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Monday, October 5, 2015

When Is It Okay To Give Your Pet Aspirin?

I am writing on the topic of aspirin in pets today at the request of one of my senior vet techs. She was telling me that it sure would be nice if our clients understood how they are complicating (and often compromising) their pets' care when they give them aspirin. So here you go!

Aspirin can be a terrific drug for people (and sometimes, rarely, pets) when used properly. It reduces fever, inflammation, and pain. It also helps decrease blood clotting, which can be good or bad. Back in "the day" before safer anti-inflammatory drugs ("NSAIDs") were developed, it was not unusual for veterinarians to recommend aspirin for certain conditions.

Unfortunately, the safety profile for aspirin in pets (and especially cats) is not good. The difference between a therapeutic dose and a toxic dose is small. But it gets worse. Even at therapeutic doses, aspirin has the potential to cause serious harm to the lining of a pet's stomach, resulting in gastritis, ulceration, and even perforation leading to death.

These serious complications rarely occur after a single therapeutic dose of aspirin in an appropriate patient. However, the administration of one or more doses of aspirin by the pet-owner at home can seriously restrict the safety with which your veterinarian can prescribe safer and/or more appropriate medications. Giving your pet aspirin changes his body chemistry (temporarily), making certain subsequent medications more dangerous. This may tie our hands and delay treatment of your pet's condition.

Here's an example. A dog develops severe swelling of his face or jaw. The owner decides to give the poor guy aspirin. He looks up the dose on one of the hundreds of "be your own pet's veterinarian" websites (I'm going to blog about those in the future), and gives it to the dog. Even though he gave the proper dose, the swelling doesn't improve, so he gives a second dose 12 hours later, like the website says to do. This doesn't help either, and the dog seems to be getting worse, so he takes him to the vet. The vet diagnoses the dog as having an allergic reaction to an insect sting and wants to give a cortisone injection which should rapidly reduce the swelling and keep the reaction from escalating. Unfortunately, giving cortisone to a dog that has recently had aspirin can greatly increase the risk of gastric ulceration. The vet has to give an antihistamine instead of cortisone, knowing that it may not work nearly as well. The vet keeps the dog for observation, deciding that if the antihistamine doesn't work, she will just have to "risk it" and give the cortisone, along with multiple medications to try to protect the stomach.

There are still situations (extremely rare in veterinary medicine) where it is okay to give aspirin to a pet. But in my opinion, this should only be done after consulting a veterinarian. At our practice, and most others, there is a veterinarian available 24/7 for client emergency phone consults. Ask us before you give that aspirin!

By the way, Tylenol is never safe for cats, and usually not appropriate for dogs. Again, call us before you give it!

Monday, August 31, 2015

Things Your Veterinarian Would Like You To NOT Do!

1. Cleaning your pet's ears before bringing him in for an ear problem. We would really like to see what those ears look like (what kind of "goo" is in there) to help us determine the severity of, and help characterize the nature of, the problem. Cleaning them before the visit makes it harder for us to do this!

2. Not coming back for the recheck visit because your pet is all better now, and you don't need to pay us to tell you that. I understand the thinking here, but there's a couple reasons that recheck visits are important in pets who are doing well with their treatment. First of all, the pet may be doing much better, but there can be subtle things going on which indicate that there still is a problem. Detecting and addressing these things before they spiral is pretty cost-effective, and better for the pet. Secondly, I often use the recheck visit to determine, based on your pet's response to the initial treatment, a long-term plan to prevent recurrence of the problem. This is especially important in skin and ear diseases.

3. Not coming back for the recheck visit because your pet isn't better, and we obviously don't know what we're doing.  Again, I understand the rationale, but there is much to be learned from treatment failure. If you switch vets at this point, you will be starting all over from scratch. We are human, and we don't hit the target 100% of the time when treating your pets' illnesses. Lack of response to therapy is an important diagnostic clue which helps us redirect our thinking, hopefully in a direction which will lead to an improved outcome. I've been the "second opinion" doctor on many of these cases over the years, and usually the original doctor had done exactly what I would have done. But when it didn't work, the client decided to seek a second opinion. Please give your vet a couple opportunities to come up with an effective treatment plan!

4. Making an appointment, then not showing up. Believe it or not, when you make an appointment, your vet has reserved about 30 minutes of time, which could be used to help other patients! If you can't come in, please have the courtesy to call and tell us.

