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Monday, December 6, 2010

The Scooting Dog

It never fails. My beagle, "Wilson", has made a real sport out of embarrassing me in front of guests. It may be a dinner function at our home, or friends hanging out in our living room enjoying some wine. That is when Wilson will position himself where the majority of company can see him, then proceed to sit down, elevate his back legs ever so slightly, lift his tail, and drag his butt across the floor. Sometimes it's in a circle, sometimes in a straight line, but either way, he certainly seems to be conscious of the best route to maintain the attention of the crowd. And the look on his beagle face? Pure ecstasy.

Of course everyone in the room is thinking, "Look, the vet's dog's got worms." Because that's what people think when they see a scooting dog. And what a nice thing to think when you're having a pasta dish at the vet's house.

The truth is, the majority of dogs who scoot, do so because they have an anal sac impaction. Anal sacs are paired structures just under the skin on either side of the anus in dogs and cats. The sacs are lined with glands which secrete a foul-smelling substance which fills the sacs over time. In some dogs, the full sacs create an itchy sensation, which they try to relieve by scooting. Usually the scooting dog can be relieved simply by emptying the anal sacs. All veterinarians, and even some groomers can do this. Some dogs need it done monthly, and some never need it at all.

Less-common causes of scooting include skin conditions around the anal/tail area (fleas, food allergies, hot spots) or proctitis (which is a form of colitis). Incidentally, the majority of dogs with worms do not scoot! Occasionally, the anal sac may become infected or form an abscess. In that case, there will be pain and a thick discharge from the area. Any dog who is scooting for the first time should see a veterinarian to make sure of the cause. If it is simply an anal sac impaction, subsequent episodes can usually be dealt with by having someone at the veterinary clinic (we use vet techs for this), or the groomer clean out the sacs.

I know of some vets who recommend routine emptying of anal sacs in all dogs. I personally do not agree with this, and only recommend emptying the sacs if they're bothering the dog (ie the dog is scooting). Of course, in Wilson's case I'm thinking of making an exception to that policy, just to save my dignity.

Wednesday, November 3, 2010

Itchy Dogs

It's been a rough autumn for dogs with allergies. I am spending most of my recent days, it seems, treating uncomfortable itchy canine patients. My clients are frustrated, my patients are miserable, and my staff, well, they're learning a lot about skin disease!

While airborne allergens cause people sinus and airway irritation, in dogs they almost always cause dermatitis. There are many many causes of skin disease in dogs (demodectic mange, sarcoptic mange, ringworm, hypothyroidism, etc...), but well over half the cases we see have an allergic component. There are three major categories of allergic skin disease in dogs: flea allergies, food allergies, and atopic dermatitis (environmental allergies). It can be difficult to sort out which type of allergy a dog may have, especially since it's not uncommon for a dog to suffer from more than one of the three major types. Add in the fact that allergic skin disease is often complicated by secondary bacterial and/or yeast infections, and the diagnosis can be challenging!

Treatment of atopic dermatitis first involves identifying and addressing all other skin issues (bacterial or yeast infections, dry or greasy skin, fleas, thyroid conditions, etc...) Once these have been identified and treated, the allergic condition will be easier to manage. In a dramatic oversimplification, I will describe four medical approaches to control atopic dermatitis:
Glucocorticoids ("steroids")-This group of medications typically works really well for atopic dogs. They are also pretty inexpensive. Unfortunately, they can cause all kinds of long- and short-term side-effects. They are considered the least-safe drugs for long-term therapy. Dogs on long-term or repeated doses of glucocorticoids should be monitored with blood and urine tests. (Side note: Clients love these drugs because they're cheap and work great. They tend to get testy when we recommend other, safer options, or require labwork to refill the glucocorticoids!)
Antihistamines -These drugs do not work as well as glucocorticoids, but can be effective in mild cases or patients whose severe symptoms have been controlled with glucocorticoids. Sometimes we have to try several different kinds of antihistamines to find the one that works best for a given dog.
Atopica -This is the new "wonder drug" for atopic dermatitis. It is reported to work nearly as well as glucocorticoids while being much safer for long-term use. It is a much more expensive drug, and must be given year-round. Therefore, I only use it for patients whose symptoms occur over half the year and do not respond well to antihistamines.
Hyposensitization Therapy -This is similar to what is done in people with severe allergies. The dog is tested to find out what she's allergic to, then small amounts of those substances are given to her by injection at regular intervals so she will become tolerant of the allerge ns. This is an expensive, and time-consuming process. I have had mixed results in my patients who have had this done. It is certainly the most "natural" approach to treating atopic dermatitis.

