Veterinary Acupuncture, Where East Meets West

Two very different trains of thought exist as explanations as to how acupuncture benefits the body. According to Chinese philosophy, the body contains two opposing forces: yin and yang. When these forces are in balance, the body and its organs are healthy. From this point of view, energy, called qi (pronounced “chi), flows like rivers along pathways, or meridians, throughout the body. This constant flow of energy keeps the yin and yang balanced. Disruption of optimal health results when the flow of energy gets blocked, like water getting stuck behind a dam. A disruption in the flow of energy can lead to disease.

From the western point of view, acupuncture likely works by stimulating the central nervous system – the brain, spinal cord, and the nerves of the body – to release chemicals called neurotransmitters and hormones. These chemicals reduce pain, boost the immune system and regulate various body functions to promote restoration of health.

From whichever point of view one chooses to view veterinary acupuncture, there is no question that it works. While people may have the ability to convince themselves that any course of treatment helps their given condition, a phenomenon know as “placebo effect,” dogs and cats do not experience this phenomenon. For dogs and cats, a treatment either will work, or it will not, typically leaving little grey area or room for interpretation.

In my practice, I use acupuncture regularly as augmentive therapy for, and relief from: degenerative joint disease, osteoarthritis, and intervertebral spinal disk disease. It is painless, and canine and feline patients actually progress into a state of relaxation they receive treatment. My results have been particularly impressive in cases of intervertebral spinal disk compression injuries, where since adding acupuncture as an ancillary treatment used in combination with other alternative modalities, I have enjoyed unprecedented success in helping patients to avoid expensive and invasive spinal disk surgery.

Musculoskeletal disease and spinal disk disease are just the tip of the iceberg for veterinary acupuncture, however. Acupuncture has shown vast improvement in a broad range of diseases, including seizure disorders, inflammatory bowel disease, skin allergies, autoimmune disease, and even behavioral disorders. It can therefore be helpful to decrease or even eliminate a patient’s dependence on medications for many of the aforementioned chronic disorders, medications that unlike acupuncture, have the potential to create unwanted side effects.

Dr. Roger Welton is the President of Maybeck Animal Hospital and CEO/Chief Editor of the veterinary information and blog online community, Web-DVM.

While We Must Be Open to Alternative Medicine, We Must Recognize When Veterinary Western Medicine is Necessary

Continuing my reporting on the cutting edge field of veterinary rehabilitation, as I discussed in my previous post, Veterinary Rehabilitation and Integrative Medicine, that integrative medicine is the best approach to providing optimal health care for our patients.  Being integrative mandates being open to proven alternative medicine techniques, such as the ones outlined in that article.  It is important to recognize, however, that  integrative medicine also mandates that we do not lose sight of the importance of western medicine, which still remains an integral component of saving lives and maintaining the health of our patients.  This post will highlight the areas where alternative medicine falls short and we must rely on the western veterinary medical paradigm to stabilize and treat our patients.  Don’t fret, my holistic minded fans, there is plenty of holistic/alternative awareness to come in future posts! 🙂

In cases of hemorrhage, or when fracture, major ligament or tendon ruptures occur, western modalities must be implored to reverse shock, control severe pain, maintain blood volume and circulation, and strengthen vital signs as a whole.  In cases of hemorrhage and shock, treatments such as intravenous fluids, steroids and other drugs, as well as blood transfusion may be necessary to stabilize the patient.

When fractures or ligament ruptures occur, they must be aligned sometimes by surgical means if necessary, and some kind of fixation applied to enable healing.  We have a saying in veterinary rehabilitation, “if it is unstable, send it to the table.”  No amount of alternative therapy will re-stabilize tears of major ligaments or mend displaced fractures, and that is something that even the most ardent followers of alternative/holistic medicine must accept.

In the case of severe, acute pain, letting an animal suffer without relief is not only cruel, but it is also bad medicine.  Pain causes stress, which in turn slows recovery and reduces overall patient stability.  As such, in cases of severe, acute pain, anti-inflammatory in combination with narcotic pain therapy is not only humane, but practicing optimal medicine.

Lastly, western medicine provides us advanced diagnostic capability that alternative medicine does not.  Imaging to visually identify lesions, blood work to determine organ function, blood gases and blood pressure to determine organ stability,  and systemic oxygenation, and many other diagnostic techniques are necessary components to confirming a diagnosis.

Once we have a stable, pain controlled, and fully diagnosed patient, then we can move on to alternative treatment modalities to hasten recovery rates, bolster healing, help us to wean the patient off of pain medication, and maintain overall health to reduce the potential for chronic conditions that may result from injury.

In my next post, I will be detailing veterinary acupuncture, where East meets West.  

Dr. Roger Welton is the President of Maybeck Animal Hospital and CEO/Chief Editor of the veterinary information and blog online community, Web-DVM.

Veterinary Rehabilitation and Integrative Medicine

 

This past Friday, my staff and I had a little office happy hour after work. We were all still in our scrubs hanging out at a popular local Irish pub, when suddenly we hear, “Hey, that guy saved my dog’s life.” The man was pointing at me as I instantly recognized as the owner of a Shih Tzu who brought his dog to me in desperation to help his dog.

The little dog had suffered from severe spinal disk disease, to the point that all of his lower back muscles, gluteal muscles and quads were severely atrophied (shrunken), he could barely take two steps without both of his rear legs falling underneath him, and he was in severe pain. The owner’s previous veterinarian had exhausted all medical options, with the dog having come to me already on a steroid and muscle relaxer for months with the dog only getting worse each week. His veterinarian recommended referral to a spet for spinal disk surgery, but with the MRI and surgery combined, this father of three children simply could not justify spending $7000 to fix his dog.

