http://www.petmd.com/blogs/thedailyvet/rss en 'Rich' Ingredients on the Pet Food Label Are Worthless http://www.petmd.com/blogs/thedailyvet/ken-tudor/2014/november/rich-ingredients-pet-food-label-are-worthless-32171 a2a_config = { menu_type:'mail' };
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The focus of the holidays always seems to center around food in some way or another. When people talk about nutrition, human or pet, the word “rich” is frequently heard. Foods will be referred to as rich in this vitamin, that mineral, or those fats.
 
Commercial pet food companies promote their diets as rich in this or that. Those who make homemade diets also like to use the word rich about their chosen ingredients. Unfortunately, we tend to use the word “rich” to mean adequate. The implication is that if a food rich in X is in the diet, in whatever amount, it represents a nutritionally adequate amount of X.
 
But rich is a comparative word, not a quantitative one. Rich only refers to a comparison to something else, generally a food that is deficient or contains miniscule amounts of the identified nutrients.
 
The concept of rich has also spawned many new pet feeding philosophies. Many dog owners are now regularly fasting their dogs 1-2 days a week. A celebrity vet is encouraging the “hybrid diet,” where dogs are fed a balanced commercial diet 5 days a week and then given any unbalanced combination of table scraps or people food for 2 days. And a popular manufacturer of raw foods advocates an “ancestral diet” that is fed as little as once a week to provide the nutrients he feels are necessary to achieve the right ancestral mix of protein and fats.
 
These various programs are predicated on the assumption that replacing foods “rich in” will make up for any deficiencies during deprivation or are capable of correcting all deficiencies that were previously present. It is a concept of “biological catch-up” that is a not supported by nutritional science. I will address the concept of biological catch-up in a separate post.
 
Rich is a Meaningless Word
 
As mentioned, rich is a comparative term and is meaningless with regards to nutrition.
 
I have had actual conversations with owners who insisted that the chicken and brown rice diet they were feeding their dog is adequate in calcium because they added kale, a food considered rich in calcium. When I point out that it takes eighteen cups of cooked kale or nineteen cups of chopped raw kale for every 1,000 calories of chicken and rice to provide the daily requirement of calcium, they are mystified.
 
If they substituted milk in the diet, another touted rich source of calcium, it would take almost 5 cups of milk and 12 cups of cottage cheese per 1,000 calories of chicken and rice for adequate calcium. It would be impossible and not even advisable to feed these amounts of kale, milk, or cottage cheese to your dog.
 
The point is, the word rich is meaningless. In science, if it isn’t measured it didn’t happen. If you don’t know the quantity and comparison of that quantity to daily requirements, you cannot assume it is adequate. Rich is not a guarantee of quantity.
 
I could repeat this exercise for almost every necessary nutrient, even mixing the ingredient choices to reduce volumes, and the results would be the same. It takes an un-consumable amount of food or a consumable amount that far exceeds caloric intake to balance a diet with foods that are “rich in...”
 
With all due respect to Dr. Oz, “rich in” means nothing.
 

Dr. Ken Tudor
 
Image: guidocava / Shutterstock
 
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TheOldBroad Agree! 11/26/2014 03:17pm What you say makes perfect sense. I am, however, horrified that some people don't feed their pets daily. And, of course, I'm equally horrified that some people are feeding their dogs/pets an unbalanced diet two days a week. (I'm sure the critters are loving it, though!)

To me, "rich in" means that something is abundant, not just adequate.

Chicken, brown rice and kale doesn't strike me as an adequate diet for any living creature. There are other vitamins and minerals necessary - not to mention the inadequate calcium you mention.

This post gives some extreme fad diets for pets and I sure hope that people aren't taking them too seriously. Sadly, there's always someone who will. Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/ken-tudor/2014/november/rich-ingredients-pet-food-label-are-worthless-32171#comments nutrition TheDailyVet Wed, 26 Nov 2014 11:00:00 +0000 32171 at http://www.petmd.com
The Philosophy Behind Diagnosing Diseases in Pets http://www.petmd.com/blogs/thedailyvet/drjintile/2014/november/philosophy-behind-diagnosing-diseases-pets-32169 Nov 25, 2014 The Philosophy Behind Diagnosing Diseases in Pets by Dr. Joanne Intile     Share    
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I have an unusual fascination with the concept of medicine as both an art and a science. Superficially, the two disciplines have little to do with each other. Where medicine is sterile, factual, statistical, and specific, art is paradoxically relaxed, fluid, and imaginative.
 
The role for creativity in the mind of a doctor is limited. We are thinkers and memorizers of minutia. Artists are thoughtful and philosophical. The proverbial war of the left brained versus the right brained prevails.
 
The ancient Greek physician Hippocrates is credited with being the first to truly separate medical science from religion and philosophy, based on his belief that disease was not a punishment inflicted by the gods but rather the product of environmental factors, diet, and living habits. For this, he is touted as being the “father of medicine.”
 
Fast-forward a thousand years and we meet a lesser known, but equally influential, ancient physician named Claudius Galenus. Galenus studied Hippocrates’s understanding of pathology but was also heavily influenced by the writings of the great Greek and Roman thinkers like Plato and Aristotle. He recognized medicine as an interdisciplinary field that was best practiced by utilizing theory, observation, and experimentation in conjunction.
 
One of Galenus’s most famous writings is the treaty entitled “That the best physician is also a philosopher,” which called for a melding of rationalist and empiric medicine sects. Galenus believed the best doctors were the best because they really thought about what they did.
 
My obsession with medical philosophy introduced me to the interesting and opposing theories called Occam’s razor and Hickam’s dictum. No, these strange sounding terms do not refer to unusual diseases but rather to two important, yet contradictory, fundamental philosophical ideals of medicine, with specifics regarding the approach to the diagnosis of disease.
 
Occam’s razor refers to the idea of “diagnostic parsimony,” which means that when diagnosing a given injury, ailment, illness, or disease, a doctor should strive to look for the fewest possible causes that will account for all the symptoms.
 
Hickam’s dictum counterbalances Occam’s razor by stating that more often it’s statistically more likely that a patient has several common diseases rather than a single, rare disease that explains a myriad of symptoms.
 
In veterinary school we learn when that we hear hoofbeats, we should look for horses, not zebras. The adage refers to more than just the sounds made by the limbs of our patients. Essentially, we’re trained to think more like Occam and base our diagnoses on the idea that “common things happen commonly.”
 
An unvaccinated puppy with vomiting, bloody diarrhea, and a fever likely has parvovirus. An older cat with vomiting, weight loss, a rough hair coat, and a lump on its throat likely has hyperthyroidism. In other words, keep it simple, explain things in the most uncomplicated way, and you will have your answer.
 
There are times, as a veterinary oncologist, when I find Occam’s razor to be a bit cumbersome. Don’t get me wrong — I’m a huge fan of giving my patients as few problems as possible, and I’m happy to leave Hickam’s mentality to my internist friends who love to come up with dozens of differential diagnoses for each and every one of a patient’s clinical signs. But I can’t ignore the innumerable instances where I’ve seen Occam’s line of thinking not only to be wrong, but also downright dangerous for my patients.
 
Perhaps the worst “Occam offense” occurs when a veterinarian concludes a pet’s most likely diagnosis is cancer based solely on demographical characteristics such as age or breed, in lieu of performing diagnostics designed to verify their suspicions.
 
I understand owners are reluctant to spend money on expensive tests when the outlook for their beloved companion may be poor, and vets are often expected to offer their professional opinion as to a diagnosis prior to having the evidence they need to be sure. This doesn’t excuse doctors from their responsibility for knowing and stating their limitations and their obligation to divulge their inability to predict an outcome off of limited information.
 
Occam’s razor also fails owners when we “blame” cancer, or anti-cancer treatments, for a pet’s adverse signs, behavior changes, or labwork alterations that actually result from a completely separate illness or condition. Cancer most commonly strikes older to geriatric pets, a population of animals predisposed to a wide variety of chronic, progressive diseases. 
 
Sometimes a cat with lymphoma isn’t eating well because it has worsening kidney disease unrelated to its cancer. Sometimes dogs have diarrhea because they’re fed a remarkable amount of table scraps and it has nothing to do with their chemotherapy.
 
I don’t think it’s an end-all-be-all West Side Story type of analogy, where a veterinarian must choose whether they’re an Occam or a Hickam. That’s an oversimplification of the point I’m trying to make.
 
The more important issue is how we need to open up some of the tunnel vision that blinds us to the bigger picture of what’s really going on with our patients. We’re obligated to treat the whole animal, and its family, with equal parts respect and knowledge. Occum’s razor isn’t an excuse for laziness or ineptitude.
 
If we sway too far towards diagnostic parsimony, we could easily miss important signs of other diseases or conditions that are unrelated to our primary concern. Likewise, it’s possible to knit pick each and every detail of a pet’s case to the point where we are blinded by the possibilities of their pathology.
 
Finally, pet owners should keep an open mind when it comes to their veterinarian’s recommendations for further testing when a definitive diagnosis has not yet been achieved. Opinions and experience account for a great deal of the art of medicine, but there’s also a tremendous amount of data garnered from the plain old science part of the discipline as well.
 
Maybe the hoofbeats are zebras more often than we think.
 
Maybe I sound a bit too philosophical for a doctor. 
 
Maybe they said the same thing about Galenus…
 

Dr. Joanne Intile
 
Image: Javier Brosch / Shutterstock
 
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TheOldBroad Philosophy 11/25/2014 06:04pm Great post! I'm a big fan of Occam, although I confess that after I Googled Occam's Razor, I found that I completely misunderstood it. I always thought it was more "the simplest solution is many times the best solution."

Luckily my vet is apparently a fan of both lines of thinking. More than once he has correctly figured out that a kitty has more than one thing going on concurrently. Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/drjintile/2014/november/philosophy-behind-diagnosing-diseases-pets-32169#comments TheDailyVet Tue, 25 Nov 2014 11:00:00 +0000 32169 at http://www.petmd.com
Surgical Site Infections Benefit Some Dogs with Bone Cancer http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/november/surgical-site-infections-benefit-some-dogs-bone-cancer-321 Nov 24, 2014 Surgical Site Infections Benefit Some Dogs with Bone Cancer by Dr. Jennifer Coates     Share    
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“Infections are bad.”
 
Now there’s a statement that seems self-evident, right? But as is always the case in veterinary medicine, exceptions to the rule exist. I know of at least one instance when a surgical site infection can be looked at as, if not exactly a good thing, at least a cloud that might very well have a silver lining.
 
Osteosarcoma is the most common type of bone cancer in dogs and usually affects a leg, although other locations are possible. The disease is most commonly diagnosed in middle-aged or older large and giant breeds of dogs. The first symptom that develops is usually a limp. Owners often think something relatively benign like arthritis is to blame, and leave the veterinary hospital heartbroken because their dog has just been diagnosed with a fatal disease.
 
Treatment for osteosarcoma is often worthwhile, however. Studies show that dogs who undergo amputation of the affected leg and no other form of treatment live, on average, another five months. When amputation isn’t possible (e.g., for pets whose other limbs are compromised by arthritis or neurological disease), limb-sparing surgery is a good, albeit expensive, alternative. Post-operative chemotherapy increases the median survival time after surgery to around one year. Radiotherapy can also play a role in treatment, either to eliminate cancerous tissue that can’t be surgically removed or simply to reduce pain.
 
I tell owners to make the decision for or against surgery and chemotherapy with that one year median survival number in mind. Of course, the very definition of “median” means that some dogs do worse and others do better. Is there something that the dogs who live longer than one year after diagnosis have in common? This is the question that a group of scientists recently tried to answer.
 
They combed through the medical records of 90 dogs with appendicular [affecting the limbs] osteosarcoma looking at a variety of parameters. Eighty-nine dogs (99%) underwent surgery, and 78 (87%) received chemotherapy. The median survival time beyond one year for these dogs was approximately 8 months (range 1 to 1,899 days). Nineteen dogs (21%) lived for more than 3 years, and 5 dogs (6%) lived for more than 3 years after diagnosis.
                                                                                                                                              
Of all the parameters the scientists evaluated that could potentially affect a dog’s survival time, the one that stood out was infection of the surgical site after limb-sparing surgery. The 20 dogs who had this complication had a median survival time after 1 year of 180 days (range 25 to 1,899 days) in comparison to the other dogs whose median survival time after 1 year was 28 days (range 8 to 282 days).
 
Two studies prior to this one had similar results, which makes one think this is a real effect, not an arbitrary finding. Veterinarians currently hypothesize that a type of “bystander effect” is at work in these cases. The immune system’s response to the infection inadvertently enhances its ability to recognize cancerous cells as a threat, thereby prolonging survival.
 
Postoperative infections aren’t all good news, of course. They increase the cost of treatment, cause discomfort for the patient, and can even shorten survival times if they don’t respond to antibiotics. So while no one is recommending that we intentionally contaminate the surgical site of a dog undergoing limb sparing surgery for osteosarcoma, if infection does develop, a small smile isn’t an irrational response.
 

Dr. Jennifer Coates
 
 
Reference
 
Evaluation of outcome and prognostic factors for dogs living greater than one year after diagnosis of osteosarcoma: 90 cases (1997-2008). Culp WT, Olea-Popelka F, Sefton J, Aldridge CF, Withrow SJ, Lafferty MH, Rebhun RB, Kent MS, Ehrhart N. J Am Vet Med Assoc. 2014 Nov 15;245(10):1141-6
 
 
Image: Jaromir Chalabala / Shutterstock
 
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TheOldBroad Fascinating! 11/24/2014 06:15pm "The immune system’s response to the infection inadvertently enhances its ability to recognize cancerous cells as a threat,"

I wonder why the immune system sees the infection as a threat, but not the cancer.

Hopefully someone is studying to find a way to stimulate the immune response without causing an infection. Perhaps there's a way to inject something into the cancer to cause the immune system to attack it. Reply to this comment Report abuse Dr. Jennifer Coates 11/25/2014 10:53am "I wonder why the immune system sees the infection as a threat, but not the cancer."

Cancers have evolved multiple ways to evade detection by the immune system. Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/november/surgical-site-infections-benefit-some-dogs-bone-cancer-321#comments TheDailyVet Mon, 24 Nov 2014 11:00:00 +0000 32168 at http://www.petmd.com
Documentary on Pet Cancer Aims to Lower Cancer Related Deaths http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2014/november/documentary-pet-cancer-aims-lower-cancer-related-dea Nov 20, 2014 Documentary on Pet Cancer Aims to Lower Cancer Related Deaths by Dr. Patrick Mahaney     Share    
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November is National Pet Cancer Awareness Month, so my PetMD Daily Vet articles are trending toward topics pertaining to cancer diagnosis and treatment.
 
The statistics about cancer in our pets are astounding and are definitely not in favor of our companion canines and felines.
 
According to PetCancerAwareness.org:
 

Cancer accounts for nearly 50% of all disease-related pet deaths each year (via The Veterinary Cancer Center)


Dogs get cancer at roughly the same rate as humans (via the American Veterinary Medical Association)


Approximately 1 in 4 dogs develops a tumor of some kind during his lifetime (via the American Veterinary Medical Association)

 
If you're not already aware, I have endured the process of putting my own pet through surgery and chemotherapy to resolve his cancer. It's been a challenging yet inspirational process that has taught me much about the integrative approach to Cardiff’s cancer care, where I combine Western (conventional) and Eastern (Chinese medicine) approaches to consider his disease and treatment from a holistic perspective (see links to Cardiff’s story and others on PetMD and Pet360 at the end of this article).
 