The most important thing that I have learned about atopic dermatitis over the years, and the thing I always emphasize to new veterinarians and veterinary students, is that no two atopic dogs are the same and the dog owner must always be forwarned that it will take some time and patience to discover what will work best for their dog.

Wednesday, October 27, 2010

Sleep Tight (Don't Let The Bedbugs Bite!)

When I was a kid, my Mom used to tuck me in at bed time with the admonition, "Sleep tight! Don't let the bedbugs bite!" In my mind, there was no literal interpretation of what she said; it was just a way of telling me she loved me and to sleep well. It wasn't until my Veterinary Entemology class that I even knew that bedbugs were real. Even then, we were taught that bedbugs were no longer a problem in the US thanks to DDT. So...I pretty much forgot about bedbugs.

Now guess what? Theeeey're baaaaack. But you probably already know that if you read Time magazine (they made the cover!), or just about any US newspaper. Thanks to increased overseas travel and the disappearance of DDT, bedbugs have returned with a vengeance! They have been found in five-star hotels, upscale department stores, and homes across the US, but especially in the big cities. People are cancelling travel plans for fear of bedbugs.

The good news is, bedbugs don't spread disease like fleas, lice, and ticks do. However, they're still nasty little creatures that leave an itchy rash when they bite. And they are soooo difficult to eradicate.

Bedbugs look like apple seeds with legs. They tend to come out at night, so you may not see them. They like to live under mattresses and baseboards. Sometimes they leave behind "bedbug poop" which are small round black spots which may be found on bedding, headboards, or near baseboards. Bedbugs do not live on pets or people - they will bite us (or our pets) to take a blood meal and then scurry back to their hiding places.

You need the help of a professional exterminator to get rid of them. Don't even bother with over-the-counter pesticides. Let the exterminator know about your pets, so they can use pet-friendly products. Washing all pet bedding (and cloth toys) with hot soapy water is also recommended. Most pet flea and tick products will not prevent bedbug bites. The best way to protect the pets is to eradicate the bedbugs from the house. DO NOT put insecticides on your pets that are not labeled for such use.

The most effective way to control bedbugs is to avoid them! The ways to do this are beyond the scope of my blog, but here is a link to the CDC's webpage on bedbugs: http://www.cdc.gov/nceh/ehs/Topics/bedbugs.htm.

Having pets does not increase your risk of acquiring bedbugs! In fact, you are more likely to bring bedbugs to the pet than the pet is to bring bedbugs to you. So do what you can to avoid them, and "Sleep tight..." You know the rest.

Tuesday, October 19, 2010

The Attachment Score

One of the most challenging aspects of being a veterinarian is the different levels of attachment our clients feel toward their pets, and to a lesser degree, the varied income levels of the clients. To many, the pet is an important member of the family, and anything that can be done should be done to keep the pet healthy. This level of attachment is independent of family income -we see "financially-challenged" people frequently forgo their own needs to pay for their beloved pet. Conversely, there are well-to-do people who feel that even basic care for a pet is too expensive. Of course, there are infinite variations on these attitudes and income levels. I certainly am not implying that wealthy people care less about their pets! What I am saying is that the amount of money spent on a sick pet is often not a function of the owners' income!

Unfortunately, and to my own chagrin, I have a tendency to recommend the best medicine for pets whose owners I estimate are best able to afford it, and scale back my recommendations to people who I estimate to be lower-income. Shame on me! After 23 years of practice I should know better. It is humbling and embarrassing when I suggest to the owner of a sick pet that we should try some medication, and if that doesn't help, maybe we should take an Xray...and the person says, "Wouldn't it be better to take the Xray now? Why wait?" The truthful answer would be that I was trying to save her some money, which completely devalues what that pet means to her. I have to remind myself that I am doing my job best when I present all the best options, and let the client decide. Period.

