fecal Testing an Important Part of Cancer Treatment?
Fecal patterns help in the process of determining a pet’s quality of life. If a pet is constantly having diarrhea or is not able to stand and squat properly to pass a bowel movement, or the animal ends up frequently falling into its feces, then quality of life becomes less than ideal.
If your pet is undergoing treatment for cancer and his treatment is causing him to have diarrhea more often than normal stools, then his quality of life is lessened. Yet, is his diarrhea a result of his chemotherapy, gastrointestinal infections, food changes, or other ailment? Such isn't known unless baseline or advanced fecal testing is performed to help determine the underlying cause or causes.
In my veterinary practice, my canine patients are frequently out and about walking on sidewalks or in grassy areas in Los Angeles. As a result, they can come into contact with a variety of bacteria, viruses, and parasites in their day-to-day lives. I routinely perform baseline parasite screening every 3-12 months depending on their potential exposure to parasites (at parks, daycare, etc.).
Besides striving to keep the digestive tract parasite-free by pursuing a lifestyle of minimal exposure, eating a whole-food diet, taking intestine-sporting supplements (pre- and probiotics, etc.), knowing a pet’s parasite status before clinical signs of disease occur is a crucial wellness practice.
The baseline test I perform for fecal parasites is called an Idexx Fecal Panel Comp, which includes an Ova & Parasite evaluation under the microscope, and an ELISA (Enzyme Linked Immunosorbent Assay) test for giardia, hookworm, roundworm, and whipworm. This thorough evaluation is a great place to start.
If a patient has digestive tract signs and there are no parasites are turning up on the baseline testing, then advanced testing, like an IDEXX Canine or Feline Diarrhea Panel, can help find evidence of certain bacteria, viruses, and parasites that aren’t as common.
So, even though your pet may be undergoing cancer treatment and all energies are being focused on killing cancer cells, it’s crucial to keep up with routine monitoring of the urine, feces, and other aspects of whole body health.
]]> TheDailyVet Fri, 22 Apr 2016 11:00:00 +0000 34009 at
All Dogs Are at Risk in the Hot Months – Don’t Let Yours Be a Summer Casualty  
Most of us understand that this affects how we go about our day, and the intrepid make the necessary adjustments so they can continue their normal activities without problems. Unfortunately, there are a number of people who still fall short in the common sense department.
I took my dog Brody for a hike yesterday, starting early because I knew the day was going to hit 80 degrees before noon. When we parked I saw a huge sign out front with a heat warning and a message for people to be sure to bring enough water for themselves as well as their pets. The park ranger told me it’s not uncommon for them to see at least several dogs a year die of heat stroke on the trails, which are remote enough where there is no easy access out other than the way you came in. And it’s tragic because it’s so preventable.
Fortunately, the signs seem to be helping. On this hot day I saw plenty of dogs and people carrying lots of water. We stop at least every 30 minutes to let Brody drink, and he plops himself face first into the bowl with glee. We also picked a trail that curves around a lake, so halfway through he was able to take a dip and then enjoy the cooling evaporation process on the hike back.
Because dogs don’t have sweat glands the way humans do, they are limited to panting as their major cooling effort. (They do have some sweat glands in their paws, though they are not the principal mechanism for cooling.) This, coupled with the insulation effect of their fur, means they are prime candidates for heat exhaustion, particularly if they haven’t been building up to longer walks—which is why the weekend warriors are the ones who so frequently run into trouble.
Everyone should know the signs of heat exhaustion and impending heat stroke in dogs: sluggishness, very heavy panting, bright red gums, hypersalivation (which can progress to the opposite: dry tacky gums), vomiting or diarrhea, and collapse. In the later stages, death can occur rapidly if not treated in an ER.
Certain dogs are especially prone to heat stroke: overweight pets, brachycephalic (flat faced) breeds like pugs and bulldogs, and dogs with dark coats. If you have any suspicion that your dog is showing early signs of heat exhaustion, stop, spray your pet with cool water (NOT ice!), and call an ER for guidance.
Of course, the best solution is to prevent it from happening in the first place by being aware of the risks. Avoid walks during the hottest periods of the day, acclimate your pet to longer walks, and make sure you take plenty of water breaks. And for goodness sake, don’t leave your pet in the car on a hot day. But you knew that one, right?
As we head into the hot months, remember with a little planning there’s no reason you can’t enjoy the great outdoors. Have fun and stay safe
]]> summer summer-bronze TheDailyVet Thu, 21 Apr 2016 11:00:00 +0000 33982 at
Leveling Up in Veterinary Medicine – Sharing Skills with the Next Generation  
I entered this endeavor thinking, “No big deal, I’ve got this.” I’m a serial multitasker and I enjoy keeping busy. How hard could it be?
It wasn’t too long before I realized just how much I had underestimated the commitment I had made. And now, just a few short weeks before final exams will be distributed and students will break for the summer, I find myself counting down the credit hours, willing the time to come where I can resume my “normal” bustling schedule rather than my current “way out of control, not a second to myself” situation.
Several years ago, I temporarily abandoned my plans to attend veterinary school and entertained the idea of working in biomedical research. To achieve my new goal, I enrolled in graduate school to pursue a master’s degree in biology.
One of the requirements for the program included teaching. Specifically, I was assigned to teach the laboratory portion of the anatomy and physiology course for non-biology majors.
I possessed no previous teaching experience and was terrified at the prospect of stepping over to the other side of the classroom. I wasn’t comfortable with public speaking, and wasn’t sure how I would explain complex biological terminology to individuals lacking a background in the subject.
My anxiety was only slightly tempered by the eager faces of my students, thirsty to learn about the intricacies of the human body. The learning curve was exceedingly steep, for both my students and myself, but if I’m being completely honest, the pressure I placed on myself far exceeded anything generated by the co-eds I was in charge of for a few hours, twice a week
Especially during those initial weeks of my first semester, I stumbled and made mistakes and faltered more times than I’d like to admit. But I also experienced some remarkable achievements watching students synthesize, memorize, and comprehend. It didn’t take long before the teaching bug bit me and I decided to pursue my PhD in biology, with a goal to focus a portion of my training on developing curriculum objective for more effectively teaching the biological sciences to non-majors.
I enrolled in a program and commenced my curriculum, only to nearly instantly discover my ideals didn’t mesh with those of the department I’d signed on to. It turns out people don’t pursue PhD degrees in neurobiology to teach science. They do it because they are passionate about research and writing papers and grants, and those were aspects of earning the degree I never could align with.
Veterinary medicine was thus my “fall back” plan. I gave up one dream to pursue another and placed teaching on the way back burner as I spent four years focusing entirely on memorizing minutia and resuming my role on the receiving side of the classroom.
Opportunities related to teaching arose here and there during my residency and my professional career as a medical oncologist working in private practice. In fact, I’d argue nearly every appointment I see represents a chance to educate pet owners about cancer. Though it has not been in the formal setting of a classroom, over the years I’ve trained dozens of veterinary students, interns, and residents, as well as motivated veterinary technicians and assistants.
