Tuesday, July 22, 2014

To Amputate Or Not To Amputate: Heidi's Story

by  Krista Magnifico, DVM

As a veterinarian there are so many talks that you discuss so many times that you feel as if it might just be a whole lot easier to video tape the discussion, push play when the next appropriate patient presents, and pop back in the exam room to discuss the final details of the treatment plan.

Wouldn't it be so simple? 

You bring your pet in, I diagnose the problem, tell you how to fix it, and then we schedule it the following day.

No wasting time, no idle insignificant chit chat, no silly feelings about your pet "not wanting to go through any procedures," or ridiculous excuses about “sparing them from the hardships of recovery,” etc. etc.

It can be frustrating to feel as if I need to repeat the same thing over and over. 

And yet, I’ll do it tomorrow, and the day after, and the day after,.Its my job. To tell you what disease, condition, ailment, need, etc., that your pet has and how I suggest it be treated.

How do I keep myself from feeling like a broken record? Well, I employ my clients to serve as future character witnesses, provide their own personal experiences, and pass it forward.

Here is one story I find myself repeating often. It is about bone tumors.

In large breed older dogs that present to me with swelling, lameness and intense pain at the site I will place a bet that your dog has a bone tumor. The diagnosis is usually pretty easy. OK, well, I should back track a bit and clarify.

In the earliest stages of bone cancer it can be difficult to pin the diagnosis exactly. Because your pet knows before the x-ray does that there is a problem.

The typical presentation of a bone tumor is a progressive limb lameness that persists.

On the first trip to the vet we corroborate your suspicion; The leg hurts and the pet is limping.

The normal course of events after that first trip is to prescribe an NSAID, (a non-steroidal anti-inflammatory) and monitor for response to treatment and resolution of clinical signs, (they stop limping). These work very well on pain and inflammation associated with osteoarthritis (OA). Most older dogs, just like most older people, have some joint pain because their joints get sore after years of wear and tear.  A response to treatment is a quick, cheap, easy way to help confirm a diagnosis. If we are right, and if it is just OA, then the medications lessen the inflammation which in turn will help alleviate the pain. If we are wrong then the owner will call back in a few days/weeks and report that the lameness is worse, or no different.

Trip number two is for a re-check and x-rays.

Depending on the degree of bone destruction we may or may not have visible evidence on the x-ray.

 (One little tip here from a weathered vet; take the x-ray of the whole foot..shoulder /hip to toes. It makes you look like a bone head when you miss the big lytic (destruction of bone) lesion in the foot because you cut the film short).

If there is a lytic lesion on the bone it is most likely a bone tumor, and the most common bone tumor is an osteosarcoma.

Osteosarcomas are incredibly painful aggressive tumors. They essentially eat away at the bone until it crumbles. They also spread fast! Those little microscopic cancer cells will hijack a ride through the bodies internal highway system (blood stream or lymphatics) and land in remote areas where they then lay down roots and begin to eat away at another part of the body.

After you and I have gotten to this point the waters get muddy and the navigational gear gets all screwy.

The dance of the decisions, the debating, the doubt, the second guessing, hesitation and indecision begins.

Here’s where I'd like to take the command and remove you from the bridge. What I really want to say, “OK, I got the wheel. I am steering the ship. Here's what you need to know: The estimate for surgery is $800 - $1000, average lifespan after surgery 6 months. But, trust me, your pet will be happier because they will no longer be in pain."

At which time you say, “OK, thanks doc, see you tomorrow for surgery.”

Now, I understand there is a lot to discuss. But remember I have had this discussion about 300 times before you, so in truth, I’m not looking forward to number 301.

Here are the arguments and points of discussion that pet parents have:

Number One:
“I don’t want to put my dog through that.” OK, I’m going to put on my best “be nice” face. Your dog is in an immense amount of pain. That pain is manageable only for a short period of time. At some point we will be putting your dog down because they refuse to move, or eat, or do anything because they are in so much pain. SO, if you are telling me this I will remind you that not taking that leg off is not wanting your pet to be pain free. Be honest. I think that most people use this excuse because they don’t want to put their wallet through the procedure.

Number Two:
“He will be unhappy with three legs. I can’t do that to him.” My response; Your dog is already three legged. They are just three legged with one additional painful rotting limb stuck to them. Another important point to remember is that at some point the cancer will eat away so much of the bone that it will fracture, or crumble.