He found my clinic because of research he had done on veterinary therapy laser and how it may benefit his dog’s condition. I was one of the only veterinarians at the time that had such a laser. The three week course of treatment I recommended consisted of six, eighteen minute laser sessions with each treatment accompanied by an injection of glycosaminoglycan, a molecule that is integral in the repair of connective tissues (for more on glycosaminoglycan, see my previous post on joint chews). For the entire three week course of treatment, the gentleman’s investment was a mere fraction of what the cost of surgery would have been.

By treatment three, the dog had shown remarkable improvement, using his legs almost normally and having regained his old peppy spirit. By the final treatment, he had restored nearly all of his muscle mass, was showing no clinical signs of spinal disk disease, and was enjoying a normal quality of life. And this was before I became qualified in veterinary acupuncture, an additional rehabilitation treatment modality I have added to cases like these to maximize success (more on acupuncture to come in my next post).

After seeing this man who proceeded to tell me that his dog as had no problems since last year after he finished his rehabilitation, it occurred to me that I need to spread awareness about this cutting edge field of veterinary rehabilitation that I have to come rely on as an integral component of the medicine I practice in my hospital.

Veterinary rehabilitation refers to the use of physical rehabilitation techniques to improve the physical condition of an animal patient. These techniques encompass a variety of modalities that include nutrition, low level therapy laser, acupuncture, therapeutic massage, hydrotherapy, sound, active/passive resistance, and weight management. Many veterinary rehabilitation techniques are alternative modalities that carry little to no side effects, unlike more traditional western treatment modalities that may offer more rapid results, but carry higher incidence of side effects.

The most effective approach to veterinary rehabilitation is to use integrative medicine, where western modalities are implored when necessary to rapidly reduce severe pain through pain medication and/or surgically stabilize fractures or tears of major stabilizing tendons and ligaments; while using alternative techniques to minimize dependence on pain medication, speed recovery rates, and in some cases help the patient to avoid surgery.

In the end, veterinary health practitioners fail to work in the best interests of the patient when they draw lines in the sand by refusing to adopt Eastern versus Western techniques, or traditional versus alternative techniques, because of misguided convictions that their paradigm of medicine is the only method to benefit the patient.

Integrative medicine that combines all available proven treatment modalities is what is best for the patient and is the wave of the future for veterinary medicine. In coming weeks, I will be highlight several rehabilitation techniques that my clinic utilizes in every day practice for the benefit of our canine and feline patients.

Dr. Roger Welton is the President of Maybeck Animal Hospital and CEO/Chief Editor of the veterinary information and blog online community, Web-DVM.

The Internet Has Created a Generation of Amateur Veterinarians

I began this work week – literally my first case – with a cat owner and her kitty in a yearly visit telling me that she learned on the internet that dry cat food is the kiss of death for cats and is responsible for most of what goes wrong with them, so she took her cat off of the high quality kibble he had been on in exchange for canned food.  She made it a point to tell me that I really should take a look on the internet to learn what dry cat food does to cats, as I would most certainly stop recommending it.  Interestingly, she had to resort to a low grade, grocery store sold food, because her cat actually prefers to eat dry cat food, and the low grade brand was the only canned formulation he would eat.

The cat is 5 years old, and the last time I saw him, he was in very good health.  This time around, has had grade 3 out of 4 dental disease with gingivitis.  I explained to the owner that most veterinarians favor a kibble type diet for its dental health benefits, and that with modern kibble technology that is applied to higher quality kibble type diets, we really do not have to sacrifice species appropriate nutrient balance for the sake of the kibble texture.  I also pointed out that her cat is a case in point, as he gone 4 years on kibble in good health without a hint of dental disease, and suddenly one year of canned diet and he has advanced periodontal disease and is badly in need of a dental cleaning and possibly tooth extractions.  Regardless of the fact that I am an actual licensed and practicing veterinarian and with the proof with right in front of her, she still did not want to believe me and told me that before she decided on anything, she was going to go back to her internet “sources” to double check.

The next day, a lady brought in her Labrador retriever who had been urinating in her sleep for the past month.  Despite having to constantly clean the dog and her bed (and despite the fact that the dog had a bad case of urine scald on its inner thighs an groin area) for an entire month, she had held off on bringing her in all this time, because the internet told her that her dog had a urinary tract infection and all she had to do was feed her dog cranberry juice.

As it turns out, the dog had no infection at all, not that cranberry juice would have helped for an actual infection anyway, but instead had a hormone deficiency that led to her unconscious urinary control becoming compromised.  It is easy to treat, the dog is going to be fine, but she could have had relief weeks ago if her owner had not decided to self-treat using the internet as a guide.

However, the mother of all internet base self-treatment near disasters this week came in yesterday, when an owner brought her little dog in for itchy skin.  I determined that the dog had a case of seasonal allergic skin disease that led to inflammation and infection of his hair follicles.  Before I gave him the injections I intended to treat with, I asked my standard question about whether the dog was currently being administered any medications…even though there was no record of it in our patient history, in this day and age, I must still ask!  And the patient should thank his lucky stars I did.

She proceeded to tell me that she gave the dog a daily dose of aspirin for treatment of TIA, which stands for Transient Ischemic Episodes, which are mini-strokes.  Knowing that strokes are really not something we see in dogs, I asked her what had brought her to this conclusion.  She told me that he began having episodes last year where his head would tilt to one side and he would occasionally fall.