When the chance arose to teach in the tech program this year, I willingly accepted, somehow failing to remember the struggle of my days of working as a newly minted lecturer.
Many years later, I find myself re-experiencing the same stumbling and faltering I did back in graduate school. Though I’m hypercritical of my capabilities (or lack thereof), I’m masochistically happy when I am attempting to make topics such as antibiotics and record-keeping enthralling, and when I am painfully, yet joyfully, spending my free time writing lectures, grading papers, and creating exams.
As a good friend of mine who is a kindergarten teacher says, “When you’re a teacher, you have to be ‘on’ all the time. There’s no taking a break.” I give her a ton of credit. I only need to be “on” for one day a week.
When I was on the other side of the classroom, I assumed breaks in curriculum were designed to relieve students from the stressors of their constant study. I now understand how essential the pauses are for maintaining sanity and mental health for teachers as well.
Those that can, do. Those that can do it better, teach.
]]> TheDailyVet Wed, 20 Apr 2016 11:00:00 +0000 33981 at
New Version of Canine Flu Now Infecting Cats  
The latest surveillance data available through Cornell University shows that positive test results have been identified in dogs from 29 states. But even more interesting is the recent report from the University of Wisconsin’s School of Veterinary Medicine revealing that a group of cats housed in a Northwest Indiana shelter have tested positive for the H3N2 canine influenza virus.
According to Sandra Newbury, Clinical Assistant Professor and Director of the Shelter Medicine Program at University of Wisconsin:
“Suspicions of an outbreak in the cats were initially raised when a group of them displayed unusual signs of respiratory disease,” Newbury says. “While this first confirmed report of multiple cats testing positive for canine influenza in the U.S. shows the virus can affect cats, we hope that infections and illness in felines will continue to be quite rare.”
We already knew that feline infections were possible because South Korea cats were infected with this version of the virus when it was first identified, and one cat did test positive for the disease in the United States last year, but now the University of Wisconsin reports that it “appears the virus can replicate and spread from cat to cat.”
 “Sequential sampling of these individual cats have shown repeated positives and an increase in viral loads over time,” Kathy Toohey-Kurth, virology section head at the Wisconsin Veterinary Diagnostic Laboratory says. Eight cats tested positive on consecutive tests. More had similar clinical signs but “recovered quickly before testing and tested negative.”
Dogs in the shelter did have H3N2 canine influenza when the feline infections were diagnosed, but the cats were housed in a separate part of the facility and the “cat areas were cleaned prior to cleaning the dog areas.” This just goes to show how contagious this particular flu virus can be.
Symptoms in infected cats have been similar to those seen in dogs and include “runny nose, congestion, and general malaise, as well as lip smacking and excessive salivation. Symptoms have resolved quickly and so far the virus has not been fatal in cats.”
I find this development fascinating because it goes to show how things change in the flu arena. Just a couple of months ago I was telling cat owners that it didn’t look like they had anything to worry about when it came to canine H3N2 flu. There is certainly still no reason to panic, but if your cat does develop symptoms consistent with the flu, a trip to the veterinarian is called for, particularly if the cat has been in a shelter setting or around flu-infected dogs.
We simply don’t know whether this outbreak in cats will turn out to be an isolated event or a harbinger of things to come. Only time will tell.
]]> TheDailyVet Mon, 18 Apr 2016 11:00:00 +0000 33979 at
Staging for Canine and Feline Cancer Patients – The Blood Testing Stage  
Staging is the process of combining a veterinarian’s physical examination with a variety of diagnostic tests to help determine if the presence of cancer is detectable or not. If the cancer is undetectable, then a pet can still be considered to be in remission. If the cancer is detectable, then the pet is not in remission.
The tests used by the overseeing veterinarian vary depending on the individual nature of the patient’s case and sometimes on the owner’s financial situation or desires to have a pet go through certain diagnostic procedures, or not, but some tests are more common than others.
This article will cover blood testing.
Types of Blood Tests for Cancer Patients
The blood tells us so much about the internal functioning of our pets’ bodies. Yet, blood testing doesn’t reveal a complete picture, which is why evaluating the blood is just one of the many tests we veterinarians often recommend when striving to determine a pet’s state of wellness or illness.
Generally, blood is relatively plentiful and easily accessible through venipuncture, which is the process of drawing a sample from one of the body’s many veins. Smaller dogs and cats commonly present a challenge due to their smaller and more fragile veins and the challenges faced during restraint, making it difficult to attain a sufficient sample. Large dogs are sometimes as much or more of a challenge to restrain than their petite counterparts and they can have veins that are more resistant to attempted puncture by a needle, though they readily give up substantial volumes of blood.
Common tests run on blood include a blood chemistry test and a complete blood count (CBC). There are many more tests that can be done, but for the purposes of this article I want to focus on those that are most commonly used when evaluating cancer patients. I run blood testing on Cardiff every 14-21 days, which is always done the day before he receives intravenous or oral chemotherapy.
What Blood Chemistry Testing Reveals
Blood must be centrifuged (spun down) to separate the serum from the red and white blood cells and platelets in order to perform chemistry testing, which assess values pertaining to the kidneys, liver, gall bladder, intestines, pancreas, blood proteins, glucose, electrolytes, calcium, thyroid glands, and more.
Blood values pertaining to the kidneys, liver, red and white blood cells, and platelets are those that are most-crucial in determining how well a pet is handling chemotherapy treatments and attaining a general sense of whole body health.
Blood urea nitrogen (BUN), creatinine (CREA), phosphorous (PHOS), and symmetric dimethylarginine (SDMA) are all tests that shed light on kidney function. Typically, levels above the high threshold of normal for the above tests cause concern for underperforming kidneys and can necessitate a modification in the treatment protocol. Fortunately, decreases don't generally create cause for concern, but still merit consideration and reevaluation.
Alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gabba glutamyl transferase (GGT) yield crucial information about liver function. An elevated ALP indicates liver inflammation, while ALT, AST, and GGT increases indicate liver cell damage. Decreases in the above values aren’t as concerning as increases but can still indicate the presence of certain liver diseases.
Bilirubin reveals information about the gall bladder, which is a blind sac that sits among the liver lobes and has a bile duct that empties into the intestines. Elevations in bilirubin can occur as a result of gall bladder, liver, intestinal, or other diseases, like hemolysis (red cell damage).
Amylase, lipase: pancreatic lipase can shed light on intestinal and pancreatic function. Increases in amylase and lipase typically indicate intestinal inflammation and are non-specific for pancreatic inflammation. Pancreatic lipase gives more reliable information about the pancreas and can be increased during bouts of pancreatitis (pancreatic inflammation). Decreases in amylase, lipase, and pancreatic lipase are not typically cause for concern.
Total protein (TP) is an important value that takes into consideration all of the blood proteins, including albumin (ALB) and globulin (GLOB). Both elevations and decreases in TP, ALB, and GLOB merit concern. Elevations are commonly seen with infection, inflammation, cancer, and dehydration. Decreases can indicate blood or protein loss through the intestines, kidneys, and elsewhere, lack of absorption of nutrients, or even endocrine (glandular) diseases like hypoadrenocorticism (Addison’s disease).
