http://www.petmd.com/blogs/thedailyvet/rss en How Much Do We Know About Medical Marijuana for Pets? http://www.petmd.com/blogs/thedailyvet/dr-coates/2015/august/how-much-do-we-know-about-medical-marijuana-pets-32933









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Aug 03, 2015 How Much Do We Know About Medical Marijuana for Pets? by Dr. Jennifer Coates








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The Colorado Board of Health recently voted against adding post-traumatic stress disorder (PTSD) to the list of conditions eligible for treatment with medical marijuana. According to the Denver Post, “Currently allowed uses of marijuana include pain (93 percent of recommendations), cancer, epilepsy, glaucoma, muscles spasms, multiple sclerosis, severe nausea and wasting disease (cachexia).” Members of the Board of Health cited a lack of scientific evidence for marijuana’s effectiveness in treating PTSD as the primary reason for their decision.
 
But a lack of scientific evidence doesn’t seem to be stopping pet owners from giving medicinal pot to their pets. If you do a quick Google search for “medical marijuana” and “pets” you’ll find lots of stories about owners who have given marijuana to their often chronically ill/dying pets. Anecdotally, they’ve seen some fairly remarkable improvements in their pets' quality of life, at least in the short term.
 
Owners are most often hoping that pot will help relieve their pet’s pain and/or work as an appetite stimulant. Marijuana has also been used in the treatment of anxiety, nausea, and seizures, primarily in dogs. But here’s the rub: even in the pot-friendly state of Colorado, medical marijuana is only legal when a physician recommends it for a human patient. Veterinarians cannot prescribe marijuana for pets.
 
Recreational marijuana is widely available, but I worry when I hear of owners giving it to their sick pets. Today’s varieties have a much higher percentage of tetrahydrocannabinol (THC) and are therefore MUCH stronger than what used to be available a few decades back. In fact, a friend’s dog recently suffered through what could only be described as a “bad trip” after ingesting a tiny amount of marijuana off the sidewalk in their neighborhood. The dog recovered, but the outcome could have been different if he was already critically ill.
 
Another option that is available to interested owners is cannabidiol (CBD), which is derived from hemp plants (hemp is basically marijuana that doesn’t make much THC). CBD has recently garnered a lot of attention duet to its apparent ability to control seizure activity in people. According to a paper that explored its potential usefulness in human medicine, CBD “displays a plethora of actions including anticonvulsive, sedative, hypnotic, antipsychotic, antiinflammatory and neuroprotective properties.”
 
Unfortunately, research into the potential usefulness of CBD in pets is lacking. The only studies I have seen found that CBD is very poorly absorbed after oral administration in dogs. “In three of the six dogs studied, CBD could not be detected in the plasma after oral administration. In the other three, the oral bioavailability ranged from 13 to 19%.”
 
So, while CBD is available to pet owners (some companies are even making CBD dog treats!), it’s hard for me to recommend its use. I doubt CBD supplements are dangerous, however. I suspect the biggest risk is to your wallet.
 
Have you treated a sick pet with marijuana or CBD? What’s your experience?
 
 

Dr. Jennifer Coates
 
 
References
 
Cannabidiol in medicine: a review of its therapeutic potential in CNS disorders. Scuderi C, Filippis DD, Iuvone T, Blasio A, Steardo A, Esposito G. Phytother Res. 2009 May;23(5):597-602. 
 
Pharmacokinetics of cannabidiol in dogs. Samara E, Bialer M, Mechoulam R. Drug Metab Dispos. 1988 May-Jun;16(3):469-72.
 
 
Image: Sherry Yates Young / Shutterstock
 
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TheOldBroad Pot 08/03/2015 06:45pm Until there are scientific studies showing benefits to Fido/Fluffy, I'll go with what the doctor prescribed. I can't imagine giving something to my critters without knowing what to expect. Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/dr-coates/2015/august/how-much-do-we-know-about-medical-marijuana-pets-32933#comments TheDailyVet Mon, 03 Aug 2015 11:00:00 +0000 32933 at http://www.petmd.com
When Cancer That Was Successfully Treated Reoccurs in a Dog http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2015/july/when-cancer-was-successfully-treated-reoccurs-dog-32923









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 31, 2015 When Cancer That Was Successfully Treated Reoccurs in a Dog by Dr. Patrick Mahaney








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If you have previously been a reader of my contributions to petMD’s The Daily Vet, you will remember that I've written extensively about my dog Cardiff’s journey through some commonly fatal illnesses over his 10 years of life.
 
Cardiff is a neutered, male Welsh Terrier who has overcome great odds to reach his 10 year milestone while maintaining a good quality of life. Considering the cards he’s been dealt by his genetics, there’s never been a time during his illnesses where I feel treatment shouldn’t be pursued as a result of Cardiff’s quality of life being less-than-ideal.
 
Unfortunately, when Cardiff gets sick, it has been from serious diseases requiring significant surgical or medical intervention to manage. As I write, Cardiff is recovering from a recurrence of cancer. I never take Cardiff’s health for granted, but the illness-free stretches yield less content for me to share with petMD readers. When sickness strikes, I’m more motivated to educate the pet-loving audience about disease recognition, treatment, and prevention.
 
Before I delve into Cardiff’s current issue, let’s review some of his prior medical issues.
 
Immune mediated hemolytic anemia (IMHA) — Yes, the pronunciation is challenging. Cardiff has endured four bouts of these typically fatal episodes where his immune system recognizes the red blood cells as foreign, targets them for destruction, and leaves the body anemic (low red blood cell level).  
 
It's a scary process, as despite working with veterinary internal medicine specialists, geneticists, and other experts in the field, we can never pinpoint even one of the underlying factors with the emergence of his disease.
 
The good news is that I catch Cardiff’s IMHA very early, aggressively treat him with immunosuppressive drugs, replace the lost red blood cells with freshly-transfused counterparts, then wait for his bone marrow to produce more red blood cells while the immunosuppressive drugs are tapered. Fortunately, I’m able to get his overreactive-immune system under control and replace his lost red blood cells before irreversible damage occurs and he quickly feels significantly better.
 
Cardiff’s most recent IMHA episode occurred in October 2014 after he finished his chemotherapy a few months earlier in July. As he was so heavily immunosuppressed during his chemotherapy, there was no way to predict if Cardiff would again develop IMHA. So, I never started him back on the immunosuppressive drug Azathioprine that he was taking on an every-other-day maintenance plan which seemingly kept his immune system under control. After the October 2014 recurrence, I knew he should always stay on this drug unless he has a more severe immune system issue (like cancer) requiring treatment.
 
T-Cell Lymphoma — In December 2013 Cardiff was diagnosed with lymphoma, which is a malignant cancer of white blood cells. The immune system relies on a variety of white blood cells to protect the body from invading pathogens (bacteria, virus, fungus, etc.), control inflammation, manage stress, and aid in a variety of other crucial bodily functions. Lymphocytes are a type of white blood cell that, in Cardiff’s case, develope defects in their DNA that cause rapid division with no turn-off switch.
 
Cardiff’s lymphoma is the terrible kind called T-Cell. B-cell Lymphoma has a better prognosis, while T-cell Lymphoma has a worse prognosis.
 
After having a focal tumor on a loop of small intestine surgically removed from his abdomen, Cardiff was given 30 days to heal. We then started a course of chemotherapy called the University of Wisconson-Madison Canine Lymphoma Protocol. This approximately six-month protocol involves the administration of a series of oral or injectable medications known as CHOP, which stands for Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), and Prednisone.
 
Technically, the surgery to remove the mass and the adjacent small intestinal tissues put Cardiff into remission immediately, as no further cancer cells could be discovered at the time. Yet, as cancer cells that could form tumors might still be present, I elected to treat Cardiff with chemotherapy while striving to support his immune system and whole body health with medications, supplements, herbs, and a whole-food diet. He tolerated his chemotherapy very well with minimal side effects.
 
Cardiff was cancer free for a full year after finishing his chemotherapy in July 2014. We were even one of the subjects of My Friend: Changing the Journey, a documentary about canine cancer created by the Canine Lymphoma Education Awareness and Research (CLEAR) Foundation. Besides his IMHA recurrence in October 2014, Cardiff had thrived until mid-July 2015.
 
His clinical signs may not alert most pet owners to the potential for cancer, but I know better considering Cardiff’s extensive history of disease. He began to show decreased appetite, mild lethargy, occasional urgently-produced soft stools containing mucus (large bowel diarrhea or colitis), and episodes of vomiting (active expulsion of stomach contents) or regurgitation (passive expulsion of stomach contents). 
 
Preliminary blood testing was mostly normal but for mild anemia pared with mild loss of protein and albumin (a type of blood protein that helps maintain blood pressure). Such findings are most consistent with digestive tract loss such as that which can occur with an ulcer or some form of moderate to severe stomach or intestinal inflammation.
 
Supportive care with probiotics (beneficial bacteria), digestive enzymes, antacids, and intestinal soothing supplements and medications yielded some improvements in his clinical signs and blood testing. Unfortunately, some of the signs lingered and Cardiff’ wasn’t bouncing back to his otherwise robust self. When he vomited a large volume of undigested food he had eaten hours before on the 6th day of his illness, I suspected that more serious issues were present.
 
So, the diagnostic workup with X-rays, ultrasound, and other diagnostics (urine, etc.) began. Check back on August 14th, when I reveal Cardiff’s latest diagnosis and delve into his treatment options.
 

Cardiff at 10!
 
 

Dr. Patrick Mahaney
 
You can find more Dr. Mahaney and Cardiff at PatrickMahaney.com
 
 
Image: Cardiff's chemo treatment, 2014
 
 
Related Content
 
A Veterinarian's Experience with Treating His Dog's Cancer
 
When Pets Complete Chemotherapy Are They Cancer-Free?
 
Unexpected Side Effects of Chemotherapy Treatment
 
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TheOldBroad Cardiff 07/31/2015 04:59pm Poor guy He's been through so much. (Thank goodness he has you!)

Fingers crossed it's a good outcome, although from the title of the article, I'm concerned for him.

He's gotten through all this before so hopefully he can get through it again. Reply to this comment Report abuse 2
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http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2015/july/when-cancer-was-successfully-treated-reoccurs-dog-32923#comments TheDailyVet Fri, 31 Jul 2015 11:00:00 +0000 32923 at http://www.petmd.com
The Dog Days of Summer: Hot Pet Reads http://www.petmd.com/blogs/thedailyvet/jvogelsang/2015/july/dog-days-summer-hot-pet-reads-32922









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 30, 2015 The Dog Days of Summer: Hot Pet Reads by Dr. Jessica Vogelsang








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I love few things more during the summer than lying down at the beach or pool with a book in hand. Well, maybe lying down with my head on my dog when it’s too hot to go outside. Either way, long summer days are perfect for reading, and fortunately for us animal lovers there is no shortage of choices for pet related books. So with that, I’d like to present my own must-read summer book list for pet lovers.
 
1. Lessons from Tara: Life Advice from the World’s Most Brilliant Dog
 
David Rosenfelt’s sweet and funny book about his beloved dog Tara hits all my favorite notes: Golden Retriever? Check. Laughs? Check. Giving credit to all the little life lessons a dog imparts to us just by being who they are? Check again.
 
2. A Street Cat Named Bob
 
Street cat meets street musician;it’s tough to know who was the scrappier of the two. You wouldn’t think a former addict turned street musician would be a natural fit for cat owner of the year, but somehow James Bowen and Bob forged a beautiful friendship that transcended their rough start. A courageous tale of love and redemption in the unlikeliest of places.
 