I told her that those signs are not really consistent with any kind of stroke, but instead indicative of vestibular disease that often results from unchecked ear infections that reach the inner ear and the spatial orientation center housed there.  With this patient having a history of past ear infections, that fit far more readily than any sort of stroke, which we know happen at an exceptionally rare rate in canines.

The greater problem here was that aspirin, an anti-inflammatory that has a 15 times greater risk of causing gastrointestinal ulcers in dogs than in people, and is therefore a big no-no for use in dogs, had been being given every day for the past year.   Not only coudl this have spelled disaster for this dog at any point he was being given aspirin all this time, I could not give him one fo the injections I wanted to give him, as it would have a high likelihood of reacting badly with the aspirin on board.  Good thing I asked, right?

So here she was, treating the dog for a condition he does not have, with a medication that could make him sick or even kill him, for the past year, all based on information that she got from the internet.  And now, I had to wait one full week to begin treatment as we pulled the dog off aspirin and waited for it to wash out of his system.  I thought my head was going to spin!

The owner defended her decision stating that she was certain that she was going to lose her dog if she didn’t do something.  But the most perplexing thing about all this was why she had been willing to bring her dog in for a skin condition yesterday, and for eaar infections a few times in the past 2 years, but back when she thought the dog might die, she felt that rather than bring him in to a full service veterinary hospital for assistance, the more effective way to go was to consult the internet and treat it herself.  I never quite got to the bottom of that discrepancy.

What is going on?  Why has the internet suddenly become the go to place to figure out what ails one’s pet and to determine the best manner to treat?  Why are people so willing to put so much faith in the internet over an experienced veterinarian, even when the proof is staring them right in the face?

I have just cited three different cases where people were completely off base about their pet’s health care, based on information that they had gotten off the internet, but that is merely an infinitesimally small sampling of the bigger picture.  Statistically, a recent study has shown that 38% of pet owners visit the internet when their pet is sick before calling their vet, and this number is expected to increase in coming years.

So if you are an internet addict who thinks that the internet has all of the answers you need for life’s problems, please think again.  There is no replacement for a hands-on, patient-doctor-client relationship.  Your veterinarian who has gone through 8 years of rigorous schooling, passed all manners of tests and certifications, and has likely practiced medicine for many years (in my case, almost 12) doing required continuing education hours along the way, remains your single best source of information regarding the health of your pet.

Internet “sources” often lack oversight or accountability, and thus provide information that is more opinion and innuendo than fact, in many cases, outright fabrications.  As a result, I I have to debunk internet generated nonsense day in and day out:

The treatment for heartworm is more likely to kill your dog than the disease itself. 

You should let your female dog have one or two heats before having her spayed to properly develop. 

Feeding garlic prevents fleas.

Dogs and cats don’t need vaccines.

Corn is a toxic food ingredient and responsible for most disease in dogs and cats.

The Swiffer mop causes liver failure in dogs.

A warm nose means a dog is sick.

Pregnant women cannot own cats.

Feeding olive oil supports healthy skin and hair coat.

Please Lord, make it go away!

Dr. Roger Welton is the President of Maybeck Animal Hospital and CEO/Chief Editor of the veterinary information and blog online community, Web-DVM.

Everything You Need to Know About Joint Chews in Dogs and Cats

There are more joint chew supplements on the market for dogs and cats then we can count, but the big question remains, do they actually work?  The short answer is, maybe, but the real answer like most things I write about, is a bit more complex.  Okay, more than a bit. 🙂

First, let’s discuss the major ingredients that go into high quality joint chews for pets, glucosamine, chondroitin, MSM, and omega-3-fatty acids

Glucosamine

All connective tissues like ligaments, tendons, and cartilage that bind the soft tissues of the body together, as well bind together the muscles and bones of the musculoskeletal system, are made of a basic building block called glycosaminoglycan.  In order for the body to make glycosaminoglycan, the body needs its major precursor, glucosamine.

Therefore, at least theoretically, and extra daily dose of glucosamine either through foods that are high in it, such as shellfish, or through supplementation with joint chews that have it on of its ingredients, should lead to a greater ability to repair damaged connective tissue structures.  In cases of arthritis, degenerative joint disease, and spinal disk disease, the major driving force behind these diseases is damaged connective tissues within these structures.  As such, glucosamine – again, at least in theory – should hold some benefit for patients suffering from these conditions.

Chondroitin

When glucosamine is linked to a protein, it makes molecules known as proteoglycans, such as chondroitin.  With the addition of sulfur, chondroitin can be converted into chondroitin sulfate, a major component of cartilage, the tissue that pads the bones of the articulating surfaces of the joints of the body.

Physiologically, glucosamine helps the body to make more chondroitin, which when sulfated, forms the major component of cartilage.  Theoretically, more glucosamine should lead to more chondroitin sulfate, which should lead to healthier cartilage in the body.  Also theoretically, additional chondroitin in the body should also increase the structural integrity of the body’s cartilaginous surfaces.

MSM

Sulfur is a critical component to the connective tissue matrix, as it is necessary to synthesize active forms of chondroitin and glucosamine, chondroitin sulfate and glucosamine sulfate, respectively, that directly facilitate connective tissue repair.  Important dietary sources of sulfur include cabbage, onions, broccoli, garlic, radishes, and mustard.  Good luck trying to get dogs and cats to eat these food items!