Blood glucose (GLC) should be kept within a normal range and levels that are high (hyperglycemia) or low (hypoglycemia) are cause for concern. Hyperglycemia can occur at times of stress, injury, or illness. Diabetes mellitus is the primary endocrine disease that causes hyperglycemia. Hypoglycemia may happen when the body’s available sugar-stores in the liver have become depleted or aren’t accessible due to hormonal imbalances (Addison’s disease), blood borne bacterial infections (sepsis), and even certain types of cancers (insulinoma, an insulin secreting cancer).
Electrolytes include Sodium (Na), Potassium (K), and Chloride (Cl), all of which are elements that play crucial roles in maintaining normal cellular function. Both increases and decreases are concerning and can be seen with a variety of ailments related to cancer, glandular diseases (kidney, liver, etc.), or even day-to-day activities (exercise, etc.).
Calcium (Ca) is another element that has a vital role in bodily function for muscular contraction, bone formation, and cellular maintenance. Elevated calcium (hypercalcemia) is a serious concern as it can occur as a result of consuming a diet that is too rich in calcium, overconsumption of calcium supplements, or secondary to kidney failure or certain types of cancers (carcinoma).  
Decreased calcium (hypocalcemia) is also a cause for concern and may happen when insufficient calcium is consumed, when ALB levels are too low, after exposure to certain toxins (ethylene glycol, or antifreeze), or other causes.
The thyroid glands, as a pair, reside in the tissue on the underside of the neck and produce hormones that regulate metabolism and other bodily functions. Under-functioning thyroid (hypothyroidism) is an immune-mediated disease that commonly occurs in adult to senior dogs and causes alterations in multiple blood tests, including T4, Free T4 by ED, and cTSH.
Decreases in T4 can also occur as part of a phenomenon called euthyroid sick syndrome—low levels of thyroid hormone unrelated to hypothyroidism—which can develop when a pet is taking certain medications. The presence of many ailments can cause a decrease in T4, which is why veterinarians should perform multiple blood tests for thyroid function when there is suspicion for hypothyroidism.
Over-functioning thyroid (hyperthyroidism) is a glandular condition where thyroid cells divide at a rapid rate and produce elevated thyroid hormone levels; common in middle-aged to senior cats and in dogs having thyroid cancers (adenocarcinoma).
Complete Blood Count (CBC)
CBC is an interesting test that sheds light on the body’s ability to transport oxygen, the immune system’s status for fighting disease and managing inflammation, and the blood’s ability to clot. A CBC must be performed a short time before chemotherapy is given to ensure the patient doesn’t have key changes that would prevent the veterinarian from administering cancer-fighting drugs. The main components evaluated by a CBC include Red Blood Cells (RBC), White Blood Cells (WBC), and Platelets (PLT).
RBCs are crucial for oxygen delivery via hemoglobin (HGB). RBC elevations (polycythemia) are commonly seen with dehydration. This typically doesn’t merit great concern except for the lack of water to provide sufficient dilution to remove metabolic wastes from the body and to permit the blood to smoothly flow through the arteries and veins to deliver oxygen, nutrients, and other crucial substances to body tissues.
A decreased RBC level (anemia) is greatly concerning and can occur as a result of the presence of cancer or other diseases (kidney failure, etc.), as an undesirable side effect of some forms of chemotherapy, after toxic exposures (binging on onions/garlic, etc.), or other causes.
WBCs are key players in helping the immune system to fight cancer, infections, and to manage inflammation and tissue damage all over the body. There are cancers of the WBCs such as Cardiff’s T-Cell Lymphoma, where WBC DNA has been altered and cells proliferate in a manner that lacks a turn-off switch.
So cancer may actually cause a pet’s WBC count to elevate (lymphocytosis) or decrease (lymphopenia), as can having an infection, inflammation, or a variety of ailments. Additionally, chemotherapy can negatively affect production of WBCs from the bone marrow and can cause a reduced WBC count on a CBC.
PLTs are the cells that form blood clots, so they serve a vital function in ensuring that the blood supply doesn’t seep out of the arteries and veins into the outside world or become sequestered in an abnormal location like the lungs, skin, or other organs.
Decreased PLT counts (thrombocytopenia) can occur as a result of cancer, infections (tick borne diseases), chemotherapy, toxic exposures (Brodifacoum rodenticides), immune mediated diseases (Immune Mediated Thrombocytopenia, or IMTP), or other causes.
Elevated PLT counts (thrombocytosis) may occur due to bleeding from trauma, toxic exposures, or certain endocrine conditions like Hyperadrenocorticism (Cushing’s Disease).
I spend a lot of time assessing my patients’ blood values and am keenly interested in the meanings behind both mild and severe changes seen in blood tests. The images here are of one of Cardiff’s pre-chemotherapy IDEXX blood tests, which shows both normal and abnormal values.
(Click images for larger view)



Some of his abnormal values are just below the threshold of normal and don’t create great concern but are being closely monitored by me and his veterinary oncologist, Dr. Avenelle Turner of the Veterinary Cancer Group (VCG).
Image: Red and White Blood Cells in the Blood Stream / Sebastian Kaulitzki
7 Signs of Cushing's Disease in Dogs
Blood work: What it means and why your pet needs it (Part 1: The CBC)
]]> TheDailyVet Fri, 15 Apr 2016 11:00:00 +0000 33966 at
Changing the World, One Seed at a Time  
Less exciting to me is the new found wonder with which she feels obligated to comment at every meal. “Can’t do chips. Did you know carbs are bad for you?” Or, “I think I got glutened last night because my WOD was really bad this morning at the box.”
While I’m so happy she has found her own person enlightenment, her need to hammer it into everyone else around her makes her company less enjoyable than it was when she could enjoy a glass of wine here and there.
It happens to all of us at some time or another: we have some big revelation, be it about health or food or religion or environmentalism, and we go temporarily insane. We are so excited about the way this one thing can change the world that we feel an innate need to not only share it but to shout it at every opportunity. For most of us, it’s temporary insanity. We come back to terra firma and find a way to integrate our new wisdom without alienating everyone we know.
But for other people, they kind of lose it. They get an idea in their head that what’s happening is so life-altering for themselves or for others that everyone would feel the same if only they would listen to them. And if they are met with resistance or even polite ambivalence, these people get mad. And that’s when things get challenging.
I have a list in my head of things I think are important when it comes to animals, and it’s constantly evolving as I get older and wiser. As of now, it looks something like this:

People should be more proactive with veterinary pain control.

Euthanasia should be a family event open to children.

Tail crops, ear docks, declaws, and debarking for any reason other than the health of the pet should go the way of the dodo.

Parents should be more aware of canine body language and teach their kids proper, safe dog interaction.

Pet owners should be better prepared for veterinary expenses, and veterinarians should be better at communication.

And so on and so forth. It’s a long list.
The more time I spend on this planet writing about issues that are important to me, the more mellow I become. Yes, important things are important, but I also have come to realize that for me, change is a seed planted here and there, not a forest razed overnight. That’s just not who I am. But I spend a lot of time dealing with people who bring their bulldozers to me and ask me to help them mow down a grove of trees, and when I demur they get mad.
