http://www.petmd.com/blogs/thedailyvet/rss en Staging for Canine and Feline Cancer Patients – Using Diagnostic Imaging to Look Inside Your Pet http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2016/may/staging-canine-and-feline-cancer-patients-%E2%80%93-using-diagnos  
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.
 
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http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2016/may/staging-canine-and-feline-cancer-patients-%E2%80%93-using-diagnos#comments TheDailyVet Mon, 09 May 2016 11:00:00 +0000 34157 at http://www.petmd.com
Tragedy at the Zoo: Tiger Keeper Who Made the Rules Dies After Breaking the Rules http://www.petmd.com/blogs/thedailyvet/jvogelsang/2016/april/tiger-keeper-who-made-rules-dies-after-breaking-rules-34046  
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
 
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http://www.petmd.com/blogs/thedailyvet/jvogelsang/2016/april/tiger-keeper-who-made-rules-dies-after-breaking-rules-34046#comments TheDailyVet Thu, 28 Apr 2016 11:00:00 +0000 34046 at http://www.petmd.com
Why Isn’t Cancer on the List of Top Diseases Covered by Health Insurance? http://www.petmd.com/blogs/thedailyvet/drjintile/2016/april/why-isnt-cancer-list-top-diseases-covered-health-insurance-34  
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
Osteoarthritis
Periodontitis/dental disease
Gastropathy
Enteropathy
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
Gastropathy
Hyperthyroidism
Enteropathy
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
 
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New Drug May Mean That FIP is No Longer a Death Sentence for Cats http://www.petmd.com/blogs/thedailyvet/dr-coates/2016/april/new-drug-may-mean-fip-no-longer-death-sentence-cats-34010  
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.
 
 
Reference
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. 
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Staging for Canine and Feline Cancer Patients – The Urine and Fecal Testing Stages http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2016/april/staging-canine-feline-cancer-patients-urine-and-fecal-34009  
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.
Other

 
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.
 
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http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2016/april/staging-canine-feline-cancer-patients-urine-and-fecal-34009#comments TheDailyVet Fri, 22 Apr 2016 11:00:00 +0000 34009 at http://www.petmd.com
All Dogs Are at Risk in the Hot Months – Don’t Let Yours Be a Summer Casualty http://www.petmd.com/blogs/thedailyvet/jvogelsang/2016/april/all-dogs-are-risk-hot-months-%E2%80%93-dont-let-yours-be-summer-casu  
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
 
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New Version of Canine Flu Now Infecting Cats http://www.petmd.com/blogs/thedailyvet/dr-coates/2016/april/new-version-canine-flu-now-infecting-cats-33979  
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.
 
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Staging for Canine and Feline Cancer Patients – The Blood Testing Stage http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2016/april/staging-canine-and-feline-cancer-patients-blood-tests-33966  
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
 
 
Related
 
7 Signs of Cushing's Disease in Dogs
 
Blood work: What it means and why your pet needs it (Part 1: The CBC)
 
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Changing the World, One Seed at a Time http://www.petmd.com/blogs/thedailyvet/jvogelsang/2016/april/changing-world-one-seed-time-33957  
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.
 
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How to Know When a Cat is Hurting http://www.petmd.com/blogs/thedailyvet/dr-coates/2016/april/how-know-when-cat-hurting-33940  
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.
 

Lameness
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
Temperament
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
Growling
Groaning
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.
 
 
References
 
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. 
 
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Spring is Back… and So Are the Bugs http://www.petmd.com/blogs/thedailyvet/jvogelsang/2016/april/spring-back-and-so-are-bugs-33909  
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?
 
 
Related
 
Lyme Disease in Dogs
 
How to Remove Ticks
 
Natural Flea and Tick Prevention
 
Pesticide Toxicity in Cats
 
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When is a Pet Too Old for Cancer Treatment? http://www.petmd.com/blogs/thedailyvet/drjintile/2016/april/when-pet-too-old-cancer-treatment-33882  
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.
 
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Fly Biting: Is it a Seizure or a Digestive Disorder? http://www.petmd.com/blogs/thedailyvet/dr-coates/2016/april/fly-biting-it-seizure-or-digestive-disorder-33881  
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.
 
 
Reference
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.
 
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What is 'Staging' and Why Is it Important for the Pet Cancer Patient? http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2016/april/what-staging-and-why-it-important-pet-cancer-patient-33  
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.
Other

 
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.
 
Biopsy
 
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.
 
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Long-term Golden Retriever Study Hopes to Learn More About Cancer in Dogs http://www.petmd.com/blogs/thedailyvet/jvogelsang/2016/march/long-term-golden-retriever-study-hopes-learn-more-about-canc  
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.
 
