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Lyme Nephropathy in Dogs
by Brad Bates, VMD

Lyme Nephropathy, just the sound of this disease makes me cringe….

This is a disease of the kidneys (from greek, nephros – kidney; opathy- disease or disorder of) with Lyme infection being the underlying cause. Lyme disease is caused by a special type of bacterium, Borrelia burgdorferi. Ixodes-type ticks, like the well-known ‘deer tick,’ spread this organism.

In dogs, Lyme disease tends to be either asymptomatic (most dogs, with 90- 95% showing no clinical signs at the time of diagnosis), or cause a transient fever, lethargy, anorexia and limping. Limping in lyme-infected dogs classically shifts from one leg to the other. It is believed that clinical signs of lyme disease, including limping, is a result of the body’s immune response to the organism. Symptoms usually take a few months from the time of infection to develop.

Most Lyme positive dogs that are clinical for the infection will get better rather quickly on antibiotics, with doxycycline being most veterinarian’s first choice. The infection is usually not cleared, even with treatment, but will usually be kept under control by the dog’s immune system once treated.

A much more serious disease process has been reported, thankfully much more rarely- Lyme Nephropathy. This disease is not completely understood, but it has been found to have an immune basis. The body’s own immune system is needed for the destruction of the kidneys. What happens is the immune system develops antibodies to the organism and these antibodies attach to the organism or pieces of the organism. The antibodies can form immune ‘complexes’ that can attach to regular tissues in the body - one place being the kidneys. This leads to activation of the rest of the immune system, where the body thinks it is clearing an infection and instead damages its own tissues. This process can be likened to laser-guided missile attacks, where the immune complexes are the lasers and the missiles are the immune system components. But in this case, it would be considered ‘friendly fire.’

Dogs with Lyme Nephropathy show signs of anorexia, lethargy, fever and some will even vomit. Kidney levels are often elevated, or elevate later in the course of the disease. The classic hallmark sign of this disease is loss of blood proteins in the urine- called proteinuria. Many will lose enough proteins that their blood work will show low albumin (the major blood protein), leading to leakage of blood fluids from the vessels into the tissues- causing the patient to develop swellings of the tissues called edema.

Most dogs with Lyme Nephropathy have a very poor prognosis, with most succumbing to the disease rather quickly after clinical signs develop despite therapy.

Prevention

The best way to prevent this infection is to administer monthly tick preventatives to your dog. The topical products, Frontline and Advantix, being the most common and two of the most reliable preventatives on the market. Others are available through veterinary clinics. It is important to follow all the directions and precautions of these products.

The lyme vaccine is controversial at this time, and people seeking this vaccine should speak with their veterinarian at length about its use and benefits/side effects. At the least, every dog receiving this vaccine should first be tested for lyme exposure.

If your dog is exposed to Lyme it is very important to follow your veterinarian’s recommendation. Guidelines recommend routine blood work at the time of diagnosis and at least yearly to check kidney values and other parameters such as white blood cells and platelets. Other tick-borne infections can also be spread by the same ticks that spread Lyme disease and some are more difficult to diagnose on routine screening, but may still cause changes on blood work. Urine should be checked at the time of diagnosis and at least every 6-12 months to check for protein loss. If there is protein in the sample, your veterinarian may want to check for an infection with a urine culture, or for bladder stones using an x-ray of the abdomen. If no other causes of protein in the urine are seen, the level of protein should be quantified with a specific test (called urine protein creatinine ratio, or UPC). This can determine if the protein loss is significant and how severe it is, as well as help guide treatment in the future.

As I first stated, just the sound of this disease makes me cringe…and as I write this blog I think about my patient currently being treated for possible Lyme Nephropathy. I just hope she is not one of the unlucky few, and I hope by following simple preventative measures other dogs can be spared this horrible disease.

Read more or contact Dr. Bates:
Brad Bates, DVM DABVP
Lap of Love Veterinary Hospice
Philadelphia, PA
drbrad@lapoflove.com |  www.lapoflove.com
(267) 317-8110
 
Dr. Bates services the Greater Philadelphia area with providing families with in home hospice and euthanasia options. (All areas around Philly including Rittenhouse, Center City, Art Museum, Queen village, Washington Square, Graduate Hospital, Society Hill, Italian Market, Logan Square, Bella Vista, Old City, West Philadelphia, South Philadelphia, University City, Fishtown, Northern liberties, Fairmount, Manayunk, Conshohocken, Roxborough, Drexel Hill, Media, Villanova, Swarthmore, New Hope, Langhorne, Bryn Mawr, and Gladwyne).
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HEAT STROKE

Hyperthermia, also known as heat stroke, is a life-threatening condition, and requires immediate help.  A dog or cat’s normal body temperature is 101.5°F plus or minus 1 degree, and any time the body temperature is higher than 105°F, it is an EMERGENCY.  The most common cause of heatstroke occurs in summer when dogs are left within cars. 