3. Cabo and Coral Dog Days of Summer
 
Dr. Udo Wahn’s Cabo and Coral series of books are a lovely children’s collection that covers multiple topics all kids should learn about: responsible pet ownership, environmental conservation, pet adoption, and revering all beings just as they are. Coupled with the lovely illustrations of dogs surfing and a big scoop of aloha, Dog Days of Summer is one of my childrens’ favorite reads. Dr Wahn offers custom signatures to books ordered through his site.
 
4. Lucky Dog: How Being a Veterinarian Saved My Life
 
Dr. Sarah Boston is an expert in veterinary oncology, providing cutting edge treatment for dogs and cats with cancer. And thank goodness she was: when Dr. Boston was herself diagnosed with thyroid cancer, she needed to draw on everything she knew to successfully navigate the labyrinthine Canadian healthcare system. Wry and funny, this is not a typical cancer memoir.
 
5. Catification: Designing a Happy and Stylish Home for Your Cat (and You!)
 
Fans of Jackson Galaxy’s hit show know he has a knack for bringing around even the most peculiar of felines. He’s paired up with cat style guru Kate Benjamin of Hauspanther to bring their best home upgrade tips to you. Forget the old stereotypes of the “crazy cat lady” living in a mess. Catification proves that cat ladies (and guys) can lead the pack when it comes to sophisticated style.
 
6. Decoding Your Dog
 
“Why is my dog doing this?” may be one the most common questions dog owners have, and depending on who you ask, the answers can be all over the place. The American College of Veterinary Behaviorists, a board certified specialty for veterinarians with advanced behavior training, represents the ultimate authority in the field. This comprehensive collaborative book covers all the bases: not only the “whys” of common behaviors, but the “how” of addressing common problem behaviors using the most up-to-date research and humane training methods. I learned a bunch from this one.
 
7. True Tails From the Dog Park
 
I picked two children’s books for the list because, like many parents, I’m finding myself constantly coming up with ways to keep my kids reading and off the computer. Dog books are one of the best tricks. Co-authors Kari Sherman and Carey Laubenburg met at a San Diego dog park and hatched the idea for a book covering the stories of the many friends they made at the park. Additionally the book addresses issues of dog park etiquette as told through the eyes of their dogs, Max and Luther.
 
8. Heart Dog: Surviving the Loss of Your Canine Soulmate
 
So Roxanne Hawn’s book about overcoming the loss of a “heart dog” may not be the most light read on the list, but for someone who really needs it, it may be the most important. Blending her personal story of loss with advice from grief experts, this quick read covers all the bases to help grieving pet owners know that not only are they not alone, there is a light at the end of the tunnel.
 
9. Texts from Mittens
 
Speaking of light reads, Angie Bailey’s book of a sassy text messaging cat may be just what the doctor ordered if you’re looking for a fun gift for cat lovers. Mittens is a sharp-tongued, narcissistic complainer who suffers greatly from living with Phil the dog, and isn’t afraid to let Mom know through his unlimited data plan. If cats had opposable thumbs, I imagine this is exactly what mine would be sending.
 
10. All Dogs Go to Kevin
 
I admit to a bit of bias on this last one, but I’m really excited and proud to have my memoir on the shelves this summer. There may be some tears in it here and there, but I made sure to balance it out with laughs as well. Although the focus is on three dogs in my life, there’s plenty of stories from the clinic too. If you’ve ever loved a dog who turned your prized Jimmy Choos into Jimmy Poos, this is the book for you. If you’d like a bookplate to turn yours into a signed version, drop me an e-mail and I’ll get it done!
 
(You can read an excerpt of All Dogs Go to Kevin here)
 
 

Dr. Jessica Vogelsang
 
 
Image: Javier Brosch / Shutterstock
 
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TheOldBroad Guswelle 07/30/2015 06:16pm If anyone ever gets a chance to pick up a book by Charles Guswelle, you'll find that his animal stories make you feel like you are right there with him and his family. Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/jvogelsang/2015/july/dog-days-summer-hot-pet-reads-32922#comments TheDailyVet Thu, 30 Jul 2015 11:00:00 +0000 32922 at http://www.petmd.com
In Praise of the Veterinary Receptionist http://www.petmd.com/blogs/thedailyvet/drjintile/2015/july/praise-veterinary-receptionist-32920









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 29, 2015 In Praise of the Veterinary Receptionist by Dr. Joanne Intile








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One of the most important people you will encounter in your veterinarian’s office is the receptionist who greets you when you walk through the door.
 
This is especially true for doctors like me who work in the veterinary referral industry. We do not evaluate healthy puppies or kittens, nor do we typically find our schedule filled with routine wellness visits. Our patients were previously diagnosed with some disorder or disease process, necessitating referral to our facility for further diagnostic and/or treatment options. Therefore, owners seek care from specialists because their pet is experiencing a problem with their health.
 
When owners cross through the entrance to our hospital, they are filled with anxiety and apprehension, and their emotional turmoil is palpable from the moment of their arrival. The receptionist is the first person they will meet and the quality of this initial interaction can set the tone for not only the remainder of their first visit, but for all subsequent interactions.
 
My goal is for each owner I encounter to feel important, comforted, relaxed, and as if they are they only pet on my appointment schedule for the day. If a receptionist can correctly identify the patient by name (and gender), this seemingly insignificant gesture often means a great deal to a distraught pet parent hoping for even just a tiny sense of reassurance.
 
In many referral hospitals, receptionists are also the people given the duty of answering all incoming calls. They are expected to do so with a maximum of one ring, to always be polite and cheerful, and to speak in a clear voice with an even cadence.
 
This is equally true on a busy day when they may be dealing with several different tasks simultaneously as is it on a slow one where those expectations may not be as daunting. Receptionists need to keep calm under high pressure situations and never let on to an owner that they have nothing but all the time in the world to help that person deal with their needs.
 
At our hospital, owners will often call and ask receptionists for advice rather than schedule a consult with a doctor. It is inappropriate for a receptionist to make medical recommendations to owners or to suggest treatment options when owners are looking for a guarantee that it’s okay to not bring their pet in for evaluation.
 
Receptionists need to be capable of directing owners to the correct person who can adequately answer the questions being posed, but also remain sympathetic to the client’s needs. Therefore, it is imperative for a receptionist to be intelligent, reliable, somewhat medically trained, but also acutely aware of their limitations and when potential lines are close to being crossed.
 
At many hospitals, and especially those tasked with emergency/urgent care, receptionists are required to triage pets experiencing urgent/life-threatening conditions from those who are stable and able to wait a short while before being seen. This can occur either via a telephone conversation or when the client/patient arrives without an appointment. They often need to make a split-second determination if the situation requires emergency attention, so they should have fundamental training for what to look for to facilitate making that judgment.
 
Receptionists are often tasked with collecting payments and/or deposits on pet’s bills. They are the frontline individuals dealing with finances and this can lead to some heated “conversations” and emotionally driven interactions, especially in emergency cases.
 
There are dozens of other responsibilities placed on receptionists, including filing, faxing, scheduling follow-up appointments, dispensing medications, fixing office equipment, and cleaning. These are typically considered the “practical” aspects of their job descriptions.
 
On the less technically tangible side are the receptionist’s obligations towards calming down anxious or irate clients, working alongside impatient doctors and technicians, and quite literally being emotionally and personally perfect and cheerful at all times.
 
Receptionists need to be able to accomplish these assignments even when they don’t feel like being particularly jovial or enthusiastic. They need to treat each owner individually and respectfully, even if the person they just spoke to on the phone berated them for charging inordinate prices or not providing them with urgent medical advice.
 
I’ve read that the job description for a veterinary receptionist requires no specific skill set and no experience. I would argue that for a receptionist to be successful, they need to possess excellent communication skills, advanced technological capabilities, and be able to multi-task without thinking too hard about it.
 
Additionally, they must possess attributes including kindness, compassion, patience, and like so many of us in the veterinary field, a thick skin to be able to deal with irate and emotional pet owners who sometimes forget to be polite.
 
I’ve always said I could never do the jobs that the front desk staff performs at my hospital, and I’m extremely grateful to work alongside competent and friendly staff members who toil away so enthusiastically at their responsibilities.
 
And I very much appreciate their ability to shield me from many of the typical daily tasks they so willingly take on in order to make my day flow as smoothly as possible.
 
 

Dr. Joanne Intile 
 
 
Image: aspen rock / Shutterstock
 
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TheOldBroad Staff 07/29/2015 07:14pm I've often said that I couldn't do their job due to all the things mentioned in the article.

People need to remember that the front desk staff doesn't set prices. Nor are they veterinarians.

Luckily, I've not encountered anyone that's grouchy, but always friendly and smiling (when it's appropriate).

The staff also ends up with the job of comforting those who are losing or just lost a pet, so they have to be good a sympathy/empathy. Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/drjintile/2015/july/praise-veterinary-receptionist-32920#comments TheDailyVet Wed, 29 Jul 2015 11:00:00 +0000 32920 at http://www.petmd.com
Why a Food Change Won't Keep Your Pet From Itching http://www.petmd.com/blogs/thedailyvet/ken-tudor/2015/july/why-food-change-wont-keep-your-pet-itching-32919







The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 28, 2015 Why a Food Change Won't Keep Your Pet From Itching by Dr. Ken Tudor








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Your pet itches and she is causing severe skin problems due to scratching. You suspect food is the cause. You go to the big-box pet store and peruse the brands that claim to “improve skin and coat quality” on the container label. This may be wrong for two reasons.
 
The first is that food is not a major cause of itching and skin disease in pets. Second is that a recent study of foods claiming to improve skin and coat quality do not offer advantages that might achieve that purpose. Let me explain.
 
Cutaneous Adverse Reactions to Food (CARF)
 
The leading cause of skin disease is bugs—fleas in particular. The second leading cause is environmental proteins. These can be tree, plant, or grass pollens, fungal spores, or dust from dead mites and other insects and microorganisms. Food is the last possibility.
 
Two recently published scientific surveys suggest that only 7.6-12 percent of allergic skin reactions can be attributed to food. Anecdotal accounts from some veterinary dermatologists indicate the possibility of skin allergic reactions to food as high as 25 percent.
 
The point of all of this information is that pet owners suspect food as the primary cause of allergic skin reactions, or cutaneous adverse reactions to food (CARF), when the reality is that the actual incidence is much lower.
 
Why do owners react this way? Incorrect internet information claiming the importance of food in allergic reactions is overwhelmingly available. Changing food brands is much cheaper than a veterinary exam. Owners also know that allergy testing for food is very inaccurate and that their veterinarians may not be very knowledgeable about nutrition.
 
So, why wouldn’t pet owners experiment without professional advice? A recent study suggests why owner experimentation may not be rewarding for improving skin and coat quality in their pets.
 
Study Findings
 
A group of veterinary nutritionists, including a colleague of mine, from Tufts University School of Veterinary Medicine, examined 24 over-the-counter (OTC) food brands that claim to help promote “skin and coat quality.” They examined the ingredients to determine if they would indeed help with skin disease caused by CARFs. The findings were quite interesting.
 