“Don’t you CARE?” they say.
“You’re with us or you’re against us!” they shout.
But that’s not how it works. Some people are Janes, who like to go all or nothing and either burn out spectacularly or go on to change the world. Others are like me, who go to the gym three times a week and try to eat more fruit and figure that’s good for now. Just because we are all headed in the same direction doesn’t mean we need to take the same path.
I understand how hard it can be to sit still when you think you are about to change the fabric of the universe, but I promise you that just because you haven’t started an overnight revolution with your newfound wisdom that doesn’t mean you haven’t made a difference. Nor does my lack of jumping in line behind you mean that I don’t care. I do, but you aren’t allowed to dictate how and when I advocate for change, because this isn’t about you; at least it shouldn’t be.
Now please stop e-mailing me to write about the plight of the red-winged Madagascar fruit gnat. I heard you the first four times.
]]> TheDailyVet Thu, 14 Apr 2016 11:00:00 +0000 33957 at
Where Do the Candidates Stand on Animal Rights and Health?  
I raise no concern with a country that prioritizes the aforementioned matters with respect to political affiliation. However, I’m disappointed that our current candidates rarely voice opinions regarding their agenda for supporting animal welfare or veterinary medicine. I therefore must question our values when we place greater emphasis on deciding which presidential candidate’s wife would make a more attractive first lady than caring about matters related to animals, their healthcare, and their caretakers.
With a bit of probing, I successfully uncovered several political issues related to animals that have direct bearing on the lives of both veterinarians and pet owners that are currently up for consideration. Not surprisingly, however, I failed to discover exactly where the individuals vying to be the next president stand on the topics.
Of the concerns I came across, the following represent those where a “veterinary favorable” stance from a potential candidate would certainly positively influence my vote towards supporting their campaign:
The first consideration is the “Fairness to Pet Owners Act.” This piece of legislation was introduced in the House in July 2015 and “Directs the Federal Trade Commission to require prescribers of animal drugs to verify prescriptions and provide copies of prescriptions to pet owners, pet owner designees, and pharmacies, without the prescriber demanding payment or establishing other conditions.”
Proponents of the bill argue veterinarians discourage pet owners from filling prescriptions outside of their office in order to promote their own financial gain.
Many veterinarians feel this bill is unnecessary because they already offer owners the option of filling prescriptions elsewhere. They also are concerned about how it creates an administrative burden for themselves and their staff in cases where a certain medication is only available through a veterinarian or when an owner wishes to have the medication dispensed from their vet. The is because the bill requires veterinarians to write a prescription and present it to the owner first, then take the script back and dispense the medication if that is the owner’s choice.
Another proposed regulation is the “Pet and Women Safety Act.” This legislation will “expand federal law to include protections for pets of domestic violence victims and establish a federal grant program that will help ensure that victims have access to safe shelters for their pets.”
Specifically, the bill aims to assist both female and male victims with pets by: making threats against pets a stalking related crime, providing grant funding to increase the availability of housing for victims and their pets, encouraging states to provide coverage for pets under protection orders, and requiring abusers who harm pets to pay veterinary and other expenses incurred as a result.
The link between animal abuse and domestic violence is well established. Human victims of abuse often face the decision of leaving their current situation without their pets or staying to ensure their companions receive the veterinary care they require. This bill would provide protection for animals, increase availability of sheltering options for pets, and shift the financial responsibility towards the abuser.
There are also several proposed bills related to veterinary professional and educational issues, including the Veterinary Medicine Loan Repayment Program (VMLRP), which provides educational loan repayment to veterinarians who agree to practice in areas of the U.S., as designated by the USDA, where there is a shortage of veterinarians.
This legislation would make the VMLRP loan repayment awards exempt from a federal withholding tax, allowing more veterinarians the opportunity to participate in the program. Currently, awards are subject to 39 percent withholding tax.
The Student Loan Interest Deduction Act and Student Loan Refinancing Act are examples of proposed legislation designed to lessen the burden recent veterinary school graduates face regarding their educational debt.
The current candidates vying for nomination for their respective political parties do not have animal welfare issues on the forefront of their campaign trails. Therefore it’s difficult to determine where each stands on the above mentioned proposed legislations.
According to the Humane Society Legislation Fund, Hillary Clinton and Bernie Sanders hold the highest ratings regarding their voting record in the U.S. Senate. Whether that would translate to anything positive should they be elected president remains to be determined.
How a particular presidential candidate stands on animal welfare issues wouldn’t be the primary measure of whom I would decide to vote for, but it does allow the opportunity to gain a better understanding of what is personally important to each candidate.
And it helps to provide a sense responsibility, integrity, and value for those of us who dedicate our lives towards promoting the importance of the human-animal bond and the sanctity of healthcare for pets.
]]> TheDailyVet Wed, 13 Apr 2016 11:00:00 +0000 33958 at
How to Know When a Cat is Hurting  
Recognizing when a cat is in pain is simple in only the most extreme of cases. Thousands of years of natural selection have made cats VERY good at masking pain. After all, it’s generally not a good idea to advertise the fact that you’re not at your best when a predator or potential mate might be found around the next bend in the trail.
Pain encompasses more than just the “I hurt” sensation, but also the overall distress that it can cause. As the World Small Animal Association’s Global Pain Council puts it:
Pain is a complex multi-dimensional experience involving sensory and affective (emotional) components. In other words, ‘pain is not just about how it feels, but how it makes you feel’, and it is those unpleasant feelings that cause the suffering we associate with pain.
I wish I had tools to help my patients like the one physicians use to relate just how bad their patients' suffering is… modified for cats, of course. “Okay Frisky, just put your paw on the face that best expresses how you feel today.”
Wong-Baker FACES® Pain Rating

(Click image for larger view)
But veterinarians and owners have to rely on a cat’s behavior to evaluate pain. Fortunately, we’ve just received a little help in this regard with the publication of a new paper entitled “Behavioural signs of pain in cats: an expert consensus.”
A panel of 19 “international veterinary experts in feline medicine” concluded that the following 25 signs were “sufficient to indicate pain, but no single sign was considered necessary for it.”
In other words, if your cat is doing any of the following, he is probably hurting. Even if he’s not, pain could still be a problem.

Difficulty jumping
Abnormal gait
Reluctance to move
Reaction to palpation [applying light pressure with the hands]
Withdrawn or hiding
Absence of grooming
Playing less
Appetite decrease
Overall activity decrease
Less rubbing toward people
General mood
Hunched-up posture
Shifting of weight
Licking a particular body region
Lower head posture
Blepharospasm [squinting]
Change in form of feeding behavior
Avoiding bright areas
Eyes closed
Straining to urinate
Tail flicking 

While this list is helpful, it only goes so far. For instance, a cat who has an abnormal gait might certainly be in pain, but other non-painful conditions (e.g., neurologic disorders) could also be involved.
In cases where I have failed to find another reason for a cat’s change in behavior and I’m left with undiagnosed pain as the most likely cause, I often rely on a tried and true veterinary test: response to treatment. I’ll put my patient on a few days of buprenorphine—my favorite kitty pain reliever—and if his behavior returns to normal, we now know that pain is to blame.