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Time to Change Your Dog’s Thyroid Medication http://www.petmd.com/blogs/thedailyvet/dr-coates/2016/march/time-change-your-dogs-thyroid-medication-33814  
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.
 
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Treating Grief with the Respect it Deserves http://www.petmd.com/blogs/thedailyvet/jvogelsang/2016/march/treating-grief-respect-it-deserves-33744  
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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Is it Okay to Apologize When You’re a Doctor? http://www.petmd.com/blogs/thedailyvet/drjintile/2016/march/it-okay-apologize-when-youre-doctor-33736  
Consider the magnitude of impact these two simple words can have.
 
Apologies, when uttered from a place of sincerity, are remarkably meaningful. They are capable of erasing negativity, clarifying misconceptions, and easing hurt feelings. They also convey understanding, solidarity, and compassion. When we are sincerely sorry, we are also truly humbled.
 
For medical professionals, saying “I’m sorry” may have the opposite result. When a doctor offers words of apology there may be perception of culpability for an inappropriate action. It’s questioned as an omission of guilt. Are we looking for forgiveness for our inadequacies? Are we searching for absolution for our inability to heal or cure? Or worse, are we somehow admitting to negligence or neglect?
 
There are examples where expressions such as “I’m sorry” or “I apologize” were used as evidence of wrongdoing or guilt in a court in the context of medical liability/malpractice cases. Doctors and other members of a patient’s medical team have been penalized for declaring their regret. As a result, individuals are advised, if not ordered, to refrain from making such statements on the off chance the case in question ends up in court.
 
Fortunately, legislation is being structured to exclude expressions of sympathy, condolences, or apologies from being used against medical professionals in court. Proponents of these so-called "I'm sorry" laws believe that allowing medical professionals to make these statements can reduce medical liability/malpractice litigation. Currently, several states in the U.S. have pending laws to prevent apologies or sympathetic gestures uttered by medical professionals from being used against them in a legal forum.
 
For example, Massachusetts enacted a statute that
 
“provides that in any claim, complaint or civil action brought by or on behalf of a patient allegedly experiencing an unanticipated outcome of medical care, any and all statements, affirmations, gestures, activities or conduct expressing benevolence, regret, apology, sympathy, commiseration, condolence, compassion, mistake, error, or a general sense of concern which are made by a health care provider, facility or an employee or agent of a health care provider or facility, to the patient, a relative of the patient, or a representative of the patient and which relate to the unanticipated outcome shall be inadmissible as evidence in any judicial or administrative proceeding and shall not constitute an admission of liability or an admission against interest.”
 
From the perspective of a veterinarian actively working in the trenches, apologies are a routine part of my day. I frequently say “I’m sorry”; not to compensate for an inordinate amount of errors but rather as a means to offer a semblance of sympathy and understanding to owners who are often anxious, confused, and searching for kindness and hope.
 
I offer an apology to an owner after bearing unfortunate news or following the death of their pet. I say I’m sorry when a treatment plan has failed and a pet’s cancer has resurfaced or when lab work indicates that I need to alter my recommendations.
 
I offer regrets when I’m running behind in my schedule, when we’ve run out of a particular medication, or when a pet can’t have an ultrasound done that same day because the doctor who performs such exams is unavailable.
 
When I do make an error, I apologize for this as well. I’m not perfect and mistakes happen. My words are never stated lightly and I would never choose only admitting regret when it’s convenient for my own need.
 
When I say I’m sorry, I truly am sorry. There’s no alternative interpretation of my message. I’m not indicating anything more than a modest sense of compassion and care.
 
My idealistic soul desperately believes the majority of pet owners appreciate authenticity from their veterinarian over a lack of disclosure borne out of fear of legal retribution. The fact that laws are being developed to protect medical professionals suggests the opposite is the more factual scenario.
 
I urge you to consider which veterinarian you would prefer: the one who apologizes out of kindness or the one who remains silent out of fear?
 
Have you ever had an apology from your veterinarian (or other medical care giver)? How did you feel and respond? 
 
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Veterinary Hospice Care is Beautiful When Done Well http://www.petmd.com/blogs/thedailyvet/dr-coates/2016/march/veterinary-hospice-care-beautiful-when-done-well-33734  
From the American Veterinary Medical Association:
 
[H]ospice care focuses on providing the best quality of life possible for a pet with a terminal disease or condition until the pet dies or is euthanized. Hospice care also helps you [owners] by providing you with time to adjust to the coming loss of your companion. The care is tailored to the needs of both you and your pet.
 
The goals of pet hospice care are relatively straightforward and include:

Maintenance of an acceptable quality of life for as long as possible
The prevention of patient suffering
Support of the family and the pet through natural death or euthanasia
Preservation of the human-animal bond

 
Veterinarians and owners need to work together to reach these goals.
 