Another alternative is to supplement the diet with methylsulfonylmethane, or MSM, a potent source of dietary sulfur.  Theoretically, the addition of sulfur to the aforementioned molecules increases the amount of active connective tissue repair occurring in the body.

Omega-3-fatty acids

Omega-3-fatty acids are powerful, anti-inflammatory molecules.  Omega-3-fatty acids are found in fish oils, flax seed, avocado, and different varieties of legumes.

Inflammation in the body occurs through different biochemical pathways that lead to inflammatory products.  Omega-3-fatty acids reduce inflammation in body tissues by diverting inflammatory biochemical pathways into alternative pathways that lead to inert end products that do not cause inflammation.

Omega-3-fatty acids also form a key component of the cell membranes of all of the cells that form the tissues of the body.  Therefore, diets rich in foods that contain omega-3-fatty acids or supplementation with a high quality omega-3-fatty acid isolate product, not only reduce tissue inflammation, but promote tissue repair and healthy tissue in general.

Notice I did not state “theoretically” for any of the benefits of omega-3-fatty acids.  The reason for this is that there is no jury out on the benefits of omega-3- fatty acids.  They have been proven to provide relief from arthritis, other diseases of the musculoskeletal system, and many other diseases of the body time and again in industry approved research studies.

So Why Maybe?

So if all of this sounds so great, why the “maybe” on the efficacy of joint chews in dogs and cats?  Well for one, with the exception of omega-3-fatty acids, the data on glucosamine, chondroitin, and MSM supplementation has been conflicting at best.  To date, there has not been one unbiased, industry approved study that has conclusively proven the benefit of supplementing with these compounds.

The next problem we have with these compounds is that there are many other factors that affect their result.  For example, glucosamine is made by the liver via a pathway called the glycolytic pathway, which requires the amino acid glutamine to function properly.  Therefore, a diet deficient in this amino acid will lessen the efficacy of dietary supplementation with glucosamine.

Likewise, proper levels of magnesium, vitamin B12, and vitamin B6 are essential for sulfation, the key step in the creation of glucosamine sulfate and chondroitin sulfate.  As such, a diet deficient in these nutrients would significantly lessen the efficacy of joint chews.

High Quality

You may have noted that I kept mentioning the term high quality throughout this post.  The reason I harp on this is that too many people are not aware that joint chews (and other health supplements) are not FDA regulated, thereby giving them no official watchdog that makes them prove their integrity, label claims, or even ingredients.  A few years ago, DVM News magazine published the results of a study that found that 3 out of 4 randomly chosen over the counter joint chews did not have the ingredients claimed on the labels.

In other cases, the ingredients may be there, but not in a bioavailable form that is absorbable for canines and felines, so much of what you give them exits the GI unabsorbed, and in some cases even causes GI upset.

In the case of omega-3-fatty acids, if they are not processed as pharmaceutical grade, they commonly go rancid and convert to omega-6 and omega-9 fatty acids.  Not only do these by-products not have the benefits of omega-3-fatty acids, but they rather than act as anti-inflammatory, they are actually pro-inflammatory.

To make up for this major lack of oversight in the health supplement industry, it is important to stick with pharmaceutical grade joint health supplements from companies that have other lines of pharmaceuticals on the market that make them stake their reputation on every product line they offer, including the ones that are not FDA regulated.  You veterinarian is the best source of information on which products carry the best efficacy and reputation.

Conclusion

While science still has yet to confirm the benefits of glucosamine, chondroitin, and MSM, under the right set of circumstances, I have seen them proven to work time and again.  By the right set of circumstances, I am referring to:

1.)    Good nutrition to support the supplement.

2.)    Selecting a pharmaceutical/veterinary grade product with proven efficacy.

3.)    Selecting a supplement that has all four of the compounds discussed in this article, not just 1, 2, or even 3 of them – all of them.

4.)    Selecting products that are rich in supporting nutrients, such as glutamine, magnesium, vitamin B2, and B12, in addition to having all the necessary joint health compounds.

5.)    Getting serious about management of mitigating factors, such as addressing underlying health concerns and obesity.

Dr. Roger Welton is the President of Maybeck Animal Hospital and CEO/Chief Editor of the veterinary information and blog online community, Web-DVM.

Back Leg Limping in Dogs – Think Knee First

I generally examine at least one limping dog per day, two thirds of which are limping on one of their back legs…what we term rear limb lameness.  I find it curious that dog owners seem in most cases, all but convinced that the source of the problem is coming from the hip.  I am not sure why this is, perhaps all the press that genetically deformed hips (a condition known as hip dysplasia) has gotten in the past several years, perhaps it is the result of internet speculation, but whatever the reason, the pet owner more often than not finds out by the end of the examination that the hip is not the primary source of the lameness.

It is not to say that a dog with rear limb lameness necessarily has good hips.  In fact, many dogs have very poor conformation in their hips, a testament to our ongoing insistence in continuing to purchase puppies from pet stores and back yard breeders that do not know a thing, nor have a care, about responsible, ethical breeding.  But while poor hips are not conducive to an optimal quality of life – to be sure bad hips will lead to degenerative joint disease and chronic pain eventually –  the most common source of canine rear limb lameness that is severe and acute enough for owners to bring the dog to the vet, is the knees.