However, heatstroke may also occur in other conditions, including:
When any animal is left outdoors in hot/humid conditions without adequate shade.
When the animal is exercised in hot/humid weather.  
When left in a car on a relatively cool (70°F) day; a recent study found the temperature within a vehicle may increase by an average of 40 degrees Fahrenheit within one hour regardless of outside temperature.  Yup, you read that right, 110 degrees or more!!!
Other predisposing factors may be obesity and/or conditions affecting a pet’s airway, including laryngeal paralysis and other diseases of the throat region and having a brachycephalic (short-nosed) breed: (Pekingese, Pug, Lhasa apso, Boston terrier, Persian, Himalayan, etc.) These pets may suffer from heatstroke more readily due to their inability to move air properly through their short crowded noses and throats.

SIGNS:
Initially the pet appears distressed, and will pant excessively and become restless.  As the hyperthermia progresses, the pet may drool large amounts of saliva from the nose and/or mouth.  The pet may become unsteady on his feet.  You may notice the gums turning blue/purple or bright red in color, which is due to inadequate oxygen.

WHAT TO DO:
Remove your pet from the environment where the hyperthermia occurred. 
Move your pet to a shaded and cool environment.
Begin to cool the body by placing cool, wet towels over the back of the neck, in the armpits, and in the groin region.  You may also wet the ear flaps and paws with cool water. 
Direct a fan on the pet for evaporative cooling, especially helpful if you can wet the pet down. 
 Transport to the closest veterinary facility immediately.

What NOT to Do:
Do not leave your pet unattended in a car or outdoors.
Do not use cold water or ice for cooling. 
Do not overcool the pet.  Most pets with hyperthermia have body temperatures greater than 105°F, and a reasonable goal of cooling is to reduce your pet’s body temperature to 102.5-103°F while transporting her to the closest veterinary facility. 
Do not attempt to force water into your pet’s mouth, but you may have fresh cool water ready to offer should your pet be alert and show an interest in drinking.


While ice or very cold water may seem logical, it fails to cool the inside of your pet where all the vital organs are its use is not advised.  Ice or cold water will cause the blood vessels in the skin to shrink in response to the extreme cold and cooling will actually be slower. Cool tap water is more suitable for effective cooling.   

It is important to seek medical care immediately to prevent further organ damage and to address complications that result from heatstroke.

WRITTEN BY:
Dr. Dana Lewis
Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties. Special arrangements can be made for other surrounding counties, and for the Triad area.)

DrDana@LapofLove.com
www.lapoflove.com


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Vet Mary Gardner
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Bloat: Danger Will Robinson! Danger!

Bloat: a life-threatening condition in which the stomach fills with air, which is called dilatation, and then it might twist upon itself, which is called volvulus. This leads to the veterinary term, Gastric Dilatation and Volvulus, or GDV.

Veterinary Medical Center of Long Island

Symptoms:
Your pet's abdomen may or may not have a bloated appearance. Signs of bloat can also include:
- drooling
- frequent retching (attempts to vomit)
- pacing, can’t seem to get comfortable, anxious
- or lethargic

What to Do:
Go to a veterinary hospital or emergency facility immediately!

What NOT to Do:
Do not give anything by mouth or try to induce vomiting.

What happens to your dog in GDV:
The condition is commonly associated with large meals and causes the stomach to dilate because of expansion of the food and the production of gas and may get to a point where neither may be expelled. As the stomach begins to dilate and rotate, the pressure in the stomach begins to increase and several severe consequences, including preventing adequate blood return to the heart from the abdomen, loss of blood flow to the lining of the stomach, and rupture of the stomach wall can occur. As the stomach expands, it may also put pressure on the diaphragm preventing the lungs from adequately expanding, which leads to decreased ability to maintain normal breathing.

While the stomach is twisted, changes occur in blood levels of oxygen leading to cell death in other organs. Cardiac arrhythmias (abnormal heart beats) are commonly seen because of the hypoxia (low oxygen). Additionally, the lining of the entire gastrointestinal tract is at risk of cell death and sloughing. As the condition progresses, toxins may be increasing the cells of the stomach and when gastric dilatation is relieved these may circulate through the body resulting in additional heart arrhythmias, acute kidney failure, and liver failure. Bacteria also get into the blood during this condition leading to sepsis.

Ohio State University

Prevention
No one entity has been shown to prevent this disease process. There is a lot of debate over risk factors that contribute to bloat. However, feeding smaller more frequent meals, and making sure fat is not in the top 4 ingredients in your pet’s diet are proven to reduce the risk of bloat.