Animals can experience many discomforts near the end of life. Conditions such as pain, anxiety, difficulty breathing, and gastrointestinal distress must be addressed, not ignored. Nutrition, hydration, hygiene, mobility, and mental stimulation are all important regardless of a pet’s age and health status.
 
Preventing pain is a very important part of hospice care. Animals experience pain much like humans, but they may not display it in the same ways.
 
Signs of pain in pets include pacing, excessive panting, hiding, reduced appetite, aggression, grumpiness, and/or reduced interaction with family members. Options for pain control include oral medications, injections, and transdermal patches. Acupuncture, laser therapy, massage, and other complementary treatments can provide additional relief from pain.
 
Effective treatments are also available for the many other types of discomfort that pets may experience at the end of life. These include such things as anti-nausea medications for vomiting, diuretics to reduce the build-up of fluid in the lungs, and mobility assistance devices that help dogs get outside to urinate and defecate.
 
One of the best ways to monitor a pet’s quality of life is by keeping a daily diary that helps identify changes affecting the pet’s comfort and happiness. Jot down the good and bad events of the day and give it an overall rating on a scale of 1 to 5. If you start to notice a downward trend, it’s time to make changes to the treatment plan.
 
Together, families and veterinarians can develop an individualized strategy for the final stages of the pet’s life and death. In some instances, the pet may experience a comfortable, natural death, but euthanasia often becomes the best option to eliminate suffering. The details of the euthanasia procedure and body care (e.g., cremation or burial) can be worked out ahead of time to reduce stress.
 
With veterinary hospice care, a pet’s final days don’t have to be filled with suffering and regret, but instead can be a time of great love and celebration of a life well-lived. 
 
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Homemade Pet Food or Store Bought Pet Food – Which is Better for Pets With Cancer? Part 3 http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2016/march/homemade-pet-food-or-store-bought-pet-food-which-better-33726  
Can My Pet Eat Homemade Foods?
 
Yes, your pet can eat foods that you make at home, provided some guidelines are followed.
 
Before commercial pet food was an option for owners, our canine and feline companions just ate the same foods we did. Now that there are many cat and dog kibble (dry food) and canned (wet food) options ready for purchase at grocery and pet stores and online, the concept of cooking for one’s pet has become completely foreign for most owners. However, homemade pet food has of late been an area of growing interest for many owners who want their pets to have healthy, long lives.
 
Here are some of the aspects of home-prepared ingredients that make them ideal for pets of any health status, but especially for cancer patients:
 
1. Human grade
The majority of commercially-available pet foods and treats are made with feed-grade ingredients that have been deemed unfit for human consumption and have higher than permissible levels of a variety of toxins, including mold-produced mycotoxins (aflatoxin, vomitoxin), animal excreta (feces and urine), and can include 4D components (dead, disabled, diseased, and dying animals).
 
2. Free from grain and protein “meals by-products”
In order to make a product that meets Association of American Feed Control Officials (AAFCO) standards, and that also is less-expensive to manufacture and for the owner to purchase, grain and protein “meals and by-products” are used instead of whole grain and protein ingredients. Grain and protein “meals and by-products” don’t exist in nature, are produced through a process that damages nutrients’ bioavailability, and are generally less-bioavailable (less-efficiently absorbed) as compared to whole foods.
 
3. Lacking chemical preservatives or artificial colors
To prevent spoilage, chemical preservatives (BHA, BHT, Ethoxyquin) can be added to pet foods and treats and may be used to preserve the rendered fat that is sprayed on kibble to enhance palatability, as well as for protein meals like fish meal. If the chemical preservative is added before the ingredient arrives at the final food production site, it does not even have to be included on the product’s label.
 
Artificial colors that are added to pet foods and treats include Blue 2, Red 40, and Yellow 5 and 6, and others, which contribute to hypersensitivity (allergic-type) reactions, behavior problems, and cancer in humans. Caramel color that is used to make foods and treats appear more like real meat contains 4-methylimidazole (4-MIE), a known animal carcinogen.
 
As a result, owners need to be extra vigilant about reading food and treat labels to make sure that what is being offered to their pets are free from chemical preservatives and artificial colors.
 
4. High moisture levels
When nature makes protein, grains, vegetables, fruit, and other nutrients, they are all created in a format containing relatively high levels of moisture. Rendering and high-heat cooking removes much of the essential moisture that is crucial to the digestive process. Instead, dogs and cats must drink water to aid the body’s digestive juices and pancreatic enzymes to facilitate digestion.
 
Consuming moist foods also helps create a feeling of satiety (fullness) that can ensure that an appropriate number of calories are consumed; this also reduces the potential for obesity-related health problems, like high blood pressure, arthritis, traumatic ligament rupture, diabetes, kidney and liver disease, others.
 