Novel ingredients — Veterinary dermatologist all agree that determining or diagnosing a CARF requires that a pet be fed proteins from meat or carbohydrates that it has unlikely experienced before; in other words, a novel protein. The list of most common allergenic foods (not novel) according to veterinary dermatologists is:

Beef
Dairy
Wheat
Egg
Chicken

 
Yet the study found that chicken and egg proteins were the most common ingredients found in pet foods claiming to improve skin and coat quality. The foods also included rice, potato, and oats, which are now found so commonly in pet foods that they have lost any novel status as carbohydrate sources.
 
Interestingly, the researchers found that most manufacturers of brands promoting skin and coat quality emphasized the lack of corn in their formulas, despite the fact that corn has not been proven by veterinary dermatologists to be a major allergen containing food.
 
Essential Fats — Proper amounts of dietary omega-3 and omega-6 fatty acids are necessary for optimum skin and coat quality. Yet less than a third of the food makers could provide the researchers with the exact amounts of omega-3 and omega-6 in their formulas.
 
Necessary Calories — Pet food is formulated so that all of the necessary daily nutrients are met if the pet consumes the proper amount of calories in the food formulation. 12.5 percent of the foods purporting skin health failed to meet the AAFCO standards for the caloric needs of pets.
 
This research and my other posts detailing the hazards of hypoallergenic diets should give you pause about commercial pet food as a viable alternative for your dog’s health. You might want to consider instead a quality homemade pet food program.
 
 

Dr. Ken Tudor 
 
 
Image: Jaromir Chalabala / Shutterstock
 
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TheOldBroad Vet Visits! 07/29/2015 07:07pm If Fido/Fluffy is itchy, a trip to the vet is the best way to begin the sleuthing.

Why people don't understand that, I can't imagine. Not to mention, the critter may not even eat the new food - especially if it's a cat. It would have been less expensive to start with the vet visit. Reply to this comment Report abuse 3
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http://www.petmd.com/blogs/thedailyvet/ken-tudor/2015/july/why-food-change-wont-keep-your-pet-itching-32919#comments TheDailyVet Tue, 28 Jul 2015 11:00:00 +0000 32919 at http://www.petmd.com
Reducing the Cost of Pet Meds? http://www.petmd.com/blogs/thedailyvet/dr-coates/2015/july/reducing-cost-pet-meds-32918









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 27, 2015 Reducing the Cost of Pet Meds? by Dr. Jennifer Coates








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The push to mandate that veterinarians provide portable prescriptions (prescriptions that can be filled by someone other than their veterinarian) appears to be moving forward.
 
The so-called Fairness to Pet Owners Act has been reintroduced in Congress. The bill basically requires that veterinarians:

Provide pet owners with copies of prescriptions whether or not they are requested

Provide copies of prescriptions or verify prescriptions if a pharmacy or person designated to act on behalf of the pet owner so requests

 
and that veterinarians do not:

Require that owners purchase animal drugs from the prescriber or any other particular person/retailer

Charge clients a fee for writing a prescription

Require a client to sign, or supply a client with, a liability disclaimer or waiver should the prescription be inaccurately filled

 
Additionally, the Federal Trade Commission (FTC) recently issued a report stating that the pet medications industry could potentially save owners money by becoming more competitive if:

Consumers had greater access to portable prescriptions

Non-veterinary retailers had greater access to supplies of pet medications, which are currently restricted by exclusive distribution and exclusive dealing arrangements put in place by manufacturers of pet medications

Consumers had more low-priced generic animal drug options to choose from

 
The Fairness to Pet Owners Act hasn’t gone anywhere in the past, but with the FTC commission unanimously (5-0) approving the issuance of their report, I wouldn’t be surprised if the bill passes in the next few years.
 
No profession likes new regulations, so it’s not surprising that, as a group, veterinarians are opposed to anything that mandates we provide written prescriptions. In accordance with American Veterinary Medical Association policies and many state laws, veterinarians should already be providing written prescriptions when asked. If a veterinarian ever gives you grief for asking for a portable prescription, take it as a sign that you should be looking for a new veterinarian!
 
Personally, I think the Fairness to Pet Owners Act is a solution to a problem that doesn’t really exist, and I suspect that it has more to do with appeasing big retailers/political donors than “fairness to pet owners.”
 
While I disagree with the need for obligatory portable prescriptions, I do think the FTC makes good points regarding the need for low-priced generic animal drugs and for retailers to have greater access to supplies of pet medications. Generics have the potential to save owners a lot of money, thereby improving their ability to provide pets with the medications they need.
 
The “exclusive distribution” arrangements that drug manufacturers claim to have with veterinarians are by and large a joke and have led to the process of diversion. Pet medication retailers buy “vet-exclusive” products from aggregators who have deals in place with veterinarians who purchase more than they need and pass it along.
 
The legality of this practice is up for debate but enforcement of vet-exclusivity is non-existent. Since everybody takes their cut, getting rid of all these middle men would do more to bring prices down for pet owners than requiring veterinarians to write prescriptions ever could.
 

Dr. Jennifer Coates
 
 
Image: Sari ONeal / Shutterstock
 
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TheOldBroad Politicians! Ack! 07/28/2015 06:56pm They're spending their time worrying about this (my vet doesn't hesitate to all in a script for my critters) instead of things like allowing people to break into cars to save a pet from heatstroke? Egads!

Seems like SOMEONE should be more worried about the critters. Reply to this comment Report abuse 1 TheOldBroad 07/28/2015 06:57pm Typo alert!

That should be "doesn't hesitate at all to write a script..." Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/dr-coates/2015/july/reducing-cost-pet-meds-32918#comments TheDailyVet Mon, 27 Jul 2015 11:00:00 +0000 32918 at http://www.petmd.com
Understanding Human Autism Through Dog Behavior http://www.petmd.com/blogs/thedailyvet/jvogelsang/2015/july/understanding-human-autism-through-dog-behavior-32913









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 23, 2015 Understanding Human Autism Through Dog Behavior by Dr. Jessica Vogelsang








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“Will this vaccine give my dog autism?”
 
I met the question, posed to me in 2004 at the height of the vaccine-children-autism controversy, with reassurance that although any vaccine has the potential for side effects, autism was not one of them. The pet received her boosters and did just great.
 
“Dogs don’t get autism at all, do they?” asked my technician.
 
“Not that I’ve ever heard of,” I said, and this was true until just this year.
 
The idea of using canine studies to model and better understand human disease is nothing new, but determining whether or not a pet has autism is a difficult thing to determine because, unlike something like diabetes, there is not a straightforward way to diagnose it.
 
Nonetheless, behaviorists have long observed obsessive-compulsive behaviors in specific breeds and noted the correlation with children with autism.
 
Dr. Nicholas Dodman, a renowned expert in animal behavior at Tufts, has been studying bull terriers, Doberman pinschers, and Jack Russell terriers for years and recently stated at the 2015 Veterinary Behavior Symposium that the genetic biomarkers for this behavior may be related to those found in people. In short, maybe dogs really can have autism.
 
All of these theories are well and good, but as we all know, veterinarians are sticklers for proof and until a little more research is done, this theory may be a tough sell.
 
Research dollars are scarce these days, and looking into the genetics of OCD behavior in Dobermans has been pretty low on the priority list, but that may be about to change.
 
The American Humane Association (AHA) recently teamed up with the nonprofit Translational Genomics Research Institute (TGen) to develop a study: Canines, Kids and Autism: Decoding Obsessive Behaviors in Canines and Autism in Children. The idea is that if we can identify a genetic basis for these behaviors in canines, we may unlock some clues to the mysteries surrounding autism in people.
 
Joining AHA and TGen are the Southwest Autism Research and Resource Center, Tufts University Cummings School of Veterinary Medicine, and the University of Massachusetts Medical School. Pretty lofty credentials for one tail-chasing bull terrier, wouldn’t you say?
 
I love seeing the way veterinary medicine and human medicine blur the line between species to better understand both. This is “One Health” at its finest.
 
Perhaps one day, “unlocking the key to autism” will be one more way dogs prove that they truly are man’s best friend.
 
 

Dr. Jessica Vogelsang
 
 
Image: Muh / Shutterstock
 
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TheOldBroad Breeds 07/23/2015 06:45pm It seems like some breeds are more prone to high-energy activity (think: terrier). Perhaps they have a hyperactivity gene?

Very interesting and I'll be anxious to hear more that you might post about this. Reply to this comment Report abuse 1
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http://www.petmd.com/blogs/thedailyvet/jvogelsang/2015/july/understanding-human-autism-through-dog-behavior-32913#comments TheDailyVet Thu, 23 Jul 2015 11:00:00 +0000 32913 at http://www.petmd.com
Focusing on the Big and Little Pictures in Pet Cancer Care http://www.petmd.com/blogs/thedailyvet/drjintile/2015/july/focusing-big-and-little-pictures-pet-cancer-care-32912









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 22, 2015 Focusing on the Big and Little Pictures in Pet Cancer Care by Dr. Joanne Intile








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There are two considerations I have before making treatment recommendations for patients diagnosed with what are known as “solid tumors” (i.e., those that develop in one tissue and can spread throughout the body).
 
The first is predicting how the tumor will behave in a localized sense, meaning directly at the same anatomical site where it began growing.
 
The second is anticipating the risk of metastasis (spread) to distant site(s) in the body.
 
This leaves me with several potential algorithms of outcome for any particular cancer:
 
1. A tumor that grows locally but has little potential for recurrence after removal and little chance for spread.
 
2. A tumor that grows locally and has a significant potential for recurrence after removal and little chance for spread.
 
3. A tumor that grows locally but has little potential for recurrence after removal and significant chance for spread
 
4. A tumor that grows locally and has significant potential for recurrence after removal and significant chance for spread.
 
Of each of those scenarios, it’s most challenging for owners to comprehend the recommendations made for treating tumors where there’s a high likelihood of regrowth after surgery and spread to distant sites in the body (#4).
 
For those cases, I try to clarify the muddy waters by emphasizing why it’s imperative to focus on both the “smaller” and the “bigger” pictures.
 
Addressing the smaller picture means we are dealing with the best way to control the local tumor itself. Examples of localized tumors include a skin growth, a bone tumor, or an intestinal mass.
 
The bigger picture entails assessing the patient for the presence of metastasis, either in the setting of “gross” disease (measurable tumors in other sites of the body), or “microscopic” disease (non-measurable tumor cells that we are nearly certain escaped from the primary tumor, but have not yet grown into anything we are able to visualize).
 
For tumors that require smaller and bigger picture treatments, ideally we obtain adequate local control over the primary tumor via aggressive surgery and/or radiation therapy and also administer systemic treatment (e.g., chemotherapy and/or immunotherapy) to address the metastatic disease.
 
The concept of combining localized and systemic treatments can be difficult for owners, owing to lack of access (radiation therapy is available only in select geographical areas), their own personal preference (not wanting to “put their pet through too much”), and most often finances (such combinations of treatments can easily run over $10,000 per pet).
 
When such limitations present themselves, I’m obligated to offer a different plan of action with the hope that I can find the “happy medium” that fits the needs of the owner and still affords their pet the best chance for long term survival.
 
Another complicating factor of the smaller/bigger picture tumor is that it’s difficult to predict how pets with tumors with both aggressive localized and metastatic potential might ultimately succumb to their disease.
 
People readily understand that cancer is a potentially fatal disease. However, the typical assumption is the end stages of disease will entail obvious outward signs of illness, weakness, loss of appetite, pain, etc. Though often true for tumors that spread around the body, however localized tumors can be equally problematic, and ultimately life limiting for that animal.
 
A cat with an oral mass will still be bright and happy and purr and sleep in its favorite spot in the house. But it will eventually stop attempting to eat because it becomes too painful to ingest food.
 