As a veterinarian, one of the top goals in my practice is to reduce the likelihood that my patients will be exposed to man-made and environmental toxins that could be carcinogenic (cancer-causing). Yet, sometimes you can strive to do your best in providing a non-toxic existence for your pet, but nature has another plan. Such was the case with Cardiff. 
 
I therefore felt an obligation to share my story as a pet owner and veterinarian dealing with cancer in his own canine companion through a documentary called My Friend: Changing the Journey. Terry Simmons, founder of the Canine Lymphoma Education Awareness and Research (CLEAR) Foundation, and the film’s director, Stacey-Zipfel Flannery, got me involved in the project, which was shot from early spring through summer 2014 and captured many aspects of Cardiff’s cancer treatment. The message I want to convey to other pet owners enduring the trials and tribulations of companion-animal cancer is that there’s hope out there to beat the disease.
 
Paige O’Hara, best known as the memorable voice of Bell from Disney’s Beauty and the Beast, narrated the film, which recently premiered at a fundraiser to benefit CLEAR foundation at the Vertigo Event Venue in Burbank, California. Laura Nativo, a pet-passionate professional dog trainer (CPDT-KA), pet lifestyle expert, and regular contributor to Hallmark Channel’s Home & Family, hosted the event. 
 
Two days later, Nativo and I teamed to educate the Home & Family audience about pet cancer awareness. See the full segment here: Canine Cancer Awareness Month
 
It’s important that all pet owners are mindful of the clinical signs of cancer, which may vary from subtle to obvious. On a weekly basis, I work at the Veterinary Cancer Group  (VCG) in Culver City, CA, alongside veterinary oncologists who provide cutting-edge cancer treatments for dogs, cats, and other species. VCG also educates people on early illness recognition through their 10 Warning Signs of Cancer in Dogs & Cats, which can include:
 

Persistent change in appetite and/or water intake
 



A lump that is enlarging, changing, or waxing and waning in size
 



Progressive weight loss or weight gain
 



Non-healing sore or infection, such as persistent nail bed infection
 



Abnormal odor
 



Persistent or recurring lameness
 



Chronic vomiting or diarrhea
 



Persistent or recurring cough
 



Unexplained bleeding or discharge
 



Difficulty swallowing, breathing, urinating, or defecating

 
In addition to looking for the above clinical signs, I always stress that my clients have their pets undergo a physical examination by a veterinarian at least every 12 months (more frequently with sick animals and those regularly receiving medications). The eyes and hands of veterinarians are highly trained to seek out problems that may not be apparent to the average pet owner. Additionally, thorough history-taking can identify behavioral trends (decreased appetite, lethargy, etc.) that may not seem as serious to a canine or feline caretaker, but may raise concern in the overseeing veterinarian.
 
I hope your pets stay healthy and cancer-free throughout their lives. Should the diagnosis of cancer occur in your pet, I suggest pursuing a consultation with a veterinary oncologist. These specialty-trained veterinarians have dedicated their professional livelihoods to diagnosing and treating cancer and are better resources in determining the most appropriate course of action than are general practice veterinarians, who may only occasionally treat tumors and their associated problems. Ask your regular veterinarian for a referral or you can find a veterinary oncologist in your area via the American College of Veterinary Internal Medicine (ACVIM).
 

The Hallmark Channel’s Home & Family, Mark Steines, Christina Ferrare, Laura Nativo, Cardiff, and Dr. Patrick Mahaney
 

Premiere of My Friend: Changing the Journey; with Terry Simmons, Dr. Patrick Mahaney, Stacey Zipfel-Flannery, Cardiff, Phil Hammond
 
 

Dr. Patrick Mahaney
 
 
You can follow Hallmark Channel’s Home & Family on Twitter: @HomeAndFamilyTV

 
Image: Cardiff getting treatment
 
 
Related articles:
 
What Can Be Learned About Treating Cancer in Captive Apes?
 
A Doggy Birthday Party, Celebrities, and the CLEAR Foundation Fight Cancer with a Fundraiser
 
When Pets Complete Chemotherapy Are They Cancer-Free?
 
Unexpected Side Effects of Chemotherapy Treatment
 
Feeding Your Dog During Chemotherapy Treatment
 
Can a Veterinarian Treat His Own Pet?
 
How a Vet Diagnoses and Treats Cancer in His Own Dog
 
A Veterinarian's Experience with Treating His Dog's Cancer
 
Top 5 Acupuncture Success Stories
 
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TheOldBroad Vets 11/20/2014 06:44pm "The eyes and hands of veterinarians are highly trained to seek out problems that may not be apparent to the average pet owner."

My kitties and I have definitely benefitted from frequent checkups and a great doctor.

Although the diagnosis was devastating and my Louise was only with me for another 10 days, he found her adenocarcinoma when she was asymptomatic. At the very least, it put me in a position to keep a close eye on her to see when she began to suffer so steps could be taken.

He knows the right questions to ask about behavior if he suspects something and can glean information I didn't know I had (and wouldn't have thought to mention). Reply to this comment Report abuse 1
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http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2014/november/documentary-pet-cancer-aims-lower-cancer-related-dea#comments TheDailyVet Thu, 20 Nov 2014 11:00:00 +0000 32133 at http://www.petmd.com
How Do You Save a Horse From a Sinkhole? Very Carefully, It Turns Out http://www.petmd.com/blogs/thedailyvet/aobriendvm/2014/november/how-do-you-save-horse-sinkhole-very-carefully-it-turns-ou Nov 19, 2014 How Do You Save a Horse From a Sinkhole? Very Carefully, It Turns Out by Dr. Anna O'Brien     Share    
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A few winters ago, it was quiet at the office, which is not unusual in the colder months. Few babies are being born, and both people and their animals are tucked away from the cold, hunkering down to wait out the snow until spring, when all hell breaks loose.
 
As I was beginning to pack up my things to head home for the day, my boss called, asking me to stop by a client’s farm to check out a horse that reportedly was stuck in a mud hole.
 
“That’s all I know,” she said. I could hear her shrugging over the phone. “Just go check it out.”
 
As it turns out, “stuck in a mud hole” was the biggest understatement of the year. Turning down the country lane to the farm, I screeched to a halt. Two fire engines took up the entire street and a police car diverted traffic. As the sun set, flashing lights lit up the sky.
 
Thinking this was perhaps something going on with a neighbor, I pulled over close to the driveway and hopped out to find my client and her horse. I was greeted at the end of the driveway by a local firefighter, who also happened to be a client of mine. “Glad you’re here,” he said. “We’re trying to figure this out.”
 
As we walked into the pasture, I strained to find the alleged horse in the mud. Exactly what kind of mud hole causes the entire local fire department to arrive on the scene? Turns out, this was way more than a mud hole. This was a sinkhole and the horse had fallen into it — the earth essentially swallowed him up. Fifteen feet into a newly formed earthen cave, the horse — an elderly white spotted gelding named Smokey — had his back legs buried. Lying somewhat sternal, he was alert and somehow not in a panic. But time was of the essence. It was cold out. Soon he would become hypothermic. The circulation to his back legs could very well be dwindling. He might even have fractures. I wasn’t sure he would make it out alive.
 
Heading toward the sinkhole to assess the horse’s health status, the firefighter grabbed my arm. “You can’t go in there,” he said. The sides of the sinkhole were too unstable. The whole thing could come crashing down, burying me in the process, along with the horse. Over the next two hours, the fire crew worked on stabilizing the walls of the sinkhole and constructing a pathway down into the hole. At one point, they allowed me to go in, winched with a rope around my waist in case they had to yank me out. They also insisted I wear one of their heavy-duty jackets and a helmet.
 
Reaching Smokey, I still couldn’t tell if his buried legs were broken, but he appeared stable. I administered some warm IV fluids and then was pulled back out. By this time, the local horse rescue squad arrived on the scene. We are lucky in our area to have such a team, which consists of individuals with specific training on large animal rescue operations. They travel to hurricane-ravaged locales and trailer accidents, pulling mangled horses from debris. They had equipment such as tethers, ropes, and hoists, and knew how to use them.
After a few more hours, the fire department deemed the hole stable and, together with the rescue team, had a well-strategized plan for “Evacuation Horse.” I could only stand and watch, and to my amazement it worked. Well-placed ropes and even, slow pressure from multiple people produced a horse from what seemed like the depths of the earth. After a few seconds of holding our collected breath to see if he could actually stand, we sighed with relief as he took slow, wobbly steps. Nothing seemed to be broken.
 
By now, it was very late. All the lights and emergency vehicles had gathered the attention of the locals and there was a group of gawkers at the gate. We put a blanket on the horse and I gave him more IV fluids and a warm bran mash to eat. He looked exhausted. All the emergency personnel were exhausted. I was elated. To this day, I still don’t really know how they all pulled it off.
 
Before everyone left for the night, I overheard the fire department instruct my client to fence off the area where the sinkhole was located. The area encompassed about half of her pasture. Through various side conversations I learned her land was close to a quarry and prone to sinkholes. In fact, a cow of hers fell through a smaller one a few years ago. Thinking it might be time to move her entire farm, I drove home for the night, watching the emergency lights dim in my rearview mirror, musing over the understatement of the year.
 

 

 

Dr. Anna O'Brien
 
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TheOldBroad Happy Endings 11/19/2014 06:04pm Scary story, but so very glad it had a happy ending. You are indeed lucky to have the horse rescue team. Reply to this comment Report abuse 1
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http://www.petmd.com/blogs/thedailyvet/aobriendvm/2014/november/how-do-you-save-horse-sinkhole-very-carefully-it-turns-ou#comments TheDailyVet Wed, 19 Nov 2014 11:00:00 +0000 32131 at http://www.petmd.com
Obesity in Cats: Different Approaches for Weight Loss http://www.petmd.com/blogs/thedailyvet/ken-tudor/2014/november/obesity-cats-different-approaches-weight-loss-32130 Nov 18, 2014 Obesity in Cats: Different Approaches for Weight Loss by Dr. Ken Tudor     Share    
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With the holiday season approaching, many of us think about our waistlines and dieting. Some will start dieting before the holidays to fit into those party clothes. Others will contemplate strategies for eating during the holidays to minimize gain with the goal to lose those extra pounds after the holidays. You know, the proverbial “New Year’s Resolution.”
 
All-in-all concerns about our weight create much angst during this joyous time of year. This got me to thinking about obesity and weight loss in pets. In particular, I was reminded of two oral presentations at the 2014 Academy of Veterinary Internal Medicine Symposium in Nashville, Tennessee, about weight loss strategies for cats.
 
Chronic Calorie Reduction
 
Chronic calorie reduction is a weight loss strategy based on restricting calories at a calculated level and maintaining or reducing that level of calories until a cat achieves its ideal weight.
 
In this particular study, 32 client owned, obese cats were evaluated by a sophisticated X-ray technology (Dual-Energy X-ray Absorptiometry or DEXA) to determine their ideal body weights (IBW). The cats were then put on a diet that delivered 80% of the calories necessary for their resting energy requirement, or RER.
 
RER is the absolute minimum number of calories necessary for body function at complete rest; not the amount of calories needed for maintenance energy requirement (MER) that includes normal, regular daily activities. The cats were fed this way until they reached their IBW, or until 104 weeks (2 years), whichever came first.
 
Twenty-six percent of the cats left the study early due to owner non-compliance. Owner relocation, cat aggression to researchers, and other medical reasons caused another nine cats to drop from the study.
 
Of the seventeen cats that finished the study, thirteen (76%) achieved their IBW within the first year. Three other cats achieved IBW in the second year, and one cat did not achieve IBW in the time period.
 
Calorie adjustments during the testing period varied from as low as 40% of RER calories to as high as 100% of RER calories based on periodic weight monitoring. Periodic blood testing ensured the safety of the diet for the cats.
 
Intermittent Calorie Restriction
 
Intermittent calorie restriction is a weight loss strategy where animals are calorie restricted part of the time and fed normally the other times.
 
In this study, 28 laboratory cats were divided into two equal groups. Fourteen cats were fed 75% of their estimated MER for six months. The other fourteen cats were fed 75% of their MER for the first two weeks of the month and then 100% of their MER for the second two weeks for twelve months. These cats were fed longer so that their calorie restricted period matched the period for the group that was chronically restricted for six months. Weekly body weights and monthly body scans for body fat were performed on all cats throughout the study period.
 
The researchers found that the intermittent group lost more body fat than the chronically restricted group. They also found that 82% of the intermittent group achieved IBW in the time period versus only 36% of the chronic restriction group.
 
My Take
 
After hearing the presentations and questioning the primary investigators, I am intrigued by the intermittent strategy as a more effective program for two reasons:
 
It has the potential for decreasing the metabolic changes that occur during dieting that promote weight regain after dieting. This may mean that cats can be fed a more satisfying amount of calories after dieting.
 
Presently, those cats and dogs that lose weight on chronic calorie restrictions are only able to ingest 10% more calories after their diet (anecdotal evidence from researchers and my own clinical experience).
 
More importantly, owner compliance may be better if there is not the perception of starving their babies. Certainly more research is needed to address these concerns.
 
Some human research has yielded the same results with intermittent calorie restriction. Perhaps this is the way we should strategize for the holidays for ourselves and our pets. Happy Holidays!
 

Dr. Ken Tudor
 
Sources
 
Weitzel A., Paetau-Robinson I, Kirk C Successful weight loss in severely obese cats. Ahead of publication
 
Pan Y Intermittent caloric restriction is more effective than chronic caloric restriction in promoting weight loss in overweight cats. Ahead of publication
 
 
Image: Andrey_Kusmin / Shutterstock
 
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TheOldBroad Great Suggestion 11/18/2014 06:04pm I really like this approach. I agree that feeling I am "starving" my baby would likely lead to owner non-compliance. This feels like something that could be more easily done when there are multiple cats in the household, too. (Of course, this doesn't keep cat #1 from stealing cat #2's dinner when no one is watching.)

I have to admit that I chuckled at "cat aggression to researchers" was a reason some kitties were dropped from the study. Heck, I'd probably be grumpy, too, if you cut my calories and did all those tests on me. Reply to this comment Report abuse 1
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http://www.petmd.com/blogs/thedailyvet/ken-tudor/2014/november/obesity-cats-different-approaches-weight-loss-32130#comments TheDailyVet Tue, 18 Nov 2014 11:00:00 +0000 32130 at http://www.petmd.com
Will 'New' Drug Help Dogs Live Longer? http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/november/will-new-drug-help-dogs-live-longer-32127 Nov 17, 2014 Will 'New' Drug Help Dogs Live Longer? by Dr. Jennifer Coates     Share    
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Humankind has been searching for a “fountain of youth” for thousands of years. For dog owners, the perfect find wouldn’t just extend our lives but also those of our beloved canine companions.
 
Not long ago, we talked about a couple of things that owners can do to potentially extend the lifespan of their dogs. I advocated for the first — a 25% reduction in caloric intake — but was hesitant to recommend second — giving older dogs L-deprenyl — because the research supporting the drug’s use for this purpose is hardly definitive.
 
Two scientists from the University of Washington are looking to expand our understanding of how dogs age and whether or not a different drug, rapamycin, might help them age better and live longer.
 
The first part of the Dog Aging Project consists of a “Longitudinal Study of Aging in Pet Dogs,” the goal of which is to “perform the first nationwide, large-scale longitudinal study of aging in pet dogs, where individual animals will be followed throughout life to understand the biological and environmental factors that determine why some dogs die early or succumb to diseases such as cancer, kidney failure, and dementia, while others live to a relatively old age free from these problems.”
 