Guidelines for recognition, assessment and treatment of pain: WSAVA Global Pain Council members and co-authors of this document: Mathews K, Kronen PW, Lascelles D, Nolan A, Robertson S, Steagall PV, Wright B, Yamashita K. J Small Anim Pract. 2014 Jun;55(6):E10-68.
Behavioural Signs of Pain in Cats: An Expert Consensus. Merola I, Mills DS. PLoS One. 2016 Feb 24;11(2):e0150040. 
]]> care cat TheDailyVet video-embed Mon, 11 Apr 2016 11:00:00 +0000 33940 at
Spring is Back… and So Are the Bugs  
I ran over like a bolt, thinking to myself, “Here we go again, another mass,” but open taking a closer look I realized the grey bump on his neck was not cancer but an engorged tick. I said as much out loud, and then the girls screamed and, I’m assuming, the neighbor then went home and told her mother we were gross because she didn’t come over again after that.
It’s my own fault, really. We had moved from an area where we just never saw ticks, so it wasn’t on my radar to look for them, and Brody was on a combination flea and heartworm prevention product. Our new home, close to an open space area, has just about everything fun a pet can be exposed to.
Here on the West Coast we had an exceptionally wet winter thanks to El Nino, so we’re expecting an early and vigorous crop of springtime creatures. Baby rattlesnakes are already hanging out on the hiking paths and I can assume ticks and fleas aren’t too far behind (if they ever went away at all, which is questionable).
There is a dizzying array of parasiticide options for dogs and cats, enough to make even an experienced veterinarian cross her eyes. There are pills and spot-ons and sprays, collars, shots—whatever way you can think of to deliver a product to a pet, we seem to have it. Some work against one type of pest, some are combination products.
To make it even more confusing, there truly is not one best product for fleas and ticks. Years ago when Advantage was the only player on the field for good flea control, life was easier. Now you have Advantage, Advantix, Bravecto, Trifexis, Comfortis, Seresto, Frontline, and those are just the ones off the top of my head, ones I actually have tried and recommended. When you factor in the natural product market and the manual tick twisters and the list of products I don’t like for various reasons, you have a small book chapter.
The optimal choice for you depends on a lot of things, starting with what sort of parasites you have in your area. Once you determine if you need to prevent fleas, ticks, or both (I’m leaving heartworms out of this because then the post turns into two chapters), you need to decide what sort of product you want. I like chewable tablets because they’re easy and less messy than the topical products. That being said, some dogs won’t eat them, others have food allergies, and some have medical conditions that are contraindicated with the oral preventives.
Topical products come in sprays, spot-ons, and collars. They rely on the oils in the skin to spread, so dogs who swim every day or need frequent baths may not get a full 30 days’ worth of protection from them, but by and large almost everyone can find one that works for them. Families with cats also need to be careful with tick prevention products for dogs, as some of them contain ingredients that are toxic to felines and aren’t recommended if your cat grooms your dog or likes to cuddle up.
I know lots of people love the natural options like cedar and lemongrass and clove, and while they’re usually pretty harmless, I find they are much less effective than the other options—particularly for ticks, who seem to just laugh at them. While they might eventually work, after 36 hours or so on the host the Lyme carrier species can pass on the disease, so you want a product that gets them off as quickly as possible.
I use the natural products to spray my dog’s bedding, and that seems like a good compromise for us.
For us, I keep the flea meds going year ‘round and just this month added the tick prevention back in. There are tons of choices and no real right or wrong ways to go about it other than to ignore the problem entirely, which I don’t recommend.
It’s time! Spring has sprung! What is your buggy action plan?
Lyme Disease in Dogs
How to Remove Ticks
Natural Flea and Tick Prevention
Pesticide Toxicity in Cats
]]> TheDailyVet Thu, 07 Apr 2016 11:00:00 +0000 33909 at
When is a Pet Too Old for Cancer Treatment?  
As a veterinary oncologist, older pets are a substantial part of my professional life. Cancer occurs most frequently in pets over the age of 10 and companion animals are living longer now than ever before. I encounter animals of all ages, but most of my time is spent with the elderly.
On a personal level, I love senior pets for all they represent: unconditional love, steadfast loyalty, and sensible temperaments. They’re guaranteed to stand by their owners at all times and diligently maintain their roles as guardians, companions, and soul mates, even when their bodies become less capable of maintaining their self-designated responsibilities.
When I meet with owners of older pets, I love to hear them tell stories of their pets’ lives. Whether owned since they were puppies or kittens or acquired later on in life, as mature dogs and cats, there’s infinite opportunities for me to discover the role that animal played in their family’s lives.
I frequently encounter owners who feel their pet’s age is a barrier to cancer treatment. A diagnosis of cancer is devastating regardless of age, but can be especially difficult when an animal is older and an owner faces making diagnostic and treatment choices. They are often concerned about putting their beloved companion through too much at their advanced age. They will often equate it to what they would consider medically and ethically appropriate for an elderly human being.
I understand the apprehension about pursuing intensive medical care for animals in general, and certainly can appreciate how magnified these worries would be for owners of older pets.
I try to reassure owners that the majority of information about risks for side effects and prognosis were determined on older animals. I’ll also often recommend additional testing to ensure the overall health of their pet is intact prior to making definitive recommendations for their cancer care. I’m equally as concerned as they are with their pet’s health and with confirming they are good candidates for treatment.
Fortunately, when the primary recommendation isn’t a reasonable plan for an individual pet, veterinary oncologists are usually able to offer anxious owners several different options. It’s my job, in such cases, to recognize when to discuss alternatives to the standard of care.
For example, when aggressive surgery is not an option because an owner feels their pet is too old to withstand the operation, veterinary oncologists are able to offer less intensive chemotherapy therapies, most often designed to slow tumor growth and metastases while maintaining an excellent quality of life. Though we may compromise our chance for a cure, we are able to extend an animal’s expected lifespan and simultaneously ensure that their remaining time is spent as happy and healthy as possible.
Many owners attribute some of the earliest signs of cancer to “old age” or on an assumption their pet is “slowing down” as it ages. Routine visits to the animal’s primary care veterinarian may provide the opportunity to detect disease at an earlier stage, further supporting the concept of extending its quality of life for as long as possible.
Senior pets ask so little from their owners. Their mellow demeanor and relaxed personalities remind us of the remarkable nature of the human-animal bond and just how impenetrable that bond can be.
If you’re an owner of an older pet facing a diagnosis of cancer, I urge you to consider consultation with a veterinary oncologist. Express your concerns and discuss your goals with your veterinarian. There’s a great chance that together you will be able to determine an option that fits both your goals and your pet’s best interests; one that takes their age into account but isn’t limited by a single physical characteristic.
]]> TheDailyVet Wed, 06 Apr 2016 11:00:00 +0000 33882 at
Fly Biting: Is it a Seizure or a Digestive Disorder?  