A dog with a tumor in its urinary bladder will continue to wag its tail, ask to go for walks, eat its meals, and lie on the couch with its owners, but it will constantly painfully strain to urinate, have accidents in the home, and produce a bloody urine stream.
 
Whether keeping my sight short on issues related to the smaller picture of local disease or focusing on the bigger picture potential for distant spread, I have to keep an open mind regarding the health of my patients, and treat them as a whole rather than a series of specific symptoms.
 
This is true for making recommendations for the ideal way to treat their cancer from the time of diagnosis to the delicate treatment approach to their final days or weeks of life, and for all the days of their care in between.
 
As always, communication is the most important aspect of managing these patients in order to ensure everyone’s expectations are met. That way I can guarantee the short and long-term pictures remain as clear as possible during the journey we embark upon when treating a pet with cancer.
 
 

Dr. Joanne Intile
 
 
Image: Ivonne Wierink / Shutterstock
 
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TheOldBroad And Then There Is Me 07/22/2015 06:11pm And then there are people like me who will do whatever is necessary to provide a quality of life. I can't imagine saying to Fluffy, "I'm sorry. We're euthanizing you because I'm not going to pay for treatment." I've been known to max out credit cards when necessary. Reply to this comment Report abuse 3mutts 07/31/2015 12:44pm Me too. I just blew a very large chunk of change on Cyberknife radiation therapy for my dog's nerve sheath tumor. I used to have a decent credit rating. Reply to this comment Report abuse 1
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http://www.petmd.com/blogs/thedailyvet/drjintile/2015/july/focusing-big-and-little-pictures-pet-cancer-care-32912#comments TheDailyVet Wed, 22 Jul 2015 11:00:00 +0000 32912 at http://www.petmd.com
Coconut Oil: The Over-Hyped 'Super Food' for Pets http://www.petmd.com/blogs/thedailyvet/ken-tudor/2015/july/coconut-oil-over-hyped-super-food-pets-32910









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 21, 2015 Coconut Oil: The Over-Hyped 'Super Food' for Pets by Dr. Ken Tudor








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Have you caught the coconut oil super food bug yet? With television celebrity Dr. Oz cheerleading for the wonders of coconut oil, pet owners are anxious to add it to their pet’s commercial food diet or use it as the sole source of fat in their pet’s homemade dog food diets.
 
And why not? According to Dr. Oz it cures bacterial, viral, and fungal infections, promotes weight loss, promotes “good cholesterol,” and improves the mental skills of Alzheimer’s patients. He stops short of coconut oil getting rid of unwanted facial hair and unwanted house guests, but the implication is that anything is possible.
 
But coconut oil is not a “super food,” and including in your pet’s diet is probably a recipe for disaster at many levels.
 
Suggested Benefits of Coconut Oil*
 

Increases metabolism and promotes weight loss

“The fats in coconut oil are called medium-chain triglycerides or MCT. MCT are believed to be the reason for coconut oil’s health benefits. MCT are burned by the liver for energy so they do not add to body fat. MCT also produces chemicals called ketones. Some scientific studies suggest that ketones suppress appetite and calorie intake. Together these effects can aid in weight loss.”

Kills bacteria, viruses, and fungi

Half of the fats in coconut oil are called lauric acid. In laboratory experiments, lauric acid kills some bacteria, viruses, and fungi.  

Increases “good cholesterol” blood levels

Coconut oil increases the blood levels of HDL, or “good” cholesterol. People with high blood levels of HDL have a lower risk of heart attacks and other heart diseases.  

Treatment for Alzheimer’s and Geriatric Cognitive Disorders

Memory loss in Alzheimer’s patient is thought to be due to the brain’s decreased ability to use sugar, or glucose, for energy. The ketones produced by MCT are an energy substitute for brain sugar. Some patients have shown improved mental function after adding coconut oil to their diet.
 
All of this sounds quit impressive, but what are the realities?
 
Deficiencies of Coconut Oil
 

Does not provide daily fat requirements for dogs

To meet the daily fat needs of dogs, every 1,000 calories (kilocalories, actually) needs to contain 2,700 mg of the omega-6 fat called linoleic acid, and 107 mg of the omega-3 fat called alpha-linolenic acid. Coconut oil contains only 243 mg of an undifferentiated form of linoleic acid. That undifferentiated form need to be converted by the body to linoleic acid. Fat conversion is the least efficient metabolic process in the body of mammals. How much of this woefully deficient amount of omega-6 is converted to linoleic acid is dependent on the sex, age, and medical condition of the pet.
 
In other words, coconut oil brings nothing to the party with regards to essential fatty acids.
 

Does not protect against bacteria, viruses, or fungi

Although lauric acid kills germs in laboratory culture dishes in amounts greater than can be consumed, research has not shown that coconut oil protects humans or animals from infection at normal amounts of consumption.
 

It also raise the blood levels of “bad cholesterol”

In addition to raising the levels of HDLs, or “good cholesterol,” in the blood, coconut oil also increases the blood levels of LDLs, or “bad cholesterol.” Fortunately this is not a problem for pets since cholesterol is not a factor in their heart disease. But it does demonstrate the misinformation associated with the benefits of coconut oil and heart disease.
 

Negative for Alzheimer’s Disease

Geriatric cognitive disorders, or dementia, are very similar to Alzheimer’s and is a real disorder in pets. That cat that howls for no reason at night or the dog that stares at the wall and seems confused are suffering from an Alzheimer’s-like brain change. It seems reasonable that a diet that increased ketones could help these pets. But guess what?
 
The bottom line is that coconut oil adds 120 calories for every tablespoon without adding any appreciable nutritional value. Adding it to a commercial diet is adding unneeded fat calories, much like an unnecessary treat. And it is certainly a recipe for fat malnutrition for those using it exclusively in their pets' homemade diets. How is this a “super food"? 
 
 

Dr. Ken Tudor
 
 
Image: Thinkstock
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TheOldBroad Popcorn! 07/21/2015 06:34pm If I remember correctly, coconut butter used to be what we got on popcorn at the movies. Maybe it still is.

And it's not at all good for you, is it? Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/ken-tudor/2015/july/coconut-oil-over-hyped-super-food-pets-32910#comments TheDailyVet Tue, 21 Jul 2015 11:00:00 +0000 32910 at http://www.petmd.com
Reconsidering Universal Spay and Neuter for Dogs http://www.petmd.com/blogs/thedailyvet/dr-coates/2015/july/what-are-risks-spay-and-neuter-dogs-32909









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 20, 2015 Reconsidering Universal Spay and Neuter for Dogs by Dr. Jennifer Coates








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Recommending whether or not to spay or neuter my canine patients used to be as close to a “no brainer” as it got in veterinary medicine. Unless an owner had plans to show and/or breed their pet, I recommended surgery. Of course, owners were perfectly within their rights to ignore my recommendation, but I was confident that after balancing out the risks and benefits, spays and neuters were ultimately in the pet’s, owner’s, and community’s best interests.
 
But over the last few years, new research has brought some previously unidentified risks associated with the surgeries to our attention. Should veterinarians and owners rethink our approach to spays and neuters? That is the question that a new video entitled Canine Gonadectomy, A Roundtable Discussion attempts to answer.
 
The roundtable and video were a joint venture between the American Veterinary Medical Association, American Animal Hospital Association, and Coral Spring Animal Hospital in Coral Springs, FL. The event “brought together a primary care practitioner and board-certified veterinarians in behavior, internal medicine, surgery and oncology to discuss the benefits and risks of gonadectomy in dogs.”
 
I’ve put together a summary of the information presented in the video, but I strongly recommend that anyone interested in this topic watch it in its entirety. The details that I had to omit (e.g., the timing of the surgeries) should be both fascinating and significant to anyone struggling with the decision of whether or not to spay/neuter their dog.
 
Firstly, several of the veterinarians involved in the roundtable made the point that their comments only apply to owned animals, not to the situation faced by animal shelters. With that taken care of, let’s move on to an outline of the benefits and risks associated with spays and neuters presented in the video.
 

(Click to enlarge)
 

(Click to enlarge)
 
It’s awfully hard to balance out all of these risks and benefits, but a big study in 2013 looked at the bottom line (life expectancy) and found that spayed/neutered dogs lived longer than those who were not spayed and neutered.
 
I still think that current research supports the idea that spaying and neutering is in the best interests of most dogs, but I am now approaching this decision on a more case-by-case basis than I did in the past. Take a closer look at the roundtable video to see why.
 
 

Dr. Jennifer Coates
 
 
Image: Kelly vanDellen / Shutterstock
 
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TheOldBroad HHmmmmm 07/20/2015 06:18pm I didn't see anything about the increased risk of Fido trying to escape to have a "date" and possibly resulting in pregnancy. Reply to this comment Report abuse 1
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Controversial Reality TV Veterinarians Do Nothing to Help the Profession http://www.petmd.com/blogs/thedailyvet/jvogelsang/2015/july/controversial-reality-tv-veterinarians-do-nothing-help-profes









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 16, 2015 Controversial Reality TV Veterinarians Do Nothing to Help the Profession by Dr. Jessica Vogelsang








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Another day, another veterinarian reality TV show. I don’t know why Animal Planet loves Denver so much, but their latest reality offering, “Dr. Jeff: Rocky Mountain Vet,” premieres on Saturday, and a bunch of us are already cringing at how this one is going to play out.
 
Dr. Jeff is a veterinarian in the Denver area who runs a low-cost spay/neuter practice. I haven’t seen it yet, so I can’t write it off without giving it a chance, but the fact that he was chosen for being a self-described “controversial pariah” doesn’t bode well. As far as I can gather, he’s so far managed to offend the following groups:

breeders
oncologists
owners who dress up their animals and refer to them as family
veterinarians who try and make a livable wage

 
Although I’m trying to keep an open mind, the Dr. Jeff show is brought to us by the same media company who brings us “Hippo Hunters,” as well as “Fat Girls and Feeders,” so I admit I don’t have the highest of hopes.
 
It’s not what he does that worries me; it’s what he says, which is of course why they cast him, I’m sure. I’m all for spay/neuter, all for veterinarians who choose to dedicate their careers to doing low cost services, but I’m also all for veterinarians who choose to dedicate their lives to providing cutting edge medicine to those who want it. It’s not an either/or thing.
 
Rather than call veterinarians who are trying to improve the quality of care for veterinary patients money-hungry, I prefer to thank them for moving us past the days where we immobilized reptiles for surgery by sticking them in the freezer and considered pets writhing in pain post-surgery as “nice and awake.” While I agree that not every pet and client can or should pursue costly high-tech procedures for every ailment, the options are there, and that is not a bad thing.
 
It’s the same stuff that pops up with shows like Dr. Pol. Controversy drives ratings, and every time a person protests about a questionable action on camera, tons more fans come out of the woodwork to defend him. The more people are fighting, the more people are paying attention, and that drives more people to the show, so I anticipate this new show will be just as migraine-inducing.
 
Controversy and fist-waving does nothing, however, to drive amicable conversations about the thorny issues that won’t be resolved without a little more finesse: access to care, finances, the balance between resources, and expensive medical care. A measured discussion with no yelling about those issues, while helpful, would be much less entertaining, so it won’t be on TV.
 
I guess what I’m getting at here is just a reminder, on the dawn of this new show, to please look at it less like a documentary and more like what it really is: a highly produced piece of entertainment.
 