The project’s second goal is “an intervention trial to treat middle-aged dogs with the FDA approved drug rapamycin. At high doses, rapamycin is used successfully in human patients to prevent organ transplant rejection and to fight cancer. At low doses, rapamycin slows aging and extends lifespan in several organisms, including mice, with few or no side effects.”
 
The first phase of this study will enroll middle-aged dogs (6-9 years depending on breed) in a short-term (3-6 month), low-dose rapamycin regimen and follow age-related parameters such as heart function, immune function, activity, body weight, and cognitive measures. These animals will then be followed throughout life to determine whether there are significant improvements in healthy aging and lifespan.
 
The next phase of the study will enroll a second cohort of middle-aged dogs into a longer-term, low-dose rapamycin regimen designed to optimize lifespan extension. As with phase one, several age-related parameters will be assessed before, during, and after the treatment period. Based on the mouse studies performed at the University of Washington and elsewhere, we anticipate that rapamycin could increase healthy lifespan of middle-aged dogs by 2-5 years or more.

 
I don’t know about you, but I’d have given just about anything for another 2-5 years with my dogs who have passed away, particularly if the majority of that “extra” time consisted of good quality of life.
 
Rapamycin is off patent, which means drug companies aren’t interested in funding additional research into its potential use as an “anti-aging” treatment. This is why your help is needed. The Dog Aging Project is looking for donations to help with funding as well as canine “citizen scientists” to participate in the longitudinal study and the first phase of the interventional trial. Take a look at the project’s website for more information.
 

Dr. Jennifer Coates
 
Image: Christian Mueller / Shutterstock
 
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TheOldBroad Agree! 11/17/2014 06:42pm "I’d have given just about anything for another 2-5 years with my dogs who have passed away"

I would have given most anything for another 2-5 good years with the kitties I've lost. My little Emma Jean (RIP 2002) had so many medications that it took about 45 minutes both morning and evenings just to do her meds. I'd do it all again in a heartbeat.

Has there been any research of using these drugs in cats? Reply to this comment Report abuse Dr. Jennifer Coates 11/18/2014 03:27pm Nothing that I'm aware of in a clinical setting. Reply to this comment Report abuse centurianmaam Where 11/21/2014 09:29am Can you give information on the university doing the study? I would be very interested.
Anne Reply to this comment Report abuse Dr. Jennifer Coates 11/21/2014 02:48pm The scientists are with University of Washington. The website with the information you are looking for is http://dogagingproject.com/. Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/november/will-new-drug-help-dogs-live-longer-32127#comments TheDailyVet Mon, 17 Nov 2014 11:00:00 +0000 32127 at http://www.petmd.com
The Cancer Side Effect No One Wants to Talk About http://www.petmd.com/blogs/thedailyvet/drjintile/2014/november/one-side-effect-cancer-treatment-doctors-cannot-control-32 Nov 14, 2014 The Cancer Side Effect No One Wants to Talk About by Dr. Joanne Intile     Share    
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We’re familiar with the more common side effects associated with chemotherapy treatments: nausea, vomiting, lethargy, and hair loss. We all too easily relate to such signs, whether a result of our own personal experience, or those of friends/loved ones, or even through different media outlets.
 
In veterinary oncology, every precaution is taken to limit such side effects. We accept a much lower rate of toxicity in dogs and cats, so our initial drug doses tend to be lower than our human counterparts. If side effects do occur, we are quick to reduce future dosages or delay treatments, keeping our patient’s safety at the forefront of concern. We want our patients to remain happy and healthy while enduring their protocols and to remain oblivious to the potentially negative repercussions of such serious remedies.
 
There’s one side effect from chemotherapy that both veterinary and human oncologists remain persistently unable to adequately control. No matter how much effort we put in to preventing it, we are at the mercy of this most disturbing of adverse treatment-related injury. The concern we are speaking of is called financial toxicity.
 
Financial toxicity, a term first coined by researchers in a study published in The Oncologist in 2013, describes how the “out-of-pocket expenses” of cancer treatment further drain the already stretched emotional and personal reserves of cancer patients, ultimately causing a significant decline in their overall quality of life and, in its most severe form, becoming an actual, palpable adverse side-event of treatment, leading to cessation of treatment.
 
In the aforementioned study, researchers compared the results of surveys evaluating the impact of health care costs on well-being and treatment of cancer patients who contacted a national copayment assistance foundation with those from patients treated at an academic medical center. The results are staggering.
 
Among 254 participants, 75% applied for drug copayment assistance. Forty-two percent of participants reported a significant or catastrophic subjective financial burden; 68% cut back on leisure activities, 46% reduced spending on food and clothing, and 46% used savings to defray out-of-pocket expenses.
 
To save money, 20% took less than the prescribed amount of medication, 19% partially filled prescriptions, and 24% avoided filling prescriptions altogether.
 
Copayment assistance applicants were more likely than non-applicants to employ at least one of these strategies to defray costs (98% vs. 78%).

 
One conclusion from the study is that financial toxicity has both an objective side (a true enumeration of the burden the treatment places on the affected individual) as well as a subjective side (the less tangible distress the burden of treatment places on the patient).
 
Another conclusion was that the consequences of financial toxicity reach far beyond the checkbook and extend into influencing important demographic information including response rates and survival statistics. Patients may actually stop taking medications, or even stop treatment entirely, because of the rising costs of their own healthcare and the burden this places on their lives.
 
Not surprisingly, though financial toxicity isn’t typically discussed as an “actual” side effect in veterinary medicine, money plays a huge role in the oncological care for companion animals. Having worked directly in the trenches for so long, I would even venture that veterinarians deal with financial toxicity far more frequently than our human doctor counterparts.
 
When cancer strikes a beloved pet, in addition to the emotional toll, the majority of owners must, at some point, consider the monetary impact of the diagnosis. Unlike humans diagnosed with cancer, our pets typically lack comprehensive healthcare to cover even routine costs, let along oncological care.
 
A long-standing joke in veterinary medicine is to be wary of the owner who states “money isn’t an issue,” as most often it’s not an issue because they don’t have any. Cancer generally always imparts a sense of urgency, and I’ve witnessed many times where  owners will make decisions regarding their pet’s care without full consideration of finances. In all seriousness, I have no way of knowing whether an owner who is giving me free reign to move forward with diagnostics and/or treatments is really able to afford things, or if they are making decisions based on emotions.
 
I’ve seen many reactions to the cost of chemotherapy for pets. Most owners are well prepared by their primary care veterinarians for estimates of what different treatment plans could cost. There are definitely cases of complete “sticker shock,” where the numbers I discuss are not at all on par with what the owners were anticipating. Other times the reaction is the polar opposite, where there’s great surprise and the treatment is considered inexpensive.
 
There’s not much I can do to control the cost of veterinary oncology care. Unfortunately, pricing schemes are complex; dictated by factors well beyond my professional “jurisdiction.” But it’s not enough for me to discuss only the physical signs associated with treatment when talking about side effects with owners. I’m equally responsible for attempting to prevent financial toxicity when I can.
 
As is true for so many aspects of veterinary medicine (and life in general), clear communication is essential to ensuring everyone is on the same page. Your veterinarian should never judge you for deciding to put finances first when considering how to proceed with your pet’s care. And you should never judge your doctor for talking candidly about prices, estimates, costs, and expectations. I’ve been placed in that situation more times than I’d care to admit, and it’s unpleasant for all parties.
 
We may not be able to eliminate financial toxicity from our treatment regimen, but veterinarians and owners both have a responsibility for making sure we pay close attention to even the subtlest signs of this important side effect. If we treat it as urgently and effectively as we do the more obvious signs, we’re guaranteed to reduce its impact and to further ensure that we maintain our patient’s quality of life, both in and out of the veterinary clinic.
 

Dr. Joanne Intile
 
 
Image: Dmitry Kalinovsky / Shutterstock
 
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DiAnPe cost of cancer 11/14/2014 09:37am I am going through this right now with one of my cats. She actually has a chemo treatment today. It isn't cheap, but I just keep handing over my credit card. I pay what I can every month. My little Gina is worth every penny that I am spending on her. She is family. The treatment has not made her sick and she is still acting like her old self. If it did cause her to be sick, I would stop. I do not want her to suffer, but for now, it is helping her. I will keep paying if it keeps helping bad side effects. My feeling is that I took her in and I owe her the best chance that I can give her. Reply to this comment Report abuse 8 TheOldBroad I Agree 11/14/2014 05:07pm I totally agree with DiAnPe. I believe that when I took them in, it was a promise to do the very best I could for them - even if that includes chemo.

Dr. Intile, have you encountered a situation where a pet owner has halved or quartered the medication for an animal due to finances? You mention that those who say "Money is not a concern" usually means there is none. Do you feel a need to delve further into the statement to see if the human truly has the funds or if Fluffy/Fido will be able to get the recommended diagnositics and treatment? Reply to this comment Report abuse 2 chellyw Insurance 11/14/2014 09:46pm I am only too aware of how high the bills can get, if your pet has a complex problem, as I encountered this with my previous Rough Collie, she did not have cancer, but problems with her kidneys, sadly she had to be put to sleep, as nothing more could be done, at that point her bill for treatment was £6000.00 I was lucky that I had her insured, but the plan I had her on, has a max of £7000.00 per illness, she was almost at this point, when we lost her. I therefore decided to ensure that I got the best policy that I could afford with my next dogs, I have 3, 1 3yr old toy poodle, 1 2 year old Rough Collie and 1 2 yr old Cavalier king charles spaniel, I have all 3 insured for £6000 a year per condition, so if they get a condition that requires on going treatment, they will get £6000.00 every year to cover that problem, the £6000.00 will be available every year, if they were unlucky enough to get a second condition, the will get a separate £6000.00 to cover that, which also renews each year. The dog with the highest premium is the cavalier king charles, as they can be prone to certain health problems, although my dog, is clear of those ailments, I still have to pay the premium for him being that breed. Dogs that are mixed breed, have much lower premiums, by far. I have seen friends distraught when their pet have become really ill and sadly, they have not been able to meet the costs of treatment, and its heartbreaking, so taking out this insurance gives me peace of mind Reply to this comment Report abuse 3 marie56 11/16/2014 10:57pm I still remember what my favorite vet @ Gulf Coast Vet Services reminded me of. It was basic Biology 101, When I brought in my purebred, he told me 2 get a pet @ a shelter Heinz 57, because there is less inbreeding. I could not agree more than that. He diagnosed my cat with cardiomyopathy. He lived life 2 the fullest. I went 2 a vet group 1 day a kitties mom was hit getting food. (A lady saw him on the street corner & brought him in. ) He put out his front paw & captured my attention ! I asked the front desk 2 tell me about him. He has been my baby for 12 years now.
There are no major health issues as of his last exam.
When I had Insurance 4 my purebred; I got the policy BEFORE the DIAGNOSIS but the Ins. put a OVER RIDE on his policy NOT 2 Treat again ! & the price went up GREEDY SOBS HATE INS CO. Reply to this comment Report abuse 2
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http://www.petmd.com/blogs/thedailyvet/drjintile/2014/november/one-side-effect-cancer-treatment-doctors-cannot-control-32#comments TheDailyVet Fri, 14 Nov 2014 11:00:00 +0000 32122 at http://www.petmd.com
What Can Be Learned About Treating Cancer in Captive Apes? http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2014/november/expert-veterinary-oncology-talks-about-treating-canc Nov 13, 2014 What Can Be Learned About Treating Cancer in Captive Apes? by Dr. Patrick Mahaney     Share    
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For pet owners, receiving word that one’s beloved canine, feline, or animal companion of another species has cancer is one of the worst imaginable conversations that can be had with their veterinarian.
 
I’ve endured this conversation as pertains to my own dog Cardiff. Yet, I was part of Cardiff’s cancer diagnosis process from the get-go, as I suspected he had a stomach, intestinal, or other abdominal organ tumor based on his clinical signs of anorexia (decreased appetite), regurgitation (bringing up partially digested food post-consumption), and lethargy. I also assisted on the ultrasound discovery and surgical removal of the small intestinal mass and then personally delivered the news to myself upon receiving the histopathology (biopsy) report. Needless to say, Cardiff’s cancer diagnosis wasn’t surprising but I knew that next up was the life-altering plan for a 7-month-long chemotherapy course (University of Wisconsin-Madison Canine Lymphoma Protocol, or CHOP) and other treatments to provide him with the best possibility of beating the cancer and experiencing the quality of life I’ve set out to provide.
 
As November is National Pet Cancer Awareness Month, my petMD Daily Vet articles are going to have a cancer-specific theme. Although society is generally aware of the options for veterinary services available to our canine and feline companions, we often fail to consider similar needs for animals residing in zoos, wildlife centers, laboratories, on movie and television sets, and more.
 
I recently became aware of a cancer patient of a unique species, a gibbon (a type of ape), who was treated at the Veterinary Cancer Group (VCG) in Culver City, CA, where on a weekly basis I work with veterinary oncologists who provide chemotherapy and radiation treatments to pets.
 
Jarred Lyons, DVM, DACVR-RO is both a veterinary oncologist who specializes in radiation treatments for animals and is the author of Survivor: The Dog Days of Cancer. I’m constantly intrigued by his veterinary practice, which is exclusive to oncology. Dr. Lyons only sees dogs, cats, and other species with cancer at VCG and is a true expert in his field.
 
Dr. Lyons oversaw the radiation treatment for the gibbon, a 25-year-old female named Ricky, who was born in Australia but has been living in Santa Clarita, CA, for 20 years at the Gibbon Conservation Center.
 
I had the opportunity to interview Dr. Lyons about Ricky’s case and his role in the cancer treatment process.
 
Dr. Mahaney: What kind of cancer did Ricky have?
 
Dr. Lyons: Ricky had a soft tissue sarcoma.
 
*Soft tissue sarcoma is a malignant cancer of connective or other non-skin tissue; Ricky had it on her left ankle. Malignant cancers are more serious than benign tumors as they are locally invasive and more prone to spreading to other parts of the body from a primary location. Sarcomas can arise from many body tissues, including muscle, connective tissue (ligament, tendon, etc.), bone, or others.
 
Dr. M: Is it unusual for a primate like a gibbon to develop this type of cancer and did Ricky’s age play a factor in her cancer development?
 
Dr. L: It is very unusual for gibbons to develop cancer and in fact at the Gibbon Conservation Center this is the first gibbon they’ve ever had that developed cancer. Like people these days, older gibbons are at higher risk for developing cancer. Whether that [the development of cancer] has to do with environment, genetics, or food is still an unanswered question.
 
Dr. M: What kind of treatment did you provide to treat Ricky’s cancer (please mention definitive vs palliative radiation and Cyberknife if used)?
 
Dr. L: We ended up giving a hypofractionated radiation protocol with the intent of definitive therapy. We radiated with our Trilogy linear accelerator with 6 doses total and given on a 2 times a week schedule. Given the fact we could not anesthetize 18-22 times on a daily schedule, I elected to treat with a high dose of radiation that could be administered safely and that could have a more definitive effect.
 
*When providing radiation treatment, palliative and definitive are two of the options available to animals. Palliative radiation involves fewer treatments and is aimed at reducing tumor size and associated inflammation, thereby alleviating pain and improving the patient’s comfort and quality of life on a more short-term basis. Definitive radiation requires a larger number of treatments and also strives to reduce tumor size and tissue inflammation, yet the goal is to have a higher likelihood of a cure or a longer caner-free interval.
 