A partial seizure is caused by abnormal electrical activity within a relatively small portion of the brain. I don’t know what part of the brain needs to be stimulated to make a dog exhibit fly biting behavior but the result was thought to be this specific set of movements. Partial seizures were not the only possible cause of fly biting, but they were the most likely… or so I was taught. New science is casting doubt on this assumption, however.
Researchers at the University of Montreal Veterinary Teaching Hospital evaluated seven dogs (an admittedly small sample size) to “characterize fly biting, perform a complete medical evaluation of dogs presented with fly biting, and evaluate the outcome of this behavior following appropriate treatment of the underlying medical condition.” Let me summarize the paper’s most intriguing results.
All seven dogs were diagnosed with some type of gastrointestinal GI) disease, including delayed gastric emptying, inflammation of various parts of the GI tract, gastro-esophageal reflux, and/or a flaccid and distended stomach. When the dogs received treatment for their GI disease, the fly biting completely resolved in five cases.
One other dog was also diagnosed with a neurologic disorder (Chiari malformation) and responded to a medication used to treat seizures and nerve pain but not to GI treatment. The owners of the seventh dog did not institute the recommended treatment and their dog’s fly biting behavior remained unchanged.
The researchers make the following points in their paper:
The data indicate that fly biting may be caused by an underlying medical disorder, GI disease being the most common. At home, 3 dogs (dogs 1, 2, and 4) consistently presented more fly biting following feeding, suggesting potential postprandial [after eating] discomfort. Dog 1 presented fly biting during hospitalization within 30 min of being fed. The video analysis data showed that in all fly biting dogs, the jaw snapping was preceded by head raising and neck extension. In 2 dogs, head raising and neck extension occurred more frequently than jaw snapping. Dogs 3 and 6 presented repeated raised head and neck extension during the consultation. On home videos as well as consultation and hospitalization videos, all dogs raised their head and extended their neck prior to fly biting.
Head raising and neck extension in the dogs may be similar to Sandifer syndrome, a rare paroxysmal movement disorder in infants characterized by abnormal movements of the head, neck, and trunk in association with gastroesophageal reflux (GER) disease (12–14)…. Sandifer movements are often precipitated by meals, unlike other movement disorders (12,14). Other conditions such as delayed gastric emptying when associated with GER disease may also result in abnormal posturing such as seen in Sandifer syndrome (12). It is still unclear why less than 1% of children with GER disease (14) present abnormal movements and others do not (12). It is believed that the abnormal movements are learned behaviors by children to reduce reflux (12) as well as protect air passages from reflux and relieve the abdominal pain caused by acid reflux (16,17).
The take home message? If your dog is fly biting, make sure your veterinarian performs a complete work-up for gastrointestinal disease. Chances are, you’ll find something that responds to treatment.
Prospective medical evaluation of 7 dogs presented with fly biting. Frank D, Bélanger MC, Bécuwe-Bonnet V, Parent J. Can Vet J. 2012 Dec;53(12):1279-84.
]]> TheDailyVet Mon, 04 Apr 2016 11:00:00 +0000 33881 at
What is 'Staging' and Why Is it Important for the Pet Cancer Patient?  
For descriptive purposes, I use the term mass-like lesion when referring to any tissue swelling.  While the mass-like lesion may be composed of a benign or malignant cancer, there also could be single or multiple other disease processes occurring, including:

Abscess - pocket of white blood cells and bacteria
Cyst - pocket of fluid, commonly associated with glandular tissue like a sebaceous (oil-containing) cyst
Urticaria - “hive,” such as that which occurs from a hypersensitivity (“allergic”) reaction caused by an insect bite or sting, vaccination, or other cause
Foreign body reaction - any foreign material that enters the body, such as a splinter, plant awn (foxtail, etc.), medical implant, or other can create a response where the body attempts to wall off the offending material to protect normal tissues from harm and potentially push the foreign material out of the body.

When concern for cancer arises, we veterinarians must take a whole-body approach when establishing our patients’ diagnoses and creating a treatment plan. This process is called staging and it has numerous components, which I will cover in this multipart article.
In Cardiff’s cancer diagnosis and treatment process, he’s been put through staging many times and will continue to do so on an ongoing basis in our attempts to keep him in remission for T-Cell Lymphoma.
Here are some of the techniques used when staging a pet for cancer.
Fine Needle Aspirate for Cytology
When the initial suspicion for cancer occurs based on an owner or veterinarian’s discovery of a mass like-lesion, one of the most-common first steps is to get a sample of the tissue via a process called fine needle aspiration (FNA) for cytology (microscopic evaluation of cells).
Performing an FNA is usually minimally invasive and often doesn’t require preparations beyond aseptic technique (cleansing the site, new needle/syringe, etc.) and possibly some degree of pain relief (local anesthesia) or sedation.
FNA involves inserting a needle into a mass-like lesion and pulling back on a syringe’s plunger to create suction that aspirates (sucks out) a small volume of cells that are then placed on a glass slide for cytology.
Although many veterinarians are able to perform cytology on an in-house basis, backing up the initial cytology findings with an official interpretation by a board-certified veterinary pathologist at a diagnostic laboratory (Idexx, Antech, etc.) or university, whose job is to make crucial diagnoses based on cellular changes that may be very subtle or quite obvious, is my recommendation. After all, the diagnosis may be life-changing for both the pet and its owner and having confidence that the correct interpretation has been achieved will ensure that the appropriate steps in performing further diagnostics and prescribing treatment will be undertaken.
FNA and cytology typically provide information that generates important initial conclusions about the nature of a pet’s particular ailment.
Sometimes, enough of a diagnosis can be achieved via FNA and cytology. Other times the results are more vague and indicate that further testing like biopsy is needed to achieve a diagnosis of greater certainty.
Although the concept of collecting tissue for microscopic evaluation is similar, the differences between performing biopsy and FNA are substantial. While FNA is minimally invasive, biopsy is more invasive as it requires a greater degree of pain relief and immobilization, like injectable or inhalant anesthesia.
FNA involves a needle and syringe to aspirate cells, whereas biopsy requires the use of a surgical instrument, such as a scalpel blade or a biopsy instrument (needle, core instrument, etc.) to cut into the mass-like lesion. FNA only permits sampling of a small representative population of cells, while biopsy involves the collection of a section of tissue. Essentially, biopsy is like taking a large scoop of ice cream, while FNA is more akin to a small spoonful.
One of the key places where biopsy and FNA differ is the potential to achieve an accurate diagnosis. Biopsy permits the pathologist to see different layers of tissue. Contained in these layers is information about the presence of both normal and abnormal cells.
Visualizing how the normal and abnormal tissues appear in opposition to each other helps create an increased likelihood that the true nature of the current disease process will be best understood.
Either a piece of tissue or an entire mass is removed when performing a biopsy.
Incisional or core biopsy is where a section of tissue is attained by cutting into the mass.
Excisional biopsy is a procedure where the entire mass is removed from the body.
Some types of cancer can conceivably be cured, or a patient can at least be put into remission (where no other clinical manifestations of disease can be determined), through excisional biopsy.