Number Three:
“The recovery will be too much on him.” Like the current excruciating minute to minute with no chance of relief in sight is better?

Now, I understand that I am not being subtle. 

Here’s why. I cannot stand seeing an animal in pain if there is anything that can be done about it. So get over your phobias, and cosmetic disfigurement, and get that damned leg off!


Here is a story of a patient of mine. Her name is Heidi.

Heidi was an older mixed breed dog who presented with the above scenario.

Her dad is one of the most devoted genuine guys around. He is direct, honest, and not at all uncomfortable making you uncomfortable when it comes to his pets. I like him all the way around. We are kismet. I get him. I don’t mince words, and he doesn't tolerate it to begin with.

When Heidi first came to see me she was lame, exceptionally lame. 

She was in pain all the time. He knew he had to do something and he was leaning towards putting her down. When he said this I started to pull out all of the tricks of my medical bag.

There was arm wrestling, and some somewhat questionable, unethical promises. I also pulled out the “past experience” card. He was so stubbornly stuck on not being able to put her through surgery that I doubled down and confided to him:

"If Heidi was my dog I would take her leg off.”

Now I’m going to be really honest. I hate when vets do this. It is coercion in my opinion. We should never ever use this as a way to persuade. While I’m being so honest I will also admit that I do say this. For my friends I feel OK saying it.

Before I convince you to take a bad terminal leg off, do your due diligence. 

A pet that is a candidate for amputation should have a full bloodwork and urinalysis done. They should also have a full 3 view set of chest x-rays. If everything is clear and normal I recommend amputation.

If there is evidence of metastasis to the chest than the prognosis is poor and the floor is opened up again for discussion and debate.

I have some distinct advantages to being so sure footed here. I have years and years of cases to use as my precedence. I have never had one owner tell me that they regretted amputating a leg after they did it. Every single pet a week later was a thousand times happier than they were the day before their surgery.

Taking pain away from a pet is giving them back their life.
"Within 24 hours of her amputation, Heidi was remarkable.  I brought her home, using a towel sling to carry her into the house.  What did she do immediately after I released pressure on her towel sling? She took off on her own accord across the house to go to her water bowl and then down the hall to her bed.  We were moved beyond words by her strength and resilience."  ~Heidi's dad

About a year later Heidi passed away at the clinic with her dad and I. 

She was unable to hold herself up anymore. Before her surgery her hips were weak and arthritic and the additional stress and strain her body had to carry with the loss of her front leg made the hip stress more pronounced. Her dad bought a special harness for her with a handle to help her get up and provide an extra point of stability. The harness was also the way that her dad could help carry some of her weight and keep her from slipping or falling.

***

Krista Magnifico, DVM owns a small animal hospital in northern Maryland, where she practices everyday. She wants to make quality veterinary care available to everyone, everywhere at any time; trying to save the world 1 wet nose @ a time.  Her blog is a diary of he day-to-day life & the animals and people she meets. 

Dr. Krista is also the founder of pawbly.com, free pet advice and assistance.

To contact her, you may leave a comment on her blog, email her or catch her on Twitter or Facebook.

Articles by Dr. Magnifico:
Don't Make This Mistake: Ruby's Death To Heat Stroke 
Parvo: Cora's Story 
Jake's Laryngeal Paralysis
The Tip Of The Iceberg: The Unexpected Dental Dilemma
The Ear Ache That Wasn't Going Away: Tottsie's Story
Cody's Eyelid Tumor
Ruger's Mysterious Illness
The Day The Heart Stood Still: Timber's Story 
Different Definition Of Comfort Food: Levi's Story 
Savannah's Pancreatitis  
Histiocytoma: Rio's Mysterious Bump
Von Willebrand's Disease: Greta's Story 
Alice's Heart Murmur  
Jekyll Loses His Tail Mo-Jo 
Pale Gums Are An Emergency: Bailey's Story


Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!

Monday, July 21, 2014

Adoption Monday: Joe Joe, Shepherd Mix, Deerfield, NH

Check out this awesome boy at Mary's Dogs Rescue and Adoption!


Joe Joe is a handsome Shepherd mix who is coming to NH soon and is looking for a great home! 

He loves the outdoors but would also like to cuddle up at the end of the day.

Joe Joe does great with other dogs and walks well on a leash. He would make a great addition to any family!