Animals are fully anesthetized for a short time, often only 15-30 minutes, for each treatment, which may affect the determination that definitive or palliative radiation is more appropriate for a particular patient. Additionally, the patient’s age, overall health, preexisting conditions (heart, lung, kidney, and liver abnormalities, and other diseases), and the owner’s financial capabilities also come into play.
 
Dr. M: How did Ricky recover from each radiation treatment?
 
Dr. L: Ricky recovered very well from anesthesia and her son, Dennis, joined her shortly after each treatment.
 
*A great video of Dennis (and another gibbon) enthusiastically latching onto Ricky post-treatment can be seen in this video: Watch: Baby Gibbon, Mom Cuddle After Cancer Treatment
 
Dr. M: Is there any risk for Ricky’s offspring in having contact with her post-radiation treatment?
 
Dr. L: No, Ricky’s offspring are at no risk for health concerns in having contact with her post-treatment.
 
Dr. M: What measures should be taken to ensure Ricky’s babies don’t cause any complications to her during her radiation-treatment and recovery process?
 
Dr. L: The radiation should not cause any significant dermal (skin and its associated tissues) side effects with the dose that was given so I would not expect any real complications during the recovery process.
 
*With an increased number of radiation treatments, there is a higher likelihood that the skin and other tissues in the area being radiated will incur side effects like inflammation, pain, and potential for secondary infection.
 
Dr. M: Did Ricky receive any other treatments besides radiation for her cancer (I know she had surgery as well)?
 
Dr. L: Yes, Ricky also had surgery to remove the tumor.
 
*Before undergoing radiation, Ricky had surgery to remove as much of the tumor as possible. Such is a common occurrence and surgery may be able to completely excise (cut out) the mass with clean margins, or the tumor may be incompletely excised leaving tumor cells behind and increasing the likelihood that recurrence will quickly occur. In Ricky’s case, the sarcoma regrew and radiation was deemed to be the best option to shrink the tumor and provide her with an ongoing good quality of life.
 
Dr. M: Is Ricky considered to be cured of her cancer post-radiation treatment?
 
Dr. L: The hope was to put Ricky in a stable disease state or decrease the size of the mass for a period of time. As far as being cured, there is always a chance [that her radiation treatments will provide a cure].
 
Dr. M: What are the steps being taken to monitor Ricky for cancer recurrence post-radiation treatment?
 
Dr. L: Dr. Martin, the on-site veterinarian at the Gibbon Conservation Center, is in charge of all further follow-ups and monitoring and is keeping a very close eye on Ricky.
 
*With any patient undergoing radiation, chemotherapy, or other cancer treatments it’s important that day-to-day behaviors (appetite, water consumption, bowel movement and urine production, activity, rest, etc.) are monitored in addition to frequent evaluation of the surgery site for recurrence of the tumor and of the whole body for development of new masses.
 
Dr. M: Will/can Ricky have radiation treatment in the future if her cancer recurs?
 
Dr. L: Yes, Ricky is definitely a candidate for future radiation treatments [should her cancer recur].
 
*
 
Hopefully, Ricky will have many years without a recurrence of her soft tissue sarcoma or the development of any new areas of cancer. If you are interested in helping fund Ricky’s medical care, financial contributions can be made in her name to the Gibbon Conservation Center donation page.
 
 

Dr. Patrick Mahaney
 
 
Image: (Not Ricky) rattanapatphoto / Shutterstock
 
 
Related articles:
 
When Pets Complete Chemotherapy Are They Cancer-Free?
 
Unexpected Side Effects of Chemotherapy Treatment
 
Feeding Your Dog During Chemotherapy Treatment
 
Can a Veterinarian Treat His Own Pet?
 
How a Vet Diagnoses and Treats Cancer in His Own Dog
 
A Veterinarian's Experience with Treating His Dog's Cancer
 
Top 5 Acupuncture Success Stories
 
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TheOldBroad Cancer 11/13/2014 05:41pm The video was adorable.

How large was the initial mass? Do you know?

Also, how was it discovered?

Regardless, rock on, Ricky. I wish you many subsequent years of health! Reply to this comment Report abuse Tariq Hossenbux Good News 11/15/2014 07:07pm It's nice to hear that these gibbons are getting the best conventional treatment possible. When it comes to the unanswered questions about food, environment, and genetics I think it comes down to antioxidants. Food may not have enough to prevent damage, the environment may have too many free radicals for the body's own antioxidant system to handle, and gibbon may genetically produce less antioxidants than others making him more prone to this disease. Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2014/november/expert-veterinary-oncology-talks-about-treating-canc#comments TheDailyVet Thu, 13 Nov 2014 11:00:00 +0000 32121 at http://www.petmd.com
Contrary to Popular Belief, Horses Do Not Sleep Standing http://www.petmd.com/blogs/thedailyvet/aobriendvm/2014/november/contraray-popular-belief-horses-do-not-sleep-standing-321 Nov 11, 2014 Contrary to Popular Belief, Horses Do Not Sleep Standing by Dr. Anna O'Brien     Share    
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Let’s clear up a common misunderstanding about horses: they do not sleep standing up. They snooze standing up. There’s a big difference.
 
Horses, like humans and, in fact, all land mammals, require deep sleep for proper mental and physical functioning. But for a prey species like the horse, whose existence in the wild depends on its ability to outrun predators, deep sleep can be a serious threat to personal safety. So how do horses get enough sleep?
 
For starters, horses doze a lot. On any given day, drive past a pasture of horses and count how many are grazing and how many are just standing there, heads down, lower lips drooping. Those are your snoozers, standing up.
 
Horses are able to get some light shut-eye without lying down by way of a really cool aspect specific to equine anatomy called the stay apparatus. When a horse is standing at rest, he is able to lock his kneecap with ligaments and tendons keeping the joints in alignment. With these soft tissues locking the bones together, no extra exertion from muscle use is required. This allows the horse to actually rest while standing.
 
But what about that deep sleep I mentioned earlier? Horses can’t attain deep REM sleep by standing; this is only accomplished when the animal lies down. Therefore, horses do lie down to get proper sleep. They just don’t do it for very long.
 
It turns out that horses do not require a lot of REM sleep — roughly two to three hours a night, typically in short bursts of ten to twenty minutes at a time. A typical night as a horse will involve grazing, snoozing standing up, and short periods of lying flat out to get some serious shut eye.
 
The important thing to note is that horses will only lie down to sleep if they feel safe in their environment, because obviously this action is very risky if you’re a prey animal in a potentially threatening situation. This issue of environmental stress also affects domesticated horses. While usually not threatened by mountain lions or wolves or other predators when in a farm pasture or in a stall for the night, if the horse is stressed, he will not lay down to sleep.
 
Very busy, loud barns, or an area that is too small for the horse to feel comfortable lying down are some common problems for the modern horse. And the result? Horses that go without REM sleep over the course of weeks will have a negative effect on physical performance, and may even factor into irritability or behavioral problems. That’s right — everyone needs beauty sleep, not just us humans.
 

Dr. Anna O'Brien
 
Image: Michael Rucker / Shutterstock
 
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TheOldBroad Horses 11/12/2014 06:46pm I was always under the impression that horses can't breathe well when lying down*. If true, does that have anything to do with it?

*Years ago I visited a vet school and everyone was frantic that a horse was laying down and not getting up. Someone explained that the weight of the animal didn't allow the horse's lungs to expand fully and, if left down, it would suffocate. Reply to this comment Report abuse 3
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http://www.petmd.com/blogs/thedailyvet/aobriendvm/2014/november/contraray-popular-belief-horses-do-not-sleep-standing-321#comments TheDailyVet Tue, 11 Nov 2014 11:00:00 +0000 32120 at http://www.petmd.com
Brain Tumors in Cats – Not Always a Death Sentence http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/november/brain-tumors-cats-%E2%80%93-not-always-death-sentence-32119 Nov 10, 2014 Brain Tumors in Cats – Not Always a Death Sentence by Dr. Jennifer Coates     Share    
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You brought your cat to the veterinary clinic with vague signs, perhaps some loss of energy and odd behavior. These symptoms weren’t all that concerning, but now you’ve been shocked by the news that your cat likely has a brain tumor. This has to be the end of the road for her, right? Not necessarily.
 
The most common type of brain tumor in cats is a meningioma. One study found that 56 percent of reported brain tumors in cats were meningiomas. Actually, calling the condition a “brain tumor” is a bit of a misnomer. The abnormal cells forming the mass don’t originate in the brain but in the membrane that covers it (the meninges). The tumor’s location on the outer surface of the brain, slow growth, and tendency to form solitary masses are the reasons why meningiomas can be treated with relative ease.
 
Don’t get me wrong; meningiomas are often deadly.  They press on and disrupt nearby parts of the brain and when large enough increase the pressure within the skull, which can have catastrophic consequences. My point is simply that if a cat has to have a brain tumor, a meningioma is the best type to have.
 
The clinical signs of meningiomas generally come on slowly, gradually worsen over time, and can include:

depression or confusion
head tilt, loss of balance
poor vision
difficulty swallowing
a change in voice
seizures
weakness
strange behaviors, including withdrawal from daily activities
gain or loss of appetite
vomiting
weight loss
pacing/circling
head pressing
collapse
paralysis
coma

 
Diagnosing a meningioma requires a complete physical and neurological examination, a general health work up (e.g., blood chemistry, complete blood cell count, urinalysis, feline leukemia virus and feline immunodeficiency virus testing) to rule out other conditions, and advanced imaging – either a CT scan or an MRI.
 
Surgical removal is the best form of treatment for cats with meningiomas. I bet some of you are rolling your eyes thinking “brain surgery for cats, yeah right,” but remember that meningiomas typically lie just under the skull and don’t invade the underlying brain tissue. While this is not a procedure that a veterinarian in general practice should attempt, it really isn’t all that complicated for an experienced, board-certified veterinary surgeon.
 
Results can be quite good after surgery for a meningioma. Once study found the median survival time to be 26 months, not too bad given the fact that most of these cats were older to begin with. Another study showed that 78% of the cats who survived for longer than 26 months after surgery had no evidence of tumor recurrence – in other words, they had essentially been cured.
 
Obviously all cats are not candidates for brain surgery and the cost can often be prohibitive, but owners should still be aware that definitive treatment is an option for some cats with meningiomas.
 

Jennifer Coates
 
Image: Shebeko / Shutterstock
 
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TheOldBroad Surgery 11/10/2014 06:15pm I certainly wasn't aware of any of this and am really glad for the information. While I haven't had to deal with this (yet), it's really good information to tuck away. Reply to this comment Report abuse 2 bcorey10 Anything Helps 11/12/2014 02:09pm It is always nice to hear there is hope. My kitty was recently diagnosed with Chronic Kidney Disease and her health has only gotten worse and more expensive to care for. I can no longer afford to help her on my own and need assistance. If you can find it in your heart to donate to our cause, I would be forever grateful. http://www.gofundme.com/helpmysickkittyfun Reply to this comment Report abuse Ringtail My cat survived this 11/14/2014 12:55pm Thanks to a great primary care vet and a wonderful veterinary neurosurgeon, my then 11 year old cat Loki survived a meningioma last year. But the costs (diagnostic and surgical) were very high, totaling $8500. This was a little higher than predicted because he nearly bled out during surgery and spent a night in the ICU. I needed to use almost a week of vacation to be home with him. To see him now, you would never know he was so sick. He would have had to have been euthanized if I had not played credit card Jenga to keep him alive. I do have insurance but that only paid $2500. Unfortunately, I have another cat who is ill with IBD if we are lucky, lymphoma if we are not. I had to tell that great primary care vet that I cannot spend anything like the money I spent last year. So all she can do is manage the symptoms. She understood. I am so sad but I can't bankrupt myself to save my other cat, though I love her just as much as the other one. Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/november/brain-tumors-cats-%E2%80%93-not-always-death-sentence-32119#comments TheDailyVet Mon, 10 Nov 2014 11:00:00 +0000 32119 at http://www.petmd.com
Do Veterinarians Owe Their Clients Closure After a Pet's Passing? http://www.petmd.com/blogs/thedailyvet/drjintile/2014/november/do-veterinarians-owe-their-clients-closure-after-pets-pass Nov 07, 2014 Do Veterinarians Owe Their Clients Closure After a Pet's Passing? by Dr. Joanne Intile     Share    
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Several years ago, an owner scheduled an appointment with me about a week after I’d euthanized their pet. It was an unusual request, seeing as though their pet was no longer alive and in need of my services. I urged the owner to call me or e-mail me with any outstanding questions or concerns. I explained that if they were to schedule a specific time to see me, not only would it take a spot away from another pet in need of treatment, but that I was required to charge them for the appointment spot, while it would not cost anything to talk on the phone or via e-mail.
 
The owner elected to keep the appointment. We met and talked about their pet and its disease and how it had progressed over time. We didn’t spend a great deal of time together, but it was a significant moment for both of us. As per the policy of the hospital, and our prior discussion, an appointment fee was generated.
 
Several days later, I received a letter from the owner criticizing the fee on the grounds that it was unethical for me to charge a visit after all they’d been through. An additional suggestion was made that I should provide follow-up appointments, free of charge, to owners who’d recently euthanized their pets as a means for them to obtain closure and to provide a forum where they could process their feelings and/or frustrations.
 
As I read the letter, a complex mixture of emotions rose within my mind. Empathy, sadness, resentment, and confusion — I felt it all. But my overriding sentiments regarding the words were, “Why had I not accurately prepared this owner for their pet’s death, leading to their compulsive need to talk with me afterwards?” and “Why should I be obligated to give my time for free when a human physician would never face this expectation?” I didn’t feel particularly good about my thoughts, but I’m being honest in my description.
 
Discussing end-of-life care is something I’m entrusted with nearly every time I enter a new appointment. Invariably, owners want to know what to look for to indicate their pet has reached the end stage of their disease. It’s never easy to consider concepts such as death and dying, planning for end-of-life care, advanced directives, or euthanasia. But experience tells me it’s much better to talk about these topics before we’re in the midst of an emotionally charged situation.
 
In human medicine, dialogue centered on end-of-life care is frequently entrusted to social workers or hospice providers. Though well trained in these difficult topics, it's a patient’s doctor who is best equipped to do so. They possess the medical knowledge about the specifics of what actually occurs physiologically within the body during measures such as cardiopulmonary resuscitation, or in response to treatment of disease, and how to prepare owners for what lies ahead.
 
The results of a pilot study presented this year at the annual Quality of Care and Outcomes Research Scientific Sessions showed physicians were reluctant to discuss end-of-life issues with their patients because they perceived their patients or their families were not ready to discuss it, they were uncomfortable discussing it, they were afraid of destroying their patients' sense of hope, or they didn’t have the time to engage in those conversations. The latter example tells us that if a doctor isn’t going to be paid for the time it takes to have an end-of-life discussion, it’s not going to happen. Period.
 
The good news is that more and more private insurance companies now offer reimbursement to doctors for conversations related to advanced care planning. The American Medical Association (AMA), the country’s largest association of physicians and medical students, recently urged Medicare to follow suit, indicating doctors are not only committed to the cause, but recognize that they are the ones best equipped for the job.
 
Unfortunately, insurance companies offer lower reimbursement rates to doctors for the time spent talking to people compared to performing medical procedures. If we’re simply sitting around talking, we can’t be ordering tests or administering drugs or performing surgeries, and ultimately, we’re not making any money. Even when doctors try to do the right thing, it seems we manage to be penalized.
 
It is incredibly sad that innocent animals develop debilitating diseases. I recognize how fortunate I am to work with owners who have the time and resources to treat their pets. And I understand that the loss of a pet is an intensely painful process. None of this changes the fact that being a veterinary oncologist is my job and my source of income. I too must earn a living, pay bills and loans, and support myself.
 