If the depth of attachment felt toward our pets could be rated on a scale from 1 to 10, we aren't all "ones", and we aren't all "tens". It would be helpful if pet owners came in with little cards which say "I have a 'seven' relationship with my pet," or "I have a 'four' relationship with this pet." Although even if that were the case, it really shouldn't affect the way I do my job. I will say this: after I get to know a client, I can cater to their level of attachment and concern for the pet, at least in the verbage I use to communicate the pet's needs. Interestingly, many clients will have a "five" level of attachment to one pet, but a "ten" level of attachment to another. We really do have our favorites.

This blog was inspired by two conversations I had this week. One was with a college student who was concerned because I hadn't recommended testing her older dog for a parasite we had found in her new puppy (I was trying to save her money. Old habits are hard to break). The other conversation was with a fashionably dressed middle-aged lady who told me that testing her dog for parasites was a ridiculous waste of money (ie the dog is not that important). I guess they don't have to have a card with a number on it after all.

Saturday, September 25, 2010


Sorry I haven't written much lately! We're making preparations to enter the National Veterinary Hospital Design contest and there's been a lot to do. Now we're taking off to the great Northeast with the family. See you when we get back!
PS--Congratulations to Partners 4 Pets on their grand opening today. You guys are incredible with all you do for the animals, and we look forward to helping your mission for years to come!

Wednesday, September 15, 2010

Fear of Flying!

Here's a news flash for those of you who fly with your pets. A recent review of US Dept. of Transportation data revealed that 122 dogs died on commercial flights in the US between 2005 and 2009. About half of these dogs were short-nosed breeds such as Pugs and English Bulldogs. The majority of all dog deaths in-flight occurred when the dogs were in cargo holds. Another study, published a few years ago, demonstrated an increase in pet deaths on airplanes if the pets were given a tranquilizer for the flight. The reason for this is unknown, but could be due to differences in the effects of tranquilizers at high altitudes, or possibly a decreased ability of tranquilized pets to thermoregulate.

The bottom line is that while it is generally safe for pets to fly, there is a risk! Ways to make flying safer include having your pet fly in the passenger cabin, do not tranquilize pets for flights, and avoid flying short-faced breeds if possible. FYI, I have heard of an airline(?) called Animal Airways that offers in-flight veterinary services on its pet flights. Might be worth investigating!

Tuesday, August 31, 2010

Politics? Is This The Right Blog?

I'm not a very political person -just ask my friends who try to engage me in political debate! However, I am every bit as concerned as the next guy about the state of our country. I don't blame our president for the many messes we are mired in, but I am disappointed by his apparent impotence to get us moving in a positive direction. Having said that, I think we should get behind our leaders (who I truly believe are doing what they think is best for our country) until it's time to replace them, if it comes to that. American citizens whose goal is simply to disrupt our leadership because they are unhappy with that leadership do us all harm. My point is more eloquently made by Blake Ashby (a Republican from St Louis) in the attached article from the St Louis Post-Dispatch:

"It bothers me that the Tea Partiers spend so much time questioning the president's patriotism and love of country. There was a time when Americans, after an election, rallied around their president, hoping that, regardless of party, he would do a good job for the country. That is what used to be called patriotism.

Now the Tea Partiers actively are hoping for President Obama's failure and doing everything within their power to ensure he does fail, even if it means four years of failure for the Unites States. They have convinced themselves that this somehow is patriotic.

The Tea Partiers justify their attacks on the president by claiming that he does not believe in freedom. But they seem to have no understanding of the role of government in creating freedom. One Tea Partier claimed in an editorial that, "When the government grows, individual liberty withers." Nothing could be farther from the truth or more removed from our actual history.

The most basic premise of civilization is that we all give up some of our freedom in nature in exchange for greater freedom to live our lives. Absolute freedom generally was believed to lead to a life that was nasty, brutish and short.

Our Founding Fathers moved from a weak Articles of Confederation to a much stronger central government with the Constitution. Clearly, they did not believe that every extension of government power comes at the expense of individual freedom.

This isn't an abstract argument. Three hundred million Americans have given up the freedom to use half of the roads in this country at any given time by agreeing to drive on the right-hand side of the road. We generally find the trade-off acceptable because doing so gives us more freedom.

The Tea Partiers claim that almost every act of the Obama administration is a step toward socialism, with the recently passed health care reform bill as a primary example. Again, there is little connection between their claims and reality.