5. Freshly prepared
Why owners think that feeding a kibble-based diet that can sit in a bag or container for months at a time will best suit their pets’ nutritional needs is beyond me. It’s such a counterintuitive concept from the manner of eating that is recommended for humans via the Choose My Plate initiative. Although we humans have differing nutritional needs from our canine and feline companions, similar concepts of consuming high-quality and fresh nutrients applies across all species.
 
Home-prepared diets for pets may not be100% nutritionally complete and balanced from the get-go, but owners can receive guidance on making pet food with appropriate ratios of protein, carbohydrates, fat, fiber, vitamins, and minerals to meet their pet’s nutritional needs.
 
Owners can partner with their veterinarians to pursue a consultation with a university’s Veterinary Nutrition Support Service—University of California Davis and University of Tennessee are excellent options—or use a service like Balance IT.
 
Which Human Foods Can Be Fed to Pets?
 
There are many pet-appropriate human foods that can be served as treats or used as meal-formulating components, including:
 
Vegetables: Beet, broccoli, carrot, cauliflower, mushroom, spinach, sweet potato, ripe tomato, and others can be fed raw or steamed and finely chopped or pureed and added to any food. Any vegetable that you would cook before eating (beet, sweet potato, etc.) should also be cooked before being served to your pet. Vegetables with skins should have the skins, especially any areas of discoloration or “eyes” (like on sweet potatoes), removed before serving.
 
Fruits: Apple, banana, blackberry, blueberry, cantaloupe, cherry, melon, pear, raspberry, watermelon, and others not only are tasty, they also provide essential moisture, fiber, minerals and vitamins. Vitamins in the format created by nature are generally absorbed better than synthetic vitamins that don’t fit binding sites inside the digestive tract as well as their natural counterparts.
 
Vegetables and fruits should always be washed before serving. If available, always choose an organic option to cut down on potential pesticide exposure.
 
Meats: Cooked, defatted, low-sodium proteins like chicken, turkey, beef, lamb, and fish are great options to use as the basis of home-prepared meals. Additionally, preservative-free and U.S. sourced meat jerky, tuna water, or meat-broth cubes can be given as snacks.
 
Before feeding your pet any human foods besides those mentioned above, reference the ASPCA’s People Foods to Avoid Feeding Your Pets.
 
Can I Feed My Pet a Raw Food Diet?
 
Yes, your pet can eat a raw food diet, depending on his overall state of health, individual nutritional needs, and the components you are considering feeding in a raw state. Generally, consumers interested in raw diets seek to feed raw meat, but in actuality uncooked vegetables, fruits, seeds, and nuts can also be components of a raw meals and snacks.
 
Diets liked kibble (dry) and canned foods are heated to > 400 F to kill pathogenic bacteria (campylobacter, listeria, and salmonella, etc.). While the goal of killing potentially harmful bacteria is ideal, the high-heat cooking also denatures proteins and deactivates enzymes essential to the digestive process.
 
FoodSafety.gov provides a chart of Safe Minimum Cooking Temperatures with recommendations to cook meat to 140-165 F (depending on the type of meat) to kill bacteria. So, if meat-cooking temperatures only need to reach 140-165 F for humans, is it really more beneficial to high-heat cook the components of our pets’ diets?
 
Raw diets have not been structurally altered by heat, so they retain their natural integrity along with beneficial or pathogenic microorganisms. My recommendation is to have the raw components of your pet’s foods and treats include certain fresh fruits or vegetables and to cook meats to a recommended bacteria-killing temperature before serving.
 
The potential for pets and human family members to face life-threatening illness if pathogenic bacteria are ingested motivates my perspective and the American Veterinary Medical Association’s (AVMA) Policy on Raw or Undercooked Animal-Source Protein in Cat and Dog Diets. No owner would want to see their pet suffer from flu-like symptoms such vomit, diarrhea, fever, and muscle aches, or have the condition progress to kidney and liver failure, seizures, coma, or even death.
 
Juvenile (puppies and kittens), geriatric (pets older than seven years), and pets having immune system-compromising ailments like cancer, immune-medicated (“autoimmune”) disease, or pets taking immunosuppressive drugs (chemotherapy, steroids, etc.) are at greater risk for toxicity from pathogenic bacteria and should only eat cooked-meat diets.
 
Thank you for reading this multi-part series. I strongly believe that our pets’ overall health and the prevention of many disease conditions depends on the purity, quality, and format of the foods and treats they consume.
 
Do you feed your pet foods and treats besides kibble and canned? Do you feel your pet’s health benefits from such a feeding strategy? Share your perspective in the comments section.
 
 
Related
 
Raw Food Diet for Dogs
 
What People Foods Are Harmful to My Pet?
 
How to Safely Feed Your Pet People Food
 
Why Your Homemade Dog Food is Not Good Enough
 
 
Image: Homemade pumpkin and bacon dog biscuits
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