Was it wrong of me to charge for an end of life/closure discussion? Did this represent detraction from my reservoir of compassion? Worse yet, did it make me a bad doctor? My answer to each of those questions is a resounding “No!”
 
Years later, I still think about that owner and their letter, and something deeper than being labeled good or bad, compassionate or unethical, or right or wrong continues to weigh on my mind. By gaining a sense of closure and peace for themselves, this owner ironically created a sense of uneasiness in my soul.
 
Sometimes the toughest cases for veterinarians have nothing at all to do with animals. Sometimes the price we pay for the stress can’t be quantitated in dollars or cents.
 
And sometimes this is why we work for free, even when we know we shouldn’t, because we hope it will somehow save us from the unyielding pressure of charging adequately for doing out jobs.
 

Dr. Joanne Intile
 
 
Image: Colleen Morgan / Flickr
 
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WestiesRule Treating the Owner 11/09/2014 08:55pm I have to make a statement here. I found this article offensive from the standpoint of being a pet-owner who suffers loss. Having been through ti too many times.. euthanasia usually being the end result for my beloved dogs; some at a "much too young" age due to cancer; the subject of paid appointments seems totally irrelevant when it comes to grief and lay persons who have to give the greatest gift of love in putting down a "member of the family." It stuck me as really callous reading the explanation given. YES! a veterinarian has a responsibility to explain to the owner what the procedure entails, and as an oncologist, a "hardened" outlook is self-preserving when one is dealing with death on a daily basis. Having worked in the medical field years ago; I am well aware of that. But it does not negate the need to educate and comfort the grieving. all that being said; prior to the actually "procedure" to end life and suffering; an explanation of the physiological aspects is necessary.n I am grateful, that my last experience was handled by a Doctor who was compassionate and explained every detail of what to expect as the procedure took place. I WAS paying for a service; and it IS a BUSINESS. But NEVER should any practicing veterinarian fail to remember that it isn't only about dollars and cents. We who enter the healthcare field should remember the "care " part of the description. I personally will not deal with any DVM who demonstrates otherwise to me. As for the " compulsive need to talk with me afterwards?" shame on you! You apparently failed to offer enough support beforehand. Reply to this comment Report abuse 4 TheOldBroad Humans 11/10/2014 06:12pm According to your story, you properly informed the person that an appointment would be "chargeable." Especially if you told the person you could chat by phone or email.

Some people are never happy and are fierce in trying to get others to comply with their wishes.

“Why had I not accurately prepared this owner for their pet’s death, leading to their compulsive need to talk with me afterwards?”

That may or may not be true.

You're right. Some doctors avoid the hard conversations and people aren't informed enough to deal with the outcome. However, there are also people that are never satisfied and want to blame something/someone*.

Without having transcripts and audio of all the conversations, it's impossible to determine what really happened.

*I've found that when people get cancer, the loved ones usually want something/someone to blame. They want to know why. Sadly, sometimes the answer is "no one knows."
Reply to this comment Report abuse 1 broken_hearted_ Closure and trust 11/14/2014 04:14am It is very difficult as a pet owner to come to terms with a pet's death. Especially as many of us feel solely responsible for our animal's wellbeing. Every single day we have to try to interpret their cues and subtle signs, they often try to hide, to establish if they are sick or in pain. We don't always see the signs, understand the symptoms or know what needs to be done. That is when the vet comes into play. You are our interpreter. You are the one that analyses our animal and uses your wealth of knowledge to advise us what to do. Whether the vet realises it or not they become our lifeline to our pet so when our pet dies I think it is only natural to expect some closure from the person we have put our trust in.

I recently lost my little dog to CHF. Lucky for him, I suppose, he really only suffered for three weeks. However during this time I was constantly fed false hope about his condition. I was told he was stable and eating, which I now know he wasn't. My concerns about his medication were dismissed. I could see him getting worse and confronted our vet as to whether he was in end stage CHF. I was told no. The next day I was told he was treatment resistant. We discussed euthanising him and I was assured he still had weeks to a month before we even needed to consider it. My vet was wrong. Very, very wrong.

My little guy had been in and out of the ICU for two weeks with CHF. After four nights they gave him back to us apparently 'stable'. But he was skin and bones, could hardly breathe and could hardly walk. We only had him home for 18 hours before he went into respiratory distress. We rushed him back to the ICU where they put him in the oxygen tent. They insisted on doing a whole battery of tests like X-rays, bloods etc. They told us he was breathing ok and to go home. Three hours later they rang me to get permission to euthanise him immediately as he had 'suddenly decompensated'. He was in cardiac arrest before the end of that two minute phone call and died a horrible, frightening and painful death.

I'm not expecting vets to be psychic. I realise that things happen unexpectedly. The problem is, if I could could see how much he was suffering, why could't my vet? After all they were the experts. My dog was under the care of specialist cardiologist at a leading teaching hospital. How could my dog's condition be so severely underestimated? How was everyone in the ICU 'taken by surprise'? If I had been given the option to painlessly euthanise my little guy I would have. I would have done anything to spare him the suffering he went through. I really couldn't understand what had happened- how had it all gone so wrong so fast? I had questions.

My dog died on a Sunday so the cardiologist wasn't there. The vet who had treated him could offer me very little explanation regarding his death. She wasn't his specialist and could only guess that he had a major heart tear or possibly a blood clot. I had to leave him with them in the morgue overnight (due to high temperatures and not being able to have him cremated immediately) and came back to pick him up the next day.

When the receptionist rang through to the cardiologist to let him know I'd come to pick up my dog I thought he might make time for me. He saw myself and my dog regularly over a year and a half period. We were friendly and often chatted. He had my faith and my trust. He made me think what I was doing with my dog was right, even if my gut told me otherwise. When a nurse I had never seen before carried my dog out to me wrapped in a white plastic 'body bag', cold and stiff from the fridge, I realised he wasn't going to offer to me. No explanation, no condolences.

Two days passed and consumed by grief and overwhelming feelings of self blame I sent the cardiologist an email asking the questions I needed answered at the time. And he did call me to say that everything that could have been done was.

Did I consider my actions to be a compulsive need to speak to him afterwards? No. Who else was going to answer my questions if not the person responsible for my dog's care? Did I consider him calling me in work hours after I had spent nearly $15,000 trying to keep my dog alive to be 'working for free'? No. I really, really didn't. Did speaking to him give me closure? Some. The circumstances surrounding my dog's death have made closure very difficult for me but had my cardiologist not bothered to respond to my email I think I would feel much, much worse.

Closure is a very small mercy to offer when someone has lost a member of their family and something I feel is deserved by any pet owner who seeks it.


Reply to this comment Report abuse 2 WestiesRule 11/14/2014 11:12am First of all, you have my sincere condolences on what both you and your beloved pet endured . I totally appreciated your comments. You articulated your experience so well in your writing. Several of the points you made are exactly what I, along with countless others, have experienced. Modern "medicine" is all too often about profit. Everything has a price tag attached now...even grief support. On rare occasion,when one finds a truly dedicated Vet; ( as gratefully I am blessed with currently) they don't treat our pets as a "commodity." I have experienced that too, albeit infrequently in recent years. I am sorry to say that today, everything has an inflated price tag . I do want to state, here; Veterinarians should hold to the same rules that other Practitioners are supposed to. After a major procedure; we all experience what is called a 'follow-up" or "post-op" checkup. There is NEVER a charge for that. It is considered inclusive in the charges for the surgery or procedure. The same principle should apply in the case of our pets. Whether it is surgery, or euthanasia. Too many are totally "clinical" in their treatment and consider it "case closed" when death occurs, whether induced or of natural causes.

A case; in example. My 8-year-old Westie has been recovering from an amputation done four months ago. It was the result of Synovial Cell Sarcoma in his right rear stifle ( knee joint). I, on the recommendation of our local Vet., who believed our dog had a torn cruciate ligament upon initial evaluation and exam, which would require surgery; was referred to a major Veterinarian Hospital (UF) where he endured endless tests for an accurate diagnosis a few days later. All were considered necessary, and I didn't question them. I was, however, horrified, by the cost just to diagnose him. It was in the thousands. While we were there; this "famous" hospital scheduled him upon initial evaluation for a biopsy the next day, and demanded 75% of the estimated costs before they would proceed. $$$$. We spent the night in a local hotel and my poor frightened animal, who was at that point lame in the suspect leg and in intense pain, was so upset and stressed that we spent a restless night with the almost certain cancer diagnosis; based on the tests done that day. When we arrived back at the hospital the next morning at 7:30 a.m., we met with the surgeon who very callously explained his findings so far, while an Intern looked on; and listened to him expound on what he believed should be done. He told me that should the suspected cancer be validated with the biopsy as expected based on their findings thus far; immediate amputation should be done, as "he is a good candidate". My dog was shaking so violently and trying to leave; that I immediately lifted him up onto my lap and as he buried his head under my arm; he stopped shaking. I pointed out to the doctor that it was apparent how frightened and extremely stressed he was, and how separating from me would affect him. I hoped perhaps they would sedate him; even though I knew the odds against that . I also pointed out to him as he witnessed the interaction, how much comfort the poor thing needed. He had no reaction.( The worst part was that unbeknownst to me, he would remain in a cage until 5 P.M. that evening as they were "over-booked " with procedures that day. $$$$. They didn't get to him for nearly 9 hours later!!) Then, as they were about to take him away, the young woman Intern picked him up from my lap and as she left the room; she had the audacity to say, "Come on ---, let's go have FUN"! I nearly flipped. I waited in fear of the worst for hours and called to check as to why I had heard no more and was told he was still pending. I was given to the "assistant" who was in the early stages of training. I learned after several calls that they would not get to him until 5 p.m.! When I finally got the call to come in later that night; I was livid as to their leaving the dog to suffer emotionally and physically all that time in a cage, especially as they knew beforehand how both he and I felt. I immediately refused to allow them to set up the amputation and told them I would have nothing further to do with their hospital and the intolerable treatment he had received. The "planned" surgery would have cost many thousands more with an extended 5-7 day stay afterwards for 'observation' and recovery. There was no way I would allow them to touch him further. I told them we were both done there; and how I felt. We returned home and my regular Vet's office performed the same surgery at 1/4 of the cost, releasing him to come home the next day! I did an online survey and voiced my complaints against the hospital about their procedures; asking for the Hospital Administrator to contact me. Instead, with an excuse, the "Dr." who called me back admitted that my dog should have been remanded back to my custody that day since his wait was going to be so long. Other than that; he justified and supported the physicians there. The young Internist, however, was" no longer" working there,(supposedly) and sent to the Lab.

The reason for this whole story is that, having been a healthcare worker; as I originally stated; I have watched the decline in patient treatment as the profit from procedures has skyrocketed. Be it humans or animals, The word "Healthcare" is no longer valid as I once said that to my Supervisor upon leaving the field. Her response was; 'That's the way it is." All the hospital bragged about was they were a largely profiting Hospital. The patients I left behind dreaded my leaving because they knew how much I cared about them. I said a tearful goodbye and worried about their emotional needs being met. That was years ago....it is much worse now. The decency of consoling a "client" who is grieving, should never have a price tag attached to it. It should be encompassed in the final cost. Maybe it is time for Veterinarians and regular medical practitioners to go back and take "Psychology 101" again? The system is failing to meet the needs of patients. Kudos to those of you out there who still feel as I did when I left the field; that emotional support is a huge part of the package. We don't belong in the filed if we are in it for the business and profits mainly. That includes providing "closure" to grieving owners. Reply to this comment Report abuse 1 Barbie5 The Conflict Betwe 11/14/2014 11:41am Interesting. The conflict between empathic human emotion and fair business practices. Perhaps the conflict functions as a means to temper the excesses inherent to a capitalist economy. I imagine it could be a tough position for anyone to experience. I have yet to be the owner of a pet requiring end of life decisions for the old dogs I have. Gratefully I have a family member close by who insisted that I listen when he told me about his experience in making the decision to put down a beloved pet.

As much as I trust our vet, and as capable and willing as they are when it comes to caring for our pets, it is the veteranarians' job to advise and provide information on behalf of the patient to the owner. It is the pet owners' responsibility to take care of owners' emotional needs, and that includes payment for services provided. If the owner wants professional help in reaching some kind of closure over the death of a family member, there are people whose professional specialty it is to provide counseling services, and most likely for a fee.

I have to give the veterinarian a whole lot of 'empathy credit' for being willing to provide limited closure in the form of recounting events as they are related to the pet. It is reasonable for the vet to be paid for the service. Reply to this comment Report abuse broken_hearted_ 11/14/2014 06:37pm Hi Barbie5,

I don't think anyone is suggesting that the veterinarian offer grief counselling in the event of a beloved pet's death. Closure is something different and actually something a grief counsellor cannot offer as they were not involved in the animal's treatment and it is impossible for them to have any knowledge of what took place. Only the vet who treated the animal can provide an owner with any kind of explanation. I know this because I felt a very strong need to contact my vet for closure and I am also currently undergoing grief counselling.

Until an owner suffers the loss of a pet (in what can be exceptionally tragic circumstances) it is impossible to know how they will react. My husband for example doesn't feel the same need for closure as myself. He doesn't want to know the details and that is fine. I really have to reiterate though that until you have actually been through it, you honestly won't know how you will feel or how many questions you will have. I trusted my vet implicitly with the care of my dog- in hindsight I feel very differently.

I don't personally feel I am being indulgent of my grief to want to have a better understanding of the death of an animal I fed, bathed, medicated, walked, played with, cuddled, nursed through sickness and absolutely cherished. I put no dollar sign on my dog. I never did but it was very hard to pay the clinic a $500 bill after 3 hours of treatment that resulted in the sudden death of my dog. I'm not suggesting I shouldn't have had to pay but emotionally it was very hard.