Elevated feeding bowls may actually increase the risk of GDV in some patients. Elevated citric acid in the diet may increase risk, but bone and meat meal in the top 4 ingredients appear to reduce the risk. It appears that dogs who eat rapidly, eat one large meal a day, consume a large volume of water, or exercise soon after a meal also have increased risk.

In breeds with a high risk of bloat, there is a preventive surgery called a prophylactic gastropexy that can often be performed when the dog is being spayed or neutered, or while young if the pet is going to be bred. Most police and military service dogs have this procedure performed at a young age to protect them. Gastropexy involves surgically attaching the stomach to the wall of the abdomen to prevent rotation.

Other risk factors:
Discontinuing breeding animals with a family history of GDV may potentially decrease the risk of GDV. Male dogs are almost twice as likely to develop gastric dilatation and volvulus as females. Neutering and spaying does not appear to have an effect on the risk of bloat. Dogs over 7 years of age are more than twice as likely to develop gastric dilatation and volvulus as those who are 2-4 years of age.

Any dog of any size can develop bloat, but large and giant breeds with a deep chest are most at risk.

The five breeds at greatest risk are Great Danes, Weimaraners, St. Bernards, Gordon Setters, and Irish Setters. In fact, the lifetime risk for a Great Dane to develop bloat has been estimated to be close to 37 percent! Standard Poodles are also at risk for this health problem, as are Irish Wolfhound, Doberman Pinschers, Rottweilers and Rhodesian Ridgebacks. Basset Hounds have the greatest risk for dogs less than 50 lbs.

What the surgeon does to fix this when it occurs:
The pet will be put on IV fluids and oxygen, and attempts to decompress the stomach will be tried. We try to put a tube down into the stomach to relieve pressure, and if that cannot be done successfully, we will pass a needle into the stomach from the outside to release air. Sometimes this then lets us pass a stomach tube as well. Then as soon as the pet is as stable as we can make it for surgery, it is off to surgery where the surgeon will determine if the stomach and spleen (which often gets entrapped in the rotating process and damaged) are viable. The surgeon will de-rotate the stomach, remove any dead portions of the stomach, and possibly remove the spleen, and do a gastropexy to attempt to prevent this from happening again in the future. After surgery, complications can include the organ failure listed above, but again, the survival rate is much better nowadays with quick surgical intervention. Survival rates used to be less than 10% a few decades ago, but now is 60-80% depending on how much damage occurs during the progression of the disease. So get that bloated dog to a hospital ASAP!

BLOG WRITTEN BY:
Dr. Dana Lewis
Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties. Special arrangements can be made for other surrounding counties, and for the Triad area.)
DrDana@LapofLove.com
www.lapoflove.com


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Lap of Love Veterinary Hospice and In Home Pet Euthanasia expands to Houston Texas! Dr. Charles Jameson joins our team of veterinarians to offer this special service in his area. Dr. Charles was born and raised in Texas and is a wonderful addition to the group.

"May all your pets be blessed with a long & healthy life and when the time comes to help them pass over, I will be here to help make it a peaceful and stress-free transition." Dr. Charles.

WELCOME!

Here is his bio page for more information: http://www.lapoflove.com/vet-biography.aspx?vet=47
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Pet Obesity

Obesity has become an extremely important health problem not just for humans but for dogs and cats as well. Obesity in pets is associated with joint problems, diabetes mellitus, trouble breathing, and decreased life span. The fifth annual veterinary survey found 53 percent of adult dogs and 55 percent of cats to be classified as overweight or obese by their veterinarian. That equals 88.4 million pets that are too heavy according to veterinarians.

Why Obesity is Bad
A common justification for over-feeding treats is that a pet gets so much joy from eating treats, but your pet certainly loses both quality and quantity when it is overweight. Here are some of problems that obese animals must contend with:

Arthritis
The over-weight animal has extra unneeded stress on joints, including the discs of the vertebrae, leading to the progression of joint degeneration and creation of more pain. Breeds very prone to disc disease include all the short long dogs: Dachshunds, Bassets, Corgis, etc. Weight management alone decreases and can even eliminate the need for arthritis medications. Then you end up in a vicious cycle as fatter pets also have poorer mobility, which leads to greater obesity.

Reduced Life Span
A study of age-matched dogs found that the dogs that were slightly underfed compared to normal to overweight dogs lived an average of 2.5 years longer than their overweight counterparts.

Respiratory Distress
The obese pet has a thick layer of blubber around the chest and having had less exercise, lower muscle mass and tone. This makes the pet less able to take deep breaths as more work is required to move the respiratory muscles. Areas of the lung cannot fully inflate. The pet also overheats more easily. Many cases of tracheal collapse can be managed with only weight loss!


Increased Surgical/Anesthetic Risk
Obesity poses an extra anesthetic risk because drug dosing becomes less accurate. Additionally, anesthesia is suppressive to respiration and adding a constrictive jacket of fat makes proper air exchange even more difficult. Surgery in the abdomen is hampered by the difficulty of finding what you need to work on through all that nasty slick fat.