Joe Joe is neutered, house trained and current on routine shots. Want more info on Joe Joe? Call Mary's Dogs: or send along an email: marysdogsrescue@gmail.com

Ready to bring Joe Joe home? Tell us about yourself and your interest in Joe Joe in the adoption questionnaire. Check out all the wonderful dogs on Mary's Dogs Facebook Fan Page.

***

Mary’s Dogs rescues and re-homes dogs and puppies from Aiken County Animal Shelter, a high-kill shelter in South Carolina, USA. They also serve as a resource to communities in Southern New Hampshire and pet owners nationwide by providing education and information on responsible pet ownership, including the importance of spay/neuter, positive behavior training, and good nutrition.

Don't forget to check out Mary's Dogs Shop where you can shop dog and support their work!


Sunday, July 20, 2014

Dog Training And Emotions: Postscript

Recently I wrote about my observations of the role emotions play in dog training.

Yes, play bow is still Cookie's favorite trick!

Probably because it still makes me so happy.

I wanted to share something else that happened to us. This might not be true for every dog, but Cookie is a very sensitive girl.

Our place is quite small so instead of all kinds of equipment I use my body for some of the things we do. Weave between the legs, cavaletti over the legs, under under my legs ...

For over I lay down on the floor and have Cookie jump over my torso.

The other night she accidentally landed with her hind legs on my stomach. I wasn't upset but couldn't help grunt. She's small for a Rottie but if she stomps on you, you feel it.


The grunt was really a physiological response. 

Even though I then laughed and made light of it, it had a significant impact on Cookie. She became quite hesitant to do the trick again. Poor girl.

I encourage her but don't make her. Can't wait to be living on the ranch where she will have real things to jump over.

Such a little thing as one grunt and such profound impact ...

Related articles:
From The End Of A Lead Line To Casa Jasmine: Meet Cookie, Our New Adoptee
Creative Solutions And An Incidental Product Review
Taming Of The Wild Beast: Cookie's Transition To Civilization  
Staying On Top Of The Ears: Cookie Is Not Impressed  
Who's Training Whom? Stick And Treat 
Observation Skills Of Dogs  
If You Want Your Dog To Do Something, Teach It  
Tricks? It's Not Just About The Tricks 
What Constitutes The Perfect Dog?
Are Dog Training Classes Really For The Dogs?  
Look Where You Want To Go: Finding My Reactive Dog Training Zen Zone? 
Dog Training And Emotions 
Dogs Love Sentences In Question Form?
Not All Dog Trainers Were Created Equal Either

Saturday, July 19, 2014

Dog Nail Trim Tutorial



***

Dr. Julie Buzby is a homeschooling mom of seven, AVCA & IVAS certified holistic veterinarian, and passionate advocate for canine mobility.  She can be reached at drbuzby@toegrips.com or Twitter @drbuzby.

Learn more about Dr. Buzby’s ToeGrips at www.toegrips.com and www.facebook.com/toegrips.




***

Related articles:
New Solution To An Old Problem For Dogs With Mobility Issues
Veterinary Highlights: Dr. Buzby's ToeGrips for Dogs 
ToeGrips Now Have A Canadian Distributor 

Veterinary Highlights: Fecal Transplants/Micro-biome Restorative Therapy (MBRT)

Does your dog eat poop? Do they know what they're doing?

In a healthy dog, healthful bacteria coat the entire surface of the gut, protecting it from invaders and toxins. Illness and antibiotic therapy can seriously damage the balance of gut microflora.

Image PrecisionNutrition

With the beneficial bacteria and other protective factors missing, harmful bacteria, yeast, parasites and toxins may accumulate. This not only leads to poor intestinal health but affects the whole body.

The large intestine houses over 500 species of bacteria.

Probiotics and prebiotics can promote the population of beneficial bacteria and help restore intestinal health. Probiotics typically contain up to five species of bacteria. Prebiotics can go a long way in restoring and maintaining healthy bacterial population. What if sometimes that's not enough?



In some cases, a fecal transplant can be a life-saving procedure.

A growing number of medical doctors and veterinarians are using fecal transplants to help patients recover and thrive. In humans, this therapy is most frequently used for people suffering from a serious intestinal infection caused by Clostridium difficle.