I don't expect vets to start holding grief sessions in their rooms during work hours or out of work hours but I think a treating vet does owe some form of explanation to an owner when their pet dies especially in unexpected circumstances. I think an email or phone call is sufficient and ongoing communication wouldn't be necessary or helpful. Reply to this comment Report abuse Catladykaren Closure or comprehension. 11/15/2014 08:47am I called the veterinary specialists, and I emailed them. I was beyond confused and quite literally insane with grief.
I don't understand how a tumor can be mistaken for a congenital diaphragmatic hernia. My vet never offered an explanation for the egregious error. She had weeks, maybe months he told me. Nothing could be done, surgery wasn't an option, just enjoy the time we had. Months went by, she seemed fine, then more months, we were lucky, still no retesting agreed to, despite my questions and prodding. Then a year passed, I wanted another Xray. The fill-in vet said it was a mass and did not appear to be a hernia. Imagine my disbelief and bewilderment. My precious girl was struggling to breathe, and thats how we ended at the hands of vet specialists at the 24hr animal ER. They gave me hope that I had not had in the year of watching and waiting for her to die. Misguided hope, false hope, because they were all wrong too.
Do I have closure now that the anniversary of her death draws near? Do I even understand what went wrong or why all their tests and procedures were worthless? No, not even close. I have PTSD from the nightmare of what I let them do to her, and how I failed to protect and care for her. I am financially devastated and have lost all faith. I had asked for her complete file/records 2 months after, it took them weeks to compile. They failed to include an OR report and the pathology results. Took another few weeks to get those. A short paragraph for the complicated surgery that failed to note her drop in blood pressure for 15 minutes. And the damning results that pointed to Thymic Carcinoma. She was misdiagnosed every step of the way. Reply to this comment Report abuse Catladykaren 11/15/2014 08:54am I will never understand why. Phone calls and emails didn't provide closure. They were inadequate, and did nothing to ease my fear that vet med is a sham, and a crap shoot at best. Reply to this comment Report abuse broken_hearted_ 11/15/2014 07:21pm Catladykaren,

I just wanted to offer you my very sincere condolences. I too thought I was doing the best by my pet. I too was given false hope. I'm currently undergoing grief counselling but suffer from panic attacks as well as anxiety and guilt about my little dog's final hours both in my care and the care of the emergency ICU. I can't give you any answers or make your pain go away but I will tell you this- everything you did for your pet you did out of pure love. They knew that you loved them right up until the end. It doesn't make what happened any less wrong but please know that you did everything you could and sometimes things are taken out of our hands. It's not right and it's not fair but please try to concentrate on the good times you had with your pet. They wouldn't want you to be miserable forever. I hope you can eventually find some peace. I hope we both can. Reply to this comment Report abuse Catladykaren 11/16/2014 06:47am Thank you brokenhearted,
The horror of my experience will always haunt me. Injured dogs came in, and they turned their attention to these emergency cases. After 8 hours of waiting in the cafeteria style lobby all night and morning, when they finally allowed me to come back to ICU to see her, she wasn't breathing. They hadn't even noticed. They had taken her out of the oxygen tank for another patient and claimed she was getting better care on the center table. They had a heater blowing on her because her temp was dropping. I started screaming, tears streaming, backed away and ran from the room. Screaming and crying "No, no, no!" over and over as I collapsed in the employee bathroom. When the doctor came to see me she claimed her heart was still beating. What a lie I was so desperate to believe. I paced in the lobby while they left her unattended to die. $10,000 to suffer this fate, for them to tell me I did everything I could but not adequately explain why she died. So yes, you owe it to your client to provide some closure or explanation. I was not given that compassion. It is part of the job and vets who don't believe it is, should work at a zoo.
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http://www.petmd.com/blogs/thedailyvet/drjintile/2014/november/do-veterinarians-owe-their-clients-closure-after-pets-pass#comments TheDailyVet Fri, 07 Nov 2014 11:00:00 +0000 32116 at http://www.petmd.com
For Anxious Dogs a Little Love Goes a Long Way http://www.petmd.com/blogs/thedailyvet/ken-tudor/2014/november/anxious-dogs-little-love-goes-long-way-32115 Nov 06, 2014 For Anxious Dogs a Little Love Goes a Long Way by Dr. Ken Tudor     Share    
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We all know how our furry friends enjoy a good pet. Well, it is amazing how little time is required for petting to make a big difference in their stress levels. At the 2014 American College of Veterinary Internal Medicine Symposium researchers presented an abstract synopsis of a yet to be published study of 15-minute petting sessions with shelter dogs. The results are illuminating and really reinforce the impact of companionship in helping shelter dogs adjust to potential adoption.
 
The Dog Stress Study
 
Fifty-five shelter dogs were subjected to one 15-minute petting session with an unfamiliar volunteer at a county animal shelter. The sessions were videotaped and the volunteers were given specific instructions on how to interact and pet the subject dogs. Saliva was collected from the dogs to analyze their body cortisol, or stress hormone, levels before and after petting. The heart rate of the dogs was also monitored for the entire 15-minute session.
 
As expected there was a great deal of variation of response depending on the age, temperament, coping styles, and time spent in the shelter among the animals. In fact, cortisol levels before and after petting were not different. This suggests that stress was still a constant despite the petting session. Another explanation is that 15 minutes is a relatively short period of time to detect significant changes in body cortisol levels in saliva and would not reflect potential real changes in cortisol secretion. 
 
What was observed was a statistically significant decrease in heart rate and behavior changes consistent with a positive state of relaxation. The observation of the researchers is that “yes, 15 minutes does make a difference” for many shelter dogs.
 
The Implications of the Dog Stress Study
 
If only 15 minutes can make a difference, what difference could multiple 15-minute sessions make in the re-socialization of abandoned or lost pets? This study reminds me of an experience I had while working at a veterinary hospital prior to acceptance to veterinary school.
 
As a lowly kennel person, my job was to ensure the cleanliness of the runs and cages of our hospitalized animals and ensure constant and adequate care and feeding. One of my charges was a dog, without a current rabies vaccination, being held for the mandatory observation period of ten days after biting someone. The dog was extremely aggressive and would not allow anyone to enter his run without attacking.
 
Initially, I had to hose down his run with him in it. I tried to minimize getting him wet but it was mostly dependent on his mood to charge the hose or not. Feeding him and changing his water was a real challenge because I had to enter the run. I devised all manners of diversions to complete the task. But I was determined to win his trust, so after cleaning and feeding I would sit down outside and lean back against the chain-link door of the run for 20-30 minutes after I had clocked out from work.
 
Within days he approached closer, until one night he licked my ear through the chain-link. I offered my fingers and he eagerly licked them. The next day I entered the run and he rushed to me with his tail wagging and allowed me to pet him while he licked crazily at my hands. From that point I was able to put a leash on him and give him multiple walks outside and he was perfectly behaved. With his newfound freedom he even befriended the veterinarians and other staff members. At the time of his release, with his current rabies vaccine, his owners could not believe his behavior change. He was definitely conflicted between me and his owners when it came time to leave, but he made the right choice and jumped in their car.
 
My Point
 
Daily, I interact with people from all walks of life who volunteer at animal shelters. Their primary job is to interact with the animals and provide that human bond that these animals need. The experiences of these volunteers and mine as a pre-vet have shown what these researchers have now proved: Fifteen minutes and more attention can make a big difference for our furry friends.
 

Dr. Ken Tudor
 
Source:
McGowan RTS, Bolte C. Impact of a 15-minute petting session on shelter dog well-being. Ahead of publication
 
Image: Pets Adviser / Flickr
 
Related:
Five Donations Your Local Animal Shelter Needs
 
Why You Should Consider Getting a Shelter Pet
 
petMD Survey Reveals Pet Owners No Longer Believe Animal Shelter Myths
 
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mdkajak Thanks 11/06/2014 10:09am My dog Lola is super hyper, when I get home and very anxious when I leave, I have started spending puppy time in the morning before I leave and petting her after her last walk before I go to work, also I come home at the same time every day, and she seems to have calmed down a lot.
Thanks, for your great article. Reply to this comment Report abuse TheOldBroad Good for Humans, Too! 11/06/2014 06:29pm Petting an animal also has benefits for the human. It's my understanding that many times it can lower blood pressure as well as stress levels.

I love your story of winning the dog's trust. Do you think he was aggressive due to stress or perhaps mistreatment in the past? Do you, by any chance, have any updates after the dog went with his humans? Did he revert to being aggressive or had he learned that humans aren't so bad after all? Perhaps he was just totally freaked out being caged? Reply to this comment Report abuse Lucy G. Nervous dogs 11/07/2014 05:03pm I have two shelties, one 6 years old, the other almost nine months old. My older dog (William) is EXTREMELY nervous. The puppy (Harry) is quite high energy, but outgoing and brave. The older dog I got at nine weeks, the younger at 10 weeks. William is highly intelligent and with extensive training and socialization, he has earned titles in obedience and his AKC therapy dog title. He is well on his way to earning one of the new advanced Therapy Dog titles they are now offering. William is good at tricks and that is how he started in Therapy work...he went to entertain. Now he shakes hands with everyone and will put his paws on their laps so they can reach him for patting if they wish to do so. In Obedience, his nerves sometimes hurt him, but when he overcomes them his scores are high. He does not enjoy competition, though, and at some point, when Harry begins his career, William will move strictly to therapy work.
My point in this is that shy dogs take work, just as the vet says in this post. I wonder if a naturally timid dog such as mine, has more trouble overcoming his nature than a dog whose nervousness arises from circumstance? William will always be neurotic - I have a friend who compared him to Sheldon Cooper from "Big Bang Theory" and everyone thinks that is really accurate. Those who knew him as a puppy, though, are always amazed at his success as a therapy dog.
Now, if only I can get his "little brother," Harry, to quit running around the house grabbing everything...:-) Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/ken-tudor/2014/november/anxious-dogs-little-love-goes-long-way-32115#comments TheDailyVet Thu, 06 Nov 2014 11:00:00 +0000 32115 at http://www.petmd.com
Nose Jobs and Facelifts for Dogs on the Rise http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2014/november/nose-jobs-and-facelifts-dogs-rise-uk-32114 Nov 05, 2014 Nose Jobs and Facelifts for Dogs on the Rise by Dr. Patrick Mahaney     Share    
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I certainly enjoy my British news. The wry journalistic perspective on the role of celebrities in society often makes for an entertaining read and often serves as inspiration for my Pet-Lebrity News column on Pet360.
 
Celebs posting photos of themselves and their canine companions on Instagram and Twitter with a favorite pooch (or two) is nothing unusual. Yet, the seemingly recent rash of stars showing off their brachycephalic (brachy= short, cephalic= of, in, or relating to the head) dogs may motivate potential dog owners to pursue similar breeds without fully recognizing the health implications associated with having a “short head.”
 
According to The Telegraph, “the celebrity-driven fad for Bulldogs and Pugs with wrinkly faces has led to an increase in medical face-lifts for pets, the Royal Veterinary College has warned.” Reportedly, “the numbers of operations on dogs to remove excess skin has increased by more than 80 per cent over the last four years.”
 
This trend of celebrities acquiring brachycephalic dogs isn’t exclusive to the U.K. and Europe.
 
On June 30, 2014 Australian pop sensation Iggy Azalea shared a photo of her new pooch via her TheNewClassic Instragram feed. We see a cuddly black, white, and tan (fawn) English Bulldog puppy nuzzling into Azalea’s embrace accompanying her statement:
 
"Shrinkabull jam don't shake like that Jelli" but you can call her Jelli, for short.

 
Azalea’s photo has received an astounding 277,000 and climbing "Likes" so far.
 
Both the Pug and the English Bulldog are brachycephalic breeds, along with the Affenpinscher, Boxer, Brussels Griffon, Pekingese, Shih Tzu, and others. Additionally, mixes of these breeds, like the Puggle (Pug and Beagle combinations), are typically considered brachycephalic.
 
There are a series of deformities to the head and face associated with Brachycephalism (the condition of being brachycephalic) collectively termed Brachycephalic Airway Syndrome including:
 
Stenotic nares — narrow nostrils, which reduce the ability for air to freely move from the outside world through the nose.
 
Overlong soft palate — extra tissue where the nose meets the throat which flaps while breathing and obstructs air flow.
 
Everting laryngeal saccules — the larynx (voice box) contains parachute-like saccules (pockets of skin) which can inflate and prevent air from moving from the mouth and nose into the windpipe.
 
Hypoplastic trachea — also known as collapsing trachea (windpipe), there can be a reduction in the diameter of the trachea caused by improper formation of or damage to cartilaginous rings, or a sagging of the membrane that lines the uppermost layer of the windpipe.
 
Such conformational abnormalities of the airway lead to a variety of health problems associated with inability to normally breathe, including exercise intolerance, obesity, heat stroke, respiratory failure, hypoxia (low blood oxygen), collapse, and death.
 
Pending the degree of airway obstruction and health problems, there is a strong likelihood that surgical intervention is needed to permit the brachycephalic dog to have a better quality of life and have a reduced likelihood of health problems or dying. If you choose to incorporate a brachycephalic pooch into your life, you’ll likely be facing some some mild to serious health problems for which you are responsible to resolve, with your veterinarian’s help.
 
Dr. Gert ter Haar, of the Royal Veterinary College, has witnessed a significant and steady increase in the number of corrective surgeries on brachycephalic dogs from an average of 30 in 2009 to more than 260 in 2014. Dr. ter Haar states that they "handle four to five of these operations every week and it has increase over the last few years.” Additionally, ”breeding has led to shortening of muscles in their faces, most are fine but we see the ones that have problems because of their breeding. The main problems are that their airways are obstructed and some have problems with their hearing and eyesight. We treat them as soon as possible. We find it is due to the breeds becoming more and more popular.”
 
Extra skin and deficient muscle support can lead to the drooping or inward-rolling of the eyelids, which inhibits normal vision or causes scraping of the surface of the eye (entropion). If such conditions go untreated, irreversible vision problems often occur and dogs can even go blind.
 
Canine rhinoplasty (a nose job, such as the correction of stenotic nares) and face and eye-lifts aren’t performed solely to achieve a more desirable cosmetic effect like they are for most people. Such surgeries are necessary so brachycephalic pooches are better able to function in their day-to-day lives. Dr. ter Haar said they "do not undertake these operations unless there is a medical reason to do so. We find some of them have excessive skin folds which can cause severe infections. It can cause blindness, and if the folds cover the nose they cannot breath.”
 
Corrective surgeries for brachycephalic pets aren’t inexpensive. A reasonable estimate range for corrective procedures is $750-2,500. Fees depend on a variety of factors, including:
 
Geography — major metropolitan areas tend to be more expensive than rural regions.
 
Surgeon experience — board certified veterinary surgeons will cost more than general practice veterinarians. My recommendation is to go the route of the board certified surgeon, who is more-highly trained in challenging or unusual procedures than is the typical general practice veterinarian.
 
Length of hospitalization — shorter hospitalization will be cheaper than a prolonged in-facility stay.
 
Potential for surgical complications — any procedure can go awry, even when done by an experienced practitioner. Since brachycephalic dogs are already at a health disadvantage, the potential for anesthetic complications is often higher than for non-brachycephalic and otherwise healthy patients.
 
Overall, the popularity of performers like Azalea and other celebrities publicly announcing the presence of their purchase, adoption, or rescue or brachycephalic breeds gives a mixed message to the pet-loving public. Although brachycephalic dogs are cute, future owners commonly pursue these breeds due to their appealing “ugly-cute” appearance without fully considering the potentially life-threatening health consequences associated with their conformational malformations.
 
My recommendation for people seeking canine companionship is to acquire a dog that does not have facial, respiratory, or other body conformation problems that will affect their health on a short or long-term basis. Choose a breed or mixed-breed having a longer muzzle and a general lack of excessive facial or bodily skin folds instead of those having a short face and plentiful creases.
 
If you are so drawn to a owning a brachycephalic canine and are determined to get one despite the health obstacles, consider adopting your pooch from a breed-specific rescue in your area instead of potentiating the ongoing reproductive cycles fostered by breeders.
 

Dr. Patrick Mahaney
 
 
Related Articles
 
Iggy Azalea's New Puppy Has The Most Unique Name Ever
 
Bankrupt Aaron Carter Values His Expensive English Bulldog at Zero in Fear of Losing Him
 
Image: Liukov / Shutterstock
 
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TheOldBroad Judges 11/05/2014 06:50pm In my mind, I blame show judges for these problems in both dogs and cats. If the flat-faced kitties and doggies didn't win, breeders would start breeding out that trait. Think about what Persian cats used to look like. They used to have a face! Now it's almost concave. Reply to this comment Report abuse 3
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http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2014/november/nose-jobs-and-facelifts-dogs-rise-uk-32114#comments TheDailyVet Wed, 05 Nov 2014 11:00:00 +0000 32114 at http://www.petmd.com
Easy Ways to Reduce the Number of Homeless Pets http://www.petmd.com/blogs/thedailyvet/lorieahuston/2014/november/easy-ways-reduce-number-homeless-pets-32113 Nov 04, 2014 Easy Ways to Reduce the Number of Homeless Pets by Dr. Lorie Huston     Share    
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There are lots of jobs that are stressful, but I don’t think there are many that can compare to being a shelter/rescue volunteer or worker. No matter how many animals you help, there are always more that need your help. And when you are unable to help, the situation is even more heartbreaking. These people truly do deserve our appreciation and our thanks for what they do.
 