If The Pet Needs a Special Diet Later In Life Due To A Health Condition
If the pet should develop a condition where a therapeutic diet is necessary to improve quality and/or quantity of life, the pet that has been maintained primarily on a diet of table scraps may be unwilling to accept commercial pet food of any kind, including those for a specific disease process. This unwillingness to eat the new food will hamper successful care of the pet.

Diabetes Mellitus
Extra body fat leads to insulin resistance in cats just as it does in humans. In fact, obese cats have been found to have a 50% decrease in insulin sensitivity. Weight management is especially important in decreasing a cat’s risk for the development of diabetes mellitus.

Hepatic Lipidosis (Fatty Liver Disease)
When an overweight cat has a sudden decrease in appetite or no appetite because of illness or psychological stress, body fat is mobilized to provide calories. Unfortunately, the cat’s liver was not designed to process such a large amount of body fat. The liver becomes filled with all that fat the body mobilizes and then fails. A stress that might have been relatively minor becomes a life-threatening disaster!

Why Did My Pet Get So Fat?
One might think weight management might be easier for a pet than it is for a human. After all, the pet relies completely on someone else for feeding and exercise so it should follow that if the humans in control can regulate feeding and exercise, the pet should lose weight, right? It seems like this would be true but, as with humans, there is tremendous individuality with how different pets store the food they have eaten. Here are some factors involved:

Slow Metabolism
Some pets do not burn calories efficiently; they simply have a slow metabolism. This might be genetic or it might be the result of a disease such as hypothyroidism or Cushing’s disease. Testing for health problems such as these is helpful to get the best treatment for resolution of the obesity. As an initial step in obesity management, be sure to rule out health issues that might specifically cause obesity. Once that is taken care of, the rest is up to you and your pet.


What Is A “Cup” Of Food?
When food packages refer to a certain number of cups of kibble being appropriate for a certain body weight, they are referring to an actual measuring cup. This may seem obvious but many mugs, coffee cups, and other scooping cups may not be equal to a cup. If you do not have a measuring cup for your pet, you can often get one from your veterinarian’s office as most manufacturers of reducing diets for pets provide free cup measures. You can also go to the dollar store and get a cheap set of baking measuring “cups” from 1/8 up to 1 cup. Those little ones make it so much easier to feed cats and small dogs since we have a tendency to “round” the measuring cup-which adds quite a bit as it is, and if you need to feed ¼ cup and you are using a full cup measure, you might be tempted to go to 3/8 in the cup instead of ¼.

The Package Guidelines Are Just That
Many packages of food include on their label some sort of feeding schedule that indicates how much food should be fed to a pet of a certain weight. These guidelines are meant as a starting point only. Feeding trials are done with small breed high energy dogs who are sexually intact and who get a decent amount of exercise where they are housed. Therefore, they need more calories than the average spayed dog lying on my couch all day while I work. If your pet is too fat on the recommended feeding schedule, then you should reduce the amount of food or change to a diet that is higher in fiber so that a satisfying volume of food can still be eaten without adding calories. Ask your vet for advice. They should be able to tell you a good starting number of cups or parts of a cup.

In And Around The Home
It is almost impossible to keep children (and a lot of adults) from providing extra treats to their dog. This may include snacks spilled or purposely feeding the pet unwanted food under the dining table. Similarly, pets that are allowed to roam (usually cats) often find food left out by neighbors, either to purposely feed their own pets or strays, or accessing someone’s trash cans. It is almost impossible to control the diet of an outdoor cat. So, keeping the dog out of the dining area, and keeping the cat indoors (indoor cats on average live to be 16 by the way, while cats that go outdoors at all on average live to be 6!), will do them a huge favor in health care.

The Power Of Treats
Many people express their affection for the pet by providing regular treats, and the pet happily obliges by begging or even performing cute behaviors. For some people, feeding treats to the pet constitutes a major part of the human-animal bond and they do not wish to give it up or reduce it. Pet treats are often high in calories, though, and “a few” treats readily converts into an extra meal’s worth of added calories. Free feeding of dry food also encourages the pet to snack as well; meal feeding represents better calorie control.

Neutering
Sterilizing a pet is good for public health, as well as pet health, is good for a better house pet (less urine marking, tendency to fight or roam), no unwanted litters, reduced risk of many diseases, etc. The change in the pet after neutering or spaying creates a tendency to form more fat cells, and typically slows metabolism by about 10%.