In toy breed and small breed dogs, the most common source of pain emanating from the knees is medially luxating patella, a condition where the knee cap continually pops out of place in the direction toward the center, or medial, region of the body.  This occurs due to a genetically inherited angular deformity of the rear limb that leads to a chronic pull of the knee cap in the medial direction.  Like deformed hips, it too is the result of unethical/irresponsible breeding practices (Those pet stores and back yard breeders are just lovely, aren’t they?).  Medially luxating patellas are in most cases very amenable to surgical repair (again, more on this below), but add in the aforementioned additional injuries, and your dog now has what we term the deranged knee, where there are now multiple injuries/abnormalities within the knee joint that require surgical attention.

 Well the knee caps are not just where they are for decoration, but they serve a very important purpose.  The patellar tendon is a very large tendon that is the convergence of the quadriceps muscles which are capable of placing a lot of force across the knee joint.  The knee cap – or patella – beneath it, serves to ease and redistribute the forces exerted across the joint.  When it is out of place, not only is it directly painful, but it leaves the knee susceptible to injury, such as tears of the CCL ligament and/or meniscus (more on these below).

For medium and large breed dogs, medially luxating patella occurs occasionally, but it is really not all that common in these guys.  Medium and large breed dogs with rear limb lameness most commonly have knee pain from a tear of the CCL ligament and possibly the meniscus as well.

The CCL ligament (cranial cruciate ligament) serves the same function as the ACL (anterior cruciate ligament) in people, which is the major stabilizing ligament of the knee joint.  Likewise, the meniscus in the dog’s knee serves the same purpose as the meniscus does in people, which is to act as padding between the articulating surfaces of the long bones (the femur and tibia) that comprise the knee joint.  Tears of the CCL ligament lead to instability and pain of the knee joint, while tears of the meniscus are additional sources of pain and inflammation within the canine knee. The injury occurs for one or a combination of these 3 reasons:

1.) Many large breed dogs as the result of unethical and irresponsible breeding inherit steep angles of the head of the tibia (the chin bone) that put excessive force on the CCL ligament (Aren’t those pet stores and back yard breeders becoming ever more lovable?) 2.) Obesity is a major contributing factor to many of these injuries, as the increased weight of obese dogs puts additional stress across major stabilizing ligaments like the CCL. 3.) Back luck…sometimes an athletic dog simply plants to change direction just the right way and the ligament just goes, as commonly happens in human athletes.

(I will address treatment for these injuries, as well as medially luxating patella just below…I’ll get there, I promise)

So why did I feel compelled to take the time to write this post?  Well, I have seen a rash of these injuries as of late and all too commonly things are far worse than they should be.  The pet owner is advised by some un-medically-trained know it all on some pet forum – or otherwise determined through their own “internet research” – that the problem lies in the hip and the best thing he or she can do is put the dog on an over the counter glucosamine product, rather than pay his/her vet to tell him/her what he/she already knows.  Only, in the process of the little dog gimping around on a medially luxating patella for a month or longer, the CCL may also rupture, so now we have gone from medially luxating patella surgery to a deranged knee surgery; which translates to more invasiveness for the patient, longer recovery period, and more expense to the owner.

 In the case of the CCL tear case, the longer the dog gimps around on the injured knee, the higher the likelihood of concurrently tearing the meniscus, a common injury that occurs with CCL tears.  With larger dogs relying on the other limb for support, they also may weaken that knee and predispose it to CCL injury later on, giving the dog and the owner two CCL tears do deal with rather than just one.  The grossly unstable knee also leads to other degenerative changes over time, such as the growth of bone spurs, damage to the cartilaginous surfaces of the joint, and thickening of the joint capsule, further complicating our ability to surgically repair the injuries.

As far as diagnosing and treating canine knee injuries, if your “internet research” has brought you here, your research this time around has served you well.  Surgical repair and rehabilitation of the canine knee is one of my special interests, for which I have done extensive postdoctoral training in advanced surgical repair of the knee and post-operative rehabilitation.  Rather than rewrite all of the information I have for you in this post, please refer to the following articles I wrote on medially luxating patella and cranial cruciate ligament ruptures, respectively:

http://web-dvm.net/mediallyluxatingpatella.html

http://web-dvm.net/cranialcruciateligamentrupture.html

So the next time your dog shows significant lameness of a rear limb for more than a couple of days, I advise you not to be so quick avoid the vet and just throw glucosamine at the problem as far too many other pet owners do.  A proper examination and early diagnosis of a  knee problem will not only save you expense in the end, but save your dog a lot of unnecessary suffering.  And in the event, the problem is the hip?  There are much better things we can do than just throw glucosamine at it…but that is for another day, on another post. 🙂

Dr. Roger Welton is a practicing veterinarian and well regarded media personality throughout a number of subjects and platforms.  In addition to being passionate about integrative veterinary medicine for which he is a nationally renowned expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care, and fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

Are Vaccine Titers Accurate Measures of Dog and Cat Immunity Against Disease? Can We Use Them To Determine What Vaccines a Dog or Cat Needs?

In a society becoming increasingly naturally minded, it should come as no surprise that this trend also applies to people’s pets.  I have blogged quite a bit about alternative medicine techniques that carry no side effect but offer proven benefits to dogs and cats, and the popularity of these techniques and how mainstream they have become in my practice, as a testament to how much people are choosing a more natural existence for their pets as well.  Knowing that immunizations, while necessary components to canine and feline disease prevention, can stress the body in the short term and have been linked to rare problems later in life, pet owners began to really question the necessity of the frequency by which veterinarians were vaccinating their pets.