Besides thanking them, there may also be some things you can do to help make their job a little less demanding, starting by reducing the number of homeless pets.
 
How do we reduce the number of homeless pets? Start by not breeding your pet for frivolous reasons.

You don’t need to breed your pet to show your child the "miracle of life."
You shouldn’t be breeding your pet because you just have to have one of her puppies or kittens.
Your pet doesn’t need to experience the "joy of motherhood."

 
In fact, most pets should be spayed or neutered.
 
Don’t buy a puppy or kitten from a pet store. Almost without exception these animals come from puppy mills (or the feline version of a puppy mill). Responsible breeders do not sell their puppies or kittens through pet stores. Buying a puppy or kitten from a pet store helps to keep a puppy (or kitten) mill in business.
 
Never buy or adopt a puppy or kitten (or any other pet) on impulse. Taking in a pet requires a commitment. You are obligated to care for that pet for the remainder of that pet’s life, both physically and financially. Be sure you are able to do that before your bring a new pet home. That means doing some homework beforehand to find out what type of care your new pet might need. Pets are not disposable commodities. If you are unwilling or unable to accept responsibility for that pet, don’t adopt the pet.
 
If you are looking for a new pet, consider adopting from a shelter or rescue rather than buying a puppy or kitten. Approximately 30 percent of animals that find their way into shelters and rescues are purebreds. So even if you have your heart set on a purebred pet, you may still be able to adopt.
 
If you do purchase a pet from a breeder, be sure the breeder is a responsible one. Ask questions.

Know what genetic conditions are common in your chosen breed and ask how the breeding animals are screened for these diseases. A responsible breeder screens for these diseases and breedings are carefully planned to reduce the potential for passing genetic diseases to the puppies or kittens.
What happens if you can’t keep the pet? A responsible breeder will take the pet back, regardless of age. They don’t want their puppies/kittens ending up in shelters and rescues.
Ask to see the mother and the father (if both are on the premises). Responsible breeders will be happy to introduce you to both.
Never buy a puppy or kitten from the Internet sight unseen. Responsible breeders will not ship a puppy or kitten unaccompanied and they will want to meet with you before the sale as well. You should expect the breeder to ask questions about you, making sure that you will be a good pet owner.

 
Lastly, support managed trap-neuter-release (TNR) programs for feral cats. TNR is controversial but is much more humane than simply killing these cats. Many of these cats are not socialized with people, do not acclimate well to indoor life, and are not candidates for adoption as a result. Cats in these colonies are trapped, spayed/neutered and vaccinated, and then returned to the colony where volunteers feed and provide shelter for them. These colonies generally do not welcome strange cats into their midst so their numbers do not continue to grow.
 

 
Dr. Lorie Huston
 
Today's blog post was originally published on November 5, 2012
 
Image: Karen Carnahan / Shutterstock
 
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TheOldBroad Amen 11/04/2014 06:18pm Not much else to say, but AMEN! Reply to this comment Report abuse 3
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http://www.petmd.com/blogs/thedailyvet/lorieahuston/2014/november/easy-ways-reduce-number-homeless-pets-32113#comments TheDailyVet Wed, 05 Nov 2014 11:00:00 +0000 32113 at http://www.petmd.com
How Big of a Problem are Intestinal Parasites? http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/november/how-big-problem-are-intestinal-parasites-32112 Nov 03, 2014 How Big of a Problem are Intestinal Parasites? by Dr. Jennifer Coates     Share    
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Despite the “ick” factor, I love fecal exams. I can’t think of another laboratory test that provides so much information with less stress on the patient. Dogs and cats readily supply the necessary samples, and in about 15 minutes or so, your veterinarian can supply you with a diagnosis.
 
In my opinion, veterinarians should run fecal examinations on every patient with gastrointestinal symptoms (diarrhea, vomiting, weight loss, change in appetite, etc.), on puppies at every “wellness” visit (usually every 3-4 weeks from approximately 8 weeks of age to 16-20 weeks of age), and at least annually on every adult dog.
 
Why so many fecal exams? Because intestinal parasites are quite common in pet dogs and cats. Every year Banfield Pet Hospitals compiles a report based on the medical records of the patients they see. In 2013 they performed fecal examinations on 2,594,599 canine samples and 319,535 feline samples. Here are the percentage of tests that were positive broken down by age and type of parasite found.
 




 


Dogs < 1 year old


Dogs 1-3 years old


Dogs 3-10 years old


Dogs > 10 years old




hookworms


3.85%


0.79%


0.38%


0.31%




roundworms


5.01%


0.26%


0.14%


0.14%




tapeworms


1.46%


0.36%


0.25%


0.35%




whipworms


0.46%


0.46%


0.21%


0.19%




 




 


Cats < 1 year old


Cats 1-3 years old


Cats 3-10 years old


Cats > 10 years old




hookworms


0.77%


0.24%


0.10%


0.04%




roundworms


4.87%


0.62%


0.26%


0.11%




tapeworms


3.31%


3.48%


1.86%


0.72%




whipworms


0.05%


0.02%


0.01%


0.00%




 
At first glance, these numbers may not look all that impressive, but digging a little deeper reveals a different story. Let’s look at the puppy and kitten numbers as examples since this is the age group most at risk for intestinal parasitism. What’s missing is the percentage of fecal samples that were positive for any type of intestinal parasite. Adding up the numbers in the columns above gives us a total of 10.78% for puppies and 9% for kittens. These percentages may not be exact since I’m sure some samples were positive for more than one type of parasite, but they give us a ball park figure.
 
However, a couple of issues make me think these estimates are actually too low. First of all, whipworms are notoriously hard to diagnose via fecal exam. Their eggs don’t float very well in the most commonly used type of solution, and the worms release their eggs on an intermittent basis (in other words, the worms are present but their eggs are not). Secondly, while hookworms, roundworms, tapeworms, and whipworms are the “Big Four,” these tables say nothing about the incidence of Giardia, coccidia, and other types of intestinal parasites that can affect dogs and cats.
 
The incidence of parasitism in pets is probably significantly higher than what the Banfield numbers show. In fact, a study published in 2009 looking at over a million canine fecal samples submitted to Antech Diagnostics revealed that 29.6% of those coming from dogs less than six months of age and were positive for intestinal parasites. Wow!
 
So next time you head to the veterinary clinic, make sure you bring along a sample of your pet’s poop. You might be surprised at what’s hiding inside.
 

Dr. Jennifer Coates
 
 
Sources
 
Pet Health by the Numbers, Today’s Veterinary Practice. September/October 2014. p 24.
 
Prevalence of intestinal parasites in pet dogs in the United States. Little SE, Johnson EM, Lewis D, Jaklitsch RP, Payton ME, Blagburn BL, Bowman DD, Moroff S, Tams T, Rich L, Aucoin D. Vet Parasitol. 2009 Dec 3;166(1-2):144-52. 
 
Image: Kachalkina Veronika / Shutterstock
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TheOldBroad Ack! Worms! 11/04/2014 06:15pm I'd be curious to have statistics on the pets that had parasites. Were the kitties outdoors or allowed outdoors?

I'm guessing the dogs/puppies were allowed outdoors to go potty, but I'd be curious to know if the humans put them in an outdoor area and didn't watch them. Reply to this comment Report abuse 1
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http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/november/how-big-problem-are-intestinal-parasites-32112#comments TheDailyVet Mon, 03 Nov 2014 11:00:00 +0000 32112 at http://www.petmd.com
The Ghost Cow of Griggstown http://www.petmd.com/blogs/thedailyvet/aobriendvm/2014/october/ghost-cow-griggstown-32103 Oct 31, 2014 The Ghost Cow of Griggstown by Dr. Anna O'Brien     Share    
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Happy Halloween, everyone! Halloween is one of my favorite holidays because it takes place in one of the prettiest months of the year AND it involves lots and lots of candy. This time of year I love driving around the farmland of central Maryland. Although the corn has been harvested, the leaves are in full color change right now and the golds and reds in the hills are so vibrant, I can’t help but stare. And, on those 3 a.m. emergency calls, at least I sometimes get to enjoy a harvest moon illuminating the pastures.
 
But what about the spookier side of Halloween? Have you ever heard of the Griggstown Ghost Cow? Huddle up close, dear readers, and grab your flashlights, for you’re about to read a tale of an apparition of the animal kind.
 
For decades, there were reports in Griggstown, New Jersey, of a ghost cow. Sightings would come in from around the D&R canal towpath from hunters and hikers but were accompanied by little evidence. A secretive and seemingly aloof yet benevolent specter, this ghost cow would be reported often on foggy nights roaming the fields along the towpath and even sometimes crossing the path itself, only to quickly shift out of sight. Of course photographs and videos were grainy and inconclusive, and lack of manure made reports seem that much more dubious, but there was history of old dairy farms in the area. Was this animal a relic of the area’s agricultural past?
 
All doubts of tall tales were erased in this New Jersey town when, on November 23, 2002, a call came in about a cow lying in a ravine near the towpath — a cow that matched the description of the fabled Ghost Cow. The local fire department, rangers from the canal state park, and the state fish and wildlife service were soon on the scene and sure enough, a real cow was stuck in the ravine.
 
Evacuation ensued and workers were able to get the animal out of the ravine; however, their actions came too late. A veterinarian on the scene determined the bovine was too weak and the Griggstown Ghost Cow was euthanized.
 
Questions remained as to what the animal was doing there years after the dairy farms disappeared from the area. Theories abound that this was an escapee from an old dairy herd, eking out an existence along the towpath, grazing and keeping a low profile from humans. Others believe this was one of probably many escapees from various dairies over the decades, each cow replacing another as they subsequently passed on.
 
My question is why was this animal so shy? Dairy cows are very domesticated due to the frequent handling required for milking, and I would think as winter came, such an animal would seek out food closer to human settlements when snow covered what meager grass was along the path.
 
Then again, perhaps this was a very resourceful (and introverted!) animal, preferring the solitude of the towpath and its ravines to the daily grind of the milking parlor, despite a guarantee of twice daily feed rations.
 
There’s almost a romantic air to this story — a lonely animal with connections to an era long gone from modern society. Certainly there lacks a sinister element to this “ghost” story, which is sort of nice once and a while. And we can always imagine that perhaps, on particularly foggy nights, if one listens closely as she walks quietly along the towpath, she just might hear a faint moo in the distance.
 

Dr. Anna O'Brien
 
Image: Tyler Olson / Shutterstock
 
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TheOldBroad Bummer 10/31/2014 06:38pm It's such a bummer that this cow eeked out an existence, only to end up stuck in a ravine and having to b euthanized.

Great story, though! Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/aobriendvm/2014/october/ghost-cow-griggstown-32103#comments TheDailyVet Fri, 31 Oct 2014 11:00:00 +0000 32103 at http://www.petmd.com
Mislabeled Pet Food: Are Your Pets at Risk? http://www.petmd.com/blogs/thedailyvet/ken-tudor/2014/october/mislabeled-pet-food-are-your-pets-risk-32110 Oct 30, 2014 Mislabeled Pet Food: Are Your Pets at Risk? by Dr. Ken Tudor     Share    
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When you shop for your food, you trust the labels to tell you what you are buying. This is especially true if there are certain foods or ingredients you need to avoid for medical reasons. That is why regulations require that labels accurately disclose the ingredients in food items. But is this also true in pet food? Apparently, the answer is no. A just published study found that 40 percent of pet food may be mislabeled.  
 
The Alarming Findings
 
Researchers in the Chapman University Food Science Program tested 52 dog and cat food products to identify the meat species in the foods. They used a sophisticated technology to identify DNA in the foods as beef, goat, lamb, chicken, goose, turkey, pork, or horse. This technology, polymerase chain reaction, allows accurate genetic fingerprinting and is also used to accurately diagnose infectious and hereditary diseases.
 
Laboratory identification of the meat species was then compared to the ingredient list on the food labels; 31 products were labeled correctly. One food contained a non-specific meat ingredient that could not be identified by the parameters of the experimental design. Of the remaining 20 mislabeled foods, 16 contained meat species that were not listed on the label as ingredients. Pork was the most common undeclared meat protein. In 3 of the mislabeled foods, evidence supported meat species substitution (for instance one type of poultry for another type). The research report did not indicate the mislabeling error of the final food sample.
 
Why is Accurate Food Labeling Important?
 
The major food safety problem with mislabeled pet food is for the allergic pet. A food that does not disclose a potential allergenic meat source could cause severe itching and skin problems, or severe stomach or intestinal adverse reactions. Worse, it might lead to a deleterious change in veterinary treatment based on the assumption that the food was as advertised.
 
Mislabeling is no small issue. U.S. households purchase $22.6 billion worth of pet food. To think that 40 percent of that market could be improperly labeled is mind boggling. The only salvation in this is that food allergies are not as common as environmental allergies and represent a smaller portion of the pet population. This only makes the food makers lucky, not exempt.
 
The bigger questions about this study are the ethical ones. Is mislabeling intentional or accidental? At what point in the production process is this occurring and how can it be corrected? How widespread is the practice in the industry? Who is responsible for the oversight and what steps are being taken to address the issue? This is not the first study to identify mislabeling. I have posted at petMD and at my own blog, Dog Food Matters, highlighting studies of contaminated hypoallergenic diets. How many studies are necessary to grab the attention of regulating agencies and the pet food industry?
 
However, I must admit to you I am not optimistic. For me this is just another reason that makes homemade pet food a much better option than commercial pet foods. It gives you, the pet owner, absolute control over the consistency, quality, and safety of your pet’s food.
 

Dr. Ken Tudor
 
 
Resouce:
 
Tara A. Okuma, Rosalee S. Hellberg. Identification of meat species in pet foods using a real-time polymerase chain reaction (PCR) assay. Food Control, 2015:50:9 DOI.
 
Image: Radu Bercan / Shutterstock
 
You might also like:
 
The Best of Intentions, Gone Astray
 
The Contribution of Commercial Pet Food to the Quality of Our Pets' Lives
 
Balanced Homemade Meals – I Sound Like a Broken Record
 
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TheOldBroad Alas 10/30/2014 06:21pm I have a sneaking suspicion that the mislabeling is intentional. I'd love to know the percentages of incorrect ingredients.

I attempted to find the study, hoping it would provide brand names so they could be avoided, but alas, the only place it seemed to be was in the study itself which is behind a "create an account and sign in"" wall.

Another site wanted to charge me about $35 to see it.

Sigh. Reply to this comment Report abuse 4 Leona Firewolf 10/31/2014 07:31am what I'd like to know which no one wants to ask! how much and which companes contain dog and cat meat !!!!????? Reply to this comment Report abuse 1 gspal No dog food control India 10/31/2014 09:52am In India there is neither any authority on dog food control nor any study done on real ingredients in dog food. India-made dog food does not figure on Whole Dog Journal nor on Dog Food Advisor. Any garbage can be fancy labeled, packed and sold to unsuspecting customers.

Pedigree made in Hyderabad, India, the world knows is bad food for dogs.

Another is Drool & Focus made by IB Company which is in poultry farming and a subsidiary of a parent company involved in hides located in the State of Chattisgarh, India. They have come up with a fancied & deceptive website: http://www.drools.in/drools.html. Against each product they will mention ‘No Fillers’, but on the package bought there will be mention of corn gluten and wheat among others. The size of the kibble also matters for small, medium, and large breeds. The term ‘all breeds’ with ‘universal’ sized kibble is misleading. The only advantage is the price as compared to imported dog food.