What Can Be Done:

Diet and Exercise
This sounds simple but in fact when one simply tries to cut back on food, it just does not always work. “Lite” or “Healthy Weight” diets that you can buy have a minimal reduction in calories and are probably best fed to maintain a pet at a more ideal weight. For weight loss, a more concerted effort is required. This means feeding a prescription diet made for weight loss, feeding a measured amount, and coming in for regular weigh-ins at the vet’s office. (FYI-The dental diet, T/D by Hill’s is a two-fer! Not only is it great for dental care, it is low in calories!)

This means:

· There must be control over what the obese pet eats. That’s easy enough if there is only one pet and roaming is not allowed, but trickier if there is more than one pet in the home. Feeding in meals makes it easier to feed multiple pets different foods or different amounts of food. You need to feed the pets separately. And only one person should be in charge of food and snacks. That person measures out all the food and doles out all the snacks the pet can eat per day, and nobody can add to it.

· Low cal snacks- think green beans, carrot sticks, apple slices, broccoli. And while cats are obligate carnivores, lots of them will eat fruit and veggies. These fruits and veggies can be raw, cooked, canned-whatever they like. But not starchy or fatty foods (potatoes, sweet potatoes, beans, nuts, corn, peas, pasta, skin or fat off any meats-think to yourself, is it good for me or not?) as they are too high in calories. No grapes, raisins, macadamia nuts, onions, or avocados due to toxicity.


· Commit to regular weigh-ins. Know what the goal weight is and how long it should take to reach this goal. It is important not to try to go too fast (you can cause hepatic lipidosis in cats, for example, by going too fast). Your veterinarian can contact the clinical nutritionists at the pet food company so as to make the best recommendations.

· Consider interactive toys that can be used when you are not home to encourage the couch potato to move.

· Exercise for your pet: Toss the ball or stick, swim, jog, etc. for the dog. “Fishing rod” toys for cats, catnip or crinkly toys, laser light, tossing the food around piece by piece so the cat has to exercise to eat (including up and down stairs). Have the kids participate in this! A few minutes a few times a day makes a big difference in the metabolism boost.


Medication
At this time there is no medication that can be used for cats in obesity management. In dogs, however, dirlotapide (Slentrol®) is available. Slentrol is an appetite suppressant that manipulates the absorption of fat into the body in such a way as to fool the brain into feeling full.

For more information on how much to feed your pet, how much your pet’s breed should weigh, and other great information to help your pet with weight issues, go to www.petobesityprevention.com


If you want one on one phone/skype consultation with our Pet Nutritionist go to our website www.lapoflove.com - click on 'Education Center' - then 'Nutrition Center'

BLOG WRITTEN BY:

Dr. Dana Lewis
Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties. Special arrangements can be made for other surrounding counties, and for the Triad area.)
Click here for Dr. Dana's bio link

DrDana@LapofLove.com
www.lapoflove.com

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Vet Mary Gardner
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Honoring shelter dogs this month!

October is Adopt-A-Shelter-Dog Month and we wanted to share with you the story of our very own shelter dog, Duncan.

We adopted Duncan 2 months after the loss of our doberman Neo.  Duncan was at a rescue site 8 hours north of us. He was 6 years old and the family just could not care for him anymore and they dropped him off at the Doberman rescue on Christmas eve.  We confirmed he was not dog or cat aggressive since we have other pets.

Everyone thought we were crazy adopting an adult doberman with no true history but he looked so similar to our Neo and I love the breed. And even if I only have 3 years with Duncan, we could still give him a great 3 years.

January 8th 2011, we met the rescue coordinator halfway and out came Duncan lumbering off the back of this pick up truck. He was HUGE -- so much bigger than Neo -- especially since Neo suffered from cancer and got skinnier towards the end. I instantly bear-hugged this beautiful giant (who was named Duke at
the time). In retrospect, it was stupid of me to do that to a strange (and huge!) dog but I just fell in love instantly.  He has been a wonderful addition to our home and I think was heavenly-guided to our family from Neo.

Duncan is a goofball. He loves to chase bees and grasshoppers, is friendly with everyone but also a very good house protector, and he LOVES all the cats!  He is a great example for the adopting cause. He is a full-blooded, purebred Doberman and was an adult dog when adopted him; people should not worry about adopting an older pet!
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Vestibular Syndrome in Dogs- by Dr. Jennifer Hawthorne

Vestibular disease refers to a disorder involving the vestibular apparatus of the inner ear and brain. It involves the 8th cranial nerve. The vestibular apparatus helps maintain balance and orientation. A condition commonly seen in older dogs is something often referred to as “geriatric vestibular syndrome” or idiopathic vestibular syndrome. It is similar to vertigo in people. Some people will also refer to it as a “stroke,” but it is not really the same as a stroke in humans. Sometimes there are other underlying reasons such as an inner ear infection or a problem within the brain. Often, however, it simply happens for no known reason.