Thankfully, the industry responded, and though extensive research in the early 2000s, the American Veterinary Medical Association established reformed vaccination protocols that led to less frequent vaccinations for core vaccines that offered longer protection than previously known; while being more discerning with the administration of non-core vaccines with regard to the individual patient’s actual risk factors (lifestyle, geographical location, breed, etc.).  For example, rather than give the core canine distemper-parvo-hepatitis-parainfluenza (DHPP) vaccine and the core feline panleukopenia-calicivirus-herpes virus (FVRCP) once yearly for dogs and cats, respectively, we began administering these vaccines once every 3 years.  For the non-core vaccines, leptospirosis, lyme, bordatella for dogs, and feline leukemia for cats, these vaccines have been tailored to the patient’s individual lifestyle and disease risk, which vary not just from patient to patient, but from one region to another.

With regard to the core rabies vaccine, the 3 year vaccine is effective, safe and approved for dogs in all jurisdictions I am aware of (from legal standpoint) for both dogs and cats, but given a past speculated link of the 3 year rabies vaccine to risk of malignant tumor formation in cats, many veterinarians advise the one year rabies Purvax manufactured by the veterinary pharmaceutical Merial.  Although this link has largely been disproven, with so many feline owners remaining concerned about the link nonetheless, many veterinarians continue to use the 1 year rabies Purvax in cats.

Now that all the background of vaccine reform history in the past decade has been established, I will move on to the topic at hand: antibody titers.  An antibody titer is a measure of protective antibody generated in the body from vaccines that mimic the disease (while not themselves causing disease), or  from having survived a bout of the actual disease and generated antibodies to it.  Antibodies are markers that attach to a bacterial or viral foreign invader and target it for removal by immune system cells.

Learning that measurement of protective antibody titers was one of the components of the research that led to vaccine reform, the establishment’s reform for some pet owners have not taken things far enough for their desire to have their pets live as naturally as possible.  As a result, in lieu of getting vaccines for their pets per our latest reform guidelines, they instead demand that their pet first have blood titers checked to determine whether or not vaccination is necessary.

The flaw in relying on titers is that, as I stated, titers are only one small component of vaccine efficacy research.  Realistically, the immune system is so complex, that titers are not reliable for every individual and for every disease, as has been proven time and again in research settings where protective titers did not hold up against a challenge to a given disease.  Remember that antibodies target the foreign invaders for destruction, but it is other immune system cells that actually destroy the invader.   An insufficiency in this process may leave a pet at risk for a given disease even if protective antibody titers are present.  Therefore, protective titers are really in the end little more than an approximation of a pet’s immunity to a given disease.

The story, however, does not end there.  In the case of the three major and life threatening diseases vaccinated for in the canine core DHPP vaccine (distemper, parvo, and hepatitis), antibody titer does seem to correlate well with adequate protection against disease.  Therefore, if owners wish to rely on titers to decide on whether or not their dog needs to be vaccinated, if they do not mind the increased expense of titer testing rather than just vaccinating, I support that decision.  Unfortunately, for rabies and the non-core vaccines, titers not proven even nearly as reliable in determining individual disease protection.  This is why in the case of rabies, any jurisdiction I am aware of will not accept proof of protective rabies antibodies as an alternative to a rabies vaccine for dogs and cats.  Thus in the case of canine non-core vaccines and rabies, I do not advise reliance on antibody titer testing…nor is it even legal to do so for rabies anyway.

For cat owners that favor the idea of relying on antibody titer testing, the story is a bit more discouraging.  For cats, titers for both core and non-core vaccines do not seem to correlate with protection from disease.  As such, at this time and given the current vaccine technology, titer measurement in cats is not a good assessment of the necessity for vaccination.  Thus, I would not advise any feline owner to rely on vaccine titers, but instead simply follow AVMA recommended vaccine protocols.

Dr. Roger Welton is the President of Maybeck Animal Hospital and CEO/Chief Editor of the veterinary information and blog online community, Web-DVM.

The Monsters Within

I got a text from my neighbor this morning, asking me if I could get her into the clinic later today, as she suspected her kitten has worms.  My neighbor has a wonderful family, doting husband, 4 great children, 2 of which are toddlers.  She also is a responsible and loving pet owner to a one year old cat.

I texted her neighbor back, letting her to that she should call the clinic, let the receptionist know she is my neighbor, and that we would get her in today without delay.  I let her know that it would not be wise to delay having her cat seen, as some worms can pose a danger to her little ones.  At this, she was shocked and became nervous that her youngest children may be at risk.  She quickly stopped over and showed me one of the worms, but it was so dried out that I could not definitively ascertain the type of worm it was.

My intention certainly was not to panic my neighbor, nor was my intention in writing this post to panic my readers.  However, it occurred to me that if my neighbor, a responsible, dedicated, and well informed mother and pet owner was not aware that parasites in her cat could pose a danger to her children, how many other parents and pet owners may be unaware of this potential danger.

Generally speaking, parasites tend to be species specific, that is, they can only complete their lifecycle, and therefore reproduce, within the definitive host animals they have evolved to thrive in.  There are many exceptions to this general statement, as dogs and cats, separate and distinct species from one another, share many parasites in common.  Also, even though most parasites cannot complete their life cycle with an animal that is not their host species, they can often reach a stage of development that still poses disease potential for non-host animals…including people.

Roundworms are one of the most common worm parasites found in dogs and cats.  They pose little to no danger to healthy adult humans, but in immune compromised individuals, children under 5, and the elderly, they can reach a stage of larval development that may migrate through the body.  Migration through the skin can cause serious skin rashes that lead to itchiness, infection, and pain.  The most dangerous and potentially tragic consequence of roundworm infection in people is when migration occurs into the eyes can cause irreversible blindness.