While this new star may be very fun to watch, by the nature of the beast he’s probably also going to be just off his rocker enough to get people worked up, for better or for worse. At the end of the day it will likely bear as much resemblance to real-life veterinary medicine as “Survivor” does to summer camp.
 
 

Dr. Jessica Vogelsang
 
 
Image: Composite: Javier Brosch and Minerva Studio / Shutterstock
 
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TheOldBroad Animal Planet 07/17/2015 06:42pm Makes me glad I don't have Animal Planet in my cable package. I'd probably watch and get all worked up.

I will confess to watching "Dr. Chris Pet Vet" (an Aussie TV vet) on CBS. It's a teensy unrealistic because rarely are sad outcomes shown. I enjoy the medicine part and wish there was more clinical stuff.

Reply to this comment Report abuse BusterB 07/23/2015 05:11pm Seriously? Reply to this comment Report abuse Cathy4330 I find it refreshing 07/31/2015 09:48am I find it refreshing to watch DR.Jeff. He helps some that have no money, yet does surgery to save a dogs life, when this dog is all these women have. I think his stand on Spay /Neuter should be commended. He also travels to places where they need a vet. I do not see our vets doing these things, so why belittle him? I also find DR Pol delightful. yes he is outdated in some of his things he does, but they work, and cost less money. I think they are entertainment shows, but I also learn something everytime I watch them. Reply to this comment Report abuse 2 froggie.blue01 Are you kidding me!! 07/31/2015 11:37am Let's talk about how many animals are put down every year because their owners can't afford the high cost of Vet care.
To suggest that we should pay more because the Vet has more humane ways of treating our animals now is ridiculous.
I applaud Dr Jeff because he is a true Vet he cares about his patients and also there owners, he is not strictly money driven. How can you condemn anyone for that.
If he brings to light the exorbitant fees and over treatment of our pets then so be it. Reply to this comment Report abuse 3 chucklesg Prejudging is like a bad 07/31/2015 01:16pm diagnosis.

When you criticize something you have not even seen, you are not acting as a professional. Granted most TV is bad these days, but the vet shows I watch all seem to have more compassion that the high priced vets I know. Reply to this comment Report abuse 2
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http://www.petmd.com/blogs/thedailyvet/jvogelsang/2015/july/controversial-reality-tv-veterinarians-do-nothing-help-profes#comments TheDailyVet Thu, 16 Jul 2015 11:00:00 +0000 32904 at http://www.petmd.com
When Treating Pet's Cancer, How Much is Too Much? http://www.petmd.com/blogs/thedailyvet/drjintile/2015/july/when-treating-pets-cancer-how-much-too-much-32903







The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 15, 2015 When Treating Pet's Cancer, How Much is Too Much? by Dr. Joanne Intile








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I regularly face owners who decide not to pursue therapy for pets that have what are considered treatable cancers. The reasons for this choice can stem from concerns for too many vet visits, too much strain for the pet to go through, projection of their own feelings about cancer treatments on their pets, or financial limitations.
 
Over the course of my career, it hasn’t become any easier to be on the receiving end of those appointments. I want to help all pets with cancer and I want all animals to be afforded the opportunity to undergo the ideal plan to afford them the best chance of survival. Logically, I know this isn’t a realistic expectation. But it’s an accepted part of my job, and it forces me to remain open-minded about my professional goals.
 
Consider the opposite scenario. Those owners who want to do everything for pets that have been diagnosed with a form of cancer that has no known beneficial therapeutic option, or where we’ve run out of choices with any realistic expectation of helping them fight their disease. Those cases create a different sense of anxiety for my soul.
 
Practically, this translates into a scenario where the “frontline” therapy fails to keep a patient cancer-free, yet they remain relatively asymptomatic for their condition. I need to be prepared with a back up plan. In those cases, most owners want to know what else can be done to help maintain their pets' quality of life.
 
My goal as a veterinarian is to make all decisions about my patient’s care using evidence-based information. I want to be sure the recommendations I present are medically sound and proven to be of a benefit.
 
Unfortunately, evidence based information is severely lacking in veterinary oncology and a startling amount of choices are made using simple inferences, experience, and logic.
 
The good news is that the more common cancers (e.g., lymphoma, osteosarcoma, mast cell tumors) do actually have fairly specific preliminary treatment algorithms. Different oncologists will offer subtle variations on the same theme, but for the most part we agree on the same initial plan of attack.
 
What many owners find confusing is that once we’ve moved past the primary recommendation, there are usually no universally agreed upon “next best” options amongst our oncology community. Just because I possess solid research-based information about how to treat one disease at the onset does not mean there’s enough evidence to support what the next best plan of action could be. The same is true for those cancers with no accepted initial standard of care. For those cases, we just face the confusion a bit earlier on in the plan.
 
Using an example of a dog with lymphoma, oncologists typically endorse a multi-drug injectable chemotherapy protocol that lasts about 6 months in duration. This plan offers the average patient about 1 – 2 years of survival. Many owners are willing to pursue this plan because of the low chance of side effects and the ability to maintain an excellent quality of life well beyond the treatment period.
 
However, despite being considered our most valuable and effective protocol, 95% percent of dogs with lymphoma are not cured with this plan. Therefore, more often than not, I need to be prepared to offer owners “something else” to help their pet when the cancer resurfaces.
 
There are numerous “rescue” protocols for such cases. In actuality, few owners are willing to try such second and third line protocols for their dogs with cancer. Many times they perceive the disease relapse as the real indicator that their pet truly has a fatal disease. Other times, a myriad of emotional, physical, financial, and ethical considerations factor in to the decision making process.
 
The most difficult scenario occurs when pets are asymptomatic for their disease and I have no suitable options to help them battle their disease. It may seem counterintuitive to feel frustrated at not being able to make an animal that already feels good any different, but it’s a core part of my work.
 
I want to be able to keep trying to help pets with cancer, not only for their owner’s sake, but also for their own happiness and well being. Even when a diagnosis of a cancer known to be 100% fatal is on the table, if the animal feels good, and the owners are happy with it’s quality of life, then I am always willing to try to come up with an alternative plan.
 
Sometimes it’s because I want to be able to give owners some form of hope. Other times it’s because I want to try a new therapy or idea and see if it can help. Mostly it’s because I want to be able to kick a patient’s cancer down as much as possible.
 
I can appreciate how owners might read my honesty as lack of experience, or “hedging” on telling them how we should proceed. Most people I meet prefer the simpler approach to treating their pets' cancer. They want me to make a recommendation they can agree, or not agree, to follow.
 
The most important point I can make in any of these scenarios is that “just because we can, doesn’t mean we should.” This is the phrase I tell all owners when making such difficult choices about their pet’s cancer care.
 
It’s how I remind everyone involved in the decision making process to keep the right perspective and to make sure we truly first do no harm.
 
 

Dr. Joanne Intile
 
 
Image: Byelikova Oksana / Shutterstock
 
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TheOldBroad Cancer Kitties 07/15/2015 06:48pm I currently have two cancer kitties and I know that eventually the cancer will force me to make difficult decisions.

I've been through it before. :-(

As long as they have a good quality of life (other than the 30 seconds a day it takes to give them a pill and a clinic visit every week or two), I'm perfectly content to follow doctor's orders.

Neither kitty had overt symptoms. The cancer was diagnosed because the regular vet is awesomely astute and observant. Fingers crossed we found the cancers early which will give them a longer survival time.

However, since neither has ever really shown symptoms, it will be difficult to determine in or out of remission without testing such as scopes.

The previous kitty with lymphocytic lymphoma came out of remission and was still happy for quite awhile. Unfortunately, there wasn't a "backup" plan.

Bless his heart. He wasn't the sharpest pencil in the box. I really think he thought all the pills, pokes and prods were individual attention, but honestly, I'm happy with that. Reply to this comment Report abuse
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That Refreshing Water Could Be Hiding a Killer http://www.petmd.com/blogs/thedailyvet/ken-tudor/2015/july/refreshing-water-could-be-hiding-killer-32900
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'Violently Toxic' Plant to Blame for Colorado Dog's Sudden Death http://www.petmd.com/blogs/thedailyvet/dr-coates/2015/july/violently-toxic-plant-blame-colorado-dogs-sudden-death-32899











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TheOldBroad Snacking 07/14/2015 07:51pm It would also seem prudent to keep Fido from snacking on anything when out playing or out for a walk. Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/dr-coates/2015/july/violently-toxic-plant-blame-colorado-dogs-sudden-death-32899#comments TheDailyVet Mon, 13 Jul 2015 11:00:00 +0000 32899 at http://www.petmd.com
Read Excerpts from Dr. Jessica Vogelsang's Memoir, 'All Dog's Go To Kevin' http://www.petmd.com/blogs/thedailyvet/jvogelsang/2015/july/read-excerpts-dr-jessica-vogelsangs-memoir-all-dogs-go-kevin-3-32896









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 09, 2015 Read Excerpts from Dr. Jessica Vogelsang's Memoir, 'All Dog's Go To Kevin' by Dr. Jessica Vogelsang








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This week we're reading Dr. Vogelsang's new memoir, All Dogs Go To Kevin, and thought you might enjoy reading some of it, too. It is scheduled for release on July 14th, but is available for pre-order now. You can find out more about where you can order here at the publisher's site. 
 
In the meantime, join us in reading some excerpts from her memoir, and please help us to congratulate Dr. V on her first book by leaving a comment. 
 
-------
 

 
Chapter 17
 
I have long held the opinion that crummy medicine is most often a by-product of crummy communication. While some veterinarians may simply be poor at the task of diagnosing disease, the vast majority of veterinarians I’ve known are excellent clinicians, regardless of their personality. More often than not we are failing not in our medicine but in relaying to our clients, in clear and concise terms, the benefit of what it is we are recommending. Or even what we are recommending, period. Muffy was a patient I hadn’t seen before, a one-​year-​old Shih Tzu who presented to the clinic for sneezing spasms. They had started suddenly, according to the client, Mrs. Townsend.
 
“So he doesn’t have a history of these episodes?” I asked.
 
“I don’t know,” she replied. “I’m just dog-​sitting for my daughter.”
 
As we spoke, Muffy began sneezing again— achoo achoo aCHOO! Seven times in a row. She paused, shaking her fuzzy little white head, and pawed at her snout.
 
“Was she outside before this happened?” I asked.
 
“Yes,” Mrs. Townsend said. “She was out with me for a couple of hours this morning while I was weeding the garden.”
 
Immediately my mind jumped to foxtails, a particularly pervasive type of grass awn found in our region. During the summer months, they have a nasty habit of embedding themselves in all sorts of locations on a dog: ears, feet, eyelids, gums, and yes, up the nose. Working like a one-​way spearhead, these barbed plant materials are known for puncturing skin and wreaking havoc inside the body. It’s best to get them out as quickly as possible.
 
Unfortunately, due to the nature of the little barbs on the seed, foxtails don’t fall out on their own—you have to remove them. Sometimes, if you’re lucky, you can pull one out of the ear canal while a pet is awake, but noses are a different story.
 
Unsurprisingly, the average dog has no interest in holding still while you slide a well-​lubricated pair of alligator forceps up his or her nose to go fishing for foxtails in their sensitive sinuses. And it’s dangerous—if they jerk at the wrong moment, you are holding a piece of sharp metal one layer of bone away from their brain. The standard nose treasure hunt in our clinic involved general anesthesia, an otoscope cone functioning as a speculum to hold the nares open, and a smidgen of prayer.
 