Symptoms usually come about suddenly in an older pet. Signs include:

· Head tilt to one side
· Falling over to one side
· Completely unable to stand or walk
· Rapid eye movements in a certain direction (nystagmus)
· Nausea/ vomiting
· Circling in one direction

Pets may show several or a few of these symptoms. Usually it is very disturbing for a pet owner to suddenly find their pet in this state and they often rush them into the veterinary clinic. Evaluation of your pet will include a good physical exam to start with to determine whether your pet has an ear infection or not.

There are certain signs that may sometimes point to a more serious problem. Vestibular disease is usually lumped into two categories: peripheral and central. Geriatric vestibular disease is typically peripheral with symptoms as above. Central vestibular disease is more serious with other signs. These include nystagmus in a vertical direction, loss of conscious proprioception (proper placing of feet) and change in mental status. Other cranial nerves are involved and there may be a problem within the brain. Typically with geriatric vestibular syndrome the nystagmus is horizontal or rotary, the pet maintains normal proprioception and normal mentation. Further tests are usually needed to rule out a central problem including bloodwork and advanced imaging of the brain (MRI, CT).

There is no real treatment for geriatric vestibular syndrome, but that does not mean that the pet is doomed. Many pets can recover with some time. Often they will start to recover in a few days, up to 2 weeks. Some medications can be used to try to alleviate symptoms. These include meclizine, which is a motion sickness medication, and prednisone, a steroid/ anti-inflammatory. Many times symptoms will resolve, although some animals will have residual side effects such as a head tilt that remains. If a pet is not recovering it may be a sign of a central problem. Sometimes owners cannot bear to see their pet in that state and worry that they will suffer while waiting for it to resolve. Other factors such as the pet’s age and overall health come into play as well. Worry that the pet will harm itself falling is often another concern. The pet should be kept confined in a safe place while trying to recover. If the symptoms are too severe some owners will elect euthanasia. This is a decision that should be discussed with your veterinarian.

Dr. Jennifer Hawthorne
Lap of Love Veterinary Hospice and In Home Euthanasia
www.lapoflove.com
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How will I know it’s time?
Dr. Dani McVety
April 2012

I’ve heard from countless pet owners that the death of their pet was worse than the death of their own parents. This might sound blasphemous to some, but to others it’s the cold truth. Making the decision to euthanize a pet can feel gut-wrenching, murderous, and immoral. Families feel like they are letting their pet down or that they are the cause of their friend’s death. They forget that euthanasia is a gift,something that, when used appropriately and timely, prevents suffering both for the pet and the family. Making the actual decision is the worst part of the experience and I’m asked on a daily basis, “Doc, how will I know when it’s time?” It’s time to shed some light on this difficult discussion.

An interesting trend that I did not expect when starting my hospice practice is that the more times families experience the loss of a pet, the sooner they make the decision to euthanize. Owners experiencing the decline or terminal illness of a pet for the first time will generally wait until the very end to make that difficult decision. They are fearful of doing it too soon and giving up without a good fight. Afterwards, however, most of these owners regret waiting too long. They reflect back on the past days, weeks, or months, and feel guilty for putting their pet through those numerous trips to the vet or uncomfortable medical procedures. The next time they witness the decline of a pet, they are much more likely to make the decision at the beginning of the decline instead of the end.

Pain in animals is another important topic that all pet owners should be well versed on. It’s the main topic I discuss during my in-home hospice consultations. Myself,and many other professionals, believe that carnivorous animals, such as cats and dogs, do not hide their pain… it simply doesn’t bother them like it bothers humans. Animals do not have an emotional attachment to their pain like we do. Humans react to the diagnosis of cancer much differently than Fluffy does! Fluffy doesn’t know she has a terminal illness, it bothers us more than it bothers her. This is much different than prey animals like rabbits or guinea pigs, ask your veterinarian for more information. If you’re interested in learning more about pain and suffering in pets, grab Temple Grandin’s book “Animals in Translation”and read chapter 5.

When discussing the decision to euthanize, we should be just as concerned about anxiety in our pet as we are about pain. Personally, I feel that anxiety is worse than pain in animals. Think about the last time your dog went to the vet. How was his behavior? Was he nervous in the exam room? Did he give you that look that said “this is terrible!”? Now think back to when he last hurt himself. Perhaps scraping his paw or straining a muscle after running too hard. My dog rarely looks as distraught when she’s in pain as she does when she’s anxious. It’s the same for animals that are dying. End stage arthritis makes up about 30% of my cases. These animals begin panting,pacing, whining, and crying, especially at night time. Due to hormonal fluctuations, symptoms can usually appear worse at night. The body is telling the carnivorous dog that he is no longer at the top of the food chain; he has been demoted and if he lies down, he will become someone else’s dinner. Anti-anxiety medications can sometimes work for a time but for pets that are at this stage, then end is certainly near.