5. Sending someone in with your pet who has no authority to make decisions. An important part of coming up with  a treatment plan for a pet is the owner's willingness and ability to pay for it, and "how far you're willing to go" in treating the pet. We want to work with  you to find a plan that best addresses the pet's needs and also takes in to consideration the owner's desires. If the decision-maker isn't at the appointment, we end up guessing. You can imagine how well that works out.

6. Sending someone in with your pet who can't handle him. It's really fun when a really worked-up pet is brought in by someone who is afraid of them.

7. Bad-mouthing another vet to us. This is just awkward. Also, it makes us wonder if you will be bad-mouthing us after this visit.

8. Citing your medical or animal knowledge to challenge our diagnosis or treatment plan. Do you seriously think animals and their diseases are exactly the same as human diseases? Do you really think that just because you have bred and raised dogs that you know more about their illnesses than a trained doctor? Look, you are welcome to question my thinking, and I will be glad to explain it. I also know that you might think of something I didn't, which could actually benefit your pet. We are happy to consider your ideas. However, you really should defer to us when we disagree. Animal diseases are what we have spent years of our lives becoming expert at. We have more and better resources than you. Give us your questions and your input, but trust us to decide what will best help your pet get better.

9. Taking advantage of a personal relationship for free pet advice, if you take your pet somewhere else that is "cheaper." I am very willing to chat with friends and even distant acquaintances about a problem their pet may be having, as long as I am that pet's doctor. But if you have chosen to take your pet elsewhere for veterinary care, don't come up to me at a social event and start asking my advice.

10. Not controlling your pet in the waiting room. Your dog may be super-friendly, and doesn't know a stranger. That's great, but other dogs, cats, and their owners often get very anxious at best, aggressive at worst, when another dog runs up to them. PLEASE keep your dog on your lap or a short leash. You can invite people to come pet him, and of course our staff is always more than happy to lavish attention on him! We love our friendly dogs!

Friday, May 22, 2015

Veterinarians and Suicide

Several veterinary newsmagazines and journals have recently published articles on the high rate of suicide among members of my profession. According to statistics for 2014, male and female veterinarians have considered suicide at a rate of 14% and 19% respectively, compared to rates of 5% and 7% among the general US population. These numbers are also higher than those for people in other medical professions. Scary stuff from where I sit.

There are varying opinions on why veterinarians experience high rates of depression, suicide, and suicide "ideation." As I read through these opinions, I began to relate and better understand this tragic phenomenon. First of all, our job is quite stressful. I suppose everyone thinks their job is stressful! But, keep in mind that more and more people really consider their pets as family members (me too!) When their four-legged family members become seriously ill or injured, it's a really big deal. The rub is, there is no insurance company or government-subsidized system to help pay for expensive care. This places two burdens squarely on the shoulders of the veterinarian: 1.A specialist referral is often not an option, so the general practitioner is on her own for the diagnosis and treatment 2. There is pressure (and guilt) to keep costs low, but without jeopardizing the outcome. I'm not having a pity party here, but it really is unfair what is sometimes expected of us.

Then there is the euthanasia thing. I really feel that ending the life of a suffering animal is one of the kindest and most compassionate things we do. But often we are asked to euthanize a young healthy pet because of a behavior problem, or for an inconvenience the pet is causing the family. Don't get me wrong, sometimes euthanasia is the only safe and compassionate solution for a behavior problem. But it sure takes a toll on us to end the life of a young, bright-eyed dog or cat. Even in cases of old pets with incurable diseases it can be awful. Often, we have known these animals and their owners for 10 years or more. The grief in the room can be overwhelming. Sometimes, the grief goes home with us, and we see those pets in our dreams.

One article discussed personality traits which veterinarians often possess that might increase the risk of depression and suicide. Veterinarians tend to be extremely hard on themselves. We are not "buck-passers." In addition, we tend to be "...highly-driven perfectionists and high achievers." And to further add to the risk of suicide, one expert describes veterinarians as "...lone wolves. They like to go into a corner and lick their wounds. Companionship and community lead to positivity and happiness, but veterinarians are introverts and soloists."