I explained all of this as best I could to Mrs. Townsend, who eyed me distrustfully from behind her cat-​eye glasses, blinking as I told her about the anesthesia.
 
“Can’t you just try without the anesthesia?” she asked.
 
“Unfortunately, no,” I said. “It would be impossible to get this long piece of metal up her nose safely without it. Her nostrils are very small and it would be very uncomfortable for her, so she wouldn’t hold still.”
 
“I need to talk to my daughter before we do that,” she said.
 
“I understand. Before we anesthetize her, we do need your daughter’s consent.”
 
Muffy left with Mrs. Townsend and a copy of the estimate. I was hoping to have them back in that afternoon so we could help the dog as quickly as possible, but they didn’t return.
 
The next day, Mary-​Kate scurried into the back and came trotting toward me, loud voices pouring into the treatment area as the door swung shut behind her.
 
“Muffy’s owner is here,” she said. “And she’s MAAAAAD.”
 
I sighed. “Put her in Room 2.”
 
Like a game of telephone, trying to communicate what’s going on with a dog who can’t talk to owners who weren’t there via a pet-sitter who misheard you is bound to cause one or two misunderstandings. When Mrs. Townsend relayed her interpretation of my diagnosis to her daughter, the daughter rushed home from work and took Muffy to her regular veterinarian, who promptly anesthetized the dog and removed the foxtail.
 
“My vet said you are terrible,” said Muffy’s owner without preamble. “Didn’t you know foxtails can go into the brain? You nearly killed her!” Her voice reached a crescendo.
 
“I think there might be a misunderstanding here. I wanted to remove it,” I told her.
 
“The pet-​sitter—it was your mother, correct? She said she needed to talk to you before approving the estimate.”
 
“That’s not what she said,” replied the owner. “She said that you said there was no way a foxtail would fit up there and we should put her to sleep. Well there was one up there! You were wrong and you almost put her to sleep because of it!”
 
I took a slow inhale and reminded myself not to sigh. “What I told your mother,” I said, “was that I thought Muffy had a foxtail, but there was no way I was going to be able to remove it without anesthesia. So I gave her an estimate for all of that.”
 
“Are you calling my mother a liar?” she demanded. This was not going well.
 
“No,” I said, “I just think that she may have misheard me.”
 
“OK, so now you’re saying she’s stupid.” I silently prayed for a fire alarm to go off, or an earthquake to rumble though. The waves of indignant anger pulsing from this woman were pressing me farther and farther into the corner and there was no escape.
 
“No, absolutely not,” I said. “I think maybe I just didn’t explain myself well enough.” I pulled the record up on the computer and showed her. “See? She declined the anesthesia.”
 
She thought about it for a minute and decided she still wanted to be mad. “You suck and I want a refund for the visit.” We provided it gladly.
 
 
Chapter 20
 
He was right. Kekoa was shaped more like a cartoonist’s exaggerated rendition of a goofy Lab than an actual Labrador.
 
Her head was disproportionately small, and her wide barrel chest was supported by four spindly legs. The total effect was that of an overinflated balloon. But we didn’t choose her for her aesthetics.
 
When she would lumber over and plop on my feet, her skinny tail smacking into the wall with such force you’d think someone was cracking a whip on the drywall, she never seemed to notice. Such was her excitement that she paced from foot to foot as she stood near me, massive, looming, and then with the gentlest motion eased her tiny head into my hands and covered them with kisses. I tried to push her head away when I’d had enough, but then she kissed that hand too, so eventually I just gave up. Her tail never stopped wagging the entire time. I’d fallen in love.
 
Whenever the kids stretched out on the floor, Kekoa scurried over, thump-​thump-​thump, and hovered over them like the Blob. She melted onto them, all tongue and fur, dissolving into a puddle of their delighted giggles. After wedging herself in between Zach and Zoe, scooting her hips back and forth to make room, she’d contentedly roll onto her back, kick her legs up in the air, and occasionally let out a small fart.
 
We left the windows open and tolerated the occasional poor photograph, because, well, no one ever said My dog’s photogenic qualities make me feel so cozy and loved.
 
We bought one of those really expensive vacuums, because fur tumbleweeds skittering across the floor is a small price to pay for the comforting pressure of a happy dog leaning into you for butt scratches. And we kept plenty of paper towels and hand sanitizer around because as gross as a string of sticky saliva is on your forearm, it was utterly charming to be so loved that Kekoa could quite literally just eat you up.
 
This complete and probably undeserved adoration of human companionship came with a heavy price tag, however. Kekoa would very much have loved to have been one of those four-pound pocket dogs one could carry effortlessly into the mall, the post office, and work, a permanent barnacle on those she loved best. Sadly, as a seventy-pound sphere of gas, fur, and saliva, there were many occasions when she had to remain at home by herself, and each and every time we left she mourned deeply, as if we were heading off for a long deployment and not a two-minute trip to the 7‑Eleven.
 
When she was stuck with no one but the cat to keep her company, she funneled her pain, anxiety, and deep, pervasive grief into “music.” She sang a song of misery, a piercing wail of heartbreaking angst that shattered glass and the sanity of those near enough to hear it on a regular basis. The first time I heard her howling, I paused in the driveway and looked out the window to see which direction the approaching ambulance was coming from. The second time, I thought a pack of coyotes had broken into the house. The third time, only day seven of her life with us, Brian and I stepped out to say hello to a neighbor and heard her ballad of woe through our open front window. BaWOOOOOOOOOOOOOOO! OOO!
 
ArrrrrroooooOOOOOOoooooooo! So this was why she had lost her last home.
 
“Is she sad?” asked the neighbor.
 
“I think she misses us,” I said, then, gingerly, “Can you hear this from inside your house?” Thankfully, they shook their heads no.
 
“Well, at least she doesn’t do it while we’re home,” I said to Brian as he grimaced in the direction of the house. “And she’s not destructive!”
 
The next day, I came home after taking the kids to school and pulled into the driveway, listening intently for the song of the sad. It was blessedly quiet. I opened the front door, and Kekoa came skittering around the corner excitedly, knocking the cat aside in her exhilaration.
 
“Hi, Kekoa,” I said, reaching down to pat her. “Did you miss me the fifteen minutes I was gone?”
 
When I removed my hand from her head, I noticed my fingers were coated in a sticky substance. I looked down at her, innocently wagging her tail with a sheen of white powder stuck to her nose, the edges of her lips, and, when I looked down, her paws. Wondering why my dog suddenly looked like Al Pacino after a coke binge in Scarface, I went around the corner and saw the pantry door ajar. A mostly empty cardboard box of powdered sugar, chewed to a barely recognizable state, lay forlornly on the kitchen floor, massacred in an exsanguination of white powder. I looked at Kekoa. She looked back.
 
“Kekoa,” I said. She wagged her tail.
 
“KeKOA,” I said again, sternly. She plopped down on the pile of powdered sugar and continued to wag at me, licking the sticky sugar paste on her nose. It took me the better part of two hours, mopping and grumbling, to get that mess cleaned up.
 
The next day, I made sure I pulled the pantry door shut before taking the kids to school. This time when I returned, the house was quiet yet again. Maybe she just needed some time to adjust, I thought, opening the door. No Kekoa. See how calm she is? We’re getting there, thank God.
 
“Kekoa!” I called again. Nothing. The cat wandered around the corner, gave me an indifferent flick of the tail, and glided back over to the windowsill.
 
Perplexed, I walked around the bottom floor, winding up again in the kitchen. There was the pantry door, still shut.
 
“Kekoa?” I called. “Where are you?”
 
Then I heard it, the quiet thump-​thump-​thump of a tail whacking a door. The sound was coming from inside the pantry. I pulled the door open and out she tumbled, a pile of wrappers, boxes, and crackers falling out behind her in a landslide across the freshly mopped floor. She immediately ran over to the other side of the kitchen island and peeked back at me, her tail nervously swishing from side to side, Goldfish crumbs spraying with each shake.
 
I was so confused I couldn’t even get upset. How the heck did she do that? She must have pushed the handle down with her nose, wedged herself into the pantry, and accidentally knocked the door shut behind her with her rear end. In her combination of fear and elation, she had devoured almost every edible item on the bottom three shelves. Fortunately most of the items were canned foods, but there was still plenty of carnage. Half a loaf of bread. A bag of peanuts. Pretzels.
 
I scanned the bags, from which she had expertly extracted the edible bits, for signs of toxic food items and to my relief found no chocolate wrappers or sugar-​free gum, two things that might have added “emergency run to the clinic” to my already packed to‑do list.
 
Peering back in, I noticed a bunch of bananas nestled among the cans of beans and soup, the sole survivor of the slaughter. Apparently, peeling them was too much work. Surveying the disaster before me, I tried to figure out what I was going to do. That afternoon, my son looked at me thoughtfully and asked, “Why doesn’t Koa go to preschool if she gets so lonely?”
 
It was a good idea. I debated the merits of leaving her at home to work it out or taking her in to work with me. Our office shared a building with a doggy day-​care facility, so my first experiment involved a trial day there. I reasoned she would enjoy being with a group more than she would sitting by herself, surrounded by equally anxious dogs and cats in cages. The day care promised to put her in a room with the other big dogs and give her lots of love.
 
I walked over at lunch and peered in the window to see how she was doing. I surveyed the room, where bouncing Weimaraners tugged on chew toys and Golden Retrievers trotted back and forth with tennis balls. Wagging tails, relaxed eyes. After scanning for a minute, I picked out a black bucket in the corner I had assumed was a trash can. It was Kekoa, hunched down motionlessly, staring mournfully at the door. The attendant walked over and held out a ball, which she ignored. Maybe she’s just tired from all the fun she had this morning, I reasoned.
 
When I picked her up after work, the daily report card indicated that Kekoa had spent the entire eight-​hour period in that exact position. “She seemed a little sad,” the note said in looping cursive, “but we loved having her. Maybe she’ll get used to us in time.”
 
The following day I decided to try bringing her directly into work instead. She immediately wedged herself under the stool by my feet, a space about an inch too short for her girth.
 
Good, I thought. In the time it takes her to wiggle out I can run into an exam room before she follows me.
 
Susan handed me the file for Room 1. I looked at the presenting complaint. “Dog exploded in living room but is much better now.”
 
“I hope this is referring to diarrhea, because if not we’ve just witnessed a miracle.”
 
“No need. It’s diarrhea.”
 
I popped up and ran into Room 1 to investigate the gut grenade incident before Kekoa realized I was taking off.
 
About two minutes into the appointment, I heard a small whine from the back hallway. Ooooooo—ooooooo.
 
It was soft, Kekoa whispering a song of abandonment to the empty corridor. The pet owners didn’t hear it, at first. The whimpers were drowned out by the gurgling in Tank’s belly.
 
“Then we gave him a bratwurst yesterday and—did I hear a baby or something?”
 
“Oh, you know the vet clinic,” I said. “There’s always someone making noise.”
 
“So anyway, I told Marie to leave the spicy mustard off but— is that dog OK?”
 
AoooOOoOOOOOOOOoooOOOOOOO. Now Kekoa was getting angry. I heard her claws scratching at the door.
 
“She’s fine,” I said. “Excuse me a moment.”
 
I poked my head out the door. “Manny?”
 
“Got it,” he said, jogging around the corner with a nylon leash in his hand. “Come on, Koa.”
 
“I’m so sorry,” I said, returning to Tank. I prodded his generous belly to see if he was in pain and if anything seemed swollen or out of place. “When was the last time he had diarrhea?”
 