Unfortunately, Royal Canin and Hill Science Diet have gone the Pedigree way after being taken over by MNCs.

Most Indian customers looking for premium quality dog foods need to visit Whole Dog Journal and Dog Food Advisor for analysis and reviews. In my opinion, there are only three premium dog food brands available in India: Farmina N&D, Solid Gold, and Taste of the Wild (ToW). Sadly, Orijen is missing. Solid Gold and ToW are made by the infamous for recalls, Diamond Foods.

For my adult adopted small breed German Spitz (American Eskimo in the States) 12 kg I am buying online Farmina LG N&D Chicken & Pomegranate Adult Mini from http://www.dogspot.in. As someone has posted there while the size of Adult Mini kibble maybe suitable for poultry, the Adult size kibble is just too big for small jaws of a Spitz. That is the only drawback, but, otherwise, I think it is great dog food.

How I wish the Chapman University Food Science Program tests of dog and cat food could be listed here at Petmd.
Reply to this comment Report abuse 5 JOLLYJIM SO WHAT ARE THE NAMES OF 11/01/2014 12:07am SO WHAT ARE THE NAMES OF THE FOODS TESTED AND THEIR RESULTS? Reply to this comment Report abuse 3
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http://www.petmd.com/blogs/thedailyvet/ken-tudor/2014/october/mislabeled-pet-food-are-your-pets-risk-32110#comments TheDailyVet Thu, 30 Oct 2014 11:00:00 +0000 32110 at http://www.petmd.com
How We Talk About Pet Cancer - Words Matter http://www.petmd.com/blogs/thedailyvet/drjintile/2014/october/how-we-talk-about-cancer-words-matter-32109 Oct 29, 2014 How We Talk About Pet Cancer - Words Matter by Dr. Joanne Intile     Share    
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The vernacular surrounding a diagnosis of cancer is intense: We speak of fighting the disease. Those who endure treatment are survivors and warriors. We battle against it and, ultimately, we dream of a world where cancer is eradicated.
 
I’m a proponent of the concept of a war on cancer. I know we need to be aggressive in order to have any success in beating this disease. I’m happy to be a part of the frontline of defense and I toil hard to treat patients and provide them with longer and happier lives. Yet, there’s one term related to cancer that’s guaranteed to fracture my assertive exterior and cause me to stumble in my dialogue with owners. The word is cure.
 
Owners will ask me what the cure rate for a particular tumor is, or if their pet will ever be cured, or when and how I will know their beloved companion is cured. When the topic comes up, I always feel somewhat anxious and unsettled. The irony isn’t lost on me: How can the one word that embodies the very thing I wish for my patients simultaneously instill such intense insecurity within my soul?
 
To answer candidly, it comes down to the pressure imparted by the accurate meaning of the word cure that’s the most overwhelming. "Cure" implies the disease was eradicated from the body and will never return. To me, stating that a patient is cured from cancer is akin to offering an impossible guarantee of future health.
 
I’m not being negative and I’m not trying to perpetuate the pervading sense of hopelessness surrounding a diagnosis of cancer. Believe me, I’m there fighting just as hard as the next doctor. But if I treat a patient and find their cancer is in remission, it’s extremely difficult to say if or how long the remission will last. Remission simply means I’m unable to detect the disease using conventional diagnostic tests. It doesn’t guarantee eradication of every last tumor cell and it doesn’t equal a cure.
 
I'm not alone when it comes to my careful word choice in relation to my patients. Human oncologists speak more frequently in terms of 5, 10, and 20 year survival rates rather than label people as cured. Though I appreciate how frustrating it would be to hear a physician say “You have a greater than 80% chance of living 20 years from your diagnosis” instead of “you’re cured,” I also know what it feels like to face someone who desperately wants to hear me say their pet is cured and know deep down I can’t reliably mean it. It’s not because I’m afraid of being wrong. It’s because I’m afraid of not being honest.
 
I would urge pet owners to be wary when they hear phrases such as “We got it all” or “There’s no evidence of spread” or “We caught it early.” Though they may be exactly what you are so desperately hoping to hear, these “cancer colloquialisms” are likely inaccurate representations of your pet’s health.
 
The only way we can say a patient is cured from cancer is for them to pass away from an unrelated cause with their cancer being completely undetectable at the time of their death. Many owners are surprised at my candor when I tell them this is my definition of cure, but I would rather be authentic and considered forthright than to give an owner a false sense of optimism.
 
This doesn’t mean we should lose sight of the most important term related to a diagnosis of cancer: Hope.
 
If we didn’t have hope, we would lose our motivation to attempt to treat patients.
 
If we didn't have hope, we would not have the motivation to battle this disease.
 
And most importantly, if we didn’t have hope, we would never even have the ability to envision the concept of a cure.

I hope one day the word cure no longer instills a sense of apprehension within me and I’m able to utter it with confidence and candor. Until then, I’ll keep fighting the battle along with the remarkably brave four legged warriors I have the privilege to meet.
 

Dr. Joanne Intile
 
Image: Neyro / Shutterstock
 
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TheOldBroad Cure 10/29/2014 06:52pm I wonder how many people would think the oncologist was fibbing when a pet is truly cured of cancer #1 - only to get cancer #2. After all, there are so many types of cancer.

Just because you're cured of one thing doesn't mean you won't end up with a similar problem later. Reply to this comment Report abuse staciejaye 10/31/2014 04:22pm I think it's important to note that Dr. Intile says that she's reluctant to say any animal is "cured" of cancer. So while cancer #1 is in remission, the animal could be diagnosed with cancer #2.

Remission is not the same as cured (as noted in the article). Reply to this comment Report abuse scottfitzgerald Curing Cancer? 11/01/2014 12:21am My beautiful boy died because of cancer. No one said he could be cured, in fact all his drs. told me he could not. But, with radiation and chemo., they gave him 14 months more than he would have lived. He was a happy boy, a brave boy and loved life. It has been 13 months since he passed away, and I miss him every day. I knew the treatments were palliative but they were well worth it, and he never suffered. So the question is, was it worth it? Yes, every single treatment was worth it to him, more time to play, more time to just be himself. A cure would have been wonderful but none existed. Reply to this comment Report abuse 1
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http://www.petmd.com/blogs/thedailyvet/drjintile/2014/october/how-we-talk-about-cancer-words-matter-32109#comments TheDailyVet Wed, 29 Oct 2014 11:00:00 +0000 32109 at http://www.petmd.com
Highlights of the 2014 Holistic Veterinary Conference http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2014/october/highlights-2014-holistic-veterinary-conference-32107 Oct 28, 2014 Highlights of the 2014 Holistic Veterinary Conference by Dr. Patrick Mahaney     Share    
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I recently had the pleasure of attending the 2014 American Holistic Veterinary Medical Association (AHVMA) Annual Conference in Portland, Oregon. It was my first opportunity to go as a conference participant (as we veterinarians regularly must accrue continuing education hours), but I was also there in an official capacity to represent Spectrum Labs and give a lecture on Vaccinosis (the syndrome of health problems that can correlate to vaccine administration). In fact, my presentation inspired two articles on the topic for petMD: Preventing Vaccine Associated Illness in Pets, Part 1 and Part 2
 
There were many great educational, networking, and social happenings occurring at this conference. I finally was able to get some face time with my fellow holistic practitioners, some of whom are my advisors on the Veterinary Information Network (shout out to my fellow Angeleno, Dr. Richard Palmquist), and others who have many years of experience on me and who have witnessed the remarkable progress holistic veterinary medicine has made integrating into conventional clinical practice.
 
Here are some of my highlights:
 
Learning About Fecal Transplants via Dr. Margo Roman
 
There are so many forward-thinking veterinarians that are AHVMA members. One in particular is Dr. Margo Roman of Massachusetts. She’s currently developing commercially-applicable products that will permit our pets to undergo fecal transplants. Yes, you heard that correctly — fecal transplants.
 
Actually, the process is quite simple. A healthy animal that has been screened for and cleared of potentially hazardous illness and fed a diet suitable to the requirements of the product’s manufacturer donates fecal material to help repopulate the gastrointestinal tract of another animal in need of a microbial boost. Pets suffering from stomach and intestinal health problems, cancer, immune-mediated diseases, and other ailments can potentially benefit from having a fecal transplant.
 
The concept really shouldn’t be so foreign or nausea-inducing, as it’s done in humans, too (Science Daily article: Fecal transplant pill knocks out recurrent C. diff infection), and has been mass-marketed in a more palatable format through probiotic supplements.
 
I look forward to working with Dr. Roman in the future to enhance the digestive and immune-system health of my patients via fecal transplants.
 
Better Understanding the Holistic Approach to Veterinary Oncology
 
I jumped at the opportunity to attend a lecture on the holistic approach to veterinary oncology presented by the wise and worldly Dr. Nancy Scanlan.
 
I learned of the importance of iron supplementation in cancer patients suffering from anemia related to bone marrow suppression by their disease or chemotherapy. After all, iron is an integral elemental component of hemoglobin, an oxygen carrying metalloprotein found in the red blood cells. Our bodies depend on hemoglobin to transport oxygen in the blood from the lungs to the body tissues.
 
Hypoxia (low blood oxygen) can make a pet feel lethargic, have a decreased appetite, and generally not seem to be doing very well. Such is not a scenario we veterinarians want for our patients as it then becomes hard to tell if the patient’s cancer or cancer-related ailments are worsening or if chemotherapeutic drugs are creating undesirable side effects.
 
Essentially, the role of iron in the formation of hemoglobin and oxygenation of tissue is a vital part of disease treatment and promotion of whole-body health.
 
Veterinarians can give iron as an intramuscular (into the muscle) injection to start, and then provide patients with an oral supplementation on a consistent basis. One of my preferred products to augment my patients’ Vitamin B and iron levels is Rx Vitamins for Pets Amino-B Plex. It’s a liquid that can be mixed with tasty, moist food or administered directly “per os” (by mouth) straight via the provided dropper or combined with a flavorful liquid and given via syringe.
 
Owners should always consult with their veterinarian to determine if iron injections or oral supplementation is appropriate for their pets.
 
Getting ZYTO Balance Tested for Standard Process Products
 
I have patients (and some of their owners) who undergo muscle testing to determine what therapeutics can best benefit their health. Having been intrigued by this type of energetic-based diagnostic approach, I’ve been seeking a practitioner to help me with my own mild-to-moderate issues with chronic pain (I’ve got intervertebral disc disease and osteoarthritis).

Standard Process is one of the companies making products I widely provide to my canine and feline patients and in my own body. Dr. Susan Howell, a veterinarian and Standard Process representative, oversaw my energetic evaluation with a technique called ZYTO Balance biosurvey (“an exchange of information between the computer and your body”). 
 
ZYTO Balance determines the Stress Profile of one’s energetic state at the time of the biosurvey and determines Biomarkers, which are “a subset of Virtual Stimulus Items that represent anatomical landmarks such as an individual vertebra, organs, etc.”  From there, Standard Process products that can help normalize Biomarker Virtual Stimulus Items that are exceeding a range boundary (i.e., out of sorts for my body at the time of testing).
 
There were two primary Standard Process supplements that corrected the greatest number of Biomarker Virtual Stimulus Items that I started taking upon returning to Los Angeles. I must say that within 24 hours of taking both of these products three times daily I’m feeling much better (improved energy, reduced generalized pain, etc.). I’m not a big believer in the placebo effect, so I feel that the ZYTO Balance results are legitimate.
 
I’m still planning on pursuing a consultation with a practitioner that does non-ZYTO Balance muscle testing to get an up-to-date assessment of my current health status and energetic needs.
 
Introducing the New Honest Kitchen Recipes
 
I’m a big fan of canine and feline foods made by The Honest Kitchen (in fact, I work for them as a veterinary consultant). Meals, treats, and supplements offered by The Honest Kitchen are whole-food based and human-grade (meaning the products are made in an FDA inspected human-grade food production facility). The majority of other pet foods and treats are considered feed-grade as they are generally made with poorer quality ingredients, can potentially harbor higher levels of toxins (some that are even carcinogenic or cancer-causing), and have been deemed unfit for human consumption. Therefore, I recommend my cat and dog patients eat meals and treats made from human-grade ingredients (see petMD article: Are You Poisoning Your Companion Animal by Feeding 'Feed-Grade' Foods?)
 
The Honest Kitchen recently introduced three new canine diets that seemingly speak to the sensibilities of holistic veterinarians. Clients typically come to holistic veterinarians seeking nutrition advice that is seemingly not being provided by conventional (e.g., non-holistic, conventional, etc.) veterinarians who generally don't share the perspective that dogs and cats should eat whole-food, human-grade diets that are similar in format and commensurate in quality to those that people consume.
 
Halcyon is a nutritionally complete and balanced meal for dogs having a novel protein source in cage-free duck and other ingredients less-commonly found in commercially available pet foods like organic oats, organic buckwheat, chia seeds, and peas. Dogs having skin or gastrointestinal allergies may benefit from eating foods containing protein, carbohydrate, and other food constituents they’ve not previously consumed (i.e., to which they haven’t developed an intolerance or allergy).
 
Hale is a fruit, vegetable, and whole grain (organic oats, organic millet, and organic buckwheat) base mix that can be combined with an owner’s choice (or veterinarian’s recommendation) of meat and water or broth to create a healthful canine meal.
 
Kindly is a grain-free, potato-free and fruit-free vegetable base mix that makes a meal similar to Hale. The “multi-free” aspect of Kindly is widely appealing to owners seeking diets for their dogs who have problems digesting or health problems that could be worsened by consuming grains, potatoes, and fruits (this school of thought is often applied to patients suffering from cancer).
 
Honest Kitchen also launched a Vet Ambassador Program where foods can be purchased at wholesale pricing to be dispensed in veterinary facilities and referral rewards can be earned.
 
Meeting AHVMA President Barbara Royal
 
I’d heard so many great things about outgoing AHVMA President Dr. Barbara Royal, and I felt as though I already knew her due to our co-hosting duties on Holistic Vets, one of the programs on Tracie Hotchner’s Radio Pet Lady Network (RLPN).
 
Finally, the chance for a face-to-face meeting occurred. I so admire Dr. Royal’s dedication to her craft, as she’s also founder and owner of Chicago’s Royal Treatment Veterinary Center, and promotes holistic veterinary medicine on a global basis.
 
I’m greatly looking forward to the 2015 AHVMA Annual Conference in Augusta, GA. I’ve submitted to be a speaker on the topic that’s very personal to me — canine lymphoma (submitted title: Canine Lymphoma Treatment: The Integrative Approach) — based on my experiences treating my own dog Cardiff’s lymphoma and immune mediated hemolytic anemia (IMHA). So, I hope my speaker submission is accepted and I’ll be going to the conference as both a presenter and attendee next year.
 

Dr. Patrick Mahaney
 
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TheOldBroad Vet Conferences 10/28/2014 06:22pm It's got to be great to be in the midst of like-minded doctors. In daily life, I'm betting you have to explain things frequently. However, at this conference, you probably didn't have to explain why holistic is good.

Sounds like you even had the opportunity to learn something that will help your patients in the future and is helping you right now. (ZYTO Balance) That is absolutely fascinating. Reply to this comment Report abuse
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http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2014/october/highlights-2014-holistic-veterinary-conference-32107#comments TheDailyVet Tue, 28 Oct 2014 11:00:00 +0000 32107 at http://www.petmd.com