Before the health care bill passed, the government paid for 45 percent of health care in the United States and had yards of regulations on how the other 55 percent was spent. When the reform bill is implemented, government might pay an estimated 50 percent of health care and will have another couple of feet of regulations for the rest. Is that really a radical transformation of our system?

The Tea Partiers are furious about the individual mandate to buy insurance. But government already mandates that hospital emergency rooms have to save people who can't afford to pay the cost of being treated. Is it really that much of a stretch for the government to mandate that people must have insurance so the hospital gets paid? Does this justify calling the president a socialist and trying to undermine him?

Former President George W. Bush, by adding the Medicare prescription drug benefit, expanded the government's responsibility for and control of health care far more than President Obama has. To my knowledge, none of the Tea Partiers called President Bush a socialist. Nor did they call him a socialist when he was radically expanding government subsidies for agriculture or creating the Troubled Asset Relief Program legislation or any number of other actions that increased the power of government.

The health care reform bill is not good legislation, and I am not suggesting it is. But Tea Partiers were intent on ensuring that only the worst bill could pass, and they succeeded.

The Tea Partiers are intent on undermining every act and effort of the Obama administration, arguing that it is their patriotic duty to do so.

It didn't used to be this way. It used to be that when a president was elected you supported him and hoped he did a good job for our country. You respected the right of the majority to choose the president and afforded that president the opportunity to lead.

I don't doubt that the Tea Partiers love our country. But I wish they would take a step back from their anger and realize it is not just the president of the United States they are undermining. It is the institution of democracy."

Blake Ashby is a University City entrepreneur and a longtime Republican.

Posted in Opinion, Columns on Thursday, August 12, 2010 12:00 am Updated: 5:52 pm. | Tags: Commentary, Tea Party

Friday, August 27, 2010

And The World Keeps Turning

My loss is the pet community's gain, at least at some point in the future. We just sent one of our brightest young "stars" (ok, she was a vet tech, not a movie star) off to Vet School. I met Casie several years ago when she was a college student with a desire to someday be a DVM. She worked as a volunteer at our practice in order to get some experience and improve her chances of being accepted some day into the U of I veterinary program. After an initial failed attempt to get in last year (hey, there's a lot of competition for those spots), she came back to work for us as a tech. She was outstanding! Fastest learner I've ever met. Clients loved her, staff loved her, doctors loved her. So it was definitely with mixed emotions that we received the news that she'd been accepted to vet school. We're ecstatic for her, but definitely sorry for our loss. She will be a heckuva DVM in four years.

It's not like we haven't been through this before though. Casie's just the latest we've sent on to the University. Lindsay is now in her fourth year of vet school and will be an incredible veterinarian as well. She's actually going to come back to our clinic to do a two-week rotation in December. She's supposed to be learning from us, but I'm excited about what new techniques and information she'll have to share. A few years before Lindsay was Erin, who spent a lot of her pre-vet and intra-vet(?) time at Horseshoe Lake Animal Hospital. She graduated number-one in her vet school class. We all puffed out our chests a little bit over that.

There are now a couple other young guns at our clinic who aspire to become veterinarians, and I hope they make it too. We have promoted a bright young lady (Amy) to take Casie's spot, and have hired a new tech named Theresa who has a resume full of accolades and accomplishments. The world keeps turning, and it's exciting to meet new people who are smart and energetic. It's also bittersweet to watch some of "our own" move on to fulfill their potential. Good luck to all; who knows, maybe someday one or more of you will be OUR doctors!

Wednesday, August 11, 2010

Human Salmonella From Pet Foods

A research paper has been published which links 79 cases of Salmonella infection in people to pet foods. Scary stuff. I won't get into the boring details of the report (the abstract can be found at http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-3273v1), but here are some tips on how this could happen, and how to avoid possible infection at your house.

Because pet foods contain animal-origin products, there is a risk of contamination with Salmonella or some other bacterial organism. In most cases, pet foods and treats are cooked to temperatures which kill these organisms. However, if a contaminated additive (flavoring, etc...) is added after cooking, the food will be contaminated. Also, the food could come in contact with some other contaminated material after cooking. There are many safeguards in place to prevent contamination, but as we have seen, mistakes and accidents do sometimes occur.