As a veterinarian, my job is to assist the family in the decision making, not do it for them. There is not one perfect moment in time in which to make that choice. Rather, there is a subjective time period in which euthanasia is an appropriate decision to make. This period could be hours, days, weeks, or even months. Before this specific period, I will refuse to euthanize since there is clearly a good quality of life. After this period, however, I will insist on euthanizing due to suffering of the pet. During this larger subjective time, it is truly dependent on the family to make whatever decision is best for them. Some owners need time to come to terms with the decline of their pet while others want to prevent any unnecessary suffering at all. Everyone is different and entitled to their own thoughts. After all, pet owners know their pet better than anyone, even the vet!

Blog by:
Dr. Dani McVety
Lap of Love Veterinary Hospice
www.lapoflove.com
Click Here for Dr. Dani's biography and contact information


Dr. Dani helps families in the Tampa / St. Pete area. She also consults for veterinary clinics and industry on end-of-life care for our companion animals.


Posted by: Mary Gardner, DVM
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Read out blog on Dental Care for Dogs and Cats by Dana Lewis, DVM. Below is the text version.. but be sure to look at the blog for some great pics: http://lapoflove.blogspot.com/2012/04/dental-care-for-dogs-and-cats.html


Dental Home Care

“Perio” means around, “dontal” means tooth: Periodontal disease is disease around the outside of the tooth. The crown of the tooth is the part we see, and the root of the tooth is the part we cannot see that is in the socket and is held there by periodontal ligaments. The tooth receives nutrients from blood vessels inside the pulp chamber of the tooth. Periodontal disease takes place inside the socket in which the tooth is seated. Pets have the worst dental hygiene in the home: they do not brush their teeth, or floss, and this goes on for years.

A full 85% of pets have periodontal disease by age 3 years.

We all have a set of baby teeth that come in and fall out to make way for adult teeth. The nerves, vessels, and dentin of our teeth are covered by a hard coat of enamel. The enamel is bathed in saliva and quickly is covered by plaque (bacteria mixed with saliva). If we do not regularly disinfect our mouths and brush away the plaque, the plaque will mineralize into tartar (also called calculus – gritty material that the dental hygienist scrapes away). Tartar, being solid and gritty, blocks oxygen from bathing the outer tooth and thus changes the nature of the bacteria that can live around the tooth. The bacteria that can withstand the oxygen-poor environment (anaerobic bacteria) are more harmful to the bone and tissues of the gum. The periodontal ligament becomes damaged, the bone around the tooth is literally eaten away, and the gums become sensitive. Eventually the tooth is lost and, if the bone damage is severe enough, the jaw can actually break. Worse still, the bacteria of the mouth can seed other areas in the body leading to infection in the heart, liver, kidney or virtually anywhere the bloodstream carries them.

This picture shows a normal mouth. The teeth are clean and white and there is no redness or swelling in the surrounding gums.

With gingivitis, the gum is clearly red and swollen (there is also yellowish brown tartar extending down the length of the tooth).

The third picture shows the third stage of periodontal disease where up to 50% of the bone attachment is lost. Notice the exposure of the tooth roots.

Gingivitis is reversible. Bone loss, once it starts, is not reversible.

It is a good idea to become comfortable opening your pet’s mouth and looking inside. Lift the lip and look at the teeth, especially the back teeth. Open the mouth and look at the inside of the teeth and at the tongue. If you have pets of different ages, compare what you see inside.

Regular Professional Cleaning

Dental health requires periodic professional cleaning whether the mouth in question belongs to a person, a dog, a cat, a horse, or some other animal. Home care of the tooth is never perfect and periodically tartar must be properly removed and the tooth surface properly polished and disinfected. The professional cleaning performed at the veterinarian’s office is similar to what a person receives at their dentist’s office:

Gross (visible) tartar is removed with instruments. More delicate tartar deposits are removed from the gum line with different instruments.

Periodontal sockets are probed and measured to assess periodontal disease. The roots are planed, (meaning tartar is scraped from below the gum line) until the roots are smooth again.

The enamel is polished to remove any unevenness left by tartar removal. The mouth is disinfected and possibly treated with a fluoride sealer or plaque repellent. Professional notes are taken on a dental chart, noting abnormalities on each of the dog’s 42 teeth, or the cat’s 30 teeth.

It is important to note that a “non-anesthetic” teeth cleaning is not comparable to the above service.

It is not possible to perform the “six step” cleaning in a pet without general anesthesia.

Cosmetic cleanings do not address periodontal disease where it occurs: under the gum line.