“Last night,” the owner said. “But it was this weird green color and—”
 
He paused, furrowing his eyebrow as he looked at the back door.
 
A small yellow puddle of pee was seeping under the door, widening into a lake as it pooled toward my shoes.
 
“I’m so sorry,” I said, pulling out paper towels and wadding them under the door with my foot. I heard footsteps, and Manny muttering to Kekoa. “That’s my dog, and she is really upset I’m in here with you and not out there with her.”
 
Tank’s owner laughed. “Tank’s the same way,” he said.
 
“He ate a couch last year when we left him alone during the Fourth of July.”
 
“A couch?” I asked.
 
“A couch,” he affirmed, pulling out his cell phone for the photographic proof. He wasn’t kidding.
 
 
 
Excerpted from the book ALL DOGS GO TO KEVIN by Jessica Vogelsang. © 2015 by Jessica Vogelsang, DVM. Reprinted by permission of Grand Central Publishing. All rights reserved.
 
 
Image: Jaromir Chalabala / Shutterstock
 
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TheOldBroad Congrats!!! 07/10/2015 07:09pm i thoroughly enjoyed the excepts today and an dying to know if Kekoa ever got over her separation anxiety.

And... congratulations on your new book! Reply to this comment Report abuse 3
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http://www.petmd.com/blogs/thedailyvet/jvogelsang/2015/july/read-excerpts-dr-jessica-vogelsangs-memoir-all-dogs-go-kevin-3-32896#comments TheDailyVet Thu, 09 Jul 2015 11:00:00 +0000 32896 at http://www.petmd.com
There is No Easy Test for Finding Cancer in Pets http://www.petmd.com/blogs/thedailyvet/drjintile/2015/july/there-no-easy-test-finding-cancer-pets-32894









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 08, 2015 There is No Easy Test for Finding Cancer in Pets by Dr. Joanne Intile








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“Isn't there a blood test you can do that will tell you if it’s cancer or not?”
 
If I had a dollar for every time I’ve been asked that question, well, I’d have a lot of dollars.
 
If I could invent a test that I truly believed could answer the question with accurate, honest, and reliable results, I’d have a lot more dollars.
 
Routine lab work is a fundamental part of staging a pet’s cancer. When I order those tests, I am ensuring that my patient is systemically healthy and that there are no "warning signs" of trouble regarding things such as organ function or electrolyte status.
 
However, such tests rarely provide information about a pet’s cancer status. With few exceptions (e.g., a very high white blood cell count could indicate a pet has leukemia or an elevated blood calcium level could result from several different types of cancers), lab work will not accurately inform me whether or not a pet has cancer.
 
There’s a difference between performing a test because we are suspicious that a pet could have cancer, and performing a test in a healthy patient to rule in/out a predisposition to cancer or occult (hidden) cancer that has not yet manifested with any clinical signs.
 
The latter scenario describes what are known as screening tests. These are tests designed to survey large populations and to “weed out” those individuals with a particular disease from those who are truly healthy.
 
The precise objectives vary, but most screening tests are designed to quantitate the presence of “biomarkers.” Biomarkers are measurable indicators of particular biological states or conditions and can be used to detect, screen, diagnose, treat, and monitor disease.
 
There are several commercially available tests available that examine different biomarkers for both cats and dogs. When we consider screening tests for cancer, most frequently, assays measure serum levels of thymidine kinase (TK) and C-reactive protein (CRP). The utility of these markers is not well established but emphasis is often placed on their ability to detect what we refer to in the medical profession as minimal residual disease (MRD).
 
TK is a protein involved in DNA synthesis and is expressed in dividing cells. TK levels increase with increased rate of cellular proliferation. TK levels correlate to the proliferative activity of lymphoid cells (and less likely with proliferation of other kinds of tumor cells). Elevated TK levels are also associated with viral infections and inflammatory conditions.
 
Serum TK levels tend to be higher in dogs with cancer than in healthy dogs. However, there is a great amount of overlap in levels measured from healthy dogs, dogs with cancer, and dogs with other diseases. Meaning that even dogs previously diagnosed with cancer can have normal serum TK levels.
 
TK levels have also been measured in cats and a reference interval was established from clinically healthy cats, cats diagnosed with lymphoma, and cats with inflammatory gastrointestinal disease. Cats with lymphoma had significantly higher serum thymidine kinase activity than healthy cats or cats with inflammatory disease and cats with non-hematopoietic neoplasia.
 
CRP is the major acute phase protein produced in response to inflammation and cytokine release. Serum CRP levels correlate to the duration and severity of inflammatory response. Causes of inflammation are varied, and include infection, autoimmune disease, and cancer. Therefore, CRP is considered a sensitive marker for inflammation, but unfortunately, it is relatively non-specific as to the nature of the inflammation it represents.
 
In dogs, CRP is elevated in at least some kinds of cancer, and serum levels are generally elevated in dogs with cancer compared to healthy dogs. As with TK, there is significant overlap between these two groups, and some dogs with cancer have normal serum CRP while some healthy patients have elevated serum CRP.
 
Dogs with lymphoma who are in remission, with only microscopically detectable cancer cells in their bodies, generally have lower CRP than dogs with measurable lymphoma. This places potential value on serum CRP levels as a marker for remission status and relapse of disease.
 
Additional research is necessary to determine the value of measuring parameters such as CRP or TK before veterinarians can routinely recommend these screening tests for every patient. Additionally, doctors must cautiously interpret the results of these tests, as information regarding the benefits and complications of instituting treatment at an earlier stage are unknown.
 
Lastly, if we are to consider implementing such tests, I suggest that owners should begin testing their pets at the earliest possible age, and test consistently throughout their lives, in order to establish the most adequate control values with which to compare to.
 
I absolutely understand why owners would wish for a simple lab test that could reassure them their dogs and cats are as inwardly healthy as they appear on the outside. I also understand the importance of early detection of disease and how this could lead to a more favorable long-term outcome for a pet.
 
However, I cannot ignore the sizeable gap of evidence-based information between these two poles regarding the utility of screening tests for cancer in companion animals that needs to be filled before veterinarians should be routinely recommend such diagnostics for their patients.
 
 

Dr. Joanne Intile
 
 
Image: Dmitry Kalinovsky / Shutterstock
 
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TheOldBroad Lymphoma 07/08/2015 07:07pm One of mine is just finishing up his first 10 weeks of chemo (most of the C.H.O.P. protocol - he can't take steroids due to heart problems) and I'd love to think that a thymidine kinase test would tell me he's doing as well as I think he is.

He does extremely well after getting Vincristine, but pretty darned well after cyclophosphamide and doxorubicin. (His white count has stayed good throughout the chemo, too!)

I actually kinda hate that we're at the point that he'll get chemo every other week instead of once a week because he's done so well.

I don't see the TK on his regular bloodwork. Where is this done? Would it benefit him at all to start doing it now? Reply to this comment Report abuse 2 TheOldBroad 07/08/2015 07:08pm P.S. If you haven't guessed by now, this is about a cat. Reply to this comment Report abuse 1 Dr. Joanne Intile 07/09/2015 08:18am Those are all interesting questions - as usual, the research regarding the utility of these tests in cats is slow and lags behind that of the dogs. There are two main companies marketing tests right now:

http://vdilab.com/services.php
http://lymphoma.avactaanimalhealth.com


Yes - on the one hand it would be good to check levels in your cat right now to confirm that the clinical response you are seeing matches what is going on internally. I fear, without the baseline level to compare to, you might be left with more questions than answers?

TK levels and these other biomarkers are NOT part of routine labwork. They are additional samples that are sent only to specific labs testing for the particular biomarkers in question.

I'm a vet oncologist, and I can tell you I'm not entirely convinced it's the right thing to do. I'm open minded and I think within the next 1-5 years, this will be a much more well-researched and solid topic for us to discuss with pet owners. Reply to this comment Report abuse 3 TheOldBroad 07/09/2015 05:59pm Thanks so much for the response. I'm afraid I have to agree that cat research lags behind dog research. I find that interesting because there are more pet cats in this country than pet dogs. Sadly, I think the reason is that cats don't get the veterinary care they should get, but probably most pet dogs do.

My vet is pretty on-top-of things. I'm there often enough (I'll be there on Saturday and again on Monday) that I'll ask him what he thinks.

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http://www.petmd.com/blogs/thedailyvet/drjintile/2015/july/there-no-easy-test-finding-cancer-pets-32894#comments TheDailyVet Wed, 08 Jul 2015 11:00:00 +0000 32894 at http://www.petmd.com
Dangers in Water Are Often Invisible http://www.petmd.com/blogs/thedailyvet/ken-tudor/2015/july/dangers-water-are-often-invisible-32893









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 07, 2015 Dangers in Water Are Often Invisible by Dr. Ken Tudor








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We can’t live without water. But our waters can often be dangerous to us and our pets.
 
A Florida television channel reported last week about the deaths of two men who had contracted a rare flesh destroying bacteria found in salt water. Six others were reported to have been stricken with the same bacteria. Whether the condition was contracted directly from the water, or from oysters or fish from those waters, is still not clear.
 
There have been no reports of dogs being stricken by the same bacterial infection. The incident, however, got me to thinking about the many ways that water can harbor danger to our pets. This post will explore a few.
 
Jellyfish
 

Quintanilla / Shutterstock
 
Jellyfish washed onto the shore are a very common finding for beach combers and their beach combing dogs. The tentacles of these creatures have organs that release a stinging toxin whose potency varies with the different species of jelly fish. Even dried out tentacles in the sand or mixed in seaweed can still release the toxin.
 
Dogs that come in contact with the tentacles or bite them can have a mild to serious local allergic reaction, or a more serious anaphylactic reaction resulting in shock. That is exactly what happened to 2-year-old pit bull named Diamond after she bit the tentacles of the most toxic of jellyfish, the Portuguese Man O’ War. After several days in intensive care, including transfusions, Diamond survived and is back to her old self. Many dogs are not that fortunate. If your dog has been stung by jellyfish tentacles, even one of the less toxic species, remove the tentacles without touching them directly with your bare hands and immediately seek veterinary care.
 
Blue-Green Algae
 

basel101658 / Shutterstock
 
Warm weather can promote massive growth of blue-green algae in standing bodies of fresh or brackish (the slightly salty waters of lagoons, estuaries, and ponds near the ocean) waters. The musty or foul smell of the algae is often attractive to dogs. It can cause skin rashes for dogs swimming in the algae infested water. Dogs should be thoroughly washed as soon as possible. For dogs that drink algae contamintaed water, toxins in the algae can affect the kidneys, liver, intestines, and nervous system. Initial symptoms are vomiting, diarrhea, weakness, and difficulty walking. Immediate veterinary care is also advised in these cases.
 
Parasites and Bacteria
 

Martin Christopher Parker / Shutterstock
 
Standing areas of fresh water like small lakes, ponds, and even puddles can host various parasites and bacteria. Giardia and Cryptosporidium are the most common parasites. These parasites cause gastrointestinal distress resulting in vomiting and diarrhea. Most dogs recover quickly from the infection, but puppies and older dogs with compromised immune systems can be severely affected and need medications and diet modification in order to recover.
 