Here are some steps you should take to reduce the risk of a Salmonella infection from pet food:
1.Wash your hands after handling pet food or pet treats (including rawhide chews).
2.Do not allow small children, immunocompromised persons (HIV-pos, on dialysis, on chemotherapy, etc...), or very old/infirmed persons handle pet food or treats.
3.Keep pet food and treats away from human food.
4.Do not use the same places or utensils for preparing pet food and human food.
5.Do not let pets onto surfaces where food is prepared.
6.Do not feed your pets in the kitchen or dining areas of your home.
7.Do not feed your pets raw meat diets.

Bon apetit!

Friday, July 30, 2010

Brutus and Benson -My Friends

The past week has been rough for me. I found out that two good buddies of mine have malignant cancer. To make matters worse, the cancers have metastasized in both cases, meaning surgery is not an option. Yes, my friends Brutus the Rottweiler and Benson the Golden Retriever probably have only a few weeks to live if they receive no treatment. Happily, their pet "parents" have elected to have them undergo chemotherapy for their cancers.

"What?! Chemotherapy? For a dog? You have got to be kidding! I would never put my dog through that. Who wants their beloved pet to have all his hair fall out, vomit all the time, or waste away from chemo? Besides, the expense must be ridiculous. I mean I love my dog as much as the next person, but...chemo?" This is a typical response a person gets when their friends find out they've chosen chemotherapy to prolong the life of their pet.

What's important to understand is that chemotherapy in pets is pretty different from chemotherapy in people. The primary difference is that in people, the goal is usually to affect a cure. In pets, the goal is to improve and prolong the life of an animal with cancer. We use the same drugs as in people, but at lower doses. Side-effects are still possible, and potentially very serious, but whereas side-effects are expected and accepted in human patients, our goal is quality of life throughout the treatment process for our canine and feline patients.

Cost certainly can be a factor. Benson's chemo (which will be administered by a veterinary oncologist) is something like $500-$600 per treatment for four or five treatments. Brutus' chemo will be given by me (he has a more common form of cancer), and will average $100-$150 per week for twelve weeks. There are no guarantees of success for either dog, but we are hopeful to give them each another happy year with their families.

I'm certainly not saying that everyone who has a pet with cancer has a moral obligation to put them through chemo, but many people dismiss the notion immediately, before they even understand what they're rejecting. It is true that some pets are just too sick to get chemo, and in those cases I don't even recommend it. Almost all the patients I've given chemo to have benefited, for some length of time, from the improved quality and quantity of life chemo has given them.

So keep your fingers crossed for Brutus, Benson, their families, and me. I'd sure like to see their smiling faces and wagging tails for at least another year.

Friday, July 23, 2010

"Senility" in Dogs and Cats-There is Hope!

A friend emailed me a story from the Huffington Post (Google it!) in which a human neurologist writes about dementia in her two dogs and how it resembles Alzheimer's disease in people. The dogs suffered from a condition called Cognitive Dysfunction Syndrome (CDS), and it is much more common than you think. Because there is no readily-available test for CDS, and many people attribute the symptoms simply to "old age", I feel CDS is dramatically under-diagnosed, and therefore under-treated.

CDS almost always occurs in older pets and is a result of pathological changes in the brains of those affected. The symptoms have a slow, insidious onset, and may be somewhat benign at first. In dogs, the symtoms of CDS which you may overlook include: decreased attentiveness, less enthusiasm when greeting you, increased sleep time, changes in appetite, and staring into space. Just sounds like a dog who is getting older, doesn't it? Unfortunately, the symptoms usually become more serious over time: getting "lost" in the back yard or "stuck" in corners, having accidents in the house, becoming restless at night, not recognizing familiar people, and/or not responding to verbal commands or their own name. Symptoms in cats are similar, but even more difficult to recognize because, well, they're cats, and they tend to be less interested in verbal commands and the affairs of people in general! (By the way, I am a "cat person", with three of my own at home.)

If pet-parents aren't aware of this disease, they may assume their pet is just getting old and won't report the symptoms to their vet. This is a shame, because we can help them! The therapy consists of a very effective (in most cases) medication called Anipryl (Pfizer), and increased attention and interaction with the pet. Also, there is a prescription dog food called b/d Diet (Hills) which has been shown to improve "learning" in senior dogs. We have recently been trying a holistic medication called Senilife (Ceva).