On a personal note, I feel very fortunate to have earned the privilege of being a veterinarian. I honestly can't imagine having enjoyed myself as much in any other profession (which I could realistically have achieved, which rules out rock star and quarterback!) I can certainly relate and have experienced the risk factors mentioned above, but I have never considered taking my own life. For this I credit a sincere and meaningful relationship with God (and a church family which nourishes that); an amazing family support group which includes my late mother, my amazing wife Kathy, my three terrific kids, my older sisters, and my dad. And I also credit the fact that I have been able to work beside some really gifted and giving veterinarians, as well as having a relationship with our support staff over the years that has felt more like "my family" than "my employees."

It really is a rewarding career in many ways. I never would have thought  that becoming a veterinarian would increase one's risk for suicide, but after learning why it is, I get it. I have never had a colleague end their life, and I hope I never do. But I do worry about my friends in the profession - stay strong guys!

Monday, March 2, 2015

Is Beneful Harming Our Dogs?

I'm going to briefly touch base on a topic that we've been getting a lot of calls about. It seems that there is a class-action lawsuit being brought against Nestle-Purina because a gentleman feels that their "Beneful" dog food caused the illness or death of his three dogs. He claims that Propylene Glycol and mycotoxins in the food are the culprits. In spite of the claims, Propylene Glycol  is safe for dogs to consume at recommended levels according to veterinary nutritionist, Dr. Jennifer Larson. Mycotoxins certainly could be harmful, but I have seen no data to support the claim of mycotoxins in Beneful.

Before I go any further, I want to be clear that I have no financial investment in Purina or Beneful. I do carry Purina diets at my hospital, but they have not contacted me to defend them, and I get no special favors or perks from them other than getting my personal dog food at reduced cost (every pet food company offers that same deal to vets).

What concerns me is the general alarm among people because of this lawsuit. I certainly get that  the prospect of feeding our friends a dangerous food is horrifying. However, please keep in mind that Beneful is an extremely popular food, which means that hundreds of thousands of dogs are eating it. Many of these dogs are going to get sick and/or die from something. That doesn't necessarily mean the food is at fault.

At my hospital, we track pet food recalls and post them on our Facebook page to help warn our clients when a food might be dangerous. We subscribe to reliable, unbiased data to get this information. It is dangerous, in my opinion, to make decisions based on unfounded accusations, your neighbor's opinion, or social media.

With regard to the whole "big pet food companies are evil" notion, here is my opinion after spending over thirty years researching and practicing ways to keep pets (including my own) as healthy as possible (as posted on our Facebook page):
 There are a lot of opinions out there, and people are understandably concerned for the welfare of their pets. Please keep a few of things in mind: 1.Dogs (unlike cats) are omnivores, not carnivores. 2.Just because someone brings a lawsuit, that doesn't mean their claim is legitimate. 3.There has been a tremendously successful MARKETING campaign by certain "boutique" and "natural" pet food companies promoting grain-free dog foods. I hate to break the bad news, but these companies are looking to make a profit just like Purina, Iams, or any other company. That doesn't make them, or their products bad, it's just something to keep in mind. I have spoken with several nutrition specialists on this topic, and they all say that there is NO specific benefit to grain-free diets for most dogs. Again, grain-free is fine, but corn, wheat, etc as dog food ingredients are fine as well! Here is a direct quote from a respected veterinary nutritionist, who does not work for any pet food company as far as I know: "There are a lot of myths and misconceptions out there. Some people hate by-products (which can be a great ingredient, very nutrient rich) and some people hate grains (I still don't get why potato starch is so much better than corn starch), and some people dislike meals (a rendered product) and only want meat... The thing is, you cannot tell the quality of an ingredient by its name. There are very good meals out there but some of them are not so good (meaning that their digestibility is bad), and the same goes for meats, by products, vegetable products... 

My usual recommendation is to choose a diet from a reputable company, ideally that has undergone AAFCO feeding trials (all diets should have an AAFCO statement, and this will tell you if the diet has been through trials or it has been formulated to meet the requirements for that specific life stage), and feed it to achieve a good body condition. 
Many diets fit this bill, and it is usually possible to find a diet that is also acceptable to owners with different feeding philosophies." - Cecilia Villaverde, BVSc, PhD, DACVN, DECVCN

I don't know about you, but I'm going to believe the opinion of a respected professional who spends her life studying animal nutrition over a grieving dog-owner who wants someone to pay because he has lost a pet, or the social media rumor-spreaders. These decisions are too important to make based on anything less than the best available information.