Home Care Products

Toothpaste and Brushing
Just as with your own teeth, nothing beats brushing. The fibers of the toothbrush are able to reach between teeth and under gums to pick out tiny deposits of food. A toothbrush acts as a tiny scrub brush for the closest possible cleaning.
Notice the shape of the canine and feline brushes and how they conform to a pet's mouth. You can use a human toothbrush but you will probably find it difficult to manipulate in the pet's mouth. Never use human toothpaste for a pet as these contain ingredients that are not meant to be swallowed. Animal toothpastes come in pet-preferred flavors (chicken, seafood, and malt) in addition to the more human-appreciated mint and all are expected to be swallowed. Don't attempt to clean the inner surface of your pet's teeth. Natural saliva cleans this surface on its own. Do try to perform dental home care at least once daily.

Dental Wipes, Rinses and Pads
Some animals, especially those with tender gums, will not tolerate brushing but are more amenable to disinfecting wipes or pads. These products will wipe off plaque deposits from the surface of the tooth and, though they lack the ability to pick food particles out of the gum socket, they are probably the next best thing to brushing and, like brushing, these products are best used daily.


Dental Treats
For many people, doing anything inside their pet’s mouth on a regular basis is simply never going to happen. Fortunately, all is not lost: chewing on a proper dental chew can reduce plaque by up to 69%. This may not be as good as brushing but it certainly beats doing nothing. There are many products available for both dogs and cats.

Not all chews are alike. Chewing provides abrasion against the tooth removing plaque and tartar. Some chews and biscuits include the ingredient hexametaphosphate, which prevents the mineralization of plaque into tartar.

Greenies
A treat that has been proven to remove plaque from teeth. The new formulation came out mid-2006 and is available in both canine and feline treats. Both are approved by the Veterinary Oral Health Council, a group that awards its seal of approval to treats and diets showing scientific evidence of plaque and tartar retardation.

(Dog and Cat Greenie Dental Chews)

Dental Diets
There is a common misconception that simply feeding a kibbled diet will protect teeth from dental disease. Consider what it would be like to attempt to replace brushing your own teeth with eating crunchy foods and it is easy to see how ineffective this method would be. When it comes to pet foods, much of the kibble is swallowed whole and not chewed at all.

But with Hill’s Tartar Diet (T/D) the kibbles are very large, which means the pet must chew them before swallowing them. These diets are high in fiber, which means the kibbles do not shatter when chewed but instead the tooth sinks into the kibble allowing plaque to be essentially scrubbed away. The large kibbles may pose an acceptance problem for the pet, leading the owner to use them as treats or mixed with other kibbles. The smaller the percentage of the diet these kibbles represent, the less benefit will be reaped. It is also important to realize that these diets are helpful only in cleaning the molars and premolars (i.e. the chewing teeth) and do not help the fangs or incisors. (There are original and small bites for dogs, and also a version for cats.)


Chew Toys
Use your judgment with chew toys. A chew toy must be easily bent or dented or it will break teeth. A chew can be readily swallowed in a large chunk and lead to intestinal obstruction. A pet with diseased teeth may break teeth on a hard chew. Cow hooves and bones are not appropriate chew toys as they are too hard and readily break teeth. Pig ears are well loved by most dogs but have been known to have bacterial contamination, nor do they help clean teeth.

See a list of the VOHC’s currently approved products: http://www.vohc.org/accepted_products.htm

BLOG WRITTEN BY:

Dr. Dana Lewis
Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties. Special arrangements can be made for other surrounding counties, and for the Triad area.)

DrDana@LapofLove.com
www.lapoflove.com


Blog posted by:
Vet Mary Gardner
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Lap of Love provides compassionate, in-home end-of-life care for your pet. Our veterinarians assist with pet hospce and at-home euthanasia. Love and dignity are at the center of all that we do.
Introduction

Lap of Love is a group of 21 veterinarians in 4 states whose goal is to empower every owner to care for their geriatric pets.

Click here to locate a Lap of Love veterinarian in your area:  LOCATE A VET

Dr. Dani McVety had experience in human hospice before veterinary school and wanted to use that knowledge for pets and started Lap of Love Veterinary Hospice and In Home Euthanasia in 2009.

After providing hospice for her own dog (who had terminal cancer) and then finally having to say goodbye to him at home, Dr. Mary Gardner knew first hand the importance of veterinary hospice and joined Dr. Dani (friends from veterinary school) in this wonderful specialty.

The communities' desire for compassionate end of life veterinary care was obvious and they began receiving calls from all over the United States. 

In just a few short years, Drs. McVety and Gardner have spoken at the world's largest  veterinary conferences as well as to local veterinarians and universities about veterinary hospice, palliative care, and euthanasia.  Lap of Love has been featured in numerous newspapers, magazines, television news stations, radio shows, and veterinary related publications. 

Our philosophy centers around the human-animal bond and the need for that bond to be as undisturbed as possible during this most difficult time.  The desire to bring this important service to families across the United States is slowly being realized as additional veterinarians begin working under the same philosophy.  Lap of Love is honored to have some of the most compassionate and empathetic vets working with us.