Most of the "parents" of my CDS patients have been incredibly grateful once the therapy starts working. They feel like they're getting their pet back. The disease is not curable, but it is also not fatal. So pay attention to the signs of "old age" in your senior pets. It may be something more.

Wednesday, July 14, 2010

Parasites in Cat Hearts

When I was in vet school, I was taught that cats don't get heartworms. Well, that was good, because there was one less thing to worry about in my feline patients. Unfortunately, they taught us wrong. Cats DO get heartworms, and probably more often than we realize.

The problem is, heartworms behave very differently in cats than in dogs. In the cat, heartworms rarely become adults. It is a tiny larval form of the worm that usually causes all the trouble. And it does cause trouble! These larvae reside in the cats' airways where they may cause significant damage, even though the cats may show no symptoms at all. After a few months, these immature worms die and cause a much greater inflammatory response in the lungs resulting in coughing, difficult breathing, and sometimes death. Cats with these symptoms may be misdiagnosed as having asthma.

You see, there really is no good diagnostic test for heartworms in cats. They can even be missed at autopsy. I wonder how many cats over the years I thought had asthma that really had heartworms. To make matters worse, there's no good way to safely cure a cat that has heartworms. We just treat the symptoms and hope for the best.

The solution is to prevent cats from getting heartworms to begin with. Since heartworms are spread by the bite of a mosquito, all cats (EVEN INDOOR CATS!) are susceptible. I recommend that all my feline patients take monthly heartworm preventative. My favorite is Revolution. It's a topical spot-on product applied once a month which also does a great job at killing fleas and intestinal worms. It is a prescription product, so you can't get it at Rural King, the pet store, etc... My opinion is that all cats should be on Revolution year-round.

Friday, July 2, 2010

Routine Labwork in Healthy Pets - Waste of Money?

I had a couple of interesting cases last week which inspired this blog. The first was an eight year old cat who came in for her annual vaccine visit and wellness exam. She was a new patient at our hospital. Her owner said she was doing fine, but maybe had lost a little weight, which she attributed to the cat getting older. We advised the owner that we recommend routine labwork on annual wellness visits just like MDs do for people. She consented, and low and behold, the cat had a serious thyroid imbalance (hyperthyroidism). This condition is usually fatal if untreated, but the prognosis is good with treatment. The cat was lucky we caught it early!

The second case was a little less dramatic. It involved a healthy little dog who also came in for his annual wellness visit and vaccines. On his labwork we found that he was infected with a protozoan parasite called Giardia, which is potentially contagious to his owner. Like the cat's hyperthyroidism, this condition can cause serious health problems if allowed to continue untreated, not to mention the risk to the owner's health.

It is a very rare week when I don't have at least three or four patients who come in for their "shots", but have some undectected condition which will threaten their health. These conditions are usually VERY easy to treat when detected early, and VERY difficult (and in a few cases impossible) to treat when the pet is showing advanced symptoms.

I'm the "old fogey" at our practice, and I was resistant to the idea of routine labwork for healthy patients at vaccine visits. One of my associates convinced me about seven years ago to give it a try, and I am now leading the parade for wellness labwork. I do it for myself (through my MD), I do it for my pets, and I recommend it for yours.

Monday, June 14, 2010

Internet Veterinary Pharmacies

"The same medication I get from my vet...for half the price!" The internet pharmacies LOVE to advertise this message on TV. It used to bother me, but now, not so much. Thanks to these pharmacies, the veterinary business model is changing, maybe even for the better. Let me explain...

In the not-so-distant past, veterinarians derived most of their profit from two sources: vaccines (marked-up 500-1000%) and pharmacy items (marked-up 100-1000%). Makes us look like scoundrels, doesn't it? The other side of that equation was that we lost money on almost everything else! We used to charge $35 for an X-Ray taken on a $20,000 machine, or repair a fracture or do a bowel resection for $300. We lost money on these things because: 1)We were afraid to charge what we needed to to make them profitable 2)We were subsidized by our vaccine/pharmacy income 3)That's the way it was always done.