For Cardiff, excisional biopsy has been the means of resolving his clinical signs and putting him into remission (see Surgical Treatment of Canine T-Cell Lymphoma in a Dog). 
I’m an advocate of surgery as the best type of treatment for Cardiff’s cancer, yet it’s not possible, appropriate, or affordable for all pets to have mass-like lesions removed.
In Cardiff’s case he is also receiving ongoing chemotherapy to kill the cancer cells that can form new tumors (see After Cancer Remission, Using Chemotherapy to Prevent Recurrence).
Look for my next articles soon, where I cover blood and urine testing, radiographs (x-rays), ultrasound, MRI, CT scans, and other means of cancer staging used for our pets.
]]> TheDailyVet Fri, 01 Apr 2016 11:00:00 +0000 33847 at
Long-term Golden Retriever Study Hopes to Learn More About Cancer in Dogs  
I’m ever vigilant because Brody is a Golden Retriever, and 60 percent of Goldens die from cancer. All of mine have. And given that this percentage is higher in this breed than in the general canine population, it stands to reason that there is probably a genetic component in there that predisposes a dog to cancer.
Despite what the internet rumor mill will have you believe, cancer is complicated, and it’s going to take a lot more than feeding organic food to get to the root of the problem.
Fortunately for us, the Morris Animal Foundation is already on the case. The Golden Retriever Lifetime Study completed enrollment in 2015. This study, comprised of 3,000 Golden Retriever families who agreed to be part of the project for the life of the dog, aims to develop the most comprehensive set of data ever collected on a group of dogs. Having that data available will help to better understand the link between genetics and disease.
By starting the data collection from a young age, scientists will have a much more complete view of the factors contributing to the dog’s health. Owners complete intensive questionnaires, give samples of the dog’s blood, urine, and feces, and even have their home drinking water evaluated. Down the road, as the dogs get older and start to develop disease, there will be a complete set of data specific to that individual to help the study designers pinpoint what is going on.
The discussion of “hybrid vigor” has long been a contentious one in animal circles, the idea being that the inbreeding necessary to maintain a purebred line will make an animal more susceptible to genetic disease and therefore less healthy overall than mixed-breed dogs. While the reasoning makes sense if you think about it, the reality is a bit more nuanced.
A study published in the Journal of the American Veterinary Medical Association in 2013 evaluated 27,000 dogs with disorders known to have a genetic component: hemangiosarcoma, lymphoma, mast cell tumor, osteosarcoma, aortic stenosis, dilated cardiomyopathy, hypertrophic cardiomyopathy, mitral valve dysplasia, patent ductus arteriosus, ventricular septal defect, hyperadrenocorticism, hypoadrenocorticism, hypothyroidism, elbow dysplasia, hip dysplasia, intervertebral disk disease, patellar luxation, ruptured cranial cruciate ligament, atopy or allergic dermatitis, bloat, cataracts, epilepsy, lens luxation, and portosystemic shunt.
Of the 24 disorders, 13 of them showed equal expression in both purebred and mixed-breed dogs. Purebred dogs were more likely to have 10 of them, and mixed breed dogs were actually more likely to develop cranial cruciate ligament disease. So what does that mean?
Several things, the main one being that we still have a lot of work to do. The study writers concluded that the disorders common in both purebred and mixed breed dogs likely resulted from mutations earlier in the canine evolutionary history; so while there is still a genetic component, it is more equally spread among the canine genome.
While the 3,000 families enrolled in the study might not benefit directly from the information gleaned, their willingness to participate is very likely going to make a huge difference in the lives of others down the road—for Golden Retrievers, for all dogs, and even for people, since we share many of the same diseases.
Though this study has lots of implications for medicine as a whole and how we diagnose and treat disease in the future, it doesn’t change anything for individual pet owners in the here and now. Focus on your individual dog and be aware of possible problems, have masses evaluated and removed promptly, know your dog and don’t wait if something seems off.
The fight for a long and healthy life is taking place on many levels, and at the end of the day the little eyes peering up at you in your home are the only ones you need to worry about.
]]> TheDailyVet Thu, 31 Mar 2016 11:00:00 +0000 33850 at
How the 'Will Rogers Phenomenon' Affects Your Pet’s Cancer Diagnosis  
This quote, though obviously swathed with wit and sarcasm, has surprising applicability to several real world scenarios. The Will Rogers Phenomenon is used to explain what happens when the movement of an element from one set to another set raises the average values of both sets.
The Will Rogers Phenomenon is extrapolated to describe an observation in medicine called stage migration. In simplest terms, stage migration occurs when improved detection of disease leads to patients being reclassified from “healthy” to “unhealthy.”
For any given patient, disease may be present, but if we’re unable to identify it, patients will erroneously be classified as “negative” or “healthy.” Increasing the sensitivity of a diagnostic test allows doctors to capture disease at an earlier stage.  Therefore it’s possible to reclassify a previously “healthy” patient as “unhealthy” simply by running a “superior” test. That patient would therefore “migrate” from a healthy group to an unhealthy group because of improved detection of disease.
An important consideration is that despite migrating, nothing has changed about the patient itself. Its true prognosis was previously determined before any test was done.  The new test simply allowed for better detection of their disease status.
As an example, I can answer the question of “Did my pet’s cancer spread to its lungs?” by recommending radiographs (x-rays) or a CT scan of the patient’s chest. CT scans will pick up on tumors that are only a few millimeters in size, whereas radiographs will only find lesions that are closer to a centimeter.
If the same patient underwent radiographs and a CT scan, it’s possible the former test could return negative for spread and the latter test could return positive. If we’d only done radiographs, I would offer that owner a better prognosis than if I’d done the CT scan. I would characterize that patient as “healthy” when it truly was “unhealthy.”
Patients diagnosed with more advanced disease are generally not expected to live as long as their truly healthy counterparts. Therefore, “migration” of a newly detected “unhealthy” patient from the healthy group would cause an increase in the average survival time of the healthy group.
Likewise, the migrated patients are generally healthier than the patients previously segregated to the unhealthy group because their disease is considered “less noticeable.” Therefore, their movement to the unhealthy group will increase the average lifespan of that population as well.
Regardless of whether early detection of disease results in an actual difference in patient outcome, the average survival times of both the healthy and unhealthy groups are increased. The Will Rogers Effect holds true!
Stage migration pertains to many aspect of medicine, but there’s distinctive applicability to the discipline of oncology.
Cancer patients are assigned a particular stage of disease depending on where in their body the disease can be detected. For most cancers, stage is predictive of survival. The higher the stage of disease, the more advanced the cancer, and the shorter the anticipated survival time.
Many pet owners are concerned with determining what stage of cancer their dog or cat has without fully understanding what the term stage means or what information it provides.
In order to accurately assign a stage to a pet with cancer, veterinary oncologists must perform all of the recommended staging tests. For example, complete staging for dogs diagnosed with lymphoma includes a complete blood count with pathology review of a blood smear, serum chemistry panel, urinalysis, three view thoracic radiographs, abdominal ultrasound, biopsy of affected tissue, immunohistochemistry for phenotyping purposes, and bone marrow aspirate cytology.