There are many species of tapeworms that we commonly see in veterinary medicine that can be transmitted by several different species.  One of the most common types of tapeworms we see dogs and cats, dipylidium caninum, is carried in the gut of the flea, infecting dogs and cats when an infected flea is ingested during routine grooming.  A person can become infected by accidental ingestion of an infected flea that came from the animal.  It may seem a silly notion that a person could accidentally ingest a flea, but insect ingestion while sleeping occurs far more commonly than any of us would care to think about.  For those that allow their pets to sleep in bed with them, they have the biggest likelihood of accidental ingestion of a flea.

Luckily like the roundworm, canine and feline flea tapeworms pose little to no threat to healthy adults, but immune compromised people, children under 5, and the elderly can experience mild to severe GI symptoms if infected.

Lastly, hookworms, another commonly diagnosed worm parasite in dogs and cats, can infect people by an early larval stage passing through their skin.  Hookworm eggs are passed through the feces of a canine or feline and can hatch into an early stage of larvae that can penetrate a person’s skin.  Thus, the most common mode of hookworm transmission to people is walking barefoot in grass where dogs and cats have passed stool.  Direct contact with the stool may not be necessary as the infective larvae can live in the stool well after the feces have been picked up and discarded or washed away.

What makes hookworm different from the aforementioned parasites is that age or immune status does not as significantly affect its ability to infect a person.  Once in the body, hookworms commonly cause hallmark itchy, often painful skin rashes whose distinctive pattern is usually recognizable to a human dermatologist.

In cases where the hookworm parasite eggs or larvae are accidentally ingested, such as when a child may be playing in contaminated dirt or perhaps a contaminated sand box, the larvae can reach a state of development where they may latch onto the walls of the GI tract, causing GI upset andeven bleeding.

Again, the purpose of this post was not to create mass hysteria and make people fear pet ownership and fear their pets.  Overall, incidences of human infection from canine and feline parasites remain uncommon, especially viewed in comparison to the high numbers of infected pets we treat every day.  However pet owners should be aware that there are more than just health consequences for their pets if infected with intestinal parasites, but it can also place the human family at risk as well, especially its most vulnerable members.  What’s more, these parasites are all very preventable.

Here are some tips to help you protect your family from canine and feline parasites:

1.) Do not allow young children, immune compromised family members, or the elderly to come in close contact with puppies or kittens until they have had stool screening and broad spectrum deworming by a veterinarian.

2.) In any case of pet diarrhea or vomiting lasting more than 24-48 hours, a veterinary visit should be scheduled with a stool sample brought in for analysis.  Parasites remain among the most common causes for pet GI disturbance.

3.) Engage in good potty patrol: do not leave stool on the ground for prolonged periods of time, as this increases the potential for human contact and contamination of the soil with parasite eggs and larvae.  This is especially true when a pet has diarrhea or under treatment for a parasite.

4.) Engage in at least yearly stool screening that most veterinarians recommend as part of a routine well visit…even if the pet is asymptomatic.  Pets do not always show symptoms of parasite infestation, thus, we find pets positive for parasites on routine stool analysis every day.

5.) Treat all dogs and cats with monthly flea prevention, even if you do not see fleas.  Infestations can break out at any time, with one female flea being capable of making 3000 new fleas in one month’s time.  If pets are fastidious groomers, flea populations can exist in the environment that go under pet owner radar.

6.) Give strong consideration to newer generation “all in one” monthly preventives that kill fleas, heartworm, and multiple species of intestinal worms, such as Trifexis in dogs and Revolution for cats.

Dr. Roger Welton is the President of Maybeck Animal Hospital and CEO/Chief Editor of the veterinary information and blog online community, Web-DVM.

What’s in a Name? (Tips for Naming Pets)

While I think it is kind of fun to know the most common names (listed below) that people are naming their dogs and cats these days, illustrating these names was not my primary motivation for writing this article.  When it comes to naming dogs and cats, there are more effective and less effective methods to choose names for them, in terms of name recognition and response to their names.

Here is the list of the 10 most popular dog names:

10.) Buster
9.) Sam
8.) Rocky
7.) Bailey
6.) Charlie
5.) Cody
4.) Jack
3.) Buddy
2.) Jake
1.)  Max

Here is the list of the most popular cat names:

10,) Kitty
9.) Leo
8.) Jack
7.) Smokey
6.) Milo
5.) Charlie
4.) Simba
3.) Tiger
2.) Oliver
1.) Max

While canines and felines can seem so human like, we do not really actually know that they are aware that they are identified by the names we give them.  It could be perhaps that dogs and cats simply associate the sounds that we make in enunciating their names know that is our way of summoning them.  Since we cannot ask them, we will never really know.

Either way, what we do know is that both dogs and cats seem to learn their names and recognize them often very effectively.  However, how effectively they will respond to and recognize their names will vary depending on the name that is chosen.  You can maximize the effectiveness of pet names them by following some simple rules.

While we all like to have the freedom to choose whatever names we want for our pets whether because of personality traits, physical traits, or naming one after a favorite athlete, you can still have fun naming your pet yet make it so that he/she is minimally confused in recognizing it/responding to it.