The emergence of the internet pharmacies is changing everything. Our vaccine and pharmacy mark-up is now lower, so we can compete with the internet on price. They do have some competitive advantages here. They buy in bulk, and often pay much less than we do for the same products. They also lack the overhead expenses of a full-service veterinary hospital. We still have to pay for that X-Ray machine, continuing education for doctors and staff, surgical instruments, emergency drugs and equipment, ECG, blood pressure, and other diagnostic equipment.

As a rule, we now charge more for our medical and surgical services (although I submit that an $800 fracture repair is a bargain when you consider the cost at a human hospital), and less for vaccines and medicine. It is actually a more logical business model, but it's a little scary for clients who don't have an extra stash saved up for emergencies. (I'm hoping that more of you will purchase Pet Health Insurance, but that's for another blog!)

There are some other things to consider. Numerous state pharmacy boards have found internet pharmacies guilty of selling veterinary drugs illegally. The EPA has fined a major internet pharmacy $100,000 for selling Australian products (that look like US products) to US pet-owners. Most heartworm products are guaranteed by the manufacturer only if purchased from a veterinarian. Unlike products purchased from your vet, drugs sold through over-the-counter channels are not monitored or regulated by any federal or state agencies like the Board of Veterinary Examiners. These medications may have been stored in an unregulated warehouse for an extended period of time.

Lastly, these pharmacies don't care squat about your pets. If there's a problem, you are on your own. Veterinarians stand firmly behind what we sell, and many of us are available for your pets 24/7. Internet veterinary pharmacies make HUGE profits, and that's all they're about. Hopefully most of us in private practice are motivated by something more meaningful.

Wednesday, June 9, 2010


One of my least favorite topics to discuss with pet owners is their pets' teeth. When the teeth need to be cleaned (actually to call it "cleaning" is an oversimplification of a very comprehensive and complicated procedure), there is often resistance on the part of the pet owner. The two most common reasons for resistance are, understandably, cost and anesthetic risks. Anesthetic risks can be mitigated with preanesthetic blood tests and ECG, anesthetic protocols tailored to the specific patient, IV fluids given during the procedure, comprehensive and dedicated patient monitoring (a dedicated anesthetist, ECG, blood pressure, oxygen levels, CO2 output, temperature, etc...), and careful post-anesthetic monitoring.

Sounds like a lot, doesn't it? It is a lot, which is why pet dentistry can be pretty expensive. I've talked to a number of my colleagues, and my informal survey reveals pet dental procedures to run between $200 and $1000, depending on X-rays, extractions, etc... The good news is that those who get their pets' teeth cleaned before things get too far along, usually see dental charges on the low end of the scale!

The other source of resistance is that pet owners sometimes don't percieve the necessity of dental health. It is the veterinarian's job to educate these folks. The truth is, we believe that chronic dental infections lead to deterioration and damage to numerous vital organs such as the kidneys, lungs, and heart. A recent study published in the AVMA Journal showed a six-fold increased risk of heart valve disease in dogs with periodontal disease. Chronic kidney failure and pulmonary disease have also been linked to bad teeth.

So...my best advice is that when your vet first tells you it's time to clean your pet's teeth, don't wait a few years to do it. You will pay for the delay from your wallet, and your pet may pay with a few years of his life.

Friday, June 4, 2010

The Scheduling Conundrum

I'm a bit frustrated today by a problem that I've never been able to solve completely, even in 25 years of trying. We are (fortunately) a very busy practice, and it is not unusual for all the doctors on duty to be completely booked up on appointments in any given day. In spite of this, we take pride in the fact that if a pet owner feels the need to get their pet in TODAY, we will accommodate them. We charge an additional $15 for these "squeeze-in" appointments to discourage people from taking advantage (if their pet isn't that sick) and because it seriously disrupts our scheduling and causes other clients to wait. We try to leave a little space in our schedules each day to accommodate some of these "squeeze-ins" (we call them Urgent Care Appointments), but they often cause us to run a bit late. OK, sometimes up to 45 minutes late.

Most people seem to appreciate that we will get them in on short notice, even when we don't have openings, and are willing to pay the additional fee. Likewise, those who are made to wait are usually gracious and state that they would be glad if we did the same for their pets in an emergency. However...I can't seem to please everyone on this issue. Yesterday, we had someone walk out after waiting 30 minutes to see the doctor. The doctor was running late because of two Urgent Care patients seen earlier which set her behind. Today, I had a lady (who I go to church with) who wanted to get her dog in to see me for his severely itchy skin. This lady was informed that all my appointments were filled for the next two days (and then some), but that we could get her squeezed in as an Urgent Care appointment and there would be the additional charge. She was quite upset by this, and informed the receptionist that she would just take the dog elsewhere.

Damned if you do, damned if you don't I guess.

Monday, May 31, 2010

Memorial Day- My Mom

Just a quick Memorial Day remembrance and reflection. My mom passed away in 1986 while I was still in Vet School. She didn't live to see me graduate, and I know that would have been a really proud day for her. After all she'd done for me, I would've liked to have given her that day. Almost 25 years later, the acute pain of losing her is long gone, but there is still a dull ache that flares up intermittantly. My dad came to visit this weekend, and I feel lucky to still have him. We all (especially my dad) thought Mom would outlive him, but I'm happy to say he seems as healthy as ever. I guess the moral for me is: Live for today as much as possible. Enjoy the many wonders and blessings of this world, while preparing for the future. For life can be short, so don't miss your opportunities to take what is there for us. But life can also be enduring, so make sure today's actions don't ruin your chance at tomorrow's opportunities.

Wednesday, May 26, 2010

A Terrible Way To Start My Day

I got a call at home early yesterday morning from clients of mine whose dog was in serious distress. In fact, they believed she was dying. I told them I would meet them at the clinic ASAP. By the time I got there, they were already there, and the dog had died on the way. She was a beautiful, young, Golden Retriever, and she lay lifeless in the back seat of the car. She was surrounded by the entire family, all of them with moist, bloodshot eyes. The father told me, "If God created the perfect dog, it would have been this one."

One of my associates had been seeing the dog for a couple of weeks (months?) for mysterious, neurologic symptoms. At first it was believed that her strange behavior was related to her epilepsy, which had been diagnosed a couple of years ago. It could also have been due to the phenobarbital that she was taking for the epilepsy. Her lab tests showed nothing of consequence, and in such a young dog we wanted to believe that it was something simple. But the mom knew better.

She brought the dog to see me (we are friends), and said, "Something is seriously wrong. I can't say what, but she is definitely not right." She mentioned that she seemed to breathe funny. We took a chest Xray and noticed an enlarged heart and some fluid in her chest. We then did a cardiac ultrasound and discovered that her heart sac (pericardium) was full of fluid and compressing the heart so severely that it couldn't beat properly. Unfortunately, that wasn't the worst of it. The source of the fluid was a tumor attached to the heart.

The radiologist placed a catheter through the chest into the pericardial sac and started draining the fluid. The dog actually sighed with relief as the fluid drained out. It was only a matter of minutes until we could see that she was feeling much much better. Unfortunately we knew that it would only be a matter of time until the tumor caused the fluid to return. They took her home, happy to have her back to normal, but with heavy hearts because of the short amount of time she would have left.

They told me yesterday that she was almost completely normal until her symptoms suddenly reoccured the night before. By morning, she was almost gone. By the time she got to my office she was gone. What a terrible way to start my day.

Monday, May 24, 2010

My First Blog

Well, there's always got to be a first time, so here it is for my blogging "career." I have read that unless one is some sort of celebrity, the first set of blogs are read by no one! With that in mind, I have nowhere to go but up!

The centerpiece of my professional (and personal) life right now is our brand new hospital. We are starting our fourth week here and the reviews have been very very encouraging! My wife was in charge of the project, and I must say, the beauty of this place is a tribute to her vision. The layout was designed by an award-winning veterinary archetect from Boulder, Colorado. Blueprints were done by a local firm (EWR), and major input was given by all our doctors and staff. So, it is not only beautiful, but functional. Photos are posted on our website, www.horseshoepets.com, and also on our Facebook page. We are having a fun open house event June 6 from 1:00 until 4:00 (wine!) We've invited anyone who's interested to check it out, and even bring their pets if they want.

My wife is now turning her attention to the "old" building which we're converting to an upscale boarding and grooming facility. It should really be something when it's done! More on that later.

OK, I know this has been a pretty boring start, but I wanted to share what's foremost in my mind at the moment. I promise to give more info about pet issues, my personal views, and other related or unrelated stuff as I pick up some followers. I have a lot to talk about, and I promise it will be interesting!