Though I recommend complete staging for all pets diagnosed with lymphoma, very few owners agree to this plan. Further complicating the decision is that although stage is an important predictor of outcome; it generally doesn’t influence the initial treatment recommendations.
Factors such as finances, perception of what the pet will “go through” in terms of testing, timing, and availability of resources all influence whether a pet will have full versus partial staging.
Many patients have some of the tests performed, but it’s rare that they will have all of them done. This means that I’m often making educated guesses about a patient’s stage, and therefore their expected prognosis.
Stage migration is a useful tool to remind doctors to consider every patient as its own separate entity. Generalizations are helpful; however, they do not predict what will happen specifically to your pet.  
An open and honest dialogue is the best way to understand what tests your pet needs and what information the results will provide.
This reminds me of another one of Will Rogers’s best quotes: “If there are no dogs in Heaven, then when I die I want to go where they went.”
]]> TheDailyVet Wed, 30 Mar 2016 11:00:00 +0000 33849 at
Time to Change Your Dog’s Thyroid Medication  
Hypothyroidism is one of the most common endocrine (hormonal) diseases of dogs. The condition usually develops when the dog’s own immune system destroys functional thyroid tissue, resulting in lower than normal concentrations of thyroid hormone in the body.
The thyroid gland is essentially responsible for setting a dog’s metabolic rate, and some of the classic signs of hypothyroidism, such as weight gain, lethargy, and heat-seeking behaviors, reflect that role. Other common symptoms include recurrent infections (particularly of the skin and urinary tract) and hair loss. In some cases, seizures or other neurologic problems, tendon or ligament injuries, and a thickening of the skin producing a “tragic” facial expression may also develop.
When dogs have some of these symptoms and blood work has revealed low thyroid hormone levels, and they have not been diagnosed with another disease or treated with a drug known to reduce thyroid hormone levels, a tentative diagnosis of hypothyroidism is appropriate. I say “tentative” because the last stage of diagnosis should be response to treatment.
If your dog’s symptoms improve with thyroid hormone replacement therapy after recheck blood work has confirmed that therapeutic levels have been reached, you can be confident that your dog truly has hypothyroidism and that hormone replacement therapy should continue.
But now there are far fewer treatment options for hypothyroidism in dogs. Veterinarians in the United States used to have 10 brands of thyroid hormone replacement to choose from… now we have only one. True, all of these products contain the same active ingredient, levothyroxine, but most veterinarians can tell stories about how, for unknown reasons, Brand A seemed to work better for Boomer while Brand B was the better choice for Annie.
How did this happen? The U.S. Food and Drug Administration (FDA) recently approved one product, Thyro-Tabs Canine, for the treatment of hypothyroidism in dogs. Now that there is an FDA-approved drug available (none of the manufacturers had gone through this process in the past) it is illegal for other companies to manufacture or distribute levothyroxine for dogs. As the FDA announcement of the change put it:
In January 2016, FDA issued warning letters to companies manufacturing an unapproved levothyroxine product informing them that they are in violation of the law. If a company continues to manufacture an unapproved levothyroxine product, the agency may take enforcement action, such as seizing the illegal product, filing for an injunction to prevent further sale of the product, or both.
Unapproved animal drugs may not meet the agency’s strict standards for safety and effectiveness. They also may not be properly manufactured or labeled.
I don’t know whether this change will ultimately be beneficial or detrimental. Perhaps some of the variation veterinarians have seen in their patients’ response to levothyroxine has been due to inconsistent product quality, which shouldn’t be a problem in an FDA-approved drug. On the other hand, I can envision levothyroxine shortages and increased costs now that only one manufacturer is responsible for supplying the drug to all hypothyroid dogs in the U.S., at least until another company applies for FDA approval.
Only time will tell.
]]> TheDailyVet Mon, 28 Mar 2016 11:00:00 +0000 33814 at
Treating Grief with the Respect it Deserves  
I’d argue that it’s necessary, really, to be able to detach somewhat in order to maintain your own mental health. That being said, it’s also important to remember that what comes daily to you is a life shattering moment for someone else, and just because you’re removed from the situation doesn’t mean you shouldn’t be able to at least empathize with the person you’re dealing with.
Because I do a lot of end-of-life work, I’m constantly trying to find the balance in those situations. One of the biggest struggles I have is in trying to offer people services or goods surrounding memorials. I truly believe people would like some of the things I’ve found over the years—such as memorial globes and nose-print necklaces, things that for various reasons need to be ordered before a pet is cremated—but can’t imagine offering those things to someone on the day they are euthanizing a pet, which is often the only chance I have to interact with the owners.
We offer them not because we make money on the items (we don’t), but because I think some people would truly like to have them. But there’s no way to offer them to owners during a euthanasia without sounding horribly crass, so we simply have the items listed on our website and hope people see them ahead of time. Most people don’t, but that’s okay. Until I find an appropriate way to present it, we’ll simply soldier on like we have been doing.
If ever I wondered if we were doing the right thing by being very conservative in marketing, those doubts were alleviated this week when I received an unexpected phone call in the middle of the afternoon. I let it go to voicemail, which in retrospect was a very good thing, because it probably would have been a horrible conversation.
“Hello, this is Tammy from the ABC Mortuary,” the message began. “Don’t worry, it’s not an emergency, nothing’s wrong.” So why are you calling me? “We had the honor of helping you with your mother last year.” I know. I haven’t forgotten. “I just wanted you to know we have a new service we are offering for pre-planning funeral services. If you might be interested in this, my direct line is: 123 456 7890.” I can’t believe I just got a call asking if I might have anyone else dying they could help with.
After hearing the message, I hung the phone up with my jaw on the floor. Maybe I’m sensitive since the one-year anniversary of my mother’s diagnosis is just around the corner and I’m already having a hard time with that, but I couldn’t believe the thoughts and emotions running through my head as I heard that message.
It brought me back to the day after she died, sitting in the mortuary office trying to figure out the address and phone number of a cemetery in Massachusetts where she might be buried. “You want to split the ashes?” asked the woman. “So what, like 50/50 or 30/70, do you think?” After that, we were left to ourselves in a room lined with coffins. On top, the $20,000 “Silver Bullet” lined with velvet. As you worked your way down the line, you saw metal, oak, maple, and various other options and colors. Furthest down, particle board, and then, dusty and sad in the corner, a dented cardboard box; “The Economy.”
It was horrible to have to sit there and pick all that stuff out, and the business is attuned to your heightened emotions and guilt to gently sway you into spending more than you intended. I’m sure we would have benefitted from doing it ahead of time, but nonetheless, that’s a choice I want to make in my own time. Yes, mortuaries are a business, but they had my phone number strictly to contact me about my mother’s cremation, not to add to their marketing list. A direct solicitation for memorial planning is, when unasked for, a horrible thing to do. It ruined my whole afternoon, which up until that point had actually been quite nice.
So there you have it, my own very informal anecdotal evidence that grief and loss business providers should never try to sell something to a person unless they are specifically approached by the client. I would rather never sell anything again than make someone feel the way I did when I heard that phone message.
What do you think? When is it okay to try and sell memorial items or services to a person?
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