It's not really a new idea. A “cud” transplant has long been used to transfer good bacteria to sick ruminant animals (sheep, goats, and cows).

Sounds horrible to us, dogs have a different point of view at such things.

Photo funny memes

Source article:
When medicine is crap: Fecal transplants in veterinary medicine

Further reading:
Micro-Biome Restorative Therapy
Poop Therapy
Transfaunation and Fecal Transplants: What Goes Around Comes Around, Literally and Figuratively

Thursday, July 17, 2014

Veterinary Specialists: Neurologist

by Nancy Kay, DVM 

Just as is true with other specialists, veterinary neurologists spend a minimum of three years completing internship and residency training following veterinary school.

Proprioception evaluation. Photo Shelf 3D

During this time they master the nuances of a plethora of neurological diseases, from brain tumors and epilepsy to meningitis and intervertebral disk disease (slipped disk). 

Not only are they adept at treating their patients medically, they are also gifted surgeons performing the most delicate sorts of surgeries required when working in and around the brain and spinal cord.

The physical exam performed by a neurologist is quite different than what you are likely used to seeing. 

You will observe gentle probing of the nostrils, ears, eyes, and throat. There will be flexion and extension of every joint, tapping of the knees and elbows with a reflex hammer, stretching of the neck into a variety of yoga-like poses, two legged hopping exercises, and inspection of the patient when rolled upside down. All of these observations help the neurologist “localize the lesion” (figure out which part of the nervous system is malfunctioning).

Jana note: below are videos by by Dr. Chauvet demonstrating (to professionals) steps of the neurological exam. It does illustrate some of the things you might expect done during your dog's examination. Jasmine had most of these done with her.











When should your dog be evaluated by a board certified veterinary neurologist?

  • Your dog has a neurological disorder that is not getting better or is getting worse despite multiple visits with your family veterinarian.
  • Your dog has a gait abnormality the cause of which cannot be clearly determined.
  • Your dog has partial or complete disuse of one or more legs.
  • Your dog has seizures that are not well controlled with medication.
  • Your dog has an unexplained change in behavior.
  • Your dog is experiencing pain the source of of which cannot be identified.
  • Your dog has been diagnosed with a neurological disorder, particularly one with which your family veterinarian has limited experience.
  • You simply want to be more certain about the advice you’ve received from your family veterinarian.
  • The breed you fancy is prone to neurological disease. For example, Great Danes and Doberman Pinchers are predisposed to cervical spondylomyelopathy (abnormal alignment of bones within the neck that can result in pinching of the spinal cord) and Dachshunds are notorious for developing intervertebral disk disease (slipped disk). A visit with a veterinary neurologist will allow you to preemptively learn more about the disorder as well as any preventative measures you might be able to take at home.
To find a board certified veterinary neurologist in your community or learn more about this specialty, visit the American College of Veterinary Internal Medicine. Neurology is a subspecialty within this organization.

Be forewarned, there simply aren’t enough veterinary neurologists to go around. 

If there are none practicing in your neck of the woods, I encourage you to seek help from an internal medicine specialist for neurological issues that can be treated medically. For neurological issues requiring surgical management, the best substitute for a neurologist is a veterinarian who specializes in surgery.

Have you and your dog ever visited a veterinary neurologist? What was the reason and what was the outcome?

***

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook


Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Did you get your copy of Speaking for Spot yet?

If not, go get the book. It's likely the most important dog book you'll ever read.


Articles by Dr. Kay:
Reasonable Expectations: The Ability to Discuss Your Internet Research With Your Vet
Finding Dr. Wonderful And Your Mutt's Mayo Clinic: Getting Started
Even The Best Veterinarian Can Make A Mistake
A Different Way to Spay
Making Tough Medical Decisions For Your Dog: Lily's Story
If You Don't Know What A Lick Granuloma Is, Count Your Blessings!
Anesthesia-Free Dental Cleaning 
Talking Teeth 
Urinary Accidents
I Can't Believe He Ate That! Foreign Body Ingestion 
What Caused Murphy's And Ruska'sPneumothorax?
The Whole Picture: When The Test Results Don't Match What's In Front Of You 
Stop that Scratching
Veterinarians And Vaccines: A Slow Learning Curve
What is a Veterinary Specialist? 
Veterinary Specialists: Oncologist 
Veterinary Specialists: Cardiologist 
Veterinary Specialists: Internist 
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