Leptospirosis can also be found in small bodies of water that have been contaminated by rodents and other small animal that urinate in the water. Although not as common as water-borne parasites, the bacteria is much more dangerous to dogs that drink the contaminated water. Leptospirosis causes kidney damage that can lead to kidney and liver failure. Infected dogs may be lethargic and vomit. With early diagnosis and treatment, dogs do not suffer long-term kidney or liver problems. Vaccines are available to prevent the disease but they are somewhat controversial due to their tendency to cause allergic reactions and because of the vaccination frequency needed to effectively prevent the disease.
 
Salt Water Poisoning
 

Susan Schmitz / Shutterstock
 
Dogs love to frolic in the ocean, but salt water is toxic to humans and dogs if they drink too much. Ocean soaked tennis balls or other absorbent fetch toys contain enough salt to cause problems for the dogs that are fetching them. Mild ingestion of salt water can cause “beach diarrhea.” The excess salt (or hypernatremia) in the intestines draws water from the blood into the intestines, causing the diarrhea. The diarrhea can sometimes contain blood and mucous. If your dog drinks large amounts of salt water, hypernatremia can lead to vomiting, dehydration, incoordination, seizures, and require veterinary care.
 
Avoid salt poisoning by taking a break every 15 minutes away from the water to offer fresh water to the dog. If your dog won’t drink willingly, use a bottle with a sports cap and squirt fresh water into the mouth.
 
Water activity is great for dogs and the exercise far outweighs the risks, but it is important to be mindful of the risks in the water you dog so dearly loves.
 
 

Dr .Ken Tudor
 
Read Part 2 of Dogs and Water Borne Diseases
 
 
Image: Stanimir G.Stoev / Shutterstock
 
Related Content
 
Parasites and Dog Parks
 
The Challenges of Diagnosing Giardia in Cats and Dogs
 
Leptospirosis in Dogs
 
Video: The Rise of Leptospirosis and Combating this Bacterial Disease
 
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TheOldBroad Fear of Water 07/07/2015 06:31pm How would a dog owner determine if water is safe for a dog? Is there any way to do that? If not, do you recommend avoiding water (standing water, ponds, lakes, oceans) completely. Reply to this comment Report abuse 5 Dr. Ken Tudor 07/07/2015 08:12pm This is a great question and the answer is not about what I think. I know this sounds trite but every action has consequences or more crudely “there are no free lunches.” Every decision we make about our dogs has a risk benefit. Personally, I have a very high risk tolerance for my dog as I did with my children. But I have learned after 66 years of life and 32 years of veterinary practice that everybody has their own risk benefit standard.

Pet owners want to know all of the potential problems so they can then apply their level of comfort. I have clients who refuse to let their puppy’s feet touch any strange ground until they have their entire set of vaccines. Others who won’t have a much needed dental procedure (and I am in way conservative in recommending them), due to anesthetic risk. For them, that possibility that their dog could be the 1 in a 1000 or 1 in a million is too much worse than the benefits of socialization for the puppy and disease prevention for the dental. Their risk tolerance won’t allow for their dog to have any chance of problems.

That is not what I would do but I understand the owner’s paradigm. So I have learned to give pet owners as much information as I can and let them decide whether to avoid or not. Their risk benefit standard is the one that is important, not mine. They don’t care that I say “let’em swim.”
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http://www.petmd.com/blogs/thedailyvet/ken-tudor/2015/july/dangers-water-are-often-invisible-32893#comments parasite TheDailyVet Tue, 07 Jul 2015 11:00:00 +0000 32893 at http://www.petmd.com
Nasopharyngeal Polyps in Cats http://www.petmd.com/blogs/thedailyvet/dr-coates/2015/july/nasopharyngeal-polyps-cats-32890









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 06, 2015 Nasopharyngeal Polyps in Cats by Dr. Jennifer Coates








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If young cats can avoid injury or infectious disease, they usually only see the veterinarian for preventive care. One condition that bucks this trend is called the nasopharyngeal polyp.
 
Polyps are benign masses of tissue that can form in many places throughout the body. In this case, the descriptor “nasopharyngeal” is a bit confusing, because these masses generally do not originate in the nasopharynx (the area within the throat that lies behind the nasal cavities and above the soft palate*) but from the Eustachian tubes connecting the middle ear to the nasopharynx, or from within the tympanic bulla, a part of the middle ear. That said, when they grow large enough, nasopharyngeal polyps can extend into the nasopharynx or even into the external ear canal.
 
Though technically benign (i.e., not having the tendency to spread or worsen appreciably*), nasopharyngeal polyps can cause big problems for cats. They are usually diagnosed in animals under the age of two and cause symptoms that include some combination of the following:

sneezing
nasal discharge
gagging
a change in voice
difficulty breathing or eating
head shaking
ear scratching
discharge from the ear
head tilt
circling
unsteadiness when walking
changes in the shape of the pupils or movement of the eyes

 
Of course, these clinical signs are seen with other conditions affecting young cats (e.g., upper respiratory infections and ear infections/mites), but when these more common problems have been ruled-out, the presence of a nasopharyngeal polyp must be considered.
 
Many nasopharyngeal polyps can be diagnosed by sedating the cat, and pulling the soft palate forward within the mouth using an instrument called a spay hook. There really shouldn’t be anything in the space above the soft palate, so when a lump of tissue appears, you have your diagnosis. If the polyp has invaded the middle ear, it may be visible through the tympanic membrane (ear drum) when examining the ears with an otoscope. X-rays or a CT-scan are sometimes necessary to reach a definitive diagnosis.
 
In the best case scenario, a nasopharyngeal polyp can essentially just be pulled off the tissue from which it is growing, either via the mouth or through the ear. The veterinarian applies steady traction on the polyp until it releases, hopefully at its base. Post-op treatment with pain relievers, antibiotics, and corticosteroids is necessary.
 
Polyps can recur after traction removal and medical treatment. This is more likely if the mass had to be removed via the ear rather than through the mouth. If the polyp does come back, a more invasive surgery called a ventral bulla osteotomy is usually necessary. I’ve never done one of these procedures myself because there are a lot of important veins and nerves that run through the surgical site, and I’m a pretty wimpy surgeon. I’ve referred these patients out to board-certified veterinary surgeons. They’ve all done really well after the procedure. So, if your cat is ever diagnosed with a nasopharyngeal polyp, take heart in knowing that with appropriate treatment, he or she should go on to live a long and hopefully uneventful (medically-speaking) life.
 
 

Dr. Jennifer Coates
 
 
* Dictionary of Veterinary Terms: Vet-speak Deciphered for the Non-Veterinarian. Coates J. Alpine Publications. 2007.
 
 
Image: De Jongh Photography / Shutterstock
 
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TheOldBroad New Diagnosis! 07/07/2015 06:26pm Something new that I've not dealt with! But then again, I tend to take in older kitties, so perhaps that has saved me from dealing with nasopharyngeal polyps.

It sounds fairly easy to diagnose, but can be frightening to treat if surgery is involved.

Thanks for a very interesting post! Reply to this comment Report abuse 3
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http://www.petmd.com/blogs/thedailyvet/dr-coates/2015/july/nasopharyngeal-polyps-cats-32890#comments TheDailyVet Mon, 06 Jul 2015 11:00:00 +0000 32890 at http://www.petmd.com
Three Best Ways to Prevent Losing Your Pet http://www.petmd.com/blogs/thedailyvet/jvogelsang/2015/july/three-best-ways-prevent-losing-your-pet-32889









The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets. < Previous Post Next Post > Jul 03, 2015 Three Best Ways to Prevent Losing Your Pet by Dr. Jessica Vogelsang








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For you, July 4th is another celebration of the United States’ independence and a chance to eat hotdogs. For your dog it’s the apocalypse, or the start of World War III, or maybe just a good old fashioned Armageddon. Regardless of the canine interpretation, suffice it to say that the Fourth of July is not a joyous day for many pets, and is in fact the number one day for frightened animals to run off into the great blue yonder.
 
It makes sense, then, that July is designated “Lost Pet Prevention Month,” since July is also not-so-coincidentally Lost Pet Month. People always ask me what the best way is to keep your dogs (and cats) identified, so let’s take a look and review some of the different options out there:
 
1. Pet Tags
 
Far and away the simplest means of identifying your pet is through the standard little collar tag with your pet’s name and your phone number.
 
Some manufacturers like PetHub have taken it a step further and actually embedded a QR code right onto the chip, so you can include information such as medical problems, veterinarian contact information, and multiple contact numbers, all linked to the tag. If your pet hates jingling tags, you can get a collar with basic contact info embroidered right onto it.
 
Pros: inexpensive, easy, doesn’t require additional effort on the part of the person who finds the pet
 
Cons: Only works if the pet is wearing the collar
 
2. Microchips
 
The gold standard in lost pet reunification, we’ve all heard tales of the cat who disappeared in Poughkeepsie in 2001 and reappeared in Tallahassee in 2012 to be reunited with their thrilled owners thanks to a microchip. Most shelters embed the small chip (about the size of a grain of rice) under the skin as a matter of course before the pet goes to its new home.
 
Pros: Pets who are microchipped and wind up in shelters are reunited with their owners at a 75% rate.
 
Cons: If the shelter scanner doesn’t pick up on the chip due to migration of the chip or a faulty scanner, or the pet is found by a person who doesn’t take the pet to a shelter for scanning, it doesn’t work as intended. Owners must remember to update their information after a move.
 
3. GPS Tracking Devices
 
GPS tracking devices are one of the hottest new pet gadgets on the market.
 
With Whistle’s acquisition of Tagg earlier this year, the Whistle brand is positioned to be the dominant device on the market this year. These devices work with local cell phone carriers and Bluetooth to provide real-time tracking through a mobile app, as well as activity monitoring so you know how much exercise your pet is (or isn’t) getting.
 
Pros: Immediate feedback on location of pet, helpful for those escape artists who jump high and run fast
 
Cons: Must pay monthly service fee to maintain location service; requires regular charging to maintain battery life
 
 
When people ask me what the best choice is for their pet, it’s hard to answer because the general answer is “all three.” Each identification option works in entirely different ways depending on who finds the dog, so there’s no reason you can’t be using multiple forms of redundant identification on the same pet.
 
At the end of the day, none of these identification methods are better than preventing the dog from getting lost in the first place. Last month Brody ran out of the front door when one of the kids left it open a crack and I didn’t notice it for about half an hour. I went out front, heart pounding, and called his name, and out he trotted from the neighbor’s courtyard, where he was visiting.
 
“Oh, I didn’t know you had a dog!” said the neighbor, to my delight (he must not be barking too much when I’m gone!). “He’s so sweet, we were going to keep him!”
 
Thank goodness for recall! 
 
 

Dr. Jessica Vogelsang
 
 
Image: Jaromir Chalabala / Shutterstock
 
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TheOldBroad Lost Cats 07/07/2015 06:22pm Friendly dogs will likely trot right up to a human if they have escaped.

Unfortunately, not so with cats. Most kitties that aren't used to strangers or being outside, will hide. You can walk right past the shrub, calling their name and you'll never know it.

I used to put tags on my indoor-only kitties that said, "If I'm outside, I'm lost" one one side and my information on the other. It finally dawned on me that someone would have to get close enough to the cat to read the tag. Most likely isn't going to happen. :-(

So all mine are microchipped. I can only hope that #1 they never escape and #2 they are scanned for a chip. (I know my vet scans for chips when a former stray is taken for a physical.) Reply to this comment Report abuse 3
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Flexibility is Key to Successful Cancer Treatment in Pets http://www.petmd.com/blogs/thedailyvet/drjintile/2015/july/3-step-guide-treating-animal-cancer-patients-32887
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