– Pick 2 syllable words.  2 syllable words resonate better with the pet’s recognition by adding more uniqueness to the name.
– Dogs and cats tend to more readily recognize names that end with an “ee” sound.   From our lists of most popular dog and cat names, Smokey, Buddy, Bailey, Rocky would fit these criteria.
– Having a “ck” sound in the name seems to improve a pet’s recognition of its name as this sound is very recognizable to dogs and cats from a auditory strandpoint.  Thus a name like Smokey or Kitty would be good choices.
– Avoid choosing names that sound similarly to other pets or humans in the home.  For example, if you have a daughter in the home named “Hailey,” it would not be wise to name a pet “Kailey.”  I actually have friends that did this, and the confusion for both human child and dog cannot be overstated.
– Never scold a pet using its name.  Doing so could confuse the pet and make them fear their name.   Verbally scolding is best accomplished by catching the pet in the midst of the inappropriate act, clapping your hands and verbalizing a loud, “No!”

Naming a new pet is fun, and a big part of the joy of pet adoption.  It is an important decision that deserves a lot of thought, and one that should not be made in haste.  Whatever your method for choosing a name, always remember that it is best to follow the few simple rules outlined above to maximize the effectiveness and enjoyment of the name.

Dr. Roger Welton is the President of Maybeck Animal Hospital and CEO/Chief Editor of the veterinary information and blog online community, Web-DVM.

New Help for Obese Dogs and Cats

For those of you who have not already received the lecture from your veterinarian about the danger your pet’s obesity poses to his/her health, I am happy to fill that role in this post.  Diseases both caused by and exacerbated by obesity include degenerative joint disease, degenerative disk disease of the spine, diabetes, pancreatitis, hypertension, cardiac disease, and pulmonary (lung) disease to name some.  While owner refusal to stop overfeeding or augmenting the dietary regimen with food from the table are by far the most common reasons for persistent obesity, there are some isolated cases of pets that despite the owner’s best efforts and vigilance in feeding only the recommended prescription weightloss diet in the right quantities, still lose weight painfully slow, not at all, or in some cases even put on weight.

Traditionally, we have had two main approaches to weightloss diets in dogs and cats.  Initially, we treated both dogs and cats the same, recommending dietary formulations that were high in fiber and complex carbohydrate, normal protein, low in simple carbohydrate, and low fat.  These diets essentially were designed to fill the tummy while at the same time restricting calories.  In dogs, these diets were met with reasonable success in effectively dropping body fat and excess weight when properly adhered to, while in cats results were widely varied and inconsistent.

While our approach to canine weightloss dietary concerns have remained by in large unchanged, a more recent movement in feline weightloss diets that became popular in the early to mid-2000s was to formulate ultra-low carbohydrate, high protein diets.  These diets were created on the premise that domestic cats are likely so obese because in a domestic setting we feed them a carbohydrate laden diet that is not consistent with the manner in which they evolved as pure carnivores.  In reality, cats can synthesize any nutrient they need effectively from protein, making them very different from dogs and people, which are omnivores, necessitating the consumption of a diet of mixed nutrients which provide certain proportions of fats, simple and complex carbohydrates, and protein.

Thus diets like Hills M/D and Purina DM were created and to this day remain popular diets among veterinarians for weight and body fat reduction, as well as diabetes management in cats.  But there are still a frustrating number of cats who do not lose any weight being fed these diets exclusively, and even some that get fatter on them, my own cat included!  What’s more, we are stumped as to why this is the case for some feline patients.

The latest innovation in weightloss works very differently than any other weightloss diet on the market.  Hills Metabolic prescription weightloss diet works by actually increasing the pet’s basal metabolic rate, thus increasing the rate at which they burn calories.  When this diet was set to be released, the Hills corporation provided veterinarians statistical data that spanned 5 years of research and numerous feeding trials that showed that 88% of dogs lost an average of 28% body fat within 2 months; and the same percentage of cats lost 29% of the body fat in the same time frame when fed this diet exclusively.

With no other weightloss diets to date having been able to claim this level of success before, my first reaction was one of skepticism.  While the Hills Corporation does an impressive level of ongoing research for their diets, the data they provided for Hills Metabolic just seemed too good to be true.  Subsequently, when my Hills rep noted my skepticism, she answered it by offering me 400 pounds of food to give away to my most frustrating obesity cases.

The first patient I tried it on, is a 12 year old Shetland Sheep Dog that was not only obese, but under treatment for debilitating thoracolumbar intervertebral spinal disease.  She was about 20 pounds overweight, which for this breed is a severe level obesity under which her spine and her joints were simply being crushed under.  At one of her therapy appointments, I suggested to the owner that she try the free Metabolic samples Hills had provided us, to which she agreed.  Once month later, the dog had lost 11 pounds, given her history, nothing short of miraculous.  Since then, she has dropped an additional 7.  As a result, her back is doing phenomenally well, but the most impressive part is that her owners report a new lease on life, with more spunk and energy, like we literally turned back the clock 5 years on the dog.

Since I started carrying Hills Metabolic earlier this year, I have seen several other similar success stories in both dogs and cats to date, but with still a relatively small case number, it remains premature for me to draw definitive general independent conclusions.  However, while it is too soon for me to necessarily sing its praise as the next great innovation in canine and feline obesity management, I do not hesitate to recommend Hills Metabolic Diet for severely obese pets whose diseases are debilitating and directly tied to their obesity, hence necessitating weightloss in as timely a fashion as possible.

Dr. Roger Welton is the President of Maybeck Animal Hospital and CEO/Chief Editor of the veterinary information and blog online community